Reimbursement Rates for Patient Care Provided at IHS Facilities

1. It is the policy of the Indian Health Service to charge patients who are not within the scope of the program for health services provided by IHS personnel at IHS facilities [42 CFR 32.111].
2. It is the policy of the Indian Health Service to charge Medicare and Medicaid for services provided to beneficiaries of the IHS program who are enrolled in Medicare and Medicaid.  See Social Security Act Section 1911 [42 USC l396j], Section 1880 [42 USC 1395qq].

   Furthermore, it is the policy of the IHS to annually review all established revised or current rates and publish these in an IHS circular or the Federal Register (whichever mechanism is appropriate for the particular rate schedule) after the close of a fiscal year, if there are no statutory bars to increasing rates in any fiscal year.

1. The current Medicare and Medicaid reimbursement rates for inpatient, outpatient, and physician services provided at IHS facilities in Alaska and all other States appear in the Federal Register as follows:

   	Alaska	All Other States
   1.  Inpatient	$421	$347
   2.  Outpatient	112	66
   3.  Physician	22	20

2. The current rates for non-beneficiary inpatient and outpatient care provided at IHS facilities in Alaska and all other States are as follows:

   Hospitalization (Inpatient) Services

   	Alaska	All Other States
   1.  Inpatient Services	$429	$397
   2.  Inpatient Physician/Consultation	22	20

   Outpatient Services

   	Alaska	All Other States
   1.  Outpatient (Ambulatory) Physician Services Brief Intermediate Comprehensive	$35 80 140	N/A NA NA
   2.  Laboratory Fees	$1.15 per cap work unit	N/A
   3.  Radiology Fees	$50 per usable view (maximum of $250 per study)	N/A
   Pharmacy Fees	To be charged cost of drug plus $4.50 dispensing fee.	N/A

3. The current rates for emergency and non-emergency dental services provided to non-beneficiaries shall be the same as those established in the Veterans Administration fee schedule.

Brief

A level of service supervised by a physician but hot necessarily requiring his presence.  It includes evaluation and treatment of a condition requiring only an abbreviated history and examination, a review of the effectiveness of past medical management, the ordering and evaluation of appropriate diagnostic tests, the adjustment of therapeutic management, as indicated, and the discussion of findings and/or medical management.

Intermediate

A level of service pertaining to the evaluation of a new or existing condition complicated with a new diagnostic or management problem not necessarily relating to the primary diagnosis that necessitates the obtaining and evaluation of pertinent history and physical or mental status findings, diagnosis tests and procedures and the ordering of appropriate therapeutic management; or a formal patient, family, or hospital staff conference regarding patient medical management and progress.

Comprehensive

A level of service providing an indepth evaluation of a patient with a new or existing problem requiring the development of complete re-evaluation of medical data.  This procedure includes the recording of a chief complaint, and present illness, family history, past medical history, personal history, system review, a complete physical examination, and the ordering of appropriate diagnostic tests and procedures.

Outpatient Ambulatory Physician Services

These fees are to be charged the non-eligible patient when seen by an IHS physician in the ambulatory (outpatient) clinic of an IHS facility.  The fees do not include laboratory, radiology, and pharmacy charges.  The fee is to be based on the medical complexity of the case as determined by the physician.  See definitions of brief, intermediate, and comprehensive.

Inpatient Physician Consultation

This fee is to be charged non-eligible in-patients when they are seen in consultation by an IHS Physician upon request of the private physician who admitted the patient.

CAP Unit

The CAP units are those units that are defined in the latest edition of Laboratory Workload Recording Method published by the College of American Pathologists.