Medicare-Like Rates Information
The Centers for Medicare and Medicaid (CMS) issued, Section 506 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, generally - provided authorization for PRC and urban Indian programs to pay no more than "Medicare-like" rates for referred services (in-patient) furnished by Medicare-participating hospitals upon the effective date of enacting regulations.
These regulations were published in a final rule in the Federal Register on June 4, 2007, with an effective date of July 5, 2007. The regulations describe the payment methodologies and other requirements covered providers must adhere to when processing claims for services authorized for purchase by a PRC or urban Indian program. This applies to programs operated by the IHS, Tribes or Tribal organizations, and urban Indian programs. A Tribal Leader letter was sent to Tribal leaders and urban program directors from the Director IHS announcing the final rule implementing "Medicare-like" payment rates.
- Review the Tribal Leader Letter. [PDF - 81 KB]
Take Advantage of Medicare-like Rates
- Notify providers in your area of the MLR regulations.
You may want to use a letter similar to this sample: Dear Provider Letter Sample [PDF - 15 KB]
- How to calculate the amount your program should pay under the MLR regulations.
- Contract with IHS/PRC or other fiscal intermediary that will calculate the MLR for you.
- Contract with a vendor to provide software to for you to use in calculating the MLR. Maximum payment for services will not exceed the Medicare-like Rate.
Frequently Asked Questions
- View the MLR FAQ document [PDF - 126 KB]
- 136.30 Payment to Medicare-participating hospital for authorized Purchased Refered Care (PRC)
- 136.31 Authorization by urban Indian organization
- 136.32 Disallowance
Email your questions and comments to The PRC Administrator. (Please read through the information on this page and FAQs before submitting questions).