On June 11, 2014, Congresswoman Betty McCollum (D-MN) and Congressman Tom Cole (R-OK) introduced HR 4843, the Native Contract and Rate Expenditure Act of 2014 (the Native CARE Act). This legislation would expand the Medicare-Like Rate cap to all non-hospital Medicare-participating providers and suppliers. It would result in the IHS Purchased/Referral Care programs being able to make hundreds of thousands of additional referrals per year, all at no additional cost to the government.
Currently, the “Medicare-Like Rate” cap allows IHS Contract Health Service (CHS) programs (now referred to as Purchased/Referred Care) to pay hospital providers (in-patient and out-patient) no more than what Medicare would pay for the same service, rather than full billed charges. This rate cap has not been interpreted to include physicians or other non-hospital providers, however. On April 11, 2013, the Government Accountability Office issued a report recommending that Congress enact legislation that would expand the Medicare-Like Rate cap to all Medicare participating providers, and the Department of Health and Human Services agreed with that recommendation. Our firm has been working with a number of tribes and tribal organizations including the United South and Eastern Tribes, Inc. (USET) and the National Indian Health Board (NIHB) to enact this legislation.
The bill was introduced with broad bi-partisan support. Joining Representatives McCollum and Cole as original co-sponsors were Representatives Ben Ray Lujan (D-NM), Darrel Issa (R-CA), Raul Grijalva (D-AZ), John Kline (R-MN), Frank Pallone (D-NJ), Don Young (R-AK), and Jared Huffman (D-CA). In the attached statement accompanying the bill, Representative McCollum remarked that “By paying health care providers the Medicare-rate, rather than the provider billed rates, IHS will be able to double the number of physician services provided to Native Americans – that means hundreds of thousands of additional patient visits. The common sense, bi-partisan legislation I have introduced will ensure that federal tax dollars already being spent on Indian health care go further.” NCAI, NIHB, USET and others have adopted resolutions in support of this legislation.
A companion bill is currently being considered in the Senate, and we understand it may be introduced in the near term. Please let us know if you would like additional information about this important legislative effort.