Analyses, Research and Studies to Address the Impact of CMS’ Programs on American Indian/Alaska Native (AI/AN) Beneficiaries and the Health Care System Serving these Beneficiaries

To further CMS’ mission and goals related to providing high quality health care to the American Indian/Alaska Native (AI/AN) community by providing research and analysis to increase the understanding of, access to, and impact of CMS’ programs in Indian Country. Congress authorized AI/ANs to have access to Medicare and Medicaid services when provided through Indian Health Service (IHS) facilities located in tribal communities and amended titles XVIII and XIX of the Social Security Act to permit IHS facilities to bill Medicare and Medicaid for services provided to eligible AI/ANs. This authority was later extended to tribal facilities. Congress has also provided authority for Indian health care programs and beneficiaries to participate in the Children’s Health Insurance program and the Health Insurance Marketplace. These changes have created a direct relationship between CMS and the Indian Health Service, The research conducted under this cooperative agreement is needed to help improve administration of CMS’ programs given that CMS and IHS programs operate under different and sometimes competing authorities for CMS’ programs, the Social Security Act and for IHS’ programs, the Indian Health Care Improvement Act and the Indian Self Determination Education and Assistance Act, P.L. 93-638. To make CMS’ programs work with Indian health program authorities, a crucial first is step is for CMS to understand the impact of its policies on Indian health care providers and tribal members so that the agency can provide the AI/AN community greater access to CMS’ programs in an effective and efficient manner. The authority at Section 1110 of the Social Security Act permits CMS to enter into grants andcooperative arrangements with organizations and certain other entities in order to aid in improving administration and effectiveness of programs administered by the agency. To this end, the work conducted under this cooperative agreement will address the potential and actual impacts of CMS’ programs on AI/ANs and the health care system serving these beneficiaries. CMS’ understanding of the impact of its policies is vital to improving greater AI/AN access to and participation in CMS’ programs; improving and ensuring that appropriate health care payments and resources are provided to IHS tribal, and urban Indian Health program providers; and contributing to overall improved health outcomes for Indian people. The information and activities produced or provided under the cooperative agreement will be used to develop culturally appropriate activities and strategies to improve how CMS’ program operate and are administered in Indian country.