53-6-146. Protection of tribal and Indian health service facilities from cost-shifting -- seeking to leverage federal financial participation for state children's health insurance program and medicaid. (1) The department shall seek exemptions under federal medicaid law or regulations to protect Indian health services and tribal facilities from changes in eligibility categories, covered services, and reimbursement levels under the medicaid program that could potentially result in a direct shift of costs from the 100% federal medicaid matching available under medicaid to either Indian health services or tribally sponsored health care services.

(2) The department shall work with tribes or representatives from the federal Indian health service to seek mechanisms, including, if necessary, a waiver of federal law as permitted by section 1915 of Title XIX of the Social Security Act, 42 U.S.C. 1396n(b), to ensure that federal Indian health service-eligible medicaid participants who live on reservations may have any prescription filled at tribal or Indian health service health care facilities.

(3) The department shall work with tribes to explore the options for the state children's health insurance program to leverage 100% federal financial participation for health care services to Indian children.

(4) The department shall engage the federal centers for medicare and medicaid services and the United States congress to support efforts to have all services provided by and referred from an Indian health service included in the state medicaid plan eligible for the 100% federal financial participation match under medicaid regardless of the location where services are provided.

(5) (a) The department shall develop a policy and process to periodically review Indian-eligibility issues as they relate to medicaid and to include tribal government, urban Indian, and Indian health service representation in the development of a policy and process. Reviews conducted by the department in areas on or near reservations or in urban areas with significant Indian populations must include consultation with representatives of tribal governments and urban Indian programs.

(b) The department shall explore the issues and feasibility of applying for a federal waiver of medicaid law for a demonstration project to delegate authority to eligible tribes for determination and certification of medicaid eligibility.

(6) The department shall work with tribes to foster a spirit of cooperation, to identify and remove current institutional barriers that limit the participation of tribal members in the medicaid program, and to develop strategies, including education, to improve the mechanics of providing medicaid services to Indians by:

(a) ensuring that tribes have an adequate opportunity to review and verify data used to monitor medicaid services and eligibility status and to modify or promote changes in medicaid policy;

(b) consulting with tribal and urban Indian representatives on the effective use and appropriate sources of information on health care needs of Indians;

(c) at the request of a tribal representative, conducting technical assistance workshops to address issues specific to tribal needs regarding matters of centralized billing procedures, sound health care business practices, and development of needed health care infrastructure; and

(d) in compliance with the requirements of 2-15-141 through 2-15-143, consulting with tribes on any policy changes that may impact services or programs operated by tribes.

History: En. Sec. 1, Ch. 128, L. 2005.