Government Mandates Reference Based Pricing For Indians

“Tonto That Hospital Charged Me 4 Times More Than They Charged You!”

Dear Tonto,

“I am pleased to announce that on June 4 the Indian Health Service (IHS) and the Centers for Medicare & Medicaid Services (CMS) published the much anticipated final rule implementing “Medicare-like” payment rates. The “Medicare-like” payinent rate will constitute payment in fill1 to Medicare-participating hospitals that deliver services to American Indians and Alaska Natives…..” SOURCE: Tribal Leader Letter

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.

Indian owned casinos employing Reference Based Pricing don’t have to pay more than 100% of Medicare plus they enjoy the guarantee of no balance billing. So why are so many of them using Blue Cross, Aetna or United Healthcare?

The Lone Ranger to Tonto: “Please ask Elizabeth Warren to extend tribal membership to me too!”