Tribal Health Plans Utilize Medicare Rates For Savings


“Tonto, is that your health plan!” ….”Yes, Great White Father finally came through – It’s called Reference Based Pricing!”

HMA Innovates to Increase Savings for Self-Funded Tribal Health Plans 

MyHealthGuide Source: Healthcare Management Administrators (HMA), 10/20/2016,

Bellevue, WA — Healthcare Management Administrators (HMA) has expanded the scope of their Tribal Health Plan product to provide clients additional savings.

Self-Funded Tribal Health Plans have the opportunity to leverage the Indian Health Service’s Purchased/Referred Care (P/RC) program to pay for certain types of care at Medicare-like rates, resulting in significant healthcare cost savings. In May, the U.S Department of Health and Human Services implemented a regulation that gives Indian Health Service (IHS) and Tribal programs the ability to cap payment rates at a “Medicare-like rate” (MLR) to physicians and other non-hospital providers who provide services through the P/RC program. Previously, only facility claims were eligible for this special treatment.

This new regulation means that there is even greater opportunity for healthcare savings for Tribal Health Plans who can navigate the complexities of the regulations and find a good partner to help them administer their health plan. HMA’s expanded product offers a flexible solution to do just that.

“We are extremely excited about being one of the first benefits administrators in the nation to develop a product that allows Tribal Health Plan clients to use P/RC for professional services and achieve substantial health plan savings.” Lindsay Harris, HMA’s Director of Strategy and Product Management said.

HMA is deeply experienced in administering Self-Funded Tribal Health Plans. HMA has administered both P/RC for facilities and CHEF since 2009. HMA’s enhanced product, which launched on October 1st, is one more way that HMA is helping Tribal Health Plans manage healthcare costs.

About HMA

HMA is one of the nation’s largest third party healthcare benefits administrators, and is headquartered in Bellevue, Washington. With offices across the Pacific Northwest, HMA has made it their mission to create a healthier future — each client, every time. Through the latest industry technology, customizable plan designs and skilled staff, HMA is committed to meeting group healthcare coverage needs.  Contact Courtney Bowman, MBA, Marketing Specialist, at and visit