Saturday, September 30, 2023
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Ruling Limits Scope Of Indian Health-Care Act

SAN FRANCISCO (CN) - The 9th Circuit reversed a decision that expanded the scope of the Indian Health Care Improvement Act, requiring the government to reimburse states for all health-care services provided to Medicaid-eligible patients who are referred by the Indian Health Service.

The IHCIA, enacted in 1976, amended the Social Security Act to allow IHS facilities to be reimbursed for services provided to Medicaid-eligible Indians. To offset the cost to state Medicaid programs, Congress added language to the SSA that required the federal government to reimburse 100 percent of the costs for services "received through an Indian Health Service facility."

The Arizona Health Care Cost Containment System interpreted the language to include the cost of referred services. The Health Care Financing Administration rejected approximately $36 million of Arizona's claim, saying federal reimbursement applied only to services provided by "an IHS facility which offers, is responsible for and bills Medicaid for the services provided."

The circuit upheld the HCFA's interpretation as reasonable, since the Departmental Appeals Board deferred to it after finding the language ambiguous. See ruling.

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