Medicare-like Rates Overview

Section 506 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, generally, provided authorization for CHS and urban Indian programs to pay no more than "Medicare-like" rates for referred services furnished by Medicare-participating hospitals upon the effective date of enacting regulations.

These regulations were published in a final rule in the Federal Register on June 4, 2007, with an effective date of July 5, 2007. The regulations describe the payment methodologies and other requirements covered providers must adhere to when processing claims for services authorized for purchase by a CHS or urban Indian program. This applies to programs operated by the IHS, Tribes or Tribal organizations, and urban Indian programs. A Tribal Leader letter was sent to Tribal leaders and urban program directors from the Director IHS announcing the final rule implementing "Medicare-like" payment rates.

Click here to review the Tribal Leader Letter. [PDF-81KB]