Federal register
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The Indian Health Service (IHS) is issuing this Statement of Policy to inform the public that the IHS will contract to purchase health services for Indian beneficiaries only with those hospitals, physicians and other health care providers which agree to accept, as payment in full, reimbursement at rates no higher than the prevailing Medicare allowable rates (including deductibles and co-payments). This encompasses those rates established for hospitals designated by the Health Care Financing Administration as "sole community providers" or "regional referral centers." Reimbursement rates for services not covered by Medicare allowable rates will be negotiated. ⋯ We may, upon further consideration and after consultation with tribal contractors, extend this policy to tribally administered contract health services programs. While tribal contractors are encouraged to adopt cost containment measures, this policy will apply only to contract health services programs administered by the IHS.
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These rules confirm interim final rules published in October 1982, and make the following changes: Provide that a physician who serves without compensation as an officer or director of any home health agency (HHA) is not, for that reason alone, considered to have a significant financial or contractual relationship with the HHA and therefore is not prohibited from certifying the need for home health services and establishing and reviewing a plan of treatment for services to be furnished by that HHA. Remove the provision that a physician who is a partner in an HHA organized as a partnership is, for that reason alone, considered to have a significant ownership interest in the HHA. Under the revised rule, a partner is not prohibited from certifying the need for home health services and establishing and reviewing a plan of treatment for services to be furnished by that HHA, unless he or she has an ownership interest of 5 percent or more. ⋯ Those provisions were contained in previous rules and were unintentionally omitted in the October 1982 revisions. Clarify that--A plan of treatment for speech pathology services may be established only by a physician or by the speech pathologist who will furnish the services to the particular individual; A physician must review a plan established by a speech pathologist; and It is not the intent to require that the plan be established or reviewed by a particular physician. The first and third changes are required to implement recent statutory amendments which provide exemptions from