(a) The United
States Congress has declared that it is the policy of the United States, in
fulfillment of the special responsibilities and legal obligations to the
American Indian people, to meet the national goal of providing the highest
possible health status to Indians. In furtherance of these national goals and
national policy, special programs have been developed by the Federal Government
to address the health problems of Indians living on and near the Indian
reservations, in rural areas, and in urban centers.
(b) These regulations are intended to
recognize the inherent sovereignty of Indian tribes and nations, the
requirements of the Indian Health Care Improvement Act and the Indian
Self-Determination and Education Assistance Act, and to recognize the special
status of Indians, Indian tribes, and Indian Health Service programs under
federal law. This special status requires that separate considerations be
applied to the inclusion or exclusion of Indians and Indian Health Service
Facilities from Medi-Cal managed care plans.
(c) The programs operated by Indian tribes
and Indian organizations within California, referred to in these regulations as
Indian Health Service Facilities, are required by federal law to provide
services to all eligible Indians who present themselves for care. Indian Health
Service Facilities are also required by federal law to act as the payor of last
resort for eligible Indians and are required to obtain reimbursement for the
services provided to eligible Indians from all sources including the Medi-Cal
program. These facilities may serve non-Indians, but only to the extent that
such services do not result in the denial or diminution of health services to
eligible Indians.
(d) The
department intends to provide a single, clear, and accessible set of guidelines
which define how Indian Health Service Facilities will relate to the Medi-Cal
managed care plans in their respective locations; to ensure that individual
Indians continue to receive the required care to which they are entitled; and
to ensure that Indian Health Service Facilities may continue to provide
comprehensive services to eligible Indians.
(e) The department intends to ensure that the
Indian Health Service Facilities are reimbursed, if they are qualified for and
elect to receive reasonable cost reimbursement, as provided in federal law, at
their reasonable cost reimbursement rate, or a percentage of reasonable cost as
provided in 42 U.S.C.
1396a(a)(13)(C), whether
they elect to act as subcontractors of the Medi-Cal managed care plans or
out-of-plan providers.
(f) The
department also intends to ensure that Indian Health Service Facilities which
choose to be and are designated as Indian Health Service (IHS) providers by the
federal government will receive the IHS payment rate.