[Federal Register Volume 62, Number 196 (Thursday, October 9, 1997)]
[Notices]
[Pages 52724-52725]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-26711]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Indian Health Service


Alternate Method of Acquisition for Health Care Services; 
Authorized by the Federal Acquisition Regulations

AGENCY: Indian Health Service, HHS.

ACTION: General notice.

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SUMMARY: The Indian Health Service (IHS) issues this General Notice to 
inform the public that IHS has adopted the Rate Quotation as an 
alternate acquisition method to establish reimbursement rates for 
health care services purchased by its Contract Health Services Program.

EFFECTIVE DATE: October 1, 1997.

FOR FURTHER INFORMATION CONTACT:
Ronald Freeman, Acting Director, Division of Managed Care, Room 6A-55, 
5600 Fishers Lane, Rockville, MD 20857, (301) 443-3024 or Carol 
Silverman, Acting Director, Division of Acquisition and Grants 
Management, Suite 450A, 12300 Twinbrook Parkway, Rockville, MD 20857, 
(301) 443-5774. (These are not toll-free numbers).

SUPPLEMENTARY INFORMATION: The IHS Contract Health Services program is 
administered under regulations at 42 CFR 36.21 et seq. and services 
purchased are governed by the Federal Acquisition Regulations (FAR). 
Under this program IHS purchases health care services from hospitals, 
physicians, and other health care facilities and providers to 
supplement the IHS direct care delivery system. The IHS last issued a 
payment policy in 51 FR 23540 on June 30, 1986. This policy requires 
the IHS Area Offices to enter into formal agreements with providers 
that they expect to use for health care services. With certain 
specified exceptions in the IHS Payment Policy, the formal agreement 
must provide for reimbursement of services at rates which do not exceed 
prevailing Medicare reimbursement rates (including deductibles and co-
insurance), and the IHS service units will make patient referrals and 
procure all its routine health care services from providers with formal 
agreements.
    The IHS issued a general notice in 56 FR 10566 on March 13, 1991 to 
inform the public that the IHS was conducting a pilot project in the 
IHS Portland Area. The project was designed to determine whether an 
alternative method of acquisition for contract health services would 
result in greater participation by health care providers and lower 
costs to IHS. The project was originally scheduled to end on March 31, 
1992,

[[Page 52725]]

however, the provider response to the project was far greater than the 
expectation of the IHS. As a result of the response, preferred provider 
lists needed to be developed as well as the need to develop complex 
analyses of reimbursement methodologies for facilities, outpatient and 
professional providers. Therefore, the pilot termination date was 
extended to March 31, 1993 (57 FR 10671 on March 27, 1992).
    The IHS published notification on June 18, 1992 (57 FR 27262) that 
additional IHS Areas (Alaska, Nashville and Billings) were added to the 
pilot project to provide more information from a wide geographic area.
    The IHS extended the termination dates for this project on March 1, 
1993, 58 FR 11864, and again on October 1, 1996, 61 FR 51298, because 
additional time was required to complete an evaluation of the pilot and 
provide IHS the necessary time to assess the results. The last 
termination date was September 30, 1997.
    The IHS review and analyses of the pilot project utilizing the rate 
quotation methodology has been completed. The overall result show that 
the rate quotation is a streamlined approach for communicating and 
establishing favorable rates with providers. Therefore, the IHS has 
adopted the rate quotation as an alternate approach to contracting for 
health care services to increase the number of formal agreements IHS 
has with health care providers.
    This policy will apply only to contract health services programs 
administered by the IHS, and will not apply to services rendered by 
traditional Indian medicine men and women under Pub. L. 95-341, Joint 
Resolution on American Indian Religious Freedom.

    Dated: October 1, 1997.
Michael H. Trujillo,
Assistant Surgeon General, Director.
[FR Doc. 97-26711 Filed 10-8-97; 8:45 am]
BILLING CODE 4160-16-M