Covering Indian Country – October 2019

October 2019

Spotlight: IHS significantly increases third-party collections

Enrollment in health coverage matters, especially for American Indian and Alaska Native (AI/AN) communities. Thanks to concerted efforts to enroll more AI/AN patients in health coverage, third-party collections at federally operated Indian Health Service (IHS) hospitals and health centers saw a 51% increase during fiscal years 2013–2018, ultimately topping $1 billion.

According to a recently released U.S. Government Accountability Office (GAO) report, (PDF, 2.6 MB, 37 pp) Medicaid collections accounted for approximately two-thirds of the increase in third-party collections. Collections from Medicare, private insurance, and U.S. Department of Veterans Affairs comprised the rest.

Third-party collections enable IHS to fund payroll and maintain its aging infrastructure. IHS also uses third-party collections to provide patients with more timely access to care by adding providers, broadening the range of health services provided, and expanding or renovating space as needed.

"Outreach and education efforts about the importance of health insurance coverage may have helped to increase enrollment."

– U.S. GAO Report to Congressional Requesters

IHS officials used various strategies to boost health coverage enrollment rates. Those strategies included public service announcements, newspaper ads, and promotion of insurance during community events.

Many federally operated IHS health facilities also increased the number of onsite patient benefits coordinators who screened patients for health coverage and helped uninsured patients enroll. And officials from most IHS area offices reported collaborating with tribes on outreach and education efforts.

October: New Medicare cards

Health observances

Breast cancer awareness

Breast Cancer Awareness Month is observed each October. And this year, Indigenous Pink Day falls on October 17. Both health observances highlight the importance of routine screening mammograms for early detection of breast cancer.

Mammograms are covered by Medicare, Medicaid, and most insurance plans as a preventive health service. The American Indian Cancer Foundation website features breast cancer survivors' stories to encourage Native women to proactively schedule their mammograms, rather than wait for a provider's recommendation.

In Indian Country, stigma may prevent people from talking about cancer. To help combat that stigma, the American Cancer Society (ACS) invites Native communities to learn more about its Circle of Life education modules (PDF, 980 KB, 1 p), which focus on coping with treatment side effects, caregiver concerns, and more.

ACS also offers Life After Treatment: The Next Chapter in the Survivorship Journey (PDF, 928 KB, 16 pp), a free downloadable resource for Native people with cancer.

Preventing misuse of opioids and other medicines

October marks the arrival of National Physical Therapy Month, Talk About Your Medicines Month, and Lock Your Meds Day. Each health observance supports efforts to reduce misuse of opioids or other prescription drugs.

• During National Physical Therapy Month, check out ChoosePT, which advocates for the use of physical therapy instead of opioids to safely manage pain. Free resources include patient stories, podcasts, videos, and a campaign toolkit for outreach efforts.
• This year, Talk About Your Medicines Month highlights the need for patients and health care professionals to discuss opioids and any other medicines a patient is taking. Such discussions should cover risks, benefits, possible side effects, and expected health outcomes.
• Observed on October 23, Lock Your Meds Day urges people to store medicines out of reach of children and adolescents. The campaign also encourages safe disposal of unused or expired medications.

Promoting good oral health for better overall health

October is National Dental Hygiene Month, which promotes healthy mouths and celebrates the work of dental hygienists nationwide.

Research suggests poor oral health may raise our risk for heart attack, stroke, and diabetes-related complications. That is why preventive dental care is so important.

CMS offers two fact sheets highlighting the need for preventive dental care.

• My Health: Dental Care for Adults (PDF, 319 KB, 2 pp) encourages people to visit an oral health provider twice yearly. It also reviews dental coverage options.
• My Health: Dental Care for Children (PDF, 930 KB, 2 pp) emphasizes the need for good oral health habits and regular preventive dental care visits from an early age. Additionally, it discusses dental coverage options available through Medicaid, the Children's Health Insurance Program, Indian Health Service, and the Marketplace.

Additional resources

New Medicare Beneficiary Identifier: Get it, use it

To help prevent identity theft, CMS has issued and mailed new Medicare cards with Medicare Beneficiary Identifiers (MBIs) (PDF, 213 KB, 6 pp) instead of Social Security numbers.

All Medicare enrollees are encouraged to destroy their old cards and start using the new cards right away. Anyone who has yet to receive their new card should visit the Medicare.gov blog for guidance.

Health care providers should use MBIs when submitting claims, checking patients' eligibility, or conducting other Medicare business. After January 1, 2020, claims submitted without MBIs will be rejected.

Preparing for flu season

As fall arrives, so does flu season. Help protect yourself, as well as your family and community, by getting a flu vaccine as soon as possible and encouraging everyone you know to get vaccinated.

The Advisory Committee on Immunization Practices recommends annual flu vaccination for persons aged 6 months and older. To reinforce that message, the Association of American Indian Physicians website features a brochure (PDF, 1.2 MB, 2 pp), fact sheet (PDF, 1.2 MB, 1 p), and several short videos promoting use of flu vaccine in pregnant women, infants, adolescents, adults, and elders.

New behavioral health resource

A new resource is available to help tribes obtain full Medicaid reimbursement for behavioral health and substance use disorder services.

The CMS Behavioral Health Service Provider Report (PDF, 2.2 MB, 44 pp) identifies which types of non-physician behavioral health practitioners are authorized to bill Medicaid in the 37 states where Indian Health Service, tribal programs, and urban Indian health programs operate.

The report lists licensure and certification requirements for full reimbursement. It also includes links to web-based tribal billing guides and other state resources.