The FINAL Qualified Health Plan Tribal Addendum
On April 5, 2013, the Department of Health and Human Services (HHS) released a final Letter to issuers in the Federal Marketplace. The Letter provides essential guidance to Marketplace issuers on operational matters, and communicates key dates for the Federal Marketplace for the 2014 plan year. This guidance may be found here.
In the letter to Issuers, CMS included information regarding the Model Qualified Health Plan (QHP) Addendum, which enables issuers to contract more efficiently with Indian health care providers to ensure that American Indians and Alaska Natives can continue to be served by their Indian provider of choice. It is anticipated that the Model QHP Addendum will assist issuers to meet the QHP certification standards and facilitate acceptance of network contracts by I/T/U providers. CMS strongly encourages issuers and providers to use this Addendum, but use of the Model QHP Addendum is optional. The Addendum was developed through tribal consultation and the engagement of tribal and issuer input. You may access a copy of the Addendum here. In addition, a list of the Indian health providers will be posted in the near future.
Draft Model Qualified Health Plan Addendum
On November 19, 2012, CMS and IHS jointly issued a Dear Tribal Leader letter seeking consultation on the Model Qualified Health Plan (QHP) Addendum for Indian health care providers. Written comments are due Wednesday, December 19th. Attached is the Dear Tribal Leader letter, the Addendum, and further information outlining the purpose and key provisions of the Addendum. A copy of the letter will be mailed to all 567 tribes and will be posted on the CMS website and the IHS website.
The Addendum is designed to facilitate the inclusion of Indian health care providers in the QHP provider networks. It was developed in response to comments made during previous tribal consultations as well as with input from the CMS Tribal Technical Advisory Group and the Indian Health Service. We anticipate that the Addendum will enable QHP issuers to contract more efficiently with Indian health care providers to help ensure that American Indians and Alaska Natives (AI/AN)s can continue to be served by their Indian provider of choice. Although the Model QHP Addendum is not required, CMS will strongly encourage its use by QHPs.