Indian Health Services (IHS) Facilities
A. General Background Information
For purposes of provider enrollment only, there are several types of IHS facilities: (1) those that are wholly owned and operated by the IHS, (2) facilities owned by the IHS but tribally operated, and (3) facilities wholly owned and operated by a tribe, though under the general IHS umbrella. When an IHS facility wishes to enroll with the Part A contractor, it may check either: (a) “Indian Health Services Facility,” or (b) the specific provider type it is. For instance, if an IHS hospital is involved, the provider may check “Indian Health Services Facility” or “Hospital” on the application - or perhaps both. Even if it only checked “Hospital,” the LBN or DBA Name will typically contain some type of reference to Indian Health Services. The contractor will therefore know that it is dealing with an IHS facility.
The overwhelming majority of IHS facilities on the Part A side are either hospitals, skilled nursing facilities (SNFs), critical access hospitals, or end-stage renal disease facilities. The contractor processes IHS applications in the same manner (and via the same procedures) as it would with a hospital, SNF, etc. (This also applies to procedures for PECOS entry.)
As for CCN numbers, the IHS facility uses the same series that its concomitant provider type does. That is, an IHS hospital uses the same CCN series as a “regular” hospital, an IHS CAH utilizes the same series as a regular CAH, and so forth.
B. IHS Enrollment
IHS facilities and tribal providers may use Internet-based PECOS or the paper Form CMS-855 enrollment application for their enrollment transactions. The designated Medicare contractor for IHS facilities and tribal providers is Novitas Solutions (Novitas).
If the IHS facility or tribal provider mails its Form CMS-855 to a Medicare contractor other than Novitas, that contractor shall forward the application directly to Novitas at the following address:
Novitas Solutions, Inc.
P.O. Box 3115
Mechanicsburg, PA 17055-1858
In Section 2 of the Form CMS-855A and Form CMS-855B applications, the provider or supplier must identify whether it is an Indian Health Facility enrolling with Novitas.
C. Licensure Requirements for Physicians and Practitioners Enrolling to Work in or Reassign Benefits to an Indian Tribe or Tribal Organization
The Affordable Care Act (Pub. L 111-148) amended Section 221 of the Indian Health Care Improvement Act (IHCIA) to provide as follows:
Licensed health professionals employed by a tribal health program shall be exempt, if licensed in any State, from the licensing requirements of the State, in which the tribal program performs the services described in the contract or compact of the tribal health program under the Indian Self-Determination and Education Assistance Act (ISDEAA) (25 U.S.C. 450, et seq.).
Pursuant to this statutory provision, any physician or practitioner need only be licensed in one State – regardless of whether that State is the one in which the practitioner practices – if he or she is employed by a tribal health program performing services as permitted under the ISDEAA (see CMS Pub. 100-04, chapter 19, section 10 for definitions).
The contractor shall apply this policy when processing applications from these individuals. In terms of the effective date of Medicare billing privileges, the contractor shall continue to apply the provisions of 42 CFR § 424.520(d) and section 15.17 of this chapter.
For additional general information on IHS facilities, see Pub. 100-04, chapter 19.
A. General Background Information
For purposes of provider enrollment only, there are several types of IHS facilities: (1) those that are wholly owned and operated by the IHS, (2) facilities owned by the IHS but tribally operated, and (3) facilities wholly owned and operated by a tribe, though under the general IHS umbrella. When an IHS facility wishes to enroll with the Part A contractor, it may check either: (a) “Indian Health Services Facility,” or (b) the specific provider type it is. For instance, if an IHS hospital is involved, the provider may check “Indian Health Services Facility” or “Hospital” on the application - or perhaps both. Even if it only checked “Hospital,” the LBN or DBA Name will typically contain some type of reference to Indian Health Services. The contractor will therefore know that it is dealing with an IHS facility.
The overwhelming majority of IHS facilities on the Part A side are either hospitals, skilled nursing facilities (SNFs), critical access hospitals, or end-stage renal disease facilities. The contractor processes IHS applications in the same manner (and via the same procedures) as it would with a hospital, SNF, etc. (This also applies to procedures for PECOS entry.)
As for CCN numbers, the IHS facility uses the same series that its concomitant provider type does. That is, an IHS hospital uses the same CCN series as a “regular” hospital, an IHS CAH utilizes the same series as a regular CAH, and so forth.
B. IHS Enrollment
IHS facilities and tribal providers may use Internet-based PECOS or the paper Form CMS-855 enrollment application for their enrollment transactions. The designated Medicare contractor for IHS facilities and tribal providers is Novitas Solutions (Novitas).
If the IHS facility or tribal provider mails its Form CMS-855 to a Medicare contractor other than Novitas, that contractor shall forward the application directly to Novitas at the following address:
Novitas Solutions, Inc.
P.O. Box 3115
Mechanicsburg, PA 17055-1858
In Section 2 of the Form CMS-855A and Form CMS-855B applications, the provider or supplier must identify whether it is an Indian Health Facility enrolling with Novitas.
C. Licensure Requirements for Physicians and Practitioners Enrolling to Work in or Reassign Benefits to an Indian Tribe or Tribal Organization
The Affordable Care Act (Pub. L 111-148) amended Section 221 of the Indian Health Care Improvement Act (IHCIA) to provide as follows:
Licensed health professionals employed by a tribal health program shall be exempt, if licensed in any State, from the licensing requirements of the State, in which the tribal program performs the services described in the contract or compact of the tribal health program under the Indian Self-Determination and Education Assistance Act (ISDEAA) (25 U.S.C. 450, et seq.).
Pursuant to this statutory provision, any physician or practitioner need only be licensed in one State – regardless of whether that State is the one in which the practitioner practices – if he or she is employed by a tribal health program performing services as permitted under the ISDEAA (see CMS Pub. 100-04, chapter 19, section 10 for definitions).
The contractor shall apply this policy when processing applications from these individuals. In terms of the effective date of Medicare billing privileges, the contractor shall continue to apply the provisions of 42 CFR § 424.520(d) and section 15.17 of this chapter.
For additional general information on IHS facilities, see Pub. 100-04, chapter 19.
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