22-822m Stay Current with OMB Rates for American Indian Health Programs
Date: 09/30/22
New rates effective for dates of service on or after January 1, 2022
On April 13, 2022, the Department of Health Care Services (DHCS) published new Office of Management and Budget (OMB) reimbursement rates for American Indian Health Service (IHS) Programs. The OMB encounter rates are all-inclusive for eligible services. Health Net* is required to reimburse American IHS program providers for eligible services at the applicable OMB encounter rates.
New OMB rates for calendar Year 2022
The rates will be effective for services provided on/or after January 1, 2022.
Description | Rates |
|---|---|
Non-Dual Rate (Medi-Cal beneficiaries who do not have Medicare Coverage or have Medicare Part A only) | $640 |
Dual rate (Medi-Cal beneficiaries with full Medicare coverage or Medicare part B only) | $495.87 |
IHS Program reimbursement
Under federal law, California must ensure that American IHS program providers are paid the applicable OMB encounter rates published annually in the Federal Register by the Indian Health Service. If there is any difference between the amount paid by a managed care plan (MCP) and the applicable OMB encounter rate, the state is required to make a supplemental payment pursuant to Title 42 of the United States Code (USC) Section 1396u-2(h)(2)(C)(ii) and Title 42 of the Code of Federal Regulations (CFR) Sections 438.14(c)(2) and (3).
Under the policy change addressed in DHCS All Plan Letter17-020, the state requires that MCPs make the necessary payments to American IHS Programs so that they receive the applicable OMB encounter rate for eligible services provided on or after January 1, 2018.
Additional information
Providers are encouraged to access the provider portal for real-time information, including eligibility verification, claims status, prior authorization status, plan summaries, and more.
If you have questions regarding the information contained in this update, contact the Health Net Provider Services Center by email within 60 days, by phone or through the Health Net provider website as listed in the right-hand column on page 1.
This information applies to Participating Physician Groups (PPGs).
For Medi-Cal, this information applies to Kern, Los Angeles, Riverside, Sacramento, San Bernardino, San Diego, San Joaquin, Stanislaus, and Tulare counties.