CMS has issued a final agency rule with several provisions that will be of interest to Medicaid clinic services tribal health programs. Through the final rule, CMS has amended the Medicaid clinic services’ regulation (at 42 CFR 440.90) to authorize Medicaid coverage for clinic services furnished by IHS and Tribal clinics outside the “four walls” of their facility. (In addition, states can also choose to cover clinic services furnished outside the “four walls” of behavioral health clinics or clinics located in rural areas.)
This change will be effective Jan. 1, 2025.
By this rule change, Tribal clinics are able to claim Medicaid reimbursement at the facility or encounter rate for healthcare services provided away from the clinic, including services furnished by contract healthcare providers. This change greatly expands access to health care services through Tribal clinics.