Reimbursement Rates for Calendar Year 2019

AGENCY:

Indian Health Service, HHS.

ACTION:

Notice.

SUMMARY:

Notice is given that the Principal Deputy Director of the Indian Health Service (IHS), under the authority of sections 321(a) and 322(b) of the Public Health Service Act, and the Indian Health Care Improvement Act, has approved the following rates for inpatient and outpatient medical care provided by IHS facilities for Calendar Year 2019 for Medicare and Medicaid beneficiaries, beneficiaries of other federal programs, and for recoveries under the Federal Medical Care Recovery Act. The inpatient rates for Medicare Part A are excluded from the table below, as Medicare inpatient payments for IHS hospital facilities are made based on the prospective payment system or reasonable costs when IHS facilities are designated as Medicare Critical Access Hospitals. Since the inpatient per diem rates set forth below do not include all physician services and practitioner services, additional payment shall be available to the extent that those services are provided.

Inpatient Hospital Per Diem Rate (Excludes Physician/Practitioner Services)

Calendar Year 2019

Lower 48 States $3,442

Alaska $3,434

Outpatient Per Visit Rate (Excluding Medicare)

Calendar Year 2019

Lower 48 States $455

Alaska $682

Outpatient Per Visit Rate (Medicare)

Calendar Year 2019

Lower 48 States $405

Alaska $646

Medicare Part B Inpatient Ancillary Per Diem Rate

Calendar Year 2019

Lower 48 States $789

Alaska $1,144

Outpatient Surgery Rate (Medicare)

Established Medicare rates for freestanding Ambulatory Surgery Centers.

Effective Date for Calendar Year 2019 Rates

Consistent with previous annual rate revisions, the Calendar Year 2019 rates will be effective for services provided on/or after January 1, 2019, to the extent consistent with payment authorities, including the applicable Medicaid State plan.