Coalition Workgroup discusses FMAP policy implementation

Paper cutout family with house under a Medicaid umbrella

The Community-Based Providers Shared Savings workgroup (a subgroup of the Health Care Solutions Coalition) met this week. The group is focused on implementing the 100% Federal Medical Assistance Percentages (FMAP) policy for South Dakota’s Medicaid program.

The state is leading the effort to implement changes in the Centers for Medicare & Medicaid Services (CMS) funding policy introduced in 2016. The changes allow states to receive 100% reimbursement for Native Americans who receive care outside the Indian Health Services (IHS) system and are eligible/enrolled in the Medicaid program. Providers are also required to meet other conditions of participation.

The process requires participating facilities to sign care coordination agreements to ensure that care originates at an IHS facility and is “coordinated” between the IHS and non-IHS providers. To date, agreements have been signed by the IHS and the three largest health systems in the state.

The workgroup is comprised of a diverse group of healthcare providers from across the state who are working to identify additional opportunities to implement the policy. Specifically, the group is exploring expansion to community support providers, nursing homes and psychiatric residential treatment facilities.

Expanding into these areas would improve care and achieve additional shared savings for enrollees. The workgroup meeting included background information on the Medicaid program and reimbursement methodology, along with explanations of the various processes for care coordination, IHS patient referral, services and other aspects of the initiative.

To view a list of workgroup members click here.