Native medical center faces termination of Medicare reimbursement

Joaqlin Estus
ICT

The Alaska Native Medical Center (ANMC) has received notice its status to receive Medicare reimbursement is in jeopardy over governance and emergency services. The Centers for Medicare and Medicaid Services told ANMC that as of July 12 the medical center no longer meets federal conditions of participation. Unless deficiencies are resolved, Medicare reimbursement would end in October.

Details about the nature of the deficiencies are not available because the investigation is ongoing, said a CMS spokesperson.

The loss of Medicare reimbursement for services would be a serious blow to the finances of the hospital. In the past, ANMC administrators have said Indian Health Service funding makes up 40 percent of their cost of health care. The center makes up the balance through Medicare, Medicaid, and private insurance reimbursements.

CMS said its agreement with the Native medical center will be terminated effective Oct. 20, 2023 unless the Native center can fix the problems. If the termination takes effect, Medicare would not reimburse ANMC for services for patients admitted on or after Oct. 10 and only for the following 30 days for patients admitted before Oct.10.

The medical center can avert termination by submitting an acceptable plan of correction and by showing state verification of its compliance with the plan. The plan of correction must be submitted by July 22, 2023.

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Alaska Native Medical Center is run by the Alaska Native Tribal Health Consortium (ANTHC) and Southcentral Foundation (SCF) through a joint operating board established by an act of Congress. Consortium and foundation leaders say they are working “collaboratively and swiftly” to resolve the CMS findings.

An ANMC spokesperson said the deemed status was temporarily removed, and the survey investigation transferred to Alaska Health Facilities and Licensing. “We expect to submit a plan of correction this week. We are confident the issue will be resolved, the deemed status restored, and that Medicare enrollment will not be terminated,” the spokesperson said.

The Alaska Native Tribal Health Consortium said it will be confirming that ANMC’s governance structure is consistent with CMS requirements. The issue was evidently raised earlier and ANMC asked CMS for guidance in November 2022.

“We now have that guidance. As joint operators on the accredited campus, ANTHC and SCF leadership have been working closely to address identified structural issues in compliance with all rules and regulations that support high-quality care for the people who we serve,” said Consortium President/CEO Valerie Nurr’araluk Davidson in a statement.

“We value the feedback from the CMS survey regarding the unique operating structure between Southcentral Foundation and the Alaska Native Tribal Health Consortium. Following a federal law, Section 325 of P.L. 105-83, SCF and ANTHC jointly operate the Alaska Native Medical Center through the Joint Operating Board. SCF and ANTHC are working together to develop a correction plan to address these concerns as quickly and thoroughly as possible. ANTHC and SCF are committed to providing the highest quality care to Alaska Native and American Indian people at ANMC,” said Foundation President/CEO April Kyle in a statement.

The Centers for Medicare and Medicaid Services said the medical center needs to come up with a plan for improving the processes that led to the deficiencies, procedures for implementing the remedy(ies), completion dates, and monitoring and tracking procedures that will be implemented to ensure the plan of correction is effected and the deficiencies remain corrected.

The medical center, according to its website, “offers comprehensive medical services and acute, specialty, primary and behavioral health care to Alaska Native and American Indian people living in Alaska.” The facility “includes a 182-bed hospital, a full range of medical specialties, primary care services and labs. The ANMC hospital houses Alaska’s first Level II Trauma Center and is also a Level II Pediatric Trauma Center. The hospital also works in close partnership with rural health facilities statewide to support a broad range of health care and related services.”

The Indian Health Service, an agency within the U.S. Department of Health and Human Services, is responsible for providing federal health services to American Indians and Alaska Natives through numerous treaties, laws, Supreme Court decisions, and Executive Orders.

Tribes have long testified to Congress that the Indian Health Service is seriously underfunded. The Indian Health Service says its baseline funding is $4,078 per user. That’s compared to $9,726 per user for other federal patient care services such as the Veterans Administration and federal prisons.

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