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Dear USET/USET SPF Family,
The Indian Health Service (IHS) has initiated consultation prior to implementing updated IHS Medical Priority Levels. The IHS establishes these Medical Priority Levels to ensure that authorization of Purchased/Referred Care (PRC) services is based on "relative medical need." IHS bases medical priority level decision making on the Medicare National Coverage Determinations Manual from the Centers for Medicare and Medicaid Services (CMS) and updates the IHS Medical Priority Levels periodically.
These revised Medical Priority Levels for care will replace previous medical, dental, and behavioral health priorities and will apply to federal PRC programs. Tribal programs may choose to use the medical priorities as a guide as well.
Under the revised Medical Priority Levels, PRC services will be divided into four categories: A) Preventative and Rehabilitative Services; B) Medical, Dental, Vision and Surgical Services; C) Reproductive and Maternal/Child Health Services; and D) Behavioral Health Services. Within each category, there are three priority levels: Priority 1 (Core - Essential Services), Priority 2 (Intermediate - Necessary Services), and Priority 3 (Elective - Justifiable Services). More information about each of the categories and priority levels can be found in these materials from IHS. Unless otherwise announced, IHS will begin implementation of the updated priority levels for IHS-operated PRC programs no later than January 1, 2024.
IHS will accept comments on the updated Medical Priority Levels until October 27, 2023. Written comments may be submitted to consultation@ihs.gov. USET SPF will continue to monitor this issue and provide updates when relevant.
For more information, please contact Ashton Martin, USET SPF Health Policy Analyst, at amartin@usetinc.org.
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