Tribal Technical Advisory Group

to the Centers for Medicare & Medicaid Services


The Tribal Technical Advisory Group (TTAG) is a group of elected tribal leaders, or an appointed representative from their Area, who are nominated from the twelve areas of the Indian Health Service (IHS) delivery System. The TTAG serves as an advisory committee to the Centers for Medicare & Medicaid Services (CMS) on important health care matters associated with the Medicare, Medicaid, and State Children Health Insurance Programs (SCHIP). There is a Principal Member and an Alternate from each of the twelve service areas. These areas are: Alaska, Aberdeen, Albuquerque, Bemidji, Billings, California, Nashville, Navajo, Oklahoma, Phoenix, Portland, and Tucson. In addition to these twelve areas, there is representation from the four Washington, DC based advocacy organizations: Tribal Self Governance Advisory Committee (TSGAC), National Indian Health Board (NIHB), National Congress of American Indians (NCAI) and National Council of Urban Indian Health (NCUIH).

The TTAG is divided into TTAG Smaller Subcommittees (Adobe Acrobat PDF) to analyze major Medicare and Medicaid topics effecting AI/ANs in greater detail. Individual TTAG and MMPC members along with employees from the CMS and IHS are subcommittee members. These subcommittees include, but are not limited to: Across State Borders, Long Term Care, Data, Outreach & Education, Affordable Care Act Policy and Behavioral Health.

For more information about the TTAG and the MMPC Technical Advisors, please refer to the document Tribal Technical Advisory Group Membership (PDF).

consumers can now compare results from home health agencies’ patient surveys

CMS to publicly report on consumer experiences with Medicare-certified home health agencies  

Results from the Centers for Medicare & Medicaid Services’ (CMS) national survey that asks patients about their experiences with Medicare-certified home health agencies are now available on the agency’s Quality Care Finder website.

CMS Acting Administrator Marilyn Tavenner today announced the new tool offering prospective patients, their families and caregivers the chance to compare home health agencies by looking at patient survey results. The Home Health Care Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) Survey, which will be updated every four months with new survey data, will complement the clinical measures already available on the agency’s “Home Health Compare” website.

“CMS is doing all it can to help consumers make better, educated choices, and help them find the home health agency that best meets their needs,” Acting Administrator Tavenner said.  “The survey is the first national assessment tool for collecting information on patient experience and will enable valid comparisons among all home health agencies.”  

The HHCAHPS is a survey that collects feedback on topics that patients have identified as important to them in determining which home health agencies provide high-quality care.  For example, the survey asks patients about the care they received from their home health agency, including such topics as overall care; provider communication skills; whether care was provided in a courteous and respectful way; and whether the agency discussed medicines, pain, and home safety.  

A prospective patient or caregiver will be able to review and compare feedback from other patients about Medicare-certified home health agencies’ care of patients, communication between providers and patients, as well as the specific care issues identified on the survey.  Ratings include an overall rating of home health care and a patient’s willingness to recommend the agency to someone else.   

The survey results are designed to create incentives for home health agencies to improve quality of care, as well as to give patients additional information so they are aware of the types of care they will receive from a particular agency. Additionally, public reporting enhances accountability in health care by increasing transparency.  

For more information on the survey, visit   

To access the survey data, visit the Quality Care Finder tool in and click on Home Health Compare at

save the date: April 25, 2012
long term services & Supports (LTSS) Webinar

The Administration on Aging (AoA), Indian Health Service (IHS), and Centers for Medicare & Medicaid Services (CMS) are conducting a series of webinars on Long Term Services and Supports (LTSS) as part of their joint technical assistance effort. The purpose of the webinars is to share knowledge and promising practices in the field and build an ongoing dialogue among tribal and IHS programs engaged in delivery of long term services and supports for AI/AN people. The audience includes Title VI grantees, IHS, tribal, and urban Indian health programs and community health representatives, and tribal program staff engaged in delivery of long term services and supports.

Webinars will take place the fourth Wednesday of every month from 2 p.m. to 3 p.m. ET.

April 25, 2012: The Green House Project
The Green House Project is a radically new, national model for skilled nursing care that returns control, dignity, and a sense of well-being to elders, their families, and direct care staff. In The Green House model, residents receive care in small, self-contained homes organized to deliver individualized care and meaningful relationships and to improve direct care jobs through a self-managed team of direct care staff working in cross-trained roles.

The Green House Overview Webinar is an opportunity to gain an initial understanding of The Green House model. In today's health care environment, culture change is no longer optional; it is demanded by the consumer and is a mark of good care. Through transformation of the philosophy, environment, and organizational structure, The Green House model is being proven to provide a high quality of life, better jobs, and excellent clinical care, and it is cost neutral to operate! This proven model is growing rapidly across the country.

Presented By: Rachel Scher and Anna Ortigara, The Green House Project.

Please reference the chart below for your location's call-in time:

Time Zone
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10:00 a.m. AKDT
11:00 a.m. PDT
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2:00 p.m. EDT

To join the meeting:

  1. Go to
  2. Select "Enter as a Guest."
  3. Type in your first and last name.
  4. Click "Enter Room."
  5. For audio, call in to the following conference number: 1-866-244-8528.
  6. Enter the following participant code and press #: 724592.

If you have never attended an Adobe Connect meeting before, you can get a quick overview at and test your connection at

Questions can be directed to [email protected] or 240-863-0355

new report: competitive bidding saving money for taxpayers and people with Medicare

Health care law expands second round, program will save up to $42.8 billion

Wednesday, April 18, 2012

People with Medicare are already saving money on durable medical equipment (DME) through the Medicare competitive bidding program, according to a report released today by Health and Human Services Secretary Kathleen Sebelius. 

According to the report, the program saved $202 million in its first year in nine metropolitan statistical areas – a reduction of 42 percent in costs and, as the program expands under the Affordable Care Act and earlier law, it could save up to $42.8 billion for taxpayers and beneficiaries over the next 10 years.  

“Thanks to the Affordable Care Act, we can expand this successful example of health care reform to include more areas and achieve savings on a national level over the next few years.  People with Medicare across the country will get the medical equipment they need to live their lives, while saving them and other taxpayers money in the process,” Secretary Sebelius said. “The law is already saving those with Medicare hundreds of dollars on their health care needs-- from medical equipment to prescription drugs—and they will continue to save in the years to come.”

The report also released results that show, after extensive monitoring by the Centers for Medicare & Medicaid Services (CMS), there have been no negative effects on the health of people on Medicare or their access to needed supplies and services.

“Seniors, and people with disabilities on Medicare, are saving money thanks to our successful competitive bidding program," said CMS Acting Administrator Marilyn Tavenner. "By expanding this successful program, we will save tens of billions of dollars for beneficiaries and taxpayers over the next 10 years."

Key information in the report: 

  • Seniors, and people with disabilities in Medicare, will directly save a projected $17.1 billion due to lower co-insurance for durable medical equipment and lower premiums for Medicare over the next decade, while taxpayers are projected to save an additional $25.7 billion through the Medicare Supplementary Medical Insurance Trust Fund because of reduced prices.
  • In the first year of implementation in nine metropolitan statistical areas, through a combination of lower prices and fewer unnecessary services, the competitive bidding program saved Medicare $202 million.
  • Medicare beneficiaries in the nine areas had substantial reductions in their co-insurance for DME.
  • Last year alone, people with Medicare saved up to $105 on hospital beds, $168 on oxygen concentrators, and $140 on diabetic test strips.
  • A real-time claims monitoring system, set up to ensure that access to supplies was not compromised, has found that people on Medicare continue to have access to all necessary and appropriate items.

The Affordable Care Act expands Round 2 of the DME competitive bidding program from 70 to 91 metropolitan statistical areas across the country.  CMS is evaluating bids from suppliers for the 91 areas.  By 2016, all areas of the country will benefit from either the competitive bidding program or lower rates based on the competitively bid rates.

View the full report here:

new health care law provisions cut red tape, save up to $4.6 billion

Monday, April 9, 2012

Department of Health and Human Services (HHS) Secretary Kathleen Sebelius today announced a proposed rule that would establish a unique health plan identifier under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The proposed rule would implement several administrative simplification provisions of the Affordable Care Act. The proposed changes would save health care providers and health plans up to $4.6 billion over the next ten years, according to estimates released by the HHS today. The estimates were included in a proposed rule that cuts red tape and simplifies administrative processes for doctors, hospitals and health insurance plans.

“The new health care law is cutting red tape, making our health care system more efficient and saving money,” Secretary Sebelius said. “These important simplifications will mean doctors can spend less time filling out forms and more time seeing patients.” Currently, when health plans and entities like third party administrators bill providers, they are identified using a wide range of different identifiers that do not have a standard length or format. As a result, health care providers run into a number of time-consuming problems, such as misrouting of transactions, rejection of transactions due to insurance identification errors, and difficulty determining patient eligibility.

The rule simplifies the administrative process for providers by proposing that health plans have a unique identifier of a standard length and format to facilitate routine use in computer systems.  This will allow provider offices to automate and simplify their processes, particularly when processing bills and other transactions.

The proposed rule also delays required compliance by one year– from Oct. 1, 2013, to Oct. 1, 2014– for new codes used to classify diseases and health problems. These codes, known as the International Classification of Diseases, 10th Edition diagnosis and procedure codes, or ICD-10, will include new procedures and diagnoses and improve the quality of information available for quality improvement and payment purposes.

Many provider groups have expressed serious concerns about their ability to meet the Oct. 1, 2013, compliance date. The proposed change in the compliance date for ICD-10 would give providers and other covered entities more time to prepare and fully test their systems to ensure a smooth and coordinated transition to these new code sets.

The proposed rule announced today is the third in a series of administrative simplification rules in the new health care law. HHS released the first in July of 2011 and the second in January of 2012, and plans to announce more in the coming months.  

More information on the proposed rule is available on fact sheets at

The proposed rule may be viewed at Comments are due 30 days after publication in the Federal Register.

cms makes improvements to medicare drug & health plans

Rate Announcement & Call Letter address 2013 payments & other program updates

“Final rule strengthens beneficiary protections, codifies coverage gap discount program”  

Monday, April 2, 2012  

The Centers for Medicare & Medicaid Services (CMS) today issued final regulations for Medicare Advantage (MA) and prescription drug benefit (Part D) programs to improve benefits and the quality of care for seniors and people with disabilities enrolled in these programs.   

“Thanks to the Affordable Care Act, people with Medicare are getting more value from their Medicare Advantage and prescription drug plans,” said CMS Acting Administrator Marilyn Tavenner.  “The changes we’re implementing today will lower costs for people with Medicare and ensure that they can choose the health plan that works for them.”  

CMS announced the estimated growth rate for 2013 and other contract management policies for its participating health and drug plans for Payment Year 2013.  The Rate Announcement and Final Call Letter are combined into a single guidance document and establish updates to payment methodologies, other policies, and program operations for Part C organizations and Part D sponsors.  The policies will become effective January 1, 2013, as required by law. “These policy changes will help keep costs low and make Medicare stronger,” said Jonathan Blum, CMS Deputy Administrator and Director of the Center for Medicare.Additional resources related to contract management can be referred based on the program enrollment.  

Highlights of the 2013 Rate Announcement and Final Call Letter include:

  • An estimated annual growth rate of 3.07%, which will sustain a stable MA landscape for next year (2013);
  • 2013 Part D Benefit Parameters, including improved coverage in the coverage gap;
  • Guidance on limiting year-over-year cost increases for MA beneficiaries;
  • New guidance to strengthen controls against prescription drug abuse.

The drug and health plan program updates, effective January 1, 2013, will help continue the trend of lower premiums and stable or improved benefits that beneficiaries in these programs have experienced over the last two years.  Earlier this year, CMS announced that MA premiums had dropped 7 percent over the past year while enrollment increased by about 10 percent. Based on the 2013 policies announced today, CMS looks forward to retaining access to MA plans as an affordable option for people with Medicare and ensuring that drug and health plan sponsors are accountable to America’s senior and disabled beneficiaries for improved quality of care and stable cost-sharing for the coming year.  

CMS also published the final 2013 C and D rule today. Highlights of the final rule include:

  • Next steps in implementation of the Part D Coverage Gap Discount Program under the Affordable Care Act;
  • Greater flexibility for doctors to assist beneficiaries in drug coverage appeals;
  • Better reporting of prescriber identifiers to improve program oversight and detect fraud;
  • New authority to remove consistently poor performing MA and Part D plans from the program;
  • Permitting certain dual eligible special needs plans (D-SNPs) to offer additional supplemental benefits beyond those that other MA plans may offer.

For information on today’s final rule, please go to:

Fact sheets for the Final Rule and 2013 Rate Announcement and Final Call Letter are available at:

Public comments on the proposed rule are posted at


May Monthly Conference Call
June 13, 2012
Monthly Conference Call
July 25-26, 2012
Face to Face Meeting
Washington, D.C.
August 8, 2012
Monthly Conference Call
September 12, 2012
Monthly Conference Call
October 10, 2012
Monthly Conference Call
November 14-15, 2012
Face to Face Meeting
Washington, D.C.
December 12, 2012
Monthly Conference Call
Click here for the 2012 TTAG meeting dates (PDF)


NIHB Regulation Review and Impact Analysis Report v. 2.7 (PDF)

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