[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[S. 406 Enrolled Bill (ENR)]
S.406
One Hundred Sixth Congress
of the
United States of America
AT THE SECOND SESSION
Begun and held at the City of Washington on Monday,
the twenty-fourth day of January, two thousand
An Act
To amend the Indian Health Care Improvement Act to make permanent the
demonstration program that allows for direct billing of medicare,
medicaid, and other third party payors, and to expand the eligibility
under such program to other tribes and tribal organizations.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,

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This Act may be cited as the ``Alaska Native and American Indian
Direct Reimbursement Act of 2000''.

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Congress finds the following:
(1) In 1988, Congress enacted section 405 of the Indian Health
Care Improvement Act (25 U.S.C. 1645) that established a
demonstration program to authorize 4 tribally-operated Indian
Health Service hospitals or clinics to test methods for direct
billing and receipt of payment for health services provided to
patients eligible for reimbursement under the medicare or medicaid
programs under titles XVIII and XIX of the Social Security Act (42
U.S.C. 1395 et seq.; 1396 et seq.), and other third party payors.
(2) The 4 participants selected by the Indian Health Service
for the demonstration program began the direct billing and
collection program in fiscal year 1989 and unanimously expressed
success and satisfaction with the program. Benefits of the program
include dramatically increased collections for services provided
under the medicare and medicaid programs, a significant reduction
in the turn-around time between billing and receipt of payments for
services provided to eligible patients, and increased efficiency of
participants being able to track their own billings and
collections.
(3) The success of the demonstration program confirms that the
direct involvement of tribes and tribal organizations in the direct
billing of, and collection of payments from, the medicare and
medicaid programs, and other third party payor reimbursements, is
more beneficial to Indian tribes than the current system of Indian
Health Service-managed collections.
(4) Allowing tribes and tribal organizations to directly manage
their medicare and medicaid billings and collections, rather than
channeling all activities through the Indian Health Service, will
enable the Indian Health Service to reduce its administrative
costs, is consistent with the provisions of the Indian Self-
Determination Act, and furthers the commitment of the Secretary to
enable tribes and tribal organizations to manage and operate their
health care programs.
(5) The demonstration program was originally to expire on
September 30, 1996, but was extended by Congress, so that the
current participants would not experience an interruption in the
program while Congress awaited a recommendation from the Secretary
of Health and Human Services on whether to make the program
permanent.
(6) It would be beneficial to the Indian Health Service and to
Indian tribes, tribal organizations, and Alaska Native
organizations to provide permanent status to the demonstration
program and to extend participation in the program to other Indian
tribes, tribal organizations, and Alaska Native health
organizations who operate a facility of the Indian Health Service.

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PAYORS.
(a) Permanent Authorization.--Section 405 of the Indian Health Care
Improvement Act (25 U.S.C. 1645) is amended to read as follows:
``(a) Establishment of Direct Billing Program.--
``(1) In general.--The Secretary shall establish a program
under which Indian tribes, tribal organizations, and Alaska Native
health organizations that contract or compact for the operation of
a hospital or clinic of the Service under the Indian Self-
Determination and Education Assistance Act may elect to directly
bill for, and receive payment for, health care services provided by
such hospital or clinic for which payment is made under title XVIII
of the Social Security Act (42 U.S.C. 1395 et seq.) (in this
section referred to as the `medicare program'), under a State plan
for medical assistance approved under title XIX of the Social
Security Act (42 U.S.C. 1396 et seq.) (in this section referred to
as the `medicaid program'), or from any other third party payor.
``(2) Application of 100 percent fmap.--The third sentence of
section 1905(b) of the Social Security Act (42 U.S.C. 1396d(b))
shall apply for purposes of reimbursement under the medicaid
program for health care services directly billed under the program
established under this section.
``(b) Direct Reimbursement.--
``(1) Use of funds.--Each hospital or clinic participating in
the program described in subsection (a) of this section shall be
reimbursed directly under the medicare and medicaid programs for
services furnished, without regard to the provisions of section
1880(c) of the Social Security Act (42 U.S.C. 1395qq(c)) and
sections 402(a) and 813(b)(2)(A), but all funds so reimbursed shall
first be used by the hospital or clinic for the purpose of making
any improvements in the hospital or clinic that may be necessary to
achieve or maintain compliance with the conditions and requirements
applicable generally to facilities of such type under the medicare
or medicaid programs. Any funds so reimbursed which are in excess
of the amount necessary to achieve or maintain such conditions
shall be used--
``(A) solely for improving the health resources deficiency
level of the Indian tribe; and
``(B) in accordance with the regulations of the Service
applicable to funds provided by the Service under any contract
entered into under the Indian Self-Determination Act (25 U.S.C.
450f et seq.).
``(2) Audits.--The amounts paid to the hospitals and clinics
participating in the program established under this section shall
be subject to all auditing requirements applicable to programs
administered directly by the Service and to facilities
participating in the medicare and medicaid programs.
``(3) Secretarial oversight.--The Secretary shall monitor the
performance of hospitals and clinics participating in the program
established under this section, and shall require such hospitals
and clinics to submit reports on the program to the Secretary on an
annual basis.
``(4) No payments from special funds.--Notwithstanding section
1880(c) of the Social Security Act (42 U.S.C. 1395qq(c)) or section
402(a), no payment may be made out of the special funds described
in such sections for the benefit of any hospital or clinic during
the period that the hospital or clinic participates in the program
established under this section.
``(c) Requirements for Participation.--
``(1) Application.--Except as provided in paragraph (2)(B), in
order to be eligible for participation in the program established
under this section, an Indian tribe, tribal organization, or Alaska
Native health organization shall submit an application to the
Secretary that establishes to the satisfaction of the Secretary
that--
``(A) the Indian tribe, tribal organization, or Alaska
Native health organization contracts or compacts for the
operation of a facility of the Service;
``(B) the facility is eligible to participate in the
medicare or medicaid programs under section 1880 or 1911 of the
Social Security Act (42 U.S.C. 1395qq; 1396j);
``(C) the facility meets the requirements that apply to
programs operated directly by the Service; and
``(D) the facility--
``(i) is accredited by an accrediting body as eligible
for reimbursement under the medicare or medicaid programs;
or
``(ii) has submitted a plan, which has been approved by
the Secretary, for achieving such accreditation.
``(2) Approval.--
``(A) In general.--The Secretary shall review and approve a
qualified application not later than 90 days after the date the
application is submitted to the Secretary unless the Secretary
determines that any of the criteria set forth in paragraph (1)
are not met.
``(B) Grandfather of demonstration program participants.--
Any participant in the demonstration program authorized under
this section as in effect on the day before the date of
enactment of the Alaska Native and American Indian Direct
Reimbursement Act of 1999 shall be deemed approved for
participation in the program established under this section and
shall not be required to submit an application in order to
participate in the program.
``(C) Duration.--An approval by the Secretary of a
qualified application under subparagraph (A), or a deemed
approval of a demonstration program under subparagraph (B),
shall continue in effect as long as the approved applicant or
the deemed approved demonstration program meets the
requirements of this section.
``(d) Examination and Implementation of Changes.--
``(1) In general.--The Secretary, acting through the Service,
and with the assistance of the Administrator of the Health Care
Financing Administration, shall examine on an ongoing basis and
implement--
``(A) any administrative changes that may be necessary to
facilitate direct billing and reimbursement under the program
established under this section, including any agreements with
States that may be necessary to provide for direct billing
under the medicaid program; and
``(B) any changes that may be necessary to enable
participants in the program established under this section to
provide to the Service medical records information on patients
served under the program that is consistent with the medical
records information system of the Service.
``(2) Accounting information.--The accounting information that
a participant in the program established under this section shall
be required to report shall be the same as the information required
to be reported by participants in the demonstration program
authorized under this section as in effect on the day before the
date of enactment of the Alaska Native and American Indian Direct
Reimbursement Act of 1999. The Secretary may from time to time,
after consultation with the program participants, change the
accounting information submission requirements.
``(e) Withdrawal From Program.--A participant in the program
established under this section may withdraw from participation in the
same manner and under the same conditions that a tribe or tribal
organization may retrocede a contracted program to the Secretary under
authority of the Indian Self-Determination Act (25 U.S.C. 450 et seq.).
All cost accounting and billing authority under the program established
under this section shall be returned to the Secretary upon the
Secretary's acceptance of the withdrawal of participation in this
program.''.
(b) Conforming Amendments.--(1) Section 1880 of the Social Security
Act (42 U.S.C. 1395qq) is amended by adding at the end the following:
``(e) For provisions relating to the authority of certain Indian
tribes, tribal organizations, and Alaska Native health organizations to
elect to directly bill for, and receive payment for, health care
services provided by a hospital or clinic of such tribes or
organizations and for which payment may be made under this title, see
section 405 of the Indian Health Care Improvement Act (25 U.S.C.
1645).''.
(2) Section 1911 of the Social Security Act (42 U.S.C. 1396j) is
amended by adding at the end the following:
``(d) For provisions relating to the authority of certain Indian
tribes, tribal organizations, and Alaska Native health organizations to
elect to directly bill for, and receive payment for, health care
services provided by a hospital or clinic of such tribes or
organizations and for which payment may be made under this title, see
section 405 of the Indian Health Care Improvement Act (25 U.S.C.
1645).''.
(c) Effective Date.--The amendments made by this section shall take
effect on October 1, 2000.

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(a) In General.--Effective November 9, 1998, section 405 of the
Indian Health Care Improvement Act (25 U.S.C. 1645(e)) is reenacted as
in effect on that date.
(b) Reports.--Effective November 10, 1998, section 405 of the
Indian Health Care Improvement Act is amended by striking subsection
(e).
Speaker of the House of Representatives.
Vice President of the United States and
President of the Senate.

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Alaska Native and American Indian Direct Reimbursement Act of 1999 — S. 406

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