[106th Congress Public Law 417]
[From the U.S. Government Printing Office]
<DOC>
[DOCID: f:publ417.106]
[[Page 1811]]
ALASKA NATIVE AND AMERICAN INDIAN DIRECT REIMBURSEMENT ACT OF 2000
[[Page 114 STAT. 1812]]
Public Law 106-417
106th Congress
An Act
To amend the Indian Health Care <<NOTE: Nov. 1, 2000 - [S.
406]>> 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 <<NOTE: Alaska Native and
American Indian Direct Reimbursement Act of 2000.>> Representatives of
the United States of America in Congress assembled,
SECTION 1. <<NOTE: 25 USC 1601 note.>> SHORT TITLE.
This Act may be cited as the ``Alaska Native and American Indian
Direct Reimbursement Act of 2000''.
SEC. 2. <<NOTE: 25 USC 1645 note.>> FINDINGS.
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
[[Page 114 STAT. 1813]]
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.
SEC. 3. DIRECT BILLING OF MEDICARE, MEDICAID, AND OTHER THIRD
PARTY 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
[[Page 114 STAT. 1814]]
``(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) <<NOTE: Reports.>> 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) <<NOTE: Deadline.>> 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.
[[Page 114 STAT. 1815]]
``(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
[[Page 114 STAT. 1816]]
section 405 of the Indian Health Care Improvement Act (25 U.S.C.
1645).''.
(c) <<NOTE: 25 USC 1645 note.>> Effective Date.--The amendments
made by this section shall take effect on October 1, 2000.
SEC. 4. <<NOTE: Effective dates. 25 USC 1645 note.>> TECHNICAL
AMENDMENT.
(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).
Approved November 1, 2000.
LEGISLATIVE HISTORY--S. 406:
---------------------------------------------------------------------------
HOUSE REPORTS: No. 106-818, Pt. 1 (Comm. on Resources).
SENATE REPORTS: No. 106-152 (Comm. on Indian Affairs).
CONGRESSIONAL RECORD:
Vol. 145 (1999):
Sept. 15, considered and passed
Senate.
Vol. 146 (2000):
Oct. 17, considered and passed
House.
<all>