[Congressional Bills 105th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4088 Introduced in House (IH)]







105th CONGRESS
  2d Session
                                H. R. 4088

 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.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             June 18, 1998

    Mr. Young of Alaska (for himself and Mr. Kildee) introduced the 
 following bill; which was referred to the Committee on Resources, and 
 in addition to the Committees on Commerce, and Ways and Means, for a 
 period to be subsequently determined by the Speaker, in each case for 
consideration of such provisions as fall within the jurisdiction of the 
                          committee concerned

_______________________________________________________________________

                                 A BILL


 
 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,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Alaska Native and American Indian 
Direct Reimbursement Act of 1998''.

SEC. 2. 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 turnaround 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.
            (5) The demonstration program was originally to expire on 
        September 30, 1996, but was extended by Congress to September 
        30, 1998, 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 authorization for direct billing and 
collection and to extend participation in direct billing and collection 
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:

``SEC. 405. DIRECT BILLING OF MEDICARE, MEDICAID, AND OTHER THIRD PARTY 
              PAYORS.

    ``(a) Establishment of Direct Billing Program.--
            ``(1) In general.--Indian tribes, tribal organizations, and 
        Alaska Native health organizations that contract or compact for 
        the operation of any health program 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 health programs 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 health program 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 health program for the 
        purpose of making any improvements in the health facilities or 
        programs that may be necessary to achieve or maintain 
        compliance with the conditions and requirements applicable 
        generally to facilities or health programs 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 or compact entered into under the 
                Indian Self-Determination Act (25 U.S.C. 450f et seq.).
            ``(2) Audits.--The amounts paid to the health programs 
        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) 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 
        health program during the period that the health program 
        participates in the program established under this section.
    ``(c) Requirements for Participation.--
            ``(1) Certification.--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 a 
certification to the Secretary that--
                    ``(A) the Indian tribe, tribal organization, or 
                Alaska Native health organization contracts or compacts 
                for any part of the operation of a health program of 
                the Service; and
                    ``(B) the health program 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; 
                1396);
            ``(2) Grandfather of demonstration program participants.--
        Any participant in the 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 1998 
        shall be deemed to have elected to participate in the program 
        established under this section and shall not be required to 
        submit a certification in order to participate in the program.
            ``(3) Duration.--A certification to the Secretary of a 
        qualified application under paragraph (1), or a deemed 
        certification of a demonstration program under paragraph (2), 
        shall continue in effect as long as the participant meets the 
        requirements of this section.
    ``(d) Examination and Implementation of Changes.--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 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.
    ``(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 and Education Assistance 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 1990 of the Social Security Act (42 U.S.C. 
        1395qq) is amended by adding at the end the following:
    ``(e) Section 405 of the Indian Health Care Improvement Act (25 
U.S.C. 1645) containing 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 health program of such tribes or 
organizations and for which payment may be made under this title shall 
apply.''; and
            (2) Section 1911 of the Social Security Act (42 U.S.C. 
        1396j) is amended by adding at the end the following:
    ``(d) Section 405 of the Indian Health Care Improvement Act (25 
U.S.C. 1645) containing 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 health program of such tribes or 
organizations and for which payment may be made under this title shall 
apply.''.
    (c) Effective Date.--The amendments made by this section shall take 
effect on October 1, 1998.
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