[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,

SECTION 1. SHORT TITLE.

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

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 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.
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
            ``(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.

SEC. 4. 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).

                               Speaker of the House of Representatives.

                            Vice President of the United States and    
                                               President of the Senate.