[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[S. 406 Introduced in Senate (IS)]
106th CONGRESS
1st Session
S. 406
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 SENATE OF THE UNITED STATES
February 10, 1999
Mr. Murkowski (for himself, Mr. Lott, Mr. Baucus, Mr. Inhofe, Mr.
Cochran, Mr. Campbell, and Mr. Inouye) introduced the following bill;
which was read twice and referred to the Committee on Indian Affairs
_______________________________________________________________________
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 1999''.
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 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.--
``(A) Quarterly reports.--Subject to subparagraph
(B), 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 a quarterly basis during the first
2 years of participation in the program and annually
thereafter.
``(B) Annual reports.--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 only be required to
submit annual reports under this paragraph.
``(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 is accredited by an accrediting
body designated by the Secretary or 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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