II 109th CONGRESS 1st Session S. 1572 IN THE SENATE OF THE UNITED STATES July 29, 2005 Mr. Johnson (for himself and Mr. Bingaman) introduced the following bill; which was read twice and referred to the Committee on Finance A BILL To amend title XIX of the Social Security Act to clarify the application of the 100 percent Federal medical assistance percentage under the medicaid program for services provided by the Indian Health Service or an Indian tribe or tribal organization directly or through referral, contract, or other arrangement.

1.

Short title

This Act may be cited as the Medicaid for American Indians and States Act of 2005.

2.

Clarification of application of 100 percent fmap

(a)

In general

The third sentence of section 1905(b) of the Social Security Act (42 U.S.C. 1396d(b)) is amended by striking services which are received through and inserting any services provided under a State plan which are received at or by written medical referral from. (b)

Conforming amendment

Section 1911(c) of such Act (42 U.S.C. 1396j(c)) is amended by striking in Indian Health Service facilities to Indians who are eligible for medical assistance under the State plan and inserting to Indians who are eligible for medical assistance under the State plan by the Indian Health Service or by an Indian tribe or tribal organization (as so defined) directly or through written medical referral to, or under contract or other arrangement with, another health care provider and the Indian Health Service or an Indian tribe or tribal organization, without regard to the location of service delivery or the entity submitting the claim for the service, or whether such provider would be considered an independent contractor. (c)

Retroactive effective date

(1)

In general

The amendments made by subsections (a) and (b) shall apply to items and services furnished on or after January 1, 1997. (2)

Application to previously disallowed payments

(A)

Review of claims

Not later than 90 days after the date of enactment of this Act, the Secretary of Health and Human Services shall— (i)review any disallowed claim described in subparagraph (B) to determine if the claim satisfies the requirements for the application of the 100 percent Federal medical assistance percentage under the third sentence of section 1905(b) of such Act (42 U.S.C. 1396d(b)), as amended by subsection (a); and (ii)if any such claim meets such requirements, revoke the disallowance of the claim and adjust the payments made to the State accordingly. (B)

Claim described

For purposes of subparagraph (A), a claim described in this subparagraph is any claim submitted by a State for Federal financial participation for medical assistance provided under title XIX of the Social Security Act which was disallowed during the period that begins on January 1, 1997, and ends on the date of enactment of this Act, on the basis that the claim was not for services received through or provided by an Indian Health Service facility or did not otherwise satisfy the requirements for the application of the 100 percent Federal medical assistance percentage under the third sentence of section 1905(b) of such Act (42 U.S.C. 1396d(b)).