[Congressional Record Volume 142, Number 119 (Wednesday, September 4, 1996)]
[House]
[Pages H9970-H9971]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                INDIAN HEALTH CARE DEMONSTRATION PROGRAM

  Mr. DOOLITTLE. Mr. Speaker, I move to suspend the rules and pass the 
bill (H.R. 3378) to amend the Indian Health Care Improvement Act to 
extend the demonstration program for direct billing of Medicare, 
Medicaid, and other third party payors.
  The Clerk read as follows:

                               H.R. 3378

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. EXTENSION OF CERTAIN DEMONSTRATION PROGRAM.

       Section 405(c)(2) of the Indian Health Care Improvement Act 
     (25 U.S.C. 1645(c)(2)) is amended by striking ``September 30, 
     1996'' and inserting in lieu thereof ``September 30, 1998''.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
California [Mr. Doolittle] and the gentleman from American Samoa [Mr. 
Faleomavaega] each will control 20 minutes.
  The Chair recognizes the gentleman from California [Mr. Doolittle].
  (Mr. DOOLITTLE asked and was given permission to revise and extend 
his remarks.)
  Mr. DOOLITTLE. Mr. Speaker, I yield myself such time as I may 
consume.
  H.R. 3378 would extend a demonstration project for direct billing of 
Medicare, Medicaid, and other third party payors. This bill will extend 
this demonstration project through September 30, 1998, rather than 
allowing it to sunset at the end of this month.
  In 1988, the Indian Health Care Improvement Act established 
demonstration programs to authorize up to four tribally operated Indian 
Health Service hospitals or clinics to test methods for direct billing 
and receipt of payment for health services provided to Medicare and 
Medicaid eligible patients. The program was established to decide 
whether these collections could be increased through direct involvement 
of the tribal health care provider versus the current practice which 
required such billings and collections to be routed through the Indian 
Health Service.
  Currently, there are four tribal health care providers participating 
in this demonstration project: the Bristol Bay Area Health Corporation 
of Dillingham, AK; the South East Alaska Regional Health Consortium of 
Sitka, AK; the Mississippi Choctaw Health Center of Philadelphia, MS; 
and the Choctaw Tribe of Oklahoma of Durant, OK. All participants have 
expressed success and satisfaction with the demonstration project and 
report dramatically increased collections for Medicare and Medicaid 
services, thereby providing additional revenues for Indian health 
programs at these facilities. They also report a significant reduction 
in the turnaround time between billing and receipt of payment, and 
increased efficiency by being able to track their own billings and 
collections. Therefore, they can act quickly to resolve questions and 
problems.
  The Indian Health Service is required to monitor participation and 
receive quarterly reports from the four participants. The law also 
requires the Indian Health Service to report to Congress on the 
demonstration program at the end of fiscal year 1996. This report is to 
evaluate whether the objectives have been fulfilled, and whether direct 
billing should be allowed for other tribal providers who operate an 
entire Indian Health Service facility.
  H.R. 3378 extends this demonstration authority for 2 more years to 
give Congress time to review the report the Indian Health Service must 
submit on September 30, 1996, and determine the future of the program. 
Secretary Donna E. Shalala sent a letter to Chairman Don Young on 
August 1 in support of H.R. 3378 for the administration. I urge my 
colleagues to support the extension of this productive demonstration 
program and to vote for final passage of H.R. 3378.
  Mr. Speaker, I reserve the balance of my time.
  Mr. FALEOMAVAEGA. Mr. Speaker, I yield myself such time as I may 
consume.
  (Mr. FALEOMAVAEGA asked and was given permission to revise and extend 
his remarks.)
  Mr. FALEOMAVAEGA. Mr. Speaker, I am pleased to offer my support for 
this bill which would extend for 2 more years an important 
demonstration project contained in section 405 of the Indian Health 
Care Improvement Act. This demonstration project allows participating 
tribes and tribal organizations who operate their own hospitals

[[Page H9971]]

or clinics to directly bill Medicaid and Medicare for services provided 
to eligible Indian patients. Direct billing has saved these tribes 
invaluable time and money that they otherwise would have lost by having 
to route their billing through the Indian Health Service. By saving the 
tribes time, the program has allowed the tribes to more efficiently 
manage their limited resources and improve billing practices, which in 
turn has generated even more income for these programs. At a time when 
the national level of need funded [LNF] for most Indian health programs 
rests at 60-70 percent, these additional dollars make an important 
difference in the kinds of services and quality of care these tribes 
can provide.
  Mr. Speaker, I believe that this demonstration program has been a 
remarkable success and hope that in time we will be able to expand this 
worthwhile project to other tribes and tribal organizations.
  Mr. Speaker, I thank the author of this bill, the gentleman from 
Alaska [Mr. Young], the chairman of the House Resources Committee, and 
the gentleman from California [Mr. Miller], the ranking Democrat of the 
Resources Committee, for their support.
  Mr. Speaker, I urge my colleagues to support this legislation.
  Mr. Speaker, I yield back the balance of my time.
  Mr. DOOLITTLE. Mr. Speaker, I include for the Record a letter from 
the gentleman from Virginia [Mr. Bliley], chairman of the Committee on 
Commerce.

                                    U.S. House of Representatives,


                                        Committee on Commerce,

                                   Washington, DC, August 1, 1996.
     Hon. Don Young,
     Chairman, Committee on Resources,
     U.S. House of Representatives,
     Washington, DC.
       Dear Mr. Chairman: On June 19, 1996, the Committee on 
     Resources ordered reported H.R. 3378, a bill to amend the 
     Indian Health Care Improvement Act to extend the 
     demonstration program for direct billing of Medicare, 
     Medicaid, and other third party payors. It is my 
     understanding that you would like the Committee on Commerce 
     to be discharged from consideration of this measure.
       I have a number of concerns about proceeding in this 
     manner. As you know, this Committee has invested countless 
     hours in Medicaid reform legislation. The status of our 
     reform efforts makes separate consideration of H.R. 3378 
     somewhat awkward. Despite my position on this matter, I do 
     understand your interest in having H.R. 3378 move forward 
     expeditiously, since authorization for these demonstration 
     projects ends September 30, 1996. Therefore, the Committee on 
     Commerce will agree to be discharged from consideration of 
     this legislation.
       By agreeing to be discharged from consideration, this 
     Committee does not waive its jurisdictional interest in the 
     matter. I reserve the right to seek equal conferees during 
     any House-Senate conference that may be convened on this 
     legislation.
       I want to thank you and your staff for your assistance in 
     providing the Commerce Committee with a timely opportunity to 
     review its interests in H.R. 3378. I would appreciate your 
     including this letter as a part of the Resource Committee's 
     report on H.R. 3378, and as part of the record during 
     consideration of this bill by the House.
           Sincerely,
                                   Thomas J. Bliley Jr., Chairman.

  Mr. DOOLITTLE. Mr. Speaker, I urge passage of this legislation, and I 
yield back the balance of my time.
  The SPEAKER pro tempore. The question is on the motion offered by the 
gentleman from California [Mr. Doolittle] that the House suspend the 
rules and pass the bill, H.R. 3378.
  The question was taken; and (two-thirds having voted in favor 
thereof) the rules were suspended and the bill was passed.
  The motion to reconsider was laid on the table.

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