[Congressional Record Volume 145, Number 120 (Wednesday, September 15, 1999)]
[Senate]
[Pages S10959-S10960]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




   ALASKA NATIVE AND AMERICAN INDIAN DIRECT REIMBURSEMENT ACT OF 1999

  Mr. SHELBY. Mr. President, I ask unanimous consent that the Senate 
proceed to the consideration of Calendar No. 272, S. 406.
  The PRESIDING OFFICER. The clerk will report.
  The legislative clerk read as follows:

       A bill (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.

  There being no objection, the Senate proceeded to consider the bill 
which had been reported from the Committee on Indian Affairs, with an 
amendment to strike all after the enacting clause and inserting in lieu 
thereof the following:

     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

[[Page S10960]]

     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).

  Mr. SHELBY. Mr. President, I ask unanimous consent that the committee 
substitute amendment be agreed to.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The committee substitute amendment was agreed to.
  Mr. SHELBY. Mr. President, I ask unanimous consent that the bill be 
read a third time and passed, the motion to reconsider be laid upon the 
table, and that any statements relating to the bill be printed in the 
Record.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The bill (S. 406), as amended, was read the third time and passed.

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