[106th Congress Public Law 417]
[From the U.S. Government Printing Office]


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[DOCID: f:publ417.106]


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   ALASKA NATIVE AND AMERICAN INDIAN DIRECT REIMBURSEMENT ACT OF 2000

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Public Law 106-417
106th Congress

                                 An Act


 
      To amend the Indian Health Care <<NOTE: Nov. 1, 2000 -  [S. 
406]>> 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 <<NOTE: Alaska Native and 
American Indian Direct Reimbursement Act of 2000.>> Representatives of 
the United States of America in Congress assembled,

SECTION 1. <<NOTE: 25 USC 1601 note.>> SHORT TITLE.

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

SEC. 2. <<NOTE: 25 USC 1645 note.>> 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

[[Page 114 STAT. 1813]]

        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

[[Page 114 STAT. 1814]]

                    ``(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) <<NOTE: Reports.>>  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) <<NOTE: Deadline.>>  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.

[[Page 114 STAT. 1815]]

                    ``(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

[[Page 114 STAT. 1816]]

section 405 of the Indian Health Care Improvement Act (25 U.S.C. 
1645).''.
    (c) <<NOTE: 25 USC 1645 note.>>  Effective Date.--The amendments 
made by this section shall take effect on October 1, 2000.

SEC. 4. <<NOTE: Effective dates. 25 USC 1645 note.>> 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).

    Approved November 1, 2000.

LEGISLATIVE HISTORY--S. 406:
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HOUSE REPORTS: No. 106-818, Pt. 1 (Comm. on Resources).
SENATE REPORTS: No. 106-152 (Comm. on Indian Affairs).
CONGRESSIONAL RECORD:
                                                        Vol. 145 (1999):
                                    Sept. 15, considered and passed 
                                        Senate.
                                                        Vol. 146 (2000):
                                    Oct. 17, considered and passed 
                                        House.

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