+------------------------------------------------------+---+-------------+
| [TITLE IV\--ACCESS TO HEALTH SERVICES]{.underline}   |   | **[NOTE:]{  |
|                                                      |   | .underline} |
| ~~ELIGIBILITY OF INDIAN HEALTH SERVICE FACILITIES~~  |   | Now in      |
|                                                      |   | section     |
| ~~UNDER MEDICARE PROGRAM~~                           |   | 801**       |
|                                                      |   |             |
| TREATMENT OF PAYMENTS UNDER MEDICARE PROGRAM         |   | P.L.102-573 |
|                                                      |   |             |
| SEC. 401. (a) Any payments received by a hospital or |   | P.L.102-573 |
| skilled nursing facility of the Service (whether     |   |             |
| operated by the Service or by an Indian tribe or     |   | P.L.102-573 |
| tribal organization pursuant to a contract under the |   |             |
| Indian Self‑Determination Act) for services provided |   | P.L.100-203 |
| to Indians eligible for benefits under title XVIII   |   |             |
| of the Social Security Act shall not be considered   |   | **Secs.     |
| in determining appropriations for health care and    |   | 4211(h) and |
| services to Indians.                                 |   | 4           |
|                                                      |   | 118(f)(1)** |
| \(b\) Nothing in this Act authorizes the Secretary   |   |             |
| to provide services to an Indian beneficiary with    |   | P.L.100-203 |
| coverage under title XVIII of the Social Security    |   |             |
| Act, as amended, in preference to an Indian          |   | P.L.100-203 |
| beneficiary without such coverage.                   |   |             |
|                                                      |   | P.L.100-713 |
| > \[NOTE: Sections 401(a) and 401(b) as originally   |   |             |
| > enacted by P.L. 94-437 amended titles XVIII of the |   | P.L.102-573 |
| > Social Security Act. Subsequent amendments to      |   |             |
| > title IV of P.L. 94-437 did not change these       |   | P.L.102-573 |
| > earlier amendments to the Social Security Act. As  |   |             |
| > a convenience, the original lanuage of sections    |   | P.L.102-573 |
| > 401 (a) and 401(b) are reprinted below though they |   |             |
| > are not now part of P.L. 94-437 as amended.\]      |   | P.L.96-537  |
| >                                                    |   |             |
| > {Sec. 401. **(a) Sections 1814(c) and 1835(d) of   |   | P.L.102-573 |
| > the Social Security Act are each amended by        |   |             |
| > striking out \"No payment\" and inserting in lieu  |   | P.L.102-573 |
| > thereof \"Subject to section 1880, no payment\".** |   |             |
| >                                                    |   | P.L.100-713 |
| > **{(b) Part C of title XVIII of such Act is        |   |             |
| > amended by adding at the end thereof the following |   | **[NOTE]{   |
| > new section:**                                     |   | .underline} |
|                                                      |   | Substance   |
| **{\"INDIAN HEALTH SERVICE FACILITIES**              |   | of sec      |
|                                                      |   | 402(c) now  |
| > **{\"Sec. 1880. (a) A hospital or skilled nursing  |   | in sec 402  |
| > facility of the Indian Health Service, whether     |   | (a)         |
| > operated by such Service or by an Indian tribe or  |   | byP.L       |
| > tribal organization (as those terms are defined in |   | .102-573.** |
| > section 4 of the Indian Health Care Improvement    |   |             |
| > Act), shall be eligible for payments under this    |   | **Reference |
| > title, notwithstanding sections 1814(c) and        |   | to sec      |
| > 1835(d), if and for so long as it meets all of the |   | 402(c)has   |
| > conditions and requirements for such payments      |   | not been    |
| > which are applicable generally to hospitals or     |   | changed**   |
| > skilled nursing facilities (as the case may be)    |   |             |
| > under this title.**                                |   | **[NOTE:    |
| >                                                    |   | ]{.underlin |
| > **{\"(b) Notwithstanding subsection (a), a         |   | e}Substance |
| > hospital or skilled nursing facility of the Indian |   | of sec      |
| > Health Service which does not meet all of the      |   | 402(c) now  |
| > conditions and requirements of this title which    |   | in sec      |
| > are applicable generally to hospitals or skilled   |   | 402(a) by   |
| > nursing facilities (as the case may be), but which |   | P.L.        |
| > submits to the Secretary within six months after   |   | 102-573.**  |
| > the date of enactment of this section an           |   |             |
| > acceptable plan for achieving compliance with such |   | **Reference |
| > conditions and requirements, shall be deemed to    |   | to**        |
| > meet such conditions and requirements (and to be   |   |             |
| > eligible for payments under this title), without   |   | **s         |
| > regard to the extent of its actual compliance with |   | ec402(c)has |
| > such conditions and requirements, during the first |   | not been**  |
| > 12 months after the month in which such plan is    |   |             |
| > submitted.**                                       |   | **changed** |
| >                                                    |   |             |
| > **{\"(c) Notwithstanding any other provision of    |   | P.L.102-573 |
| > this title, payments to which any hospital or      |   |             |
| > skilled nursing facility of the Indian Health      |   | P.L.104-313 |
| > Service is entitled by reason of this section      |   |             |
| > shall be placed in a special fund to be held by    |   | P.L.102-573 |
| > the Secretary and used by him (to such extent or   |   |             |
| > in such amounts as are provided in appropriation   |   | P.L.102-573 |
| > Acts) exclusively for the purpose of making any    |   |             |
| > improvements in the hospitals and skilled nursing  |   | P.L.102-573 |
| > facilities of such Service which may be necessary  |   |             |
| > to achieve compliance with the** **applicable      |   |             |
| > conditions and requirements of this title. The     |   |             |
| > preceding sentence shall cease to apply when the   |   |             |
| > Secretary determines and certifies that            |   |             |
| > substantially all of the hospitals and skilled     |   |             |
| > nursing facilities of such Service in the United   |   |             |
| > States are in compliance with such conditions and  |   |             |
| > requirements.**                                    |   |             |
| >                                                    |   |             |
| > **{\"(d) The annual report of the Secretary which  |   |             |
| > is required by section 701 of the Indian Health    |   |             |
| > Care Improvement Act shall include (along with the |   |             |
| > matters specified in section 403 of such Act) a    |   |             |
| > detailed statement of the status of the hospitals  |   |             |
| > and skilled nursing facilities of the Service in   |   |             |
| > terms of their compliance with the applicable      |   |             |
| > conditions and requirements of this title and of   |   |             |
| > the progress being made by such hospitals and      |   |             |
| > facilities (under plans submitted under subsection |   |             |
| > (b) and otherwise) toward the achievement of such  |   |             |
| > compliance.\"}**                                   |   |             |
|                                                      |   |             |
| ~~(c) Any payments received for services provided to |   |             |
| beneficiaries hereunder shall not be considered in   |   |             |
| determining appropriations for health care and       |   |             |
| services to Indians.~~                               |   |             |
|                                                      |   |             |
| ~~(d) Nothing herein authorizes the Secretary to     |   |             |
| provide services to an Indian beneficiary with       |   |             |
| coverage under title XVIII of the Social Security    |   |             |
| Act, as amended, in preference to an Indian          |   |             |
| beneficiary without such coverage.~~                 |   |             |
|                                                      |   |             |
| ~~SERVICES PROVIDED TO MEDICAID ELIGIBLE INDIANS~~   |   |             |
|                                                      |   |             |
| TREATMENT OF PAYMENTS UNDER MEDICAID PROGRAM         |   |             |
|                                                      |   |             |
| SEC. 402. (a) Notwithstanding any other provision of |   |             |
| law, payments to which any facility of the Service   |   |             |
| (including a hospital, nursing facility,             |   |             |
| intermediate care facility for the mentally          |   |             |
| retarded, or any other type of facility which        |   |             |
| provides services for which payment is available     |   |             |
| under title XIX of the Social Security Act) is       |   |             |
| entitled under a State plan by reason of section     |   |             |
| 1911 of such Act shall be placed in a special fund   |   |             |
| to be held by the Secretary and used by him (to such |   |             |
| extent or in such amounts as are provided in         |   |             |
| appropriation Acts) exclusively for the purpose of   |   |             |
| making any improvements in the facilities of such    |   |             |
| Service which may be necessary to achieve compliance |   |             |
| with the applicable conditions and requirements of   |   |             |
| such title. In making payments from such fund, the   |   |             |
| Secretary shall ensure that each service unit of the |   |             |
| Service receives at least 80 percent of the amounts  |   |             |
| to which the facilities of the Service, for which    |   |             |
| such service unit makes collections, are entitled by |   |             |
| reason of section 1911 of the Social Security Act.   |   |             |
|                                                      |   |             |
| \(b\) Any payments received by such facility for     |   |             |
| services provided to Indians eligible for benefits   |   |             |
| under title XIX of the Social Security Act shall not |   |             |
| be considered in determining appropriations for the  |   |             |
| provision of health care and services to Indians.    |   |             |
|                                                      |   |             |
| > **\[NOTE: Section 401(b)(2) of P.L. 102-573        |   |             |
| > provides that:**                                   |   |             |
| >                                                    |   |             |
| > **\"The increase (from 50 percent) in the          |   |             |
| > percentage of the payments from the fund to be     |   |             |
| > made to each service unit of the Service specified |   |             |
| > in the amendment made by paragraph (1) shall take  |   |             |
| > effect beginning with payments made on January 1,  |   |             |
| > 1993.\"**                                          |   |             |
| >                                                    |   |             |
| > \[NOTE: Sec. 402(a) as originally enacted by P.L.  |   |             |
| > 94-437, added section 1911 to title XVIII of the   |   |             |
| > Social Security Act. Subsequently, a number of     |   |             |
| > amendments to section 1911 were made.However, the  |   |             |
| > amendments made by P.L. 100-573 neither repeal nor |   |             |
| > amend section 1911. As a convenience, section      |   |             |
| > 1911, as previously amended, is reprinted below.\] |   |             |
| >                                                    |   |             |
| > {Sec. 402. (a) Title XIX of the Social Security    |   |             |
| > Act is amended by adding at the end thereof the    |   |             |
| > following new section:                             |   |             |
|                                                      |   |             |
| INDIAN HEALTH SERVICE FACILITIES                     |   |             |
|                                                      |   |             |
| > {Sec. 1911. (a) **A facility of the Indian Health  |   |             |
| > Service (including a hospital, ~~intermediate care |   |             |
| > facility, or skilled nursing facility or nursing   |   |             |
| > facility~~ nursing facility or any other type of   |   |             |
| > facility which provides services of a type         |   |             |
| > otherwise covered under the State plan), whether   |   |             |
| > operated by such Service or by an Indian tribe or  |   |             |
| > tribal organization (as those terms are defined in |   |             |
| > section 4 of the Indian Health Care Improvement    |   |             |
| > Act), shall be eligible for reimbursement for      |   |             |
| > medical assistance provided under a State plan if  |   |             |
| > and for so long as it meets all of the conditions  |   |             |
| > and requirements which are applicable generally to |   |             |
| > such facilities under this title.**                |   |             |
| >                                                    |   |             |
| > **{(b) Notwithstanding subsection (a), a facility  |   |             |
| > of the Indian Health Service (including a          |   |             |
| > hospital, ~~intermediate care facility, or skilled |   |             |
| > nursing facility or nursing facility~~ nursing     |   |             |
| > facility , or any other type of facility which     |   |             |
| > provides services of a type otherwise covered      |   |             |
| > under the State plan) which does not meet all of   |   |             |
| > the conditions and requirements of this title      |   |             |
| > which are applicable generally to such facility,   |   |             |
| > but which submits to the Secretary within six      |   |             |
| > months after the date of enactment of this section |   |             |
| > an acceptable plan for achieving compliance with   |   |             |
| > such conditions and requirements, shall be deemed  |   |             |
| > to meet such conditions and requirements (and to   |   |             |
| > be eligible for reimbursement under this           |   |             |
| > title),without regard to the extent of its actual  |   |             |
| > compliance with such conditions and requirements,  |   |             |
| > during the first twelve months after the month in  |   |             |
| > which such plan is submitted.**                    |   |             |
| >                                                    |   |             |
| > **{(c) The Secretary is authorized to enter into   |   |             |
| > agreements with the State agency for purpose of    |   |             |
| > reimbursement such agency for health care and      |   |             |
| > services provided in Indian Health Service         |   |             |
| > facilities to Indians who are eligible for medical |   |             |
| > assistance under the State plan.**                 |   |             |
| >                                                    |   |             |
| > **\[NOTE: Sec. 4118(f)2) of P.L. 100-203 provides  |   |             |
| > that: \"The amendments made by . . . (Sec.         |   |             |
| > 4118(f)(1)) shall apply to the health care         |   |             |
| > services performed on or after the date of         |   |             |
| > enactment (December 22, 1987) of this Act (P.L.    |   |             |
| > 100-203).\"\]**                                    |   |             |
|                                                      |   |             |
| ~~(b) The Secretary is authorized to enter into      |   |             |
| agreements with the appropriate State agency for the |   |             |
| purpose of reimbursement such agency for health care |   |             |
| and services provided in Service facilities to       |   |             |
| Indians who are eligible for medical assistance      |   |             |
| under title XIX of the Social Security Act, as       |   |             |
| amended.~~                                           |   |             |
|                                                      |   |             |
| ~~(c) Notwithstanding any other provision of law,    |   |             |
| payments to which any facility of the Indian Health  |   |             |
| Service (including a hospital, intermediate care     |   |             |
| facility, or a skilled nursing facility) skilled     |   |             |
| nursing facility, or any other type of facility      |   |             |
| which provides services of a type otherwise covered  |   |             |
| under a State plan for medical assistance approved   |   |             |
| under title XIX of the Social Security Act) is       |   |             |
| entitled to under a State plan approved under title  |   |             |
| XIX of the Social Security Act such a State plan by  |   |             |
| reason of Section 1911 of such Act shall be placed   |   |             |
| in a special fund to be held by the Secretary and    |   |             |
| used by him (to such extent or in such amounts as    |   |             |
| are provided in appropriation Acts) exclusively for  |   |             |
| the purpose of making any improvements in the        |   |             |
| facilities of such Service which may be necessary to |   |             |
| achieve compliance with the applicable conditions    |   |             |
| and requirements of such title. The preceding        |   |             |
| sentence shall In making payments from such fund,    |   |             |
| the Secretary shall ensure that each service unit of |   |             |
| the Indian Health Service receives at least 50       |   |             |
| percent of the amounts to which the facilities of    |   |             |
| the Indian Health Service for which such service     |   |             |
| unit makes collections, are entitled by reason of    |   |             |
| section 1911 of the Social Security Act, if such     |   |             |
| amount is necessary for the purpose of making        |   |             |
| improvements in such facilities in order to achieve  |   |             |
| compliance with the conditions and requirements of   |   |             |
| title XIX of the Social Security Act. This           |   |             |
| subsection shall cease to apply when the Secretary   |   |             |
| determines and certifies that substantially all of   |   |             |
| the health facilities of such Service in the United  |   |             |
| States are in compliance with such conditions and    |   |             |
| requirements.~~                                      |   |             |
|                                                      |   |             |
| ~~(d) Any payments received for services provided    |   |             |
| recipients hereunder shall not be considered in      |   |             |
| determining appropriations for the provision of      |   |             |
| health care and services to Indians.~~               |   |             |
|                                                      |   |             |
| > \[NOTE: Sec. 402(e) as originally enacted by P.L.  |   |             |
| > 94-437, amended section 1905(b) of the Social      |   |             |
| > Security Act. Subsequent amendments to title IV of |   |             |
| > P.L. 94-437 did not further change section         |   |             |
| > 1905(b). As a convenience, the original language   |   |             |
| > of section 402(e), which contains the section      |   |             |
| > 1905(b) amendment, is reprinted below thought it   |   |             |
| > is not now part of P.L. 94-437, as amended.\]      |   |             |
| >                                                    |   |             |
| > {(e) Section 1905 (b) of the Social Security Act   |   |             |
| > is amended by inserting at the end thereof the     |   |             |
| > following: \"Notwithstanding the first sentence of |   |             |
| > this section, the Federal medical assistance       |   |             |
| > percentage shall be 100 percentum with respect to  |   |             |
| > amounts expended as medical assistance for         |   |             |
| > services which are received through an Indian      |   |             |
| > Health Service facility whether operated by the    |   |             |
| > Indian Health Service or by an Indian tribe or     |   |             |
| > tribal organization (as defined in section 4 of    |   |             |
| > the Indian Health Care Improvement Act).\"}        |   |             |
| >                                                    |   |             |
| > \[NOTE: Section 401(c) of P.L. 100-713 provides    |   |             |
| > that: \"The amendments made by this section        |   |             |
| > (Section 401 of P.L. 100-713) shall apply to       |   |             |
| > services performed on or after the date of         |   |             |
| > enactment (November 23, 1988) of this Act (P.L.    |   |             |
| > 100-713).\"\]                                      |   |             |
|                                                      |   |             |
| REPORT                                               |   |             |
|                                                      |   |             |
| Sec. 403. ~~The Secretary shall include in his       |   |             |
| annual report required by section 701~~ The          |   |             |
| Secretary shall submit to the President, for         |   |             |
| inclusion in the report required to be transmitted   |   |             |
| to the Congress under section 801, an accounting on  |   |             |
| the amount and use of funds made available to the    |   |             |
| Service pursuant to this title as a result of        |   |             |
| reimbursements through title XVIII and XIX of the    |   |             |
| Social Security Act, as amended.                     |   |             |
|                                                      |   |             |
| GRANTS TO AND CONTRACTS WITH TRIBAL ORGANIZATIONS    |   |             |
|                                                      |   |             |
| Sec. 404. (a) The Secretary, acting through the      |   |             |
| Service, shall make grants to or enter into contract |   |             |
| with tribal organizations to assist such             |   |             |
| organizations in establishing and administering      |   |             |
| programs on or near Federal Indian reservations and  |   |             |
| trust areas and in or near Alaska Native villages to |   |             |
| assist individual Indians to\--                      |   |             |
|                                                      |   |             |
| > \(1\) enroll under section 1818 of part A and      |   |             |
| > sections 1836 and 1837 of part B of title XVIII of |   |             |
| > the Social Security Act;                           |   |             |
| >                                                    |   |             |
| > \(2\) pay monthly premiums for coverage due to     |   |             |
| > financial need of such individual; and             |   |             |
| >                                                    |   |             |
| > \(3\) apply for medical assistance provided        |   |             |
| > pursuant to title XIX of the Social Security Act.  |   |             |
|                                                      |   |             |
| \(b\) The Secretary, acting through the              |   |             |
| Service,shall place conditions as deemed necessary   |   |             |
| to effect the purpose of this section in any         |   |             |
| contract or grant which the Secretary makes with any |   |             |
| tribal organization pursuant to this section. Such   |   |             |
| conditions shall include, but are not limited to,    |   |             |
| requirements that the organization successfully      |   |             |
| undertake to\--                                      |   |             |
|                                                      |   |             |
| > \(1\) determine the population of Indians to be    |   |             |
| > served that are or could be recipients of benefits |   |             |
| > under titles XVIII and XIX of the Social Security  |   |             |
| > Act;                                               |   |             |
| >                                                    |   |             |
| > \(2\) assist individual Indians in becoming        |   |             |
| > familiar with and utilizing such benefits;         |   |             |
| >                                                    |   |             |
| > \(3\) provide transportation to such individual    |   |             |
| > Indians to the appropriate offices for enrollment  |   |             |
| > or applications for medical assistance;            |   |             |
| >                                                    |   |             |
| > ~~(4) develop and implement a schedule of income   |   |             |
| > levels to determine the extent of payment of       |   |             |
| > premiums by such organization for coverage of      |   |             |
| > needy individuals; and methods of improving the    |   |             |
| > participation of Indians in receiving the benefits |   |             |
| > provided pursuant to titles XVIII and XIX of the   |   |             |
| > Social Security Act.~~                             |   |             |
| >                                                    |   |             |
| > \(4\) develop and implement‑‑                      |   |             |
| >                                                    |   |             |
| > \(A\) a schedule of income levels to determine the |   |             |
| > extent of payments of premiums by such             |   |             |
| > organizations for coverage of needy individuals;   |   |             |
| > and                                                |   |             |
| >                                                    |   |             |
| > \(B\) methods of improving the participation of    |   |             |
| > Indians in receiving the benefits provided under   |   |             |
| > titles XVIII and XIX of the Social Security Act.   |   |             |
|                                                      |   |             |
| ~~(c) There are authorized to be appropriated        |   |             |
| \$5,000,000 for the fiscal year ending September 30, |   |             |
| 1981, \$5,750,000 for the fiscal year ending         |   |             |
| September 30, 1982, \$6,615,000 for the fiscal year  |   |             |
| ending September 30, 1983, and \$7,610,000 for the   |   |             |
| fiscal year ending September 30, 1984.~~             |   |             |
|                                                      |   |             |
| \(c\) The Secretary, acting through the Service, may |   |             |
| enter into an agreement with an Indian tribe, tribal |   |             |
| organization, or urban Indian organization which     |   |             |
| provides for the receipt and processing of           |   |             |
| applications for medical assistance under title XIX  |   |             |
| of the Social Security Act and benefits under title  |   |             |
| XVIII of the Social Security Act at a Service        |   |             |
| facility or a health care facility administered by   |   |             |
| such tribe or organization pursuant to a contract    |   |             |
| under the Indian Self‑Determination Act.             |   |             |
|                                                      |   |             |
| DEMONSTRATION PROGRAM FOR DIRECT BILLING OF          |   |             |
| MEDICARE,                                            |   |             |
|                                                      |   |             |
| MEDICAID, AND OTHER THIRD PARTY PAYORS               |   |             |
|                                                      |   |             |
| Sec. 405. (a) The Secretary shall establish a        |   |             |
| demonstration program under which Indian tribes,     |   |             |
| tribal organizations, and Alaska Native health       |   |             |
| organizations, which are contracting the entire      |   |             |
| operation of an entire hospital or clinic of the     |   |             |
| Service under the authority of the Indian            |   |             |
| Self-Determination Act, shall 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         |   |             |
| (medicare), under a State plan for medical           |   |             |
| assistance approved under title XIX of the Social    |   |             |
| Security Act (medicaid), or from any other           |   |             |
| third-party payor. The last sentence of section      |   |             |
| 1905(b) of the Social Security Act shall apply for   |   |             |
| purposes of the demonstration program.               |   |             |
|                                                      |   |             |
| (b)(1) Each hospital or clinic participating in the  |   |             |
| demonstration program described in subsection (a)    |   |             |
| 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 and sections 402(c) and          |   |             |
| 713(b)(2(A) of this Act, 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 program.    |   |             |
| Any funds to reimbursed which are in excess of the   |   |             |
| amount necessary to achieve or maintain such         |   |             |
| conditions requirements 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.                     |   |             |
|                                                      |   |             |
| \(2\) The amounts paid to the hospitals and clinics  |   |             |
| participating in the demonstration program described |   |             |
| in subsection (a) 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. |   |             |
|                                                      |   |             |
| \(3\) The Secretary shall monitor the performance of |   |             |
| hospitals and clinics participating in the           |   |             |
| demonstration program described in subsection (a),   |   |             |
| and shall require such hospitals and clinics to      |   |             |
| submit reports on the program to the Secretary on a  |   |             |
| quarterly basis (or more frequently if the Secretary |   |             |
| deems it necessary).                                 |   |             |
|                                                      |   |             |
| \(4\) Notwithstanding section 1880(c) of the Social  |   |             |
| Security Act or section 402(c) of this Act, no       |   |             |
| payment may be made out of the special fund          |   |             |
| described in section 1880(c) of the Social Security  |   |             |
| Act, or section 402(c) of this Act for the benefit   |   |             |
| of any hospital or clinic participating in the       |   |             |
| demonstration program described in subsection (a)    |   |             |
| during the period of such participation.             |   |             |
|                                                      |   |             |
| (c)(1) In order to be considered for participation   |   |             |
| in the demonstration program described in subsection |   |             |
| (a), a hospital or clinic must submit an application |   |             |
| to the Secretary which establishes to the            |   |             |
| satisfaction of the Secretary that\--                |   |             |
|                                                      |   |             |
| > \(A\) The Indian tribe, tribal organization, or    |   |             |
| > Alaska Native health organization contracts the    |   |             |
| > entire operation of the Service facility;          |   |             |
| >                                                    |   |             |
| > \(B\) The facility is eligible to participate in   |   |             |
| > the medicare and medicaid programs under sections  |   |             |
| > 1880 and 1911 of the Social Security Act;          |   |             |
| >                                                    |   |             |
| > \(C\) The facility meets any requirements which    |   |             |
| > apply to the programs operated directly by the     |   |             |
| > Service; and                                       |   |             |
| >                                                    |   |             |
| > \(D\) The facility is accredited by the Joint      |   |             |
| > Commission on Accreditation of Hospitals, or has   |   |             |
| > submitted a plan, which has been approved by the   |   |             |
| > Secretary,for achieving such accreditation prior   |   |             |
| > to October 1, 1990.                                |   |             |
|                                                      |   |             |
| \(2\) From among the qualified applicants, the       |   |             |
| Secretary shall, prior to October 1, 1989, select no |   |             |
| more than 4 facilities to participate in the         |   |             |
| demonstration program described in subsection (a).   |   |             |
| The demonstration program described in subsection    |   |             |
| (a) shall begin by no later than October 1, 1991,    |   |             |
| and end ~~on September 30, 1995~~ ~~1996~~           |   |             |
| **[1998]{.underline}**.                              |   |             |
|                                                      |   |             |
| (d)(1) Upon the enactment of the Indian Health Care  |   |             |
| Amendments of 1988, the Secretary, acting through    |   |             |
| the Service, shall commence an examination of\--     |   |             |
|                                                      |   |             |
| > \(A\) any administrative changes which may be      |   |             |
| > necessary to allow direct billing and              |   |             |
| > reimbursement under the demonstration program      |   |             |
| > described in subsection(a),including any           |   |             |
| > agreements with States which may be necessary to   |   |             |
| > provide for such direct billing under the medicaid |   |             |
| > program; and                                       |   |             |
| >                                                    |   |             |
| > \(B\) any changes which may be necessary to enable |   |             |
| > participants in such demonstration program to      |   |             |
| > provide to the Service medical records information |   |             |
| > on patients served by such demonstration program   |   |             |
| > which is consistent with the medical records       |   |             |
| > information system of the Service.                 |   |             |
|                                                      |   |             |
| \(2\) Prior to the commencement of the demonstration |   |             |
| program described in subsection (a), the Secretary   |   |             |
| shall implement all changes required as a result of  |   |             |
| the examinations conducted under paragraph (1).      |   |             |
|                                                      |   |             |
| \(3\) Prior to October 1, 1990, the Secretary shall  |   |             |
| determine any accounting information which a         |   |             |
| participant in the demonstration program described   |   |             |
| in subsection (a) would be required to report.       |   |             |
|                                                      |   |             |
| \(e\) The Secretary shall submit a final report at   |   |             |
| the end of fiscal year ~~1995~~ 1996, on the         |   |             |
| activities carried out under the demonstration       |   |             |
| program described in subsection (a) which have       |   |             |
| fulfilled the objectives of such program. In such    |   |             |
| report the Secretary shall provide a recommendation, |   |             |
| based upon the results of such demonstration         |   |             |
| program, as to whether direct billing or, and        |   |             |
| reimbursement by, the medicare and medicaid programs |   |             |
| and other third-party payors should be authorized    |   |             |
| for all Indian tribes and Alaska Native Health       |   |             |
| organizations which are contracting the entire       |   |             |
| operation of a facility of a Service.                |   |             |
|                                                      |   |             |
| \(f\) The Secretary shall provide for the            |   |             |
| retrocession of any contract entered into between a  |   |             |
| participant in the demonstration program described   |   |             |
| in subsection (a) and the Service under the          |   |             |
| authority of the Indian Self-Determination Act. All  |   |             |
| cost accounting and billing authority shall be       |   |             |
| retroceded to the Secretary upon the Secretary\'s    |   |             |
| acceptance of a retroceded contract.                 |   |             |
|                                                      |   |             |
| AUTHORIZATION FOR EMERGENCY CONTRACT HEALTH SERVICES |   |             |
|                                                      |   |             |
| SEC. 406. With respect to an elderly or disabled     |   |             |
| Indian receiving emergency medical care or services  |   |             |
| from a non‑Service provider or in a non‑Service      |   |             |
| facility under the authority of this Act, the time   |   |             |
| limitation (as a condition of payment) for notifying |   |             |
| the Service of such treatment or admission shall be  |   |             |
| 30 days.                                             |   |             |
|                                                      |   |             |
| AUTHORIZATION OF APPROPRIATIONS                      |   |             |
|                                                      |   |             |
| SEC. 407. There are authorized to be appropriated    |   |             |
| such sums as may be necessary for each fiscal year   |   |             |
| through fiscal year 2000 to carry out this title.    |   |             |
|                                                      |   |             |
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