SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Native Contract and Rate Expenditure 
Act of 2014'' or the ``Native CARE Act of 2014''.

SEC. 2. FINDINGS.

    Congress makes the following findings:
            (1) Federal health services to maintain and improve the 
        health of American Indians and Alaska Natives are consonant 
        with and required by the Federal Government's historical and 
        unique legal relationship with, and resulting trust 
        responsibility to, the American Indian and Alaska Native 
        people.
            (2) The unmet health needs of American Indians and Alaska 
        Natives are severe and the health status of American Indians 
        and Alaska Natives is far below that of the general population 
        of the United States, resulting in an average life expectancy 
        for American Indians and Alaska Natives 4.2 years less than 
        that for the all races population of the United States.
            (3) The Indian Health Service and tribal Purchased/Referred 
        Care programs purchase primary and specialty care services from 
        private health care providers when those services are not 
        available at Indian Health Service or Tribal health facilities.
            (4) Available Purchased/Referred Care funds have been 
        insufficient to ensure access to care for American Indians and 
        Alaska Natives, resulting in rationed care and diagnosis and 
        treatment delays that lead to the need for more intensive and 
        expensive treatment, further reducing already scarce Purchased/
        Referred Care funds.
            (5) In 2003, Congress amended title XVIII of the Social 
        Security Act to require Medicare-participating hospitals to 
        accept patients referred from the Indian Health Service and 
        Tribal Purchased/Referred Care programs and to accept payment 
        at no more than Medicare rates--the Medicare-like rate cap--for 
        the services provided.
            (6) The Medicare-like rate cap only applies to hospital 
        services, and does not apply to other types of Medicare-
        participating providers and suppliers.
            (7) Unlike other Federal health care programs, the Indian 
        Health Service and Tribal Purchased/Referred Care programs 
        continue to pay full billed charges for non-hospital services.
            (8) Because Purchased/Referred programs continue to pay 
        full billed charges for non-hospital services, in many cases 
        the Indian Health Service may only treat the most desperate 
        ``Life'' or ``Limb'' cases, leading to many undesirable health 
        outcomes for American Indians and Alaska Natives, and 
        ultimately increasing costs to the Purchased/Referred Care 
        programs.
            (9) On April 11, 2013, the Government Accountability Office 
        released a report finding that capping Purchased/Referred Care 
        reimbursement at Medicare-like rates for nonhospital services 
        would enable the Indian Health Service to double the number of 
        physician services provided by adding an additional 253,000 
        patient visits annually.

SEC. 3. LIMITATION ON CHARGES FOR CERTAIN CONTRACT HEALTH SERVICES 
              PROVIDED TO INDIANS BY MEDICARE PROVIDERS OF SERVICES AND 
              SUPPLIERS.

    (a) Application to All Providers of Services.--
            (1) In general.--Section 1866(a)(1)(U) of the Social 
        Security Act (42 U.S.C. 1395cc(a)(1)(U)) is amended, in the 
        matter preceding clause (i), by striking ``in the case of 
        hospitals which furnish inpatient hospital services for which 
        payment may be made under this title,''.
            (2) Regulations.--The Secretary of Health and Human 
        Services shall promulgate regulations to account for the 
        amendment made by paragraph (1).
            (3) Effective date.--The amendment made by paragraph (1) 
        shall apply to Medicare participation agreements in effect (or 
        entered into) on or after the date that is 90 days after the 
        date of enactment of this Act.
    (b) Application to All Suppliers.--
            (1) In general.--Section 1834 of the Social Security Act 
        (42 U.S.C. 1395m) is amended by adding at the end the following 
        new subsection:
    ``(r) Limitation on Charges for Certain Contract Health Services 
Provided to Indians by Suppliers.--No payment may be made under this 
title for an item or service furnished by a supplier (as defined in 
section 1861(d)) unless the supplier agrees (pursuant to a process 
established by the Secretary) to be a participating provider of medical 
and other health services both--
            ``(1) under the Purchased/Referred Care program (formerly 
        referred to as the `contract health services program') funded 
        by the Indian Health Service and operated by the Indian Health 
        Service, an Indian tribe, or tribal organization (as those 
        terms are defined in section 4 of the Indian Health Care 
        Improvement Act), with respect to items and services that are 
        covered under such program and furnished to an individual 
        eligible for such items and services under such program; and
            ``(2) under any program funded by the Indian Health Service 
        and operated by an urban Indian organization with respect to 
        the purchase of items and services for an eligible urban Indian 
        (as those terms are defined in such section 4),
in accordance with regulations promulgated by the Secretary regarding 
payment methodology and rates of payment (including the acceptance of 
no more than such payment rate as payment in full for such items and 
services).''.
            (2) Effective date.--The amendment made by paragraph (1) 
        shall apply to items and services furnished on or after the 
        date that is 90 days after the date of enactment of this Act.
    (c) Limitation.--There shall be no reduction, offset, or limitation 
to any appropriations made to the Indian Health Service under the 
Indian Health Care Improvement Act (25 U.S.C. 1621 et seq.), the Act of 
November 2, 1921 (25 U.S.C. 13) (commonly known as the ``Snyder Act''), 
or any other provision of law as a result of the provisions of, 
including amendments made by, this Act.
    (d) Studies and Reports.--
            (1) Study.--The Secretary of Health and Human Services (in 
        this subsection referred to as the ``Secretary''), acting 
        through the Director of the Indian Health Service, shall 
        conduct a study on the impact of the amendments made by this 
        section on access to care under the Purchased/Referred Care 
        program of the Indian Health Service.
            (2) Report.--Not later than 2 years after the date of 
        enactment of this Act, the Secretary shall submit to Congress a 
        report containing the results of the study conducted under 
        paragraph (1), including recommendations for such legislation 
        and administrative action as the Secretary determines 
        appropriate.
            (3) Section 219(c) study and report.--Section 219(c) of the 
        Indian Health Care Improvement Act (25 U.S.C. 1621r(c)) is 
        amended by striking ``12 months after the date of the enactment 
        of this section'' and inserting ``12 months after the date of 
        the enactment of the Native Contract and Rate Expenditure Act 
        of 2014, and biennially thereafter through 2020''.
Native Contract and Rate Expenditure Act of 2014 or the Native CARE Act of 2014 - Amends title XVIII (Medicare) of the Social Security Act to remove the restriction to hospitals furnishing inpatient Medicare services and allow all service providers to participate under: (1) the Purchased/Referred Care program (formerly called the contract health services program) funded and operated by the Indian Health Service (IHS), and (2) any program funded by IHS and operated by an urban Indian organization.  Prohibits Medicare payment for an item or service furnished by a supplier unless the supplier agrees to participate under both such programs. Prohibits any reduction, offset, or limitation to any appropriations made to IHS under the Indian Health Care Improvement Act, the Snyder Act, or any other provision of law as a result of this Act. Directs the Secretary of Health and Human Services (HHS), acting through the Director of IHS, to study the impact of this Act on access to care under the IHS Purchased/Referred Care program.
Native CARE Act of 2014