Page 467 TITLE 25—INDIANS § 1645

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.’’

Subsec. (c). Pub. L. 102–573, §403(2), amended subsec.

(c) generally. Prior to amendment, subsec. (c) read as

follows: ‘‘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.’’

§ 1645. Demonstration program for direct billing

of medicare, medicaid, and other third party

payors

(a) Establishment

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 [25 U.S.C. 450f et seq.], 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 [42 U.S.C. 1395 et seq.]

(medicare), under a State plan for medical assistance approved under title XIX of the Social

Security Act [42 U.S.C. 1396 et seq.] (medicaid),

or from any other third-party payor. The last

sentence of section 1905(b) of the Social Security

Act [42 U.S.C. 1396d(b)] shall apply for purposes

of the demonstration program.

(b) Direct reimbursement

(1) Each hospital or clinic participating in the

demonstration 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 1642(a) and

1680c(b)(2)(A) of this title, 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 so reimbursed

which are in excess of the amount necessary to

achieve or maintain such conditions or 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 [25 U.S.C.

450f et seq.].

(2) The amounts paid to the hospitals and clinics participating in the demonstration program

described in subsection (a) of 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) The Secretary shall monitor the performance of hospitals and clinics participating in the

demonstration program described in subsection

(a) of this section, 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 to be

necessary).

(4) Notwithstanding section 1880(c) of the Social Security Act [42 U.S.C. 1395qq(c)] or section

1642(a) of this title, no payment may be made

out of the special fund described in section

1880(c) of the Social Security Act, or section

1642(a) of this title, for the benefit of any hospital or clinic participating in the demonstration program described in subsection (a) of this

section during the period of such participation.

(c) Requirements for participation

(1) In order to be considered for participation

in the demonstration program described in subsection (a) of this section, 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 [42 U.S.C. 1395qq, 1396j];

(C) the facility meets any requirements

which apply to 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) of this section. The demonstration program

described in subsection (a) of this section shall

begin by no later than October 1, 1991, and end

on September 30, 1998.

(d) Examination and implementation changes

(1) On November 23, 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) of this section, 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 under

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)

of this section, 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
§ 1646 TITLE 25—INDIANS Page 468

participant in the demonstration program described in subsection (a) of this section would be

required to report.

(e) Report

The Secretary shall submit a final report at

the end of fiscal year 1996, on the activities carried out under the demonstration program described in subsection (a) of this section which

shall include an evaluation of whether such activities 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 of, and reimbursement by, the medicare and medicaid programs and other thirdparty payors should be authorized for all Indian

tribes and Alaska Native health organizations

which are contracting the entire operation of a

facility of the Service.

(f) Retrocession of contract

The Secretary shall provide for the retrocession of any contract entered into between a participant in the demonstration program described

in subsection (a) of this section and the Service

under the authority of the Indian Self-Determination Act [25 U.S.C. 450f et seq.]. All cost accounting and billing authority shall be

retroceded to the Secretary upon the Secretary’s acceptance of a retroceded contract.

(Pub. L. 94–437, title IV, §405, as added Pub. L.

100–713, title IV, §402, Nov. 23, 1988, 102 Stat. 4818;

amended Pub. L. 102–573, title IV, §404, title VII,

§701(c)(3), Oct. 29, 1992, 106 Stat. 4566, 4572; Pub.

L. 104–313, §2(d), Oct. 19, 1996, 110 Stat. 3822.)

REFERENCES IN TEXT

The Indian Self-Determination Act, referred to in

subsecs. (a), (b)(1)(B), and (f), is title I of Pub. L. 93–638,

Jan. 4, 1975, 88 Stat. 2206, as amended, which is classified principally to part A (§450f et seq.) of subchapter

II of chapter 14 of this title. For complete classification

of this Act to the Code, see Short Title note set out

under section 450 of this title and Tables.

The Social Security Act, referred to in subsec. (a), is

act Aug. 14, 1935, ch. 531, 49 Stat. 620, as amended. Titles

XVIII and XIX of the Act are classified generally to

subchapters XVIII (§1395 et seq.) and XIX (§1396 et seq.)

of chapter 7 of Title 42, The Public Health and Welfare.

For complete classification of this Act to the Code, see

section 1305 of Title 42 and Tables.

CODIFICATION

Section was formerly set out as a note under section

1395qq of Title 42, The Public Health and Welfare.

AMENDMENTS

1996—Subsec. (c)(2). Pub. L. 104–313 substituted ‘‘1998’’

for ‘‘1996’’.

1992—Subsec. (b)(1). Pub. L. 102–573, §701(c)(3)(A), substituted ‘‘sections 1642(a)’’ for ‘‘sections 402(c)’’ and

made technical amendment to reference to section

1680c(b)(2)(A) to reflect renumbering of corresponding

section of original act.

Subsec. (b)(4). Pub. L. 102–573, §701(c)(3)(B), substituted ‘‘section 1642(a)’’ for ‘‘section 402(c)’’ in two

places.

Subsec. (c)(2). Pub. L. 102–573, §404(1), substituted

‘‘1996’’ for ‘‘1995’’.

Subsec. (e). Pub. L. 102–573, §404(2), substituted ‘‘1996’’

for ‘‘1995’’.

§ 1646. Authorization for emergency contract

health services

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 chapter, the

time limitation (as a condition of payment) for

notifying the Service of such treatment or admission shall be 30 days.

(Pub. L. 94–437, title IV, §406, as added Pub. L.

102–573, title IV, §405, Oct. 29, 1992, 106 Stat.

4566.)

§ 1647. Authorization of appropriations

There are authorized to be appropriated such

sums as may be necessary for each fiscal year

through fiscal year 2000 to carry out this subchapter.

(Pub. L. 94–437, title IV, §407, as added Pub. L.

102–573, title IV, §406, Oct. 29, 1992, 106 Stat.

4566.)

SUBCHAPTER IV—HEALTH SERVICES FOR

URBAN INDIANS

CODIFICATION

This subchapter was in the original title V of Pub. L.

94–437. Title IV of Pub. L. 94–437 is classified to subchapter III–A of this chapter.

SUBCHAPTER REFERRED TO IN OTHER SECTIONS

This subchapter is referred to in sections 1603, 1613a,

1616a, 1616e, 1621p, 1665b, 1665g of this title; title 42 sections 256b, 1395x, 1396d, 1396r–1, 1396s.

§ 1651. Purpose

The purpose of this subchapter is to establish

programs in urban centers to make health services more accessible to urban Indians.

(Pub. L. 94–437, title V, §501, as added Pub. L.

100–713, title V, §501, Nov. 23, 1988, 102 Stat. 4820.)

PRIOR PROVISIONS

A prior section 1651, Pub. L. 94–437, title V, §501, Sept.

30, 1976, 90 Stat. 1410; Pub. L. 96–537, §7, Dec. 17, 1980, 94

Stat. 3176, related to Congressional statement of purpose, prior to the general revision of this subchapter by

Pub. L. 100–713.

§ 1652. Contracts with, and grants to, urban Indian organizations

Under authority of section 13 of this title, the

Secretary, through the Service, shall enter into

contracts with, or make grants to, urban Indian

organizations to assist such organizations in the

establishment and administration, within the

urban centers in which such organizations are

situated, of programs which meet the requirements set forth in this subchapter. The Secretary, through the Service, shall include such

conditions as the Secretary considers necessary

to effect the purpose of this subchapter in any

contract which the Secretary enters into with,

or in any grant the Secretary makes to, any

urban Indian organization pursuant to this subchapter.

(Pub. L. 94–437, title V, §502, as added Pub. L.

100–713, title V, §501, Nov. 23, 1988, 102 Stat. 4820;

amended Pub. L. 102–573, title V, §501(a), Oct. 29,

1992, 106 Stat. 4567.)

PRIOR PROVISIONS

A prior section 1652, Pub. L. 94–437, title V, §502, Sept.

30, 1976, 90 Stat. 1410; Pub. L. 96–537, §7, Dec. 17, 1980, 94