II 

109TH CONGRESS 

1ST SESSION S. 2074 

To amend title XIX of the Social Security Act to provide for fair treatment 

of services furnished to Indians under the medicaid program, and for 

other purposes. 

IN THE SENATE OF THE UNITED STATES 

NOVEMBER 18, 2005 

Mr. BINGAMAN (for himself, Mr. BAUCUS, Mr. DORGAN, Mrs. MURRAY, Ms. 

CANTWELL, and Mr. JOHNSON) introduced the following bill; which was 

read twice and referred to the Committee on Finance 

A BILL 

To amend title XIX of the Social Security Act to provide 

for fair treatment of services furnished to Indians under 

the medicaid program, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Medicaid Indian 

5 Health Act of 2005’’. 
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1 SEC. 2. APPLICATION OF 100 PERCENT FMAP FOR SERV2 ICES FURNISHED TO AN INDIAN BY AN 

3 URBAN INDIAN HEALTH PROGRAM. 

4 (a) IN GENERAL.—The third sentence of section 

5 1905(b) of the Social Security Act (42 U.S.C. 1396d(b)), 

6 is amended by inserting before the period at the end the 

7 following: ‘‘, or through an urban Indian health program 

8 receiving funds under title V of the Indian Health Care 

9 Improvement Act’’. 

10 (b) CONFORMING AMENDMENT.—Section 1911(c) of 

11 such Act (42 U.S.C. 1396j(c)), is amended by inserting 

12 ‘‘, or through an urban Indian health program receiving 

13 funds under title V of the Indian Health Care Improve14 ment Act’’ after ‘‘facilities’’. 

15 SEC. 3. PROHIBITION ON IMPOSITION OF PREMIUMS, 

16 DEDUCTIBLES, COPAYMENTS, AND OTHER 

17 COST-SHARING ON INDIANS. 

18 Section 1916 of the Social Security Act (42 U.S.C. 

19 1396o) is amended— 

20 (1) in subsection (a)(3), by inserting ‘‘(other 

21 than such individuals who are Indians (as defined in 

22 section 4 of the Indian Health Care Improvement 

23 Act)’’ after ‘‘other such individuals’’; 

24 (2) in subsection (b), in the matter preceding 

25 paragraph (1), by inserting ‘‘or who are Indians (as 
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1 defined in section 4 of the Indian Health Care Im2 provement Act)’’ after ‘‘section 1902(a)(10)’’; and 

3 (3) in subsection (c)(1), by inserting ‘‘(other 

4 than such an individual who is an Indian (as defined 

5 in section 4 of the Indian Health Care Improvement 

6 Act))’’ after ‘‘section 1902(l)(1)’’. 

7 SEC. 4. PROHIBITION ON RECOVERY AGAINST ESTATES OF 

8 INDIANS. 

9 Section 1917(b)(1) of the Social Security Act (42 

10 U.S.C. 1396p(b)(1)) is amended, in the matter preceding 

11 subparagraph (A), by inserting ‘‘ who is not an Indian 

12 (as defined in section 4 of the Indian Health Care Im13 provement Act)’’ after ‘‘an individual’’ the second place 

14 it appears. 

15 SEC. 5. REQUIREMENT FOR CONSULTATION WITH INDIAN 

16 TRIBES PRIOR TO APPROVAL OF SECTION 

17 1115 WAIVERS. 

18 Section 1115 of the Social Security Act (42 U.S.C. 

19 1315) is amended by adding at the end the following: 

20 ‘‘(g) In the case of an application for a waiver of com21 pliance with the requirements of section 1902 (or a re22 newal or extension of such a waiver) that is likely to affect 

23 members of an Indian tribe (as defined in section 4 of 

24 the Indian Health Care Improvement Act) or a tribal 

25 health program (whether operated by an Indian tribe or 
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1 a tribal organization (as so defined) serving such mem2 bers, the Secretary shall, prior to granting such a waiver 

3 under subsection (a) or renewing or extending such a 

4 waiver under subsection (e), consult with each such Indian 

5 tribe.’’. 

6 SEC. 6. REQUIREMENT FOR FAIR PAYMENT BY MEDICAID 

7 MANAGED CARE ENTITIES TO INDIAN 

8 HEALTH PROGRAM PROVIDERS. 

9 Section 1903(m)(2)(A)(ii) of the Social Security Act 

10 (42 U.S.C. 1396b(m)(2)(A)(ii)) is amended to read as fol11 lows: 

12 ‘‘(ii) such contract provides, in the 

13 case of entity that has entered into a con14 tract for the provision of services with a 

15 facility or program of the Indian Health 

16 Service, whether operated by the Service or 

17 an Indian tribe or tribal organization (as 

18 defined in section 4 of the Indian Health 

19 Care Improvement Act) or an urban In20 dian health program receiving funds under 

21 title V of the Indian Health Care Improve22 ment Act , that is not a Federally-qualified 

23 health center or a rural health clinic, that 

24 the entity shall provide payment that is not 

25 less than the highest level and amount of 
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1 payment that the entity would make for 

2 the services if the services were furnished 

3 by a provider that is not a facility or pro4 gram of the Indian Health Service;’’. 

5 SEC. 7. TREATMENT OF MEDICAL EXPENSES PAID BY OR 

6 ON BEHALF OF AN INDIAN BY AN INDIAN 

7 HEALTH PROGRAM AS COSTS INCURRED FOR 

8 MEDICAL CARE FOR PURPOSES OF DETER9 MINING MEDICALLY NEEDY ELIGIBILITY. 

10 Section 1902(a)(17)(D) of the Social Security Act 

11 (42 U.S.C. 1396a(a)(17)(D)) is amended by inserting ‘‘or 

12 by the Indian Health Service or an Indian tribe or tribal 

13 organization (as defined in section 4 of the Indian Health 

14 Care Improvement Act)’’ after ‘‘political subdivision there15 of’’. 

16 SEC. 8. STATE OPTION TO EXEMPT INDIANS FROM REDUC17 TIONS IN ELIGIBILITY OR BENEFITS. 

18 Section 1902 of the Social Security Act (42 U.S.C. 

19 1396a)) is amended by inserting after subsection (j) the 

20 following: 

21 ‘‘(k) The Secretary shall not disapprove a State plan 

22 amendment, or deny a State request for a waiver under 

23 section 1115 (or a renewal or extension of such a waiver), 

24 on the grounds that the amendment or waiver would ex25 empt Indians (as defined in section 4 of the Indian Health 
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1 Care Improvement Act) eligible for medical assistance 

2 from— 

3 ‘‘(1) any restriction on eligibility for medical as4 sistance under this title that would otherwise apply 

5 under the amendment or waiver; 

6 ‘‘(2) any imposition of premiums, deductibles, 

7 copayments, or other cost-sharing that would other8 wise apply under the amendment or waiver; or 

9 ‘‘(3) any reduction in covered services or sup10 plies that would otherwise apply under the amend11 ment or waiver.’’. 

12 SEC. 9. EFFECTIVE DATE. 

13 (a) IN GENERAL.—Except as provided in subsection 

14 (b), this Act and the amendments made by this Act apply 

15 to items or services furnished on or after January 1, 2006. 

16 (b) EXTENSION OF EFFECTIVE DATE FOR STATE

17 LAW AMENDMENT.—In the case of a State plan under 

18 title XIX of the Social Security Act which the Secretary 

19 of Health and Human Services determines requires State 

20 legislation in order for the plan to meet the additional re21 quirements imposed by the amendments made by a provi22 sion of this Act, the State plan shall not be regarded as 

23 failing to comply with the requirements of this Act solely 

24 on the basis of its failure to meet these additional require25 ments before the first day of the first calendar quarter 
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1 beginning after the close of the first regular session of the 

2 State legislature that begins after the date of enactment 

3 of this Act. For purposes of the previous sentence, in the 

4 case of a State that has a 2-year legislative session, each 

5 year of the session shall be considered to be a separate 

6 regular session of the State legislature. 

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