IB

Union Calendar No. 480

106TH CONGRESS

2D SESSION S. 406

[Report No. 106–818, Part I]

IN THE HOUSE OF REPRESENTATIVES

SEPTEMBER 17, 1999

Referred to the Committee on Resources, and in addition to the Committees

on Ways and Means, and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions

as fall within the jurisdiction of the committee concerned

SEPTEMBER 6, 2000

Reported from the Committee on Resources

SEPTEMBER 6, 2000

Referral to the Committees on Ways and Means and Commerce extended for

a period ending not later than September 6, 2000

SEPTEMBER 6, 2000

The Committees on Ways and Means and Commerce discharged; committed

to the Committee of the Whole House on the State of the Union and ordered to be printed

AN ACT

To amend the Indian Health Care 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.
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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 ‘‘Alaska Native and

5 American Indian Direct Reimbursement Act of 1999’’.

6 SEC. 2. FINDINGS.

7 Congress finds the following:

8 (1) In 1988, Congress enacted section 405 of

9 the Indian Health Care Improvement Act (25 U.S.C.

10 1645) that established a demonstration program to

11 authorize 4 tribally-operated Indian Health Service

12 hospitals or clinics to test methods for direct billing

13 and receipt of payment for health services provided

14 to patients eligible for reimbursement under the

15 medicare or medicaid programs under titles XVIII

16 and XIX of the Social Security Act (42 U.S.C. 1395

17 et seq.; 1396 et seq.), and other third-party payors.

18 (2) The 4 participants selected by the Indian

19 Health Service for the demonstration program began

20 the direct billing and collection program in fiscal

21 year 1989 and unanimously expressed success and

22 satisfaction with the program. Benefits of the pro23 gram include dramatically increased collections for

24 services provided under the medicare and medicaid

25 programs, a significant reduction in the turn-around
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1 time between billing and receipt of payments for

2 services provided to eligible patients, and increased

3 efficiency of participants being able to track their

4 own billings and collections.

5 (3) The success of the demonstration program

6 confirms that the direct involvement of tribes and

7 tribal organizations in the direct billing of, and col8 lection of payments from, the medicare and medicaid

9 programs, and other third payor reimbursements, is

10 more beneficial to Indian tribes than the current

11 system of Indian Health Service-managed collec12 tions.

13 (4) Allowing tribes and tribal organizations to

14 directly manage their medicare and medicaid billings

15 and collections, rather than channeling all activities

16 through the Indian Health Service, will enable the

17 Indian Health Service to reduce its administrative

18 costs, is consistent with the provisions of the Indian

19 Self-Determination Act, and furthers the commit20 ment of the Secretary to enable tribes and tribal or21 ganizations to manage and operate their health care

22 programs.

23 (5) The demonstration program was originally

24 to expire on September 30, 1996, but was extended

25 by Congress, so that the current participants would
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1 not experience an interruption in the program while

2 Congress awaited a recommendation from the Sec3 retary of Health and Human Services on whether to

4 make the program permanent.

5 (6) It would be beneficial to the Indian Health

6 Service and to Indian tribes, tribal organizations,

7 and Alaska Native organizations to provide perma8 nent status to the demonstration program and to ex9 tend participation in the program to other Indian

10 tribes, tribal organizations, and Alaska Native

11 health organizations who operate a facility of the In12 dian Health Service.

13 SEC. 3. DIRECT BILLING OF MEDICARE, MEDICAID, AND

14 OTHER THIRD PARTY PAYORS.

15 (a) PERMANENT AUTHORIZATION.—Section 405 of

16 the Indian Health Care Improvement Act (25 U.S.C.

17 1645) is amended to read as follows:

18 ‘‘(a) ESTABLISHMENT OF DIRECT BILLING PRO19 GRAM.—

20 ‘‘(1) IN GENERAL.—The Secretary shall estab21 lish a program under which Indian tribes, tribal or22 ganizations, and Alaska Native health organizations

23 that contract or compact for the operation of a hos24 pital or clinic of the Service under the Indian Self25 Determination and Education Assistance Act may
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1 elect to directly bill for, and receive payment for,

2 health care services provided by such hospital or

3 clinic for which payment is made under title XVIII

4 of the Social Security Act (42 U.S.C. 1395 et seq.)

5 (in this section referred to as the ‘medicare pro6 gram’), under a State plan for medical assistance

7 approved under title XIX of the Social Security Act

8 (42 U.S.C. 1396 et seq.) (in this section referred

9 to as the ‘medicaid program’), or from any other

10 third party payor.

11 ‘‘(2) APPLICATION OF 100 PERCENT FMAP.—

12 The third sentence of section 1905(b) of the Social

13 Security Act (42 U.S.C. 1396d(b)) shall apply for

14 purposes of reimbursement under the medicaid pro15 gram for health care services directly billed under

16 the program established under this section.

17 ‘‘(b) DIRECT REIMBURSEMENT.—

18 ‘‘(1) USE OF FUNDS.—Each hospital or clinic

19 participating in the program described in subsection

20 (a) of this section shall be reimbursed directly under

21 the medicare and medicaid programs for services

22 furnished, without regard to the provisions of section

23 1880(c) of the Social Security Act (42 U.S.C.

24 1395qq(c)) and sections 402(a) and 813(b)(2)(A),

25 but all funds so reimbursed shall first be used by the
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1 hospital or clinic for the purpose of making any im2 provements in the hospital or clinic that may be nec3 essary to achieve or maintain compliance with the

4 conditions and requirements applicable generally to

5 facilities of such type under the medicare or med6 icaid programs. Any funds so reimbursed which are

7 in excess of the amount necessary to achieve or

8 maintain such conditions shall be used—

9 ‘‘(A) solely for improving the health re10 sources deficiency level of the Indian tribe; and

11 ‘‘(B) in accordance with the regulations of

12 the Service applicable to funds provided by the

13 Service under any contract entered into under

14 the Indian Self-Determination Act (25 U.S.C.

15 450f et seq.).

16 ‘‘(2) AUDITS.—The amounts paid to the hos17 pitals and clinics participating in the program estab18 lished under this section shall be subject to all audit19 ing requirements applicable to programs adminis20 tered directly by the Service and to facilities partici21 pating in the medicare and medicaid programs.

22 ‘‘(3) SECRETARIAL OVERSIGHT.—The Secretary

23 shall monitor the performance of hospitals and clin24 ics participating in the program established under

25 this section, and shall require such hospitals and
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1 clinics to submit reports on the program to the Sec2 retary on an annual basis.

3 ‘‘(4) NO PAYMENTS FROM SPECIAL FUNDS.—

4 Notwithstanding section 1880(c) of the Social Secu5 rity Act (42 U.S.C. 1395qq(c)) or section 402(a), no

6 payment may be made out of the special funds de7 scribed in such sections for the benefit of any hos8 pital or clinic during the period that the hospital or

9 clinic participates in the program established under

10 this section.

11 ‘‘(c) REQUIREMENTS FOR PARTICIPATION.—

12 ‘‘(1) APPLICATION.—Except as provided in

13 paragraph (2)(B), in order to be eligible for partici14 pation in the program established under this section,

15 an Indian tribe, tribal organization, or Alaska Na16 tive health organization shall submit an application

17 to the Secretary that establishes to the satisfaction

18 of the Secretary that—

19 ‘‘(A) the Indian tribe, tribal organization,

20 or Alaska Native health organization contracts

21 or compacts for the operation of a facility of the

22 Service;

23 ‘‘(B) the facility is eligible to participate in

24 the medicare or medicaid programs under sec-
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1 tion 1880 or 1911 of the Social Security Act

2 (42 U.S.C. 1395qq; 1396j);

3 ‘‘(C) the facility meets the requirements

4 that apply to programs operated directly by the

5 Service; and

6 ‘‘(D) the facility—

7 ‘‘(i) is accredited by an accrediting

8 body as eligible for reimbursement under

9 the medicare or medicaid programs; or

10 ‘‘(ii) has submitted a plan, which has

11 been approved by the Secretary, for achiev12 ing such accreditation.

13 ‘‘(2) APPROVAL.—

14 ‘‘(A) IN GENERAL.—The Secretary shall

15 review and approve a qualified application not

16 later than 90 days after the date the applica17 tion is submitted to the Secretary unless the

18 Secretary determines that any of the criteria set

19 forth in paragraph (1) are not met.

20 ‘‘(B) GRANDFATHER OF DEMONSTRATION

21 PROGRAM PARTICIPANTS.—Any participant in

22 the demonstration program authorized under

23 this section as in effect on the day before the

24 date of enactment of the Alaska Native and

25 American Indian Direct Reimbursement Act of
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1 1999 shall be deemed approved for participa2 tion in the program established under this sec3 tion and shall not be required to submit an ap4 plication in order to participate in the program.

5 ‘‘(C) DURATION.—An approval by the Sec6 retary of a qualified application under subpara7 graph (A), or a deemed approval of a dem8 onstration program under subparagraph (B),

9 shall continue in effect as long as the approved

10 applicant or the deemed approved demonstra11 tion program meets the requirements of this

12 section.

13 ‘‘(d) EXAMINATION AND IMPLEMENTATION OF

14 CHANGES.—

15 ‘‘(1) IN GENERAL.—The Secretary, acting

16 through the Service, and with the assistance of the

17 Administrator of the Health Care Financing Admin18 istration, shall examine on an ongoing basis and

19 implement—

20 ‘‘(A) any administrative changes that may

21 be necessary to facilitate direct billing and re22 imbursement under the program established

23 under this section, including any agreements

24 with States that may be necessary to provide
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1 for direct billing under the medicaid program;

2 and

3 ‘‘(B) any changes that may be necessary to

4 enable participants in the program established

5 under this section to provide to the Service

6 medical records information on patients served

7 under the program that is consistent with the

8 medical records information system of the Service.

9 ‘‘(2) ACCOUNTING INFORMATION.—The ac10 counting information that a participant in the pro11 gram established under this section shall be required

12 to report shall be the same as the information re13 quired to be reported by participants in the dem14 onstration program authorized under this section as

15 in effect on the day before the date of enactment of

16 the Alaska Native and American Indian Direct Re17 imbursement Act of 1999. The Secretary may from

18 time to time, after consultation with the program

19 participants, change the accounting information sub20 mission requirements.

21 ‘‘(e) WITHDRAWAL FROM PROGRAM.—A participant

22 in the program established under this section may with23 draw from participation in the same manner and under

24 the same conditions that a tribe or tribal organization may

25 retrocede a contracted program to the Secretary under au-
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1 thority of the Indian Self-Determination Act (25 U.S.C.

2 450 et seq.). All cost accounting and billing authority

3 under the program established under this section shall be

4 returned to the Secretary upon the Secretary’s acceptance

5 of the withdrawal of participation in this program.’’.

6 (b) CONFORMING AMENDMENTS.—

7 (1) Section 1880 of the Social Security Act (42

8 U.S.C. 1395qq) is amended by adding at the end the

9 following:

10 ‘‘(e) For provisions relating to the authority of cer11 tain Indian tribes, tribal organizations, and Alaska Native

12 health organizations to elect to directly bill for, and receive

13 payment for, health care services provided by a hospital

14 or clinic of such tribes or organizations and for which pay15 ment may be made under this title, see section 405 of the

16 Indian Health Care Improvement Act (25 U.S.C. 1645).’’.

17 (2) Section 1911 of the Social Security Act (42

18 U.S.C. 1396j) is amended by adding at the end the

19 following:

20 ‘‘(d) For provisions relating to the authority of cer21 tain Indian tribes, tribal organizations, and Alaska Native

22 health organizations to elect to directly bill for, and receive

23 payment for, health care services provided by a hospital

24 or clinic of such tribes or organizations and for which pay-
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1 ment may be made under this title, see section 405 of the

2 Indian Health Care Improvement Act (25 U.S.C. 1645).’’.

3 (c) EFFECTIVE DATE.—The amendments made by

4 this section shall take effect on October 1, 2000.

5 SEC. 4. TECHNICAL AMENDMENT.

6 (a) IN GENERAL.—Effective November 9, 1998, sec7 tion 405 of the Indian Health Care Improvement Act (25

8 U.S.C. 1645(e)) is reenacted as in effect on that date.

9 (b) REPORTS.—Effective November 10, 1998, section

10 405 of the Indian Health Care Improvement Act is

11 amended by striking subsection (e).

Passed the Senate September 15, 1999.

Attest: GARY SISCO,

Secretary.

Union Calendar No. 480

106TH CONGRESS

2D SESSION S. 406

[Report No. 106–818, Part I]

AN ACT

To amend the Indian Health Care Improvement

Act to make permanent the demonstration program that allows for direct billing of medicare,medicaid, and other third party payors, and toexpand the eligibility under such program toother tribes and tribal organizations.

SEPTEMBER 6, 2000

Reported from the Committee on Resources

SEPTEMBER 6, 2000

Referral to the Committees on Ways and Means and

Commerce extended for a period ending not later thanSeptember 6, 2000

SEPTEMBER 6, 2000

The Committees on Ways and Means and Commerce discharged; committed to the Committee of the Whole

House on the State of the Union and ordered to beprinted