278
‘‘SEC. 810. PROVISION OF SERVICES IN MONTANA.
‘‘(a) The Secretary shall provide services and benefits
for Indians in Montana in a manner consistent with the
decision of the United States Court of Appeals for the
Ninth Circuit in McNabb for McNabb v. Bowen, 829 F.2d
787 (9th Cir. 1987).
‘‘(b) The provisions of subsection (a) shall not be con-
strued to be an expression of the sense of the Congress
on the application of the decision described in subsection
(a) with respect to the provision of services or benefits
for Indians living in any State other than Montana.
‘‘SEC. 811. MORATORIUM.
‘‘During the period of the moratorium imposed by
Public Law 100–446 on implementation of the final rule
published in the Federal Register on September 16, 1987,
by the Health Resources and Services Administration of
the Public Health Service, relating to eligibility for the
health care services of the Indian Health Service, the In-
dian Health Service shall provide services pursuant to the
criteria for eligibility for such services that were in effect
on September 15, 1987, subject to the provisions of sec-
tions 806 and 807 of the Indian Health Care Improvement
Act, as amended by this Act until such time as new cri-
teria governing eligibility for services are developed in ac-
cordance with section 802 of this Act.
279
‘‘SEC. 812. TRIBAL EMPLOYMENT.
‘‘For purposes of section 2(2) of the Act of July 5,
1935, as amended (49 Stat. 450, chapter 372), an Indian
tribe or tribal organization carrying out a funding agree-
ment under the Indian Self-Determination and Education
Assistance Act shall not be considered an ‘employer’.
‘‘SEC. 813. PRIME VENDOR.
‘‘For purposes of section 4 of Public Law 102–585
(38 U.S.C. 812) tribes and tribal organizations carrying
out a grant, cooperative agreement of funding agreement
under the Indian Self-Determination and Education As-
sistance Act (25 U.S.C. 450 et seq.) shall be deemed to
be an executive agency and part of the Indian Health
Service in the Department of Health and Human Services
and, as such, may act as an ordering agent of the Indian
Health Service and the employees of the tribe or tribal
organization may order supplies on behalf thereof on the
same basis as employees of the Indian Health Service.
‘‘SEC. 814. SEVERABILITY PROVISIONS.
‘‘If any provision of this Act, any amendment made
by the Act, or the application of such provision or amend-
ment to any person or circumstances is held to be invalid,
the remainder of this Act, the remaining amendments
made by this Act, and the application of such provisions
to persons or circumstances other than those to which it
is held invalid, shall not be affected thereby.
280
‘‘SEC. 815. ESTABLISHMENT OF NATIONAL BIPARTISAN
COMMISSION ON INDIAN HEALTH CARE ENTI-
TLEMENT.
‘‘(a) There is hereby established the National Bipar-
tisan Indian Health Care Entitlement Commission (the
‘Commission’).
‘‘(b) DUTIES
OF COMMISSION.—The Commission
shall—
‘‘(1) review and analyze the recommendations
of the report of the Study Committee, as established
below, to the Commission;
‘‘(2) make recommendations to the Congress
for providing health services for Indian persons as
an entitlement, giving due regard to the effects of
such a program on existing health care delivery sys-
tems for Indian persons and the effect of such a pro-
gram on the sovereign status of Indian tribes;
‘‘(3) establish a Study Committee composed of
those members of the Commission appointed by the
Director of the Indian Health Service and at least
4 members of Congress from among the members of
the Commission which shall—
‘‘(A) to the extent necessary to carry out
its duties, collect and compile data necessary to
understand the extent of Indian needs with re-
gard to the provision of health services, regard-
281
less of the location of Indians, including holding
hearings and soliciting the views of Indians, In-
dian tribes, tribal organizations, and urban In-
dian organizations, and which may include au-
thorizing and funding feasibility studies of var-
ious models for providing and funding health
services for all Indian beneficiaries including
those who live outside of a reservation, tempo-
rarily or permanently;
‘‘(B) make recommendations to the Com-
mission for legislation that will provide for the
delivery of health services for Indians as an en-
titlement, which will address, among other
things, issues of eligibility, benefits to be pro-
vided, including recommendations regarding
from whom such health services are to be pro-
vided and the cost, including mechanisms for
funding of the health services to be provided;
‘‘(C) determine the effect of the enactment
of such recommendations on the existing system
of delivery of health services for Indians;
‘‘(D) determine the effect of a health serv-
ices entitlement program for Indian persons on
the sovereign status of Indian tribes;
282
‘‘(E) not later than 12 months after the
appointment of all members of the Commission,
shall make a written report of its findings and
recommendations to the full Commission, which
report shall include a statement of the minority
and majority position of the Committee and
which shall be disseminated, at a minimum, to
every federally recognized Indian tribe, tribal
organization, and urban Indian organization for
comment to the Commission; and
‘‘(F) report regularly to the full Commis-
sion regarding the findings and recommenda-
tions developed by the Study Committee in the
course of carrying out its duties under this sec-
tion.
‘‘(4) By not later than 18 months following the
date of appointment of all members of the Commis-
sion, submit a written report to Congress containing
a recommendation of policies and legislation to im-
plement a policy that would establish a health care
system for Indians based on delivery of health serv-
ices as an entitlement, together with a determination
of the implications of such an entitlement system on
existing health care delivery systems for Indians and
on the sovereign status of Indian tribes.
283
‘‘(c)(1) The Commission shall be composed of 25
members, selected by as follows:
‘‘(A) 10 members of Congress, including 3 from
the United States House of Representatives and 2
from the United States Senate, appointed by their
respective majority leaders, and 3 from the United
States House of Representatives and 2 from the
United States Senate, appointed by their respective
minority leaders, and who shall be members of the
standing committees of Congress that consider legis-
lation affecting health care to Indians.
‘‘(B) 12 persons chosen by the Congressional
members of the Commission, 1 from each Indian
health care service area as currently designated by
the Director of the Indian Health Service, to be cho-
sen from among 3 nominees from each area put for-
ward by the Tribes within the area, with due regard
being given to the experience and expertise of the
nominees in the provision of health care to Indians
and with due regard being given to a reasonable rep-
resentation on the commission of members who are
familiar with various health care delivery modes and
who represent Tribes of various size populations.
‘‘(C) 3 persons appointed by the Director of the
Indian Health Service who are knowledgeable about
284
the provision of health care to Indians, at least one
of whom shall be appointed from among 3 nominees
put forward by those programs whose funding is
provided in whole or in part by the Indian Health
Service primarily or exclusively for the benefit of
urban Indians.
‘‘(D) All those persons chosen by the Congres-
sional members of the Commission and by the Presi-
dent shall be members of federally recognized Indian
tribes.
‘‘(E) The Chairman and Vice Chairman of the
Commission shall be selected by the Congressional
members of the Commission.
‘‘(d)(1) The terms of members of the Commission
shall be for the life of the Commission.
‘‘(2) Congressional members of the Commission shall
be appointed not later than 90 days after the approval
of this Act, and the remaining members of the Commis-
sion shall be appointed not later than 60 days following
the appointment of the Congressional members.
‘‘(3) A vacancy in the Commission shall be filled in
the manner in which the original appointment was made.
‘‘(e)(1) Each Congressional member of the Commis-
sion shall receive no additional pay, allowances, or benefits
by reason of their service on the Commission and shall
285
receive travel expenses and per diem in lieu of subsistence
in accordance with sections 5702 and 5703 of title 5,
United States Code.
‘‘(2) Remaining members of the Commission, while
serving on the business of the Commission (including trav-
el time) shall be entitled to receive compensation at the
per diem equivalent of the rate provided for level IV of
the Executive Schedule under section 5315 of title 5,
United States Code, and while so serving away from home
and the member’s regular place of business, a member
may be allowed travel expenses, as authorized by the
Chairman of the Commission. For purpose of pay (other
than pay of members of the Commission) and employment
benefits, rights, and privileges, all personnel of the Com-
mission shall be treated as if they were employees of the
United States Senate.
‘‘(f)(1) The Commission shall meet at the call of the
Chairman.
‘‘(2) A quorum of the Commission shall consist of not
less than 15 members, provided that no less than 6 of
the members of Congress who are Commission members
are present and no less than 9 of the members who are
Indians are present.
‘‘(g)(1)(A) The Commission shall appoint an execu-
tive director of the Commission.
286
‘‘(B) The executive director shall be paid the rate of
basic pay for level V of the Executive Schedule.
‘‘(2) With the approval of the Commission, the execu-
tive director may appoint such personnel as the executive
director deems appropriate.
‘‘(3) The staff of the Commission shall be appointed
without regard to the provisions of title 5, United States
Code, governing appointments in the competitive service,
and shall be paid without regard to the provisions of chap-
ter 51 and subchapter III of chapter 53 of such title (re-
lating to classification and General Schedule pay rates).
‘‘(4) With the approval of the Commission, the execu-
tive director may procure temporary and intermittent
services under section 3109(b) of title 5, United States
Code.
‘‘(5) The Administrator of General Services shall lo-
cate suitable office space for the operation of the Commis-
sion. The facilities shall serve as the headquarters of the
Commission and shall include all necessary equipment and
incidentals required for the proper functioning of the Com-
mission.
‘‘(h)(1) For the purpose of carrying out its duties,
the Commission may hold such hearings and undertake
such other activities as the Commission determines to be
necessary to carry out its duties, provided that at least
287
6 regional hearings are held in different areas of the
United States in which large numbers of Indians are
present. Such hearings are to be held to solicit the views
of Indians regarding the delivery of health care services
to them. To constitute a hearing under this subsection,
at least 5 members of the Commission, including at least
1 member of Congress, must be present. Hearings held
by the Study Committee established in this section may
count towards the number of regional hearings required
by this subsection.
‘‘(2) Upon request of the Commission, the Comp-
troller General shall conduct such studies or investigations
as the Commission determines to be necessary to carry
out its duties.
‘‘(3)(A) The Director of the Congressional Budget
Office or the Chief Actuary of the Health Care Financing
Administration, or both, shall provide to the Commission,
upon the request of the Commission, such cost estimates
as the Commission determines to be necessary to carry
out its duties.
‘‘(B) The Commission shall reimburse the Director
of the Congressional Budget Office for expenses relating
to the employment in the office of the Director of such
additional staff as may be necessary for the Director to
288
comply with requests by the Commission under subpara-
graph (A).
‘‘(4) Upon the request of the Commission, the head
of any Federal agency is authorized to detail, without re-
imbursement, any of the personnel of such agency to the
Commission to assist the Commission in carrying out its
duties. Any such detail shall not interrupt or otherwise
affect the civil service status or privileges of the Federal
employee.
‘‘(5) Upon the request of the Commission, the head
of a Federal agency shall provide such technical assistance
to the Commission as the Commission determines to be
necessary to carry out its duties.
‘‘(6) The Commission may use the United States
mails in the same manner and under the same conditions
as Federal agencies and shall, for purposes of the frank,
be considered a commission of Congress as described in
section 3215 of title 39, United States Code.
‘‘(7) The Commission may secure directly from any
Federal agency information necessary to enable it to carry
out its duties, if the information may be disclosed under
section 552 of title 4, United States Code. Upon request
of the Chairman of the Commission, the head of such
agency shall furnish such information to the Commission.
289
‘‘(8) Upon the request of the Commission, the Ad-
ministrator of General Services shall provide to the Com-
mission on a reimbursable basis such administrative sup-
port services as the Commission may request.
‘‘(9) For purposes of costs relating to printing and
binding, including the cost of personnel detailed from the
Government Printing Office, the Commission shall be
deemed to be a committee of the Congress.
‘‘(i) There are authorized to be appropriated
$4,000,000 to carry out the provisions of this section,
which sum shall not be deducted from or affect any other
appropriation for health care for Indian persons.
‘‘SEC. 816. APPROPRIATIONS; AVAILABILITY.
‘‘Any new spending authority (described in subsection
(c)(2)(A) or (B) of section 401 of the Congressional Budg-
et Act of 1974) which is provided under this Act shall
be effective for any fiscal year only to such extent or in
such amounts as are provided in appropriation Acts.
‘‘SEC. 817. AUTHORIZATION OF APPROPRIATIONS.
‘‘There are authorized to be appropriated such sums
as may be necessary for each fiscal year through fiscal
year 2012 to carry out this title.’’.
SEC. 3. SOBOBA SANITATION FACILITIES.
The Act of December 17, 1970 (84 Stat. 1465), is
amended by adding at the end the following new section:
290
‘‘SEC. 9. Nothing in this Act shall preclude the
Soboba Band of Mission Indians and the Soboba Indian
Reservation from being provided with sanitation facilities
and services under the authority of section 7 of the Act
of August 5, 1954 (68 Stat. 674), as amended by the Act
of July 31, 1959 (73 Stat. 267).’’.
SEC. 4. SOCIAL SECURITY ACT AMENDMENTS.
(a) Section 1866(a)(1) of the Social Security Act (42
U.S.C. 1395cc(a)(1)) is amended by adding at the end the
following new subparagraph:
‘‘(T) in the case of hospitals and critical
access hospitals which provide inpatient hospital
services for which payment may be made under
this title, to accept as payment in full for serv-
ices that are covered under and furnished to an
individual eligible for the contract health serv-
ices program operated by the Indian Health
Service, by an Indian tribe or tribal organiza-
tion or furnished to an urban Indian eligible for
health services purchased by an urban Indian
organization (as those terms are defined in sec-
tion 4 of the Indian Health Care Improvement
Act), in accordance with such admission prac-
tices, and such payment methodology and
amounts, as are prescribed under regulations
291
issued by the Secretary in implementation of
such section.’’.
(b) Section 1880 of the Social Security Act is amend-
ed to read as follows:
‘‘SEC. 1880. INDIAN HEALTH PROGRAMS.
‘‘(a) The Indian Health Service and an Indian tribe
or tribal organization (as those terms are defined in sec-
tion 4 of the Indian Health Care Improvement Act), shall
be eligible for payments under this title, notwithstanding
sections 1814(c) and 1835(d), if and for so long as it
meets the conditions and requirements for such payments
which are applicable generally to the service or provider
type for which it seeks payment under this title and for
services and provider types provided by a qualified Indian
health program under section 1880A.
‘‘(b) Notwithstanding subsection (a), if the Indian
Health Service or an Indian tribe, tribal organization, or
urban Indian organization, does not meet all of the condi-
tions and requirements of this title which are applicable
generally to such service or provider type submits to the
Secretary within 6 months after the date on which it first
sought reimbursement for the service or provider type an
acceptable plan for achieving compliance with such condi-
tions and requirements, it shall be deemed to meet such
conditions and requirements (and to be eligible for reim-
292
bursement under this title), without regard to the extent
of its actual compliance with such conditions and require-
ments, during the first 12 months after the month in
which such plan is submitted.
‘‘(c) For provisions relating to the authority of cer-
tain Indian tribes and tribal organizations to elect to di-
rectly bill for, and receive payment for, health care services
provided by a hospital or clinic of such Tribes or tribal
organizations and for which payment may be made under
this title, see section 405 of the Indian Health Care Im-
provement Act.
‘‘(d) The Indian Health Service, an Indian tribe, or
tribal organization providing a service otherwise eligible
for payment under this section through the use of a com-
munity health aide or practitioner certified under the pro-
visions of section 121 of the Indian Health Care Improve-
ment Act (25 U.S.C. 1616l) shall be paid for such services
on the same basis that such services are reimbursed under
State Plans approved under title XIX of the Social Secu-
rity Act.
‘‘(e) Notwithstanding any other provision of law, a
health program operated by the Indian Health Service, an
Indian tribe, or tribal organization, which collaborates
with a hospital operated by the Indian Health Service or
an Indian tribe or tribal organization, shall, at the option
293
of the Indian tribe or tribal organization, be paid for serv-
ices for which it would otherwise be eligible under this sec-
tion as if it were an outpatient department of the hospital.
In situations where the health program is on a separate
campus from the hospital, billing as an outpatient depart-
ment of the hospital shall not subject such a health pro-
gram to the requirements of section 1867 (42 U.S.C.
1395dd) (the Emergency Medical Treatment and Active
Labor Act).
‘‘(f) The Indian Health Service, an Indian tribe, or
tribal organization providing visiting nurse services in a
Home Health Agency Shortage Area shall be paid for such
services on the same basis that such services are reim-
bursed for other primary care providers.
‘‘(g) Notwithstanding any other provision of law, the
Secretary shall have broad authority to identify and imple-
ment alternative methods of reimbursing Indian health
programs for Medicare services provided to Indians. The
Indian tribe, tribal organization, or urban Indian organi-
zation may opt to receive reimbursement under reimburse-
ment methodologies applicable to other providers of simi-
lar services, provided that the amount of reimbursement
resulting under such alternative methodology shall not be
less than 100 percent of the reasonable cost of the service
to which the methodology applies under section 1861(v).’’.
294
(c) Title XVIII of the Social Security Act is amended
by adding after section 1880A the following new section:
‘‘SEC. 1880B. QUALIFIED INDIAN HEALTH PROGRAM.
‘‘(a) A qualified Indian health program shall be eligi-
ble for payments under this title, notwithstanding sections
1814(c) and 1835(d), if and for so long as it meets all
the conditions and requirements set forth in this section.
‘‘(b)(1) The term ‘qualified Indian health program’
means a health program operated by—
‘‘(A) the Indian Health Service;
‘‘(B) an Indian tribe, tribal organization, or
urban Indian organization (as those terms are de-
fined in section 4 of the Indian Health Care Im-
provement Act) and which is funded in whole or part
by the Indian Health Service under the Indian Self-
Determination and Education Assistance Act; and
‘‘(C) an urban Indian organization (as that
term is defined in section 4 of the Indian Health
Care Improvement Act) and which is funded in
whole or part under title V of the Indian Health
Care Improvement Act.
‘‘(2) A qualified Indian health program may include
one or more hospitals, nursing homes, home health pro-
grams, clinics, ambulance services, or other health pro-
grams providing a service for which payments may be
295
made under this title and which is covered in the Medicare
or Medicaid cost report for such qualified Indian health
program.
‘‘(c)(1) Notwithstanding any other provision in the
law, a qualified Indian health program shall be entitled
to receive payment based on an all-inclusive rate which
shall be calculated to provide full cost recovery for the cost
of furnishing services provided under this section.
‘‘(2) The term ‘full cost recovery’ shall mean—
‘‘(A) the direct costs, which are reasonable,
adequate, and related to the cost of furnishing such
services, taking into account the unique nature, loca-
tion, and service population of the qualified Indian
health program, and which shall include direct pro-
gram, administrative, and overhead costs, without
regard to the customary or other charge or any fee
schedule that would otherwise be applicable, plus
‘‘(B) indirect costs which for a qualified Indian
health program operated by—
‘‘(i) an Indian tribe or tribal organization
for which an indirect cost rate (as that term is
defined in section 4(g) of the Indian Self-Deter-
mination and Education Assistance Act) has
been established or an urban Indian organiza-
tion for which an indirect cost rate has other-
296
wise been established shall be not less than an
amount determined on the basis of the indirect
cost rate; or
‘‘(ii) the Indian Health Service, an Indian
tribe, tribal organization, or urban Indian orga-
nization for which no such rate has been estab-
lished shall be not less than the administrative
costs specifically associated with the delivery of
the services being provided.
‘‘(C) Notwithstanding any other provision of
law, the amount determined to be payable as full
cost recovery may not be reduced for coinsurance,
copayments or deductibles when the service was pro-
vided to an Indian entitled under Federal law to re-
ceive service from the Indian Health Service, an In-
dian tribe, or tribal organization, or an urban Indian
organization or because of any limitations on pay-
ment provided for in any managed care plan.
‘‘(3) In addition to full cost recovery, a qualified In-
dian health program shall be entitled to reasonable
outstationing costs, which shall include all administrative
costs associated with outreach and acceptance of eligibility
applications for any Federal or State health program in-
cluding, but not limited to medicare, medicaid, and the
Children’s Health Insurance Program.
297
‘‘(4) Costs identified for services addressed in a cost
report submitted by the qualified Indian health program
shall be used to determine an all-inclusive encounter or
per diem payment amount for such services. Not all health
programs provided or administered by the Indian Health
Service, an Indian tribe or tribal organization, or an urban
Indian organization must be combined into a single cost
report. A full cost recovery payment for services not cov-
ered by such cost report shall be made on a fee-for-service,
encounter, or per diem basis.
‘‘(5) The full cost recovery rate provided for in para-
graphs (1) through (3) of this subsection may be deter-
mined, at the election of the qualified Indian health pro-
gram, by the Health Care Financing Administration or by
a State Medicaid agency and shall be valid for reimburse-
ment made under title XVIII (medicare), title XIX (med-
icaid), and title XXI (children’s health insurance program)
purposes. The costs described in subparagraph (A) of
paragraph (2) shall be calculated under whatever method-
ology yields the greatest aggregate payment for the cost
reporting period, provided that such methodology shall be
adjusted to include adjustments to such payment to take
into account for those qualified Indian health programs
that include hospitals—
‘‘(A) a significant decrease in discharges;
298
‘‘(B) costs for graduate medical education pro-
grams;
‘‘(C) additional payment as a disproportionate
share hospital with a payment adjustment factor of
10; and
‘‘(D) payment for outlier cases.
‘‘(6) A qualified Indian health program may elect to
receive payment for services provided under this section—
‘‘(A) on the full cost recovery basis provided in
subsection (c)(1)–(5)
‘‘(B) on the basis of the inpatient or outpatient
encounter rates established for Indian Health Serv-
ice facilities and published annually in the Federal
Register;
‘‘(C) on the same basis as other providers are
reimbursed under this title, provided that to this
amount shall be added the amounts determined
under subparagraph (B) of subsection (c)(2);
‘‘(D) on the basis of any other rate or method-
ology applicable to the Service, an Indian tribe, or
tribal organization; or
‘‘(E) on the basis of any rate or methodology
negotiated with the agency responsible for making
payment.
299
‘‘(d) A qualified Indian health program may under
this section provide and be reimbursed for any service the
Indian Health Service, an Indian tribe, or tribal organiza-
tion or an urban Indian organization may be reimbursed
under section 1880 for the medicare program and section
1911 for the Medicaid program, provided that in either
event such services may also include, at the election of
the qualified Indian health program—
‘‘(1) any service when furnished by an employee
of the qualified Indian health program who is li-
censed or certified to perform such a service to the
same extent that such service would be reimbursable
if performed by a physician and any service or sup-
plies furnished as incident to a physician’s service as
would otherwise be covered if furnished by a physi-
cian or as an incident to a physician’s service;
‘‘(2) screening, diagnostic, and therapeutic out-
patient services including, but not limited to, part-
time or intermittent screening, diagnostic and thera-
peutic skilled nursing care and related medical sup-
plies (other than drugs and biologicals), furnished by
an employee of the qualified Indian health program
who is licensed or certified to perform such a service
for an individual in the individual’s home or in a
community health setting under a written plan of
300
treatment established and periodically reviewed by a
physician, when furnished to an individual as an
outpatient of a qualified Indian health program;
‘‘(3) preventive primary health services as de-
scribed under sections 329, 330, and 340 of the
Public Health Service Act, when provided by an em-
ployee of the qualified Indian health program who is
licensed or certified to perform such a service, re-
gardless of the location in which the service is pro-
vided;
‘‘(4) for children, all services specified as part
of the State medicaid plan, Children’s Health Insur-
ance Program, and EPSDT;
‘‘(5) influenza and pneumococcal immuniza-
tions;
‘‘(6) other immunizations for prevention of
communicable diseases when targeted; and
‘‘(7) the cost of transportation for providers or
patients necessary to facilitate access for patients.’’.
(d) Section 1902(a)(13) of the Social Security Act
is amended by adding at the end the following:
‘‘(D)(i) for payment for services described
in subparagraph (C) of section 1905(a)(2)
under the plan furnished by an Indian tribe,
tribal organization, or urban Indian organiza-
301
tion (as defined in section 4 of the Indian
Health Care Improvement Act) of 100 percent
of costs which are reasonable and related to the
cost of furnishing such services or based on
other tests of reasonableness as the Secretary
prescribes 
in 
regulations 
under 
section
1833(a)(3), or, in the case of services to which
those regulations do not apply, the same meth-
odology used under section 1833(a)(3).
‘‘(ii) in carrying out clause (i) in the case
of services furnished by a federally qualified
health center that is operated by an Indian
tribe, tribal organization or urban Indian orga-
nization (as defined in section 4 of the Indian
Health Care Improvement Act) pursuant to a
contract between the center and an organization
under section 1903(m), for payment to the cen-
ter at least quarterly by the State of a supple-
mental payment equal to the amount (if any) by
which the amount determined under clause (i)
exceeds the amount of the payments provided
under such contract.’’.
(e) Section 1902(a) of the Social Security Act is
amended by adding at the end the following:
302
‘‘(66) if the Indian Health Service operates or
funds health programs in the State or if there are
Indian tribes, tribal organizations or urban Indian
organizations (as those terms are defined in section
4 of the Indian Health Care Improvement Act)
present in the State, provide for meaningful con-
sultation with such entities prior to the submission
of, and as a precondition of approval of, any pro-
posed amendment, waiver, demonstration project, or
other request that would have the effect of changing
any aspect of the State’s administration of the Med-
icaid program, provided that ‘meaningful consulta-
tion’ shall be defined through the negotiated rule-
making provided for under section 802 of the Indian
Health Care Improvement Act, provided that such
consultation must be carried out in collaboration
with the Indian Medicaid Advisory Committee estab-
lished under section 415(a)(3) of the Indian Health
Care Improvement Act.’’.
(f) The last sentence of section 1905(b) of the Social
Security Act is amended to read as follows: ‘‘Notwith-
standing the first sentence of this section, the Federal
medical assistance percentage shall be 100 percent with
respect to amounts expended as medical assistance for
services which are received through the Indian Health
303
Service or an Indian tribe, tribal organization, or urban
Indian organization (as defined in section 4 of the Indian
Health Care Improvement Act) under section 1911 of the
Social Security Act. ‘Through’ in this subsection shall in-
clude services provided directly, by referral, or under con-
tracts or other arrangements between the Indian Health
Service, Indian tribe, tribal organization, or urban Indian
organization and another health provider.’’.
(g) Section 1911 of the Social Security Act is amend-
ed to read as follows:
‘‘SEC. 1911. INDIAN HEALTH SERVICE PROGRAMS.
‘‘(a) The Indian Health Service and an Indian tribe,
tribal organization, or urban Indian 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 provides services or provider types of a type
otherwise covered under the State plan and meets the con-
ditions and requirements which are applicable generally to
the service for which it seeks reimbursement under this
title and for services provided by a qualified Indian health
program under section 1880A.
‘‘(b) Notwithstanding subsection (a), if the Indian
Health Service, an Indian tribe, or tribal organization,
which provides services of a type otherwise covered under
304
the State plan, does not meet all of the conditions and
requirements of this title which are applicable generally
to such services submits to the Secretary within 6 months
after the date on which it first sought reimbursement for
the service an acceptable plan for achieving compliance
with such conditions and requirements, it shall be deemed
to meet such conditions and requirements (and to be eligi-
ble for reimbursement under this title), without regard to
the extent of its actual compliance with such conditions
and requirements, during the first 12 months after the
month in which such plan is submitted.
‘‘(c) The Secretary is authorized to enter into agree-
ments with the State agency for the purpose of reimburs-
ing such agency for health care and services provided by
the Indian Health Service, Indian tribes, tribal organiza-
tions, and urban Indian organizations, directly, through
referral, or under contracts or other arrangements be-
tween the Indian Health Service, Indian tribe, tribal orga-
nization, or urban Indian organization and another health
provider to Indians who are eligible for medical assistance
under the State plan.’’.
(h) Section 2101(c) of the Social Security Act is
amended by adding at the end the following: ‘‘Without re-
gard to which option a State chooses under section
2101(a), the Federal medical assistance percentage shall
305
be 100 per centum with respect to amounts expended as
medical assistance for services which are provided through
a health program 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 Improve-
ment Act).’’.
SEC. 5. REPEAL OF FACILITIES SURVEY AND REPORTING
REQUIREMENT.
Subsections (a) and (b) of section 506 of P.L. 101–
630 are repealed.
Æ