637 
HR 1 EAS 
SEC. 3302. RULES APPLICABLE UNDER MEDICAID AND CHIP 
TO MANAGED CARE ENTITIES WITH RESPECT 
TO INDIAN ENROLLEES AND INDIAN HEALTH 
CARE PROVIDERS AND INDIAN MANAGED 
CARE ENTITIES. 
(a) IN GENERAL.—Section 1932 of the Social Security 
Act (42 U.S.C. 1396u–2) is amended by adding at the end 
the following new subsection: 
‘‘(h) SPECIAL RULES WITH RESPECT TO INDIAN EN-
ROLLEES, INDIAN HEALTH CARE PROVIDERS, AND INDIAN 
MANAGED CARE ENTITIES.— 
‘‘(1) ENROLLEE OPTION TO SELECT AN INDIAN 
HEALTH
CARE
PROVIDER
AS
PRIMARY
CARE
PRO-
VIDER.—In the case of a non-Indian Medicaid man-
aged care entity that— 
‘‘(A) has an Indian enrolled with the entity; 
and 
‘‘(B) has an Indian health care provider 
that is participating as a primary care provider 
within the network of the entity, 
insofar as the Indian is otherwise eligible to receive 
services from such Indian health care provider and 
the Indian health care provider has the capacity to 
provide primary care services to such Indian, the con-
tract with the entity under section 1903(m) or under 
section 1905(t)(3) shall require, as a condition of re-
638 
HR 1 EAS 
ceiving payment under such contract, that the Indian 
shall be allowed to choose such Indian health care 
provider as the Indian’s primary care provider under 
the entity. 
‘‘(2) ASSURANCE
OF
PAYMENT
TO
INDIAN 
HEALTH CARE PROVIDERS FOR PROVISION OF COV-
ERED
SERVICES.—Each contract with a managed 
care entity under section 1903(m) or under section 
1905(t)(3) shall require any such entity, as a condi-
tion of receiving payment under such contract, to sat-
isfy the following requirements: 
‘‘(A) DEMONSTRATION
OF
ACCESS
TO
IN-
DIAN HEALTH CARE PROVIDERS AND APPLICA-
TION
OF
ALTERNATIVE
PAYMENT
ARRANGE-
MENTS.—Subject to subparagraph (C), to— 
‘‘(i) demonstrate that the number of 
Indian health care providers that are par-
ticipating providers with respect to such en-
tity are sufficient to ensure timely access to 
covered Medicaid managed care services for 
those Indian enrollees who are eligible to re-
ceive services from such providers; and 
‘‘(ii) agree to pay Indian health care 
providers, whether such providers are par-
ticipating or nonparticipating providers
639 
HR 1 EAS 
with respect to the entity, for covered Med-
icaid managed care services provided to 
those Indian enrollees who are eligible to re-
ceive services from such providers at a rate 
equal to the rate negotiated between such 
entity and the provider involved or, if such 
a rate has not been negotiated, at a rate 
that is not less than the level and amount 
of payment which the entity would make for 
the services if the services were furnished by 
a participating provider which is not an 
Indian health care provider. 
‘‘(B) PROMPT PAYMENT.—To agree to make 
prompt payment (consistent with rule for 
prompt payment of providers under section 
1932(f)) to Indian health care providers that are 
participating providers with respect to such enti-
ty or, in the case of an entity to which subpara-
graph (A)(ii) or (C) applies, that the entity is 
required to pay in accordance with that sub-
paragraph. 
‘‘(C) APPLICATION
OF
SPECIAL
PAYMENT 
REQUIREMENTS
FOR
FEDERALLY-QUALIFIED 
HEALTH CENTERS AND FOR SERVICES PROVIDED 
BY CERTAIN INDIAN HEALTH CARE PROVIDERS.—
640 
HR 1 EAS 
‘‘(i) FEDERALLY-QUALIFIED
HEALTH 
CENTERS.— 
‘‘(I) MANAGED CARE ENTITY PAY-
MENT REQUIREMENT.—To agree to pay 
any Indian health care provider that 
is a federally-qualified health center 
under this title but not a participating 
provider with respect to the entity, for 
the provision of covered Medicaid man-
aged care services by such provider to 
an Indian enrollee of the entity at a 
rate equal to the amount of payment 
that the entity would pay a federally- 
qualified health center that is a par-
ticipating provider with respect to the 
entity but is not an Indian health care 
provider for such services. 
‘‘(II) CONTINUED APPLICATION OF 
STATE
REQUIREMENT
TO
MAKE
SUP-
PLEMENTAL
PAYMENT.—Nothing 
in 
subclause (I) or subparagraph (A) or 
(B) shall be construed as waiving the 
application of section 1902(bb)(5) re-
garding the State plan requirement to 
make any supplemental payment due
641 
HR 1 EAS 
under such section to a federally-quali-
fied health center for services furnished 
by such center to an enrollee of a man-
aged care entity (regardless of whether 
the federally-qualified health center is 
or is not a participating provider with 
the entity). 
‘‘(ii) PAYMENT
RATE
FOR
SERVICES 
PROVIDED
BY
CERTAIN
INDIAN
HEALTH 
CARE PROVIDERS.—If the amount paid by a 
managed care entity to an Indian health 
care provider that is not a federally-quali-
fied health center for services provided by 
the provider to an Indian enrollee with the 
managed care entity is less than the rate 
that applies to the provision of such services 
by the provider under the State plan, the 
plan shall provide for payment to the In-
dian health care provider, whether the pro-
vider is a participating or nonparticipating 
provider with respect to the entity, of the 
difference between such applicable rate and 
the amount paid by the managed care enti-
ty to the provider for such services.