351 
payments under this title with respect to items and serv-
ices furnished by the Program if the furnishing of such 
services meets all the conditions and requirements which 
are applicable generally to the furnishing of items and 
services under this title.’’. 
(2) REPEAL OF OBSOLETE PROVISION.—Sub-
section (b) of such section is repealed. 
(3) COMPLIANCE WITH CONDITIONS AND RE-
QUIREMENTS.—Subsection (b) of such section is 
amended to read as follows: 
‘‘(b) COMPLIANCE WITH CONDITIONS AND REQUIRE-
MENTS.—Subject to subsection (e), a facility of the Indian 
Health Service or an Indian Tribe, Tribal Organization, 
or an Urban Indian Organization which is eligible for pay-
ment under subsection (a) with respect to the furnishing 
of items and services, but which does not meet all of the 
conditions and requirements of this title which are applica-
ble generally to such facility, shall make such improve-
ments as are necessary to achieve or maintain compliance 
with such conditions and requirements in accordance with 
a plan submitted to and accepted by the Secretary for 
achieving or maintaining compliance with such conditions 
and requirements, and shall be deemed to meet such con-
ditions and requirements (and to be eligible for payment 
under this title), without regard to the extent of its actual 
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352 
compliance with such conditions and requirements, during 
the first 12 months after the month in which such plan 
is submitted.’’. 
(4) CROSS-REFERENCES TO SPECIAL FUND FOR 
IMPROVEMENT OF IHS FACILITIES; DIRECT BILLING 
OPTION; DEFINITIONS.— 
(A) IN GENERAL.—Such section is further 
amended by striking subsections (c) and (d) 
and inserting the following new subsections: 
‘‘(b) SPECIAL FUND FOR IMPROVEMENT OF IHS FA-
CILITIES.—For provisions relating to the authority of the 
Secretary to place payments to which a facility of the In-
dian Health Service is eligible for payment under this title 
into a special fund established under section 401(c)(1) of 
the Indian Health Care Improvement Act, and the require-
ment to use amounts paid from such fund for making im-
provements in accordance with subsection (b), see sub-
paragraphs (A) and (B) of section 401(c)(1) of such Act. 
‘‘(c) DIRECT BILLING.—For provisions relating to 
the authority of a Tribal Health Program to elect to di-
rectly bill for, and receive payment for, health care items 
and services provided by such Program for which payment 
is made under this title, see section 401(d) of the Indian 
Health Care Improvement Act.’’. 
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353 
(B) CONFORMING
AMENDMENTS.—Such 
section is further amended— 
(i) in subsection (e)(3), by striking 
‘‘Subsection (c)’’ and inserting ‘‘Subsection 
(b) and section 401(b)(1) of the Indian 
Health Care Improvement Act’’; 
(ii) by redesignating subsection (e) as 
subsection (d); and 
(iii) by striking subsection (f). 
(5) DEFINITIONS.—Such section is further 
amended by amending subsection (f) to read as fol-
lows: 
‘‘(f) DEFINITIONS.—In this section, the terms ‘In-
dian Health Program’, ‘Indian Tribe’, ‘Service Unit’, 
‘Tribal Health Program’, ‘Tribal Organization’, and 
‘Urban Indian Organization’ have the meanings given 
those terms in section 4 of the Indian Health Care Im-
provement Act.’’. 
(c) APPLICATION TO SCHIP.—Section 2107(e)(1) of 
the Social Security Act (42 U.S.C. 1397gg(e)(1)) is 
amended— 
(1) by redesignating subparagraph (D) as sub-
paragraph (E); and 
(2) by inserting after subparagraph (C), the fol-
lowing new subparagraph: 
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354 
‘‘(D) Section 1911 (relating to Indian 
Health Programs, other than subsection (c) of 
such section).’’. 
SEC. 202. INCREASED OUTREACH TO INDIANS UNDER MED-
ICAID AND SCHIP AND IMPROVED COOPERA-
TION IN THE PROVISION OF ITEMS AND 
SERVICES TO INDIANS UNDER SOCIAL SECU-
RITY ACT HEALTH BENEFIT PROGRAMS. 
Section 1139 of the Social Security Act (42 U.S.C. 
1320b–9) is amended to read as follows: 
‘‘SEC. 1139. IMPROVED ACCESS TO, AND DELIVERY OF, 
HEALTH CARE FOR INDIANS UNDER TITLES 
XVIII, XIX, AND XXI. 
‘‘(a) AGREEMENTS WITH STATES
FOR MEDICAID 
AND SCHIP OUTREACH ON OR NEAR RESERVATIONS TO 
INCREASE
THE ENROLLMENT
OF INDIANS
IN THOSE 
PROGRAMS.— 
‘‘(1) IN GENERAL.—In order to improve the ac-
cess of Indians residing on or near a reservation to 
obtain benefits under the Medicaid and State chil-
dren’s health insurance programs established under 
titles XIX and XXI, the Secretary, acting through 
the Centers for Medicare & Medicaid Services, shall 
encourage each State with all or part of a reserva-
tion within its borders to take steps to provide for 
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355 
enrollment on or near such reservations. Such steps 
may 
include 
outreach 
efforts 
such 
as 
the 
outstationing of eligibility workers, entering into 
agreements with the Indian Health Service, Indian 
Tribes, Tribal Organizations, and urban Indian or-
ganizations to provide outreach, education regarding 
eligibility and benefits, enrollment, and translation 
services when such services are appropriate. 
‘‘(2) CONSTRUCTION.—Nothing in paragraph 
(1) shall be construed as affecting arrangements en-
tered into between States and the Indian Health 
Service, Indian Tribes, Tribal Organizations, or 
urban Indian organizations for such Service, Tribes, 
or Organizations to conduct administrative activities 
under such titles. 
‘‘(b) FACILITATING COOPERATION IN ENROLLMENT 
AND RETENTION.—The Secretary, acting through the 
Centers for Medicare & Medicaid Services, shall consult 
with States, the Service, Indian Tribes, Tribal Organiza-
tions, and urban Indian organizations to develop and dis-
seminate best practices with respect to facilitating agree-
ments between the States and Indian Tribes, Tribal Orga-
nizations, and urban Indian organizations relating to en-
rollment and retention of Indians in programs established 
under titles XVIII, XIX, and XXI. 
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356 
‘‘(c) DEFINITION OF INDIAN; INDIAN TRIBE; INDIAN 
HEALTH PROGRAM; TRIBAL ORGANIZATION; URBAN IN-
DIAN ORGANIZATION.—In this section, the terms ‘Indian’, 
‘Indian Tribe’, ‘Indian Health Program’, ‘Tribal Organi-
zation’, and ‘Urban Indian Organization’ have the mean-
ings given those terms in section 4 of the Indian Health 
Care Improvement Act.’’. 
SEC. 203. ADDITIONAL PROVISIONS TO INCREASE OUT-
REACH TO, AND ENROLLMENT OF, INDIANS 
IN SCHIP AND MEDICAID. 
(a) ASSURANCE OF PAYMENTS TO INDIAN HEALTH 
CARE PROVIDERS FOR CHILD HEALTH ASSISTANCE.— 
Section 
2102(b)(3)(D) 
of 
such 
Act 
(42 
U.S.C. 
1397bb(b)(3)(D)) is amended by striking ‘‘(as defined in 
section 4(c) of the Indian Health Care Improvement Act, 
25 U.S.C. 1603(c))’’ and inserting ‘‘, including how the 
State will ensure that payments are made to Indian 
Health Programs and urban Indian organizations oper-
ating in the State for the provision of such assistance’’. 
(b) INCLUSION
OF
OTHER
INDIAN
FINANCED 
HEALTH CARE PROGRAMS IN EXEMPTION FROM PROHI-
BITION ON CERTAIN PAYMENTS.—Section 2105(c)(6)(B) 
of such Act (42 U.S.C. 1397ee(c)(6)(B)) is amended by 
striking ‘‘insurance program, other than an insurance pro-
gram operated or financed by the Indian Health Service’’ 
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359 
the entity obtains a license or other documenta-
tion under such State or local law. In accord-
ance with section 221 of the Indian Health 
Care Improvement Act, the absence of the licen-
sure of a health care professional employed by 
such an entity under the State or local law 
where the entity is located shall not be taken 
into account for purposes of determining wheth-
er the entity meets such standards, if the pro-
fessional is licensed in another State. 
‘‘(2) PROHIBITION ON FEDERAL PAYMENTS TO 
ENTITIES OR INDIVIDUALS EXCLUDED FROM PAR-
TICIPATION IN FEDERAL HEALTH CARE PROGRAMS 
OR WHOSE STATE LICENSES ARE UNDER SUSPEN-
SION OR HAVE BEEN REVOKED.— 
‘‘(A) EXCLUDED ENTITIES.—No entity op-
erated by the Indian Health Service, an Indian 
Tribe, Tribal Organization, or Urban Indian 
Organization that has been excluded from par-
ticipation in any Federal health care program 
or for which a license is under suspension or 
has been revoked by the State where the entity 
is located shall be eligible to receive payment 
under any such program for health care serv-
ices furnished to an Indian. 
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360 
‘‘(B) EXCLUDED INDIVIDUALS.—No indi-
vidual who has been excluded from participation 
in any Federal health care program or whose 
State license is under suspension or has been 
revoked shall be eligible to receive payment 
under any such program for health care serv-
ices furnished by that individual, directly or 
through an entity that is otherwise eligible to 
receive payment for health care services, to an 
Indian. 
‘‘(C) FEDERAL
HEALTH
CARE
PROGRAM 
DEFINED.—In this subsection, the term, ‘Fed-
eral health care program’ has the meaning 
given that term in section 1128B(f), except 
that, for purposes of this subsection, such term 
shall include the health insurance program 
under chapter 89 of title 5, United States 
Code.’’. 
SEC. 205. SOLICITATION OF PROPOSALS FOR SAFE HAR-
BORS UNDER THE SOCIAL SECURITY ACT 
FOR FACILITIES OF INDIAN HEALTH PRO-
GRAMS AND URBAN INDIAN ORGANIZATIONS. 
The Secretary of Health and Human Services, acting 
through the Office of the Inspector General of the Depart-
ment of Health and Human Services, shall publish a no-
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361 
tice, described in section 1128D(a)(1)(A) of the Social Se-
curity Act (42 U.S.C. 1320a–7d(a)(1)(A)), soliciting a 
proposal, not later than July 1, 2010, on the development 
of safe harbors described in such section relating to health 
care items and services provided by facilities of Indian 
Health Programs or an urban Indian organization (as 
such terms are defined in section 4 of the Indian Health 
Care Improvement Act). Such a safe harbor may relate 
to areas such as transportation, housing, or cost-sharing, 
assistance provided through such facilities or contract 
health services for Indians. 
SEC. 206. ANNUAL REPORT ON INDIANS SERVED BY SOCIAL 
SECURITY ACT HEALTH BENEFIT PROGRAMS. 
Section 1139 of the Social Security Act (42 U.S.C. 
1320b–9), as amended by the sections 202, 205, and 206, 
is amended by redesignating subsection (e) as subsection 
(f), and inserting after subsection (d) the following new 
subsection: 
‘‘(e) ANNUAL REPORT
ON INDIANS SERVED
BY 
HEALTH BENEFIT PROGRAMS FUNDED UNDER THIS 
ACT.—Beginning January 1, 2007, and annually there-
after, the Secretary, acting through the Administrator of 
the Centers for Medicare & Medicaid Services and the Di-
rector of the Indian Health Service, shall submit a report 
to Congress regarding the enrollment and health status 
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362 
of Indians receiving items or services under health benefit 
programs funded under this Act during the preceding 
year. Each such report shall include the following: 
‘‘(1) The total number of Indians enrolled in, or 
receiving items or services under, such programs, 
disaggregated with respect to each such program. 
‘‘(2) The number of Indians described in para-
graph (1) that also received health benefits under 
programs funded by the Indian Health Service. 
‘‘(3) General information regarding the health 
status of the Indians described in paragraph (1), 
disaggregated with respect to specific diseases or 
conditions and presented in a manner that is con-
sistent with protections for privacy of individually 
identifiable health information under section 264(c) 
of the Health Insurance Portability and Account-
ability Act of 1996. 
‘‘(4) A detailed statement of the status of facili-
ties of the Indian Health Service or an Indian Tribe, 
Tribal Organization, or an Urban Indian Organiza-
tion with respect to such facilities’ compliance with 
the applicable conditions and requirements of titles 
XVIII, XIX, and XXI, and, in the case of title XIX 
or XXI, under a State plan under such title or 
under waiver authority, and of the progress being 
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363 
made by such facilities (under plans submitted 
under section 1880(b), 1911(b) or otherwise) toward 
the achievement and maintenance of such compli-
ance. 
‘‘(5) Such other information as the Secretary 
determines is appropriate.’’. 
SEC. 207. DEVELOPMENT OF RECOMMENDATIONS TO IM-
PROVE INTERSTATE COORDINATION OF MED-
ICAID AND SCHIP COVERAGE OF INDIAN 
CHILDREN AND OTHER CHILDREN WHO ARE 
OUTSIDE OF THEIR STATE OF RESIDENCY BE-
CAUSE OF EDUCATIONAL OR OTHER NEEDS. 
(a) STUDY.—The Secretary shall conduct a study to 
identify barriers to interstate coordination of enrollment 
and coverage under the Medicaid program under title XIX 
of the Social Security Act and the State Children’s Health 
Insurance Program under title XXI of such Act of chil-
dren who are eligible for medical assistance or child health 
assistance under such programs and who, because of edu-
cational needs, migration of families, emergency evacu-
ations, or otherwise, frequently change their State of resi-
dency or otherwise are temporarily present outside of the 
State of their residency. Such study shall include an exam-
ination of the enrollment and coverage coordination issues 
faced by Indian children who are eligible for medical as-
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