190 
ery under this section if the injury, illness, or disability 
for which health services were provided is covered under 
a self-insurance plan funded by an Indian Tribe, Tribal 
Organization, or Urban Indian Organization. Where such 
authorization is provided, the Service may receive and ex-
pend such amounts for the provision of additional health 
services consistent with such authorization. 
‘‘(g) COSTS AND ATTORNEYS’ FEES.—In any action 
brought to enforce the provisions of this section, a pre-
vailing plaintiff shall be awarded its reasonable attorneys’ 
fees and costs of litigation. 
‘‘(h) NONAPPLICATION OF CLAIMS FILING REQUIRE-
MENTS.—An insurance company, health maintenance or-
ganization, self-insurance plan, managed care plan, or 
other health care plan or program (under the Social Secu-
rity Act or otherwise) may not deny a claim for benefits 
submitted by the Service or by an Indian Tribe or Tribal 
Organization based on the format in which the claim is 
submitted if such format complies with the format re-
quired for submission of claims under title XVIII of the 
Social Security Act or recognized under section 1175 of 
such Act. 
‘‘(i) APPLICATION
TO URBAN INDIAN ORGANIZA-
TIONS.—The previous provisions of this section shall apply 
to Urban Indian Organizations with respect to populations 
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CCOLEMAN on PROD1PC71 with BILLS
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served by such Organizations in the same manner they 
apply to Indian Tribes and Tribal Organizations with re-
spect to populations served by such Indian Tribes and 
Tribal Organizations. 
‘‘(j) STATUTE OF LIMITATIONS.—The provisions of 
section 2415 of title 28, United States Code, shall apply 
to all actions commenced under this section, and the ref-
erences therein to the United States are deemed to include 
Indian Tribes, Tribal Organizations, and Urban Indian 
Organizations. 
‘‘(k) SAVINGS.—Nothing in this section shall be con-
strued to limit any right of recovery available to the 
United States, an Indian Tribe, or Tribal Organization 
under the provisions of any applicable, Federal, State, or 
Tribal law, including medical lien laws and the Federal 
Medical Care Recovery Act (42 U.S.C. 2651 et seq.). 
‘‘SEC. 404. CREDITING OF REIMBURSEMENTS. 
‘‘(a) USE OF AMOUNTS.— 
‘‘(1) RETENTION BY PROGRAM.—Except as pro-
vided in section 202(g) (relating to the Catastrophic 
Health Emergency Fund) and section 807 (relating 
to health services for ineligible persons), all reim-
bursements received or recovered under any of the 
programs described in paragraph (2), including 
under section 807, by reason of the provision of 
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CCOLEMAN on PROD1PC71 with BILLS
192 
health services by the Service, by an Indian Tribe or 
Tribal Organization, or by an Urban Indian Organi-
zation, shall be credited to the Service, such Indian 
Tribe or Tribal Organization, or such Urban Indian 
Organization, respectively, and may be used as pro-
vided in section 401. In the case of such a service 
provided by or through a Service Unit, such 
amounts shall be credited to such unit and used for 
such purposes. 
‘‘(2) PROGRAMS COVERED.—The programs re-
ferred to in paragraph (1) are the following: 
‘‘(A) Titles XVIII, XIX, and XXI of the 
Social Security Act. 
‘‘(B) This Act, including section 807. 
‘‘(C) Public Law 87–693. 
‘‘(D) Any other provision of law, including 
the Federal Medical Cost Recovery Act (42 
U.S.C. 2651–2653). 
‘‘(b) NO OFFSET OF AMOUNTS.—The Service may 
not offset or limit any amount obligated to any Service 
Unit or entity receiving funding from the Service because 
of the receipt of reimbursements under subsection (a). 
‘‘SEC. 405. PURCHASING HEALTH CARE COVERAGE. 
‘‘(a) IN GENERAL.—Insofar as amounts are made 
available under law (including a provision of the Social 
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CCOLEMAN on PROD1PC71 with BILLS
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Security Act, the Indian Self-Determination and Edu-
cation Assistance Act (25 U.S.C. 450 et seq.), or other 
law, other than under section 402) to Indian Tribes, Trib-
al Organizations, and Urban Indian Organizations for 
health benefits for Service beneficiaries, Indian Tribes, 
Tribal Organizations, and Urban Indian Organizations 
may use such amounts to purchase health benefits cov-
erage for such beneficiaries in any manner, including 
through— 
‘‘(1) a tribally owned and operated health care 
plan; 
‘‘(2) a State or locally authorized or licensed 
health care plan; 
‘‘(3) a health insurance provider or managed 
care organization; or 
‘‘(4) a self-insured plan. 
The purchase of such coverage by an Indian Tribe, Tribal 
Organization, or Urban Indian Organization may be based 
on the financial needs of such beneficiaries (as determined 
by the Indian Tribe or Tribes being served based on a 
schedule of income levels developed or implemented by 
such Indian Tribe or Tribes). 
‘‘(b) EXPENSES FOR SELF-INSURED PLAN.—In the 
case of a self-insured plan under subsection (a)(4), the 
amounts may be used for expenses of operating the plan, 
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CCOLEMAN on PROD1PC71 with BILLS
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including administration and insurance to limit the finan-
cial risks to the entity offering the plan. 
‘‘(c) CONSTRUCTION.—Nothing in this section shall 
be construed as affecting the use of any amounts not re-
ferred to in subsection (a). 
‘‘SEC. 406. SHARING ARRANGEMENTS WITH FEDERAL AGEN-
CIES. 
‘‘(a) AUTHORITY.— 
‘‘(1) IN GENERAL.—The Secretary may enter 
into (or expand) arrangements for the sharing of 
medical facilities and services between the Service, 
Indian Tribes, and Tribal Organizations and the De-
partment of Veterans Affairs and the Department of 
Defense. 
‘‘(2) 
CONSULTATION
BY
SECRETARY
RE-
QUIRED.—The Secretary may not finalize any ar-
rangement between the Service and a Department 
described in paragraph (1) without first consulting 
with the Indian Tribes which will be significantly af-
fected by the arrangement. 
‘‘(b) LIMITATIONS.—The Secretary shall not take 
any action under this section or under subchapter IV of 
chapter 81 of title 38, United States Code, which would 
impair— 
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CCOLEMAN on PROD1PC71 with BILLS
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‘‘(1) the priority access of any Indian to health 
care services provided through the Service and the 
eligibility of any Indian to receive health services 
through the Service; 
‘‘(2) the quality of health care services provided 
to any Indian through the Service; 
‘‘(3) the priority access of any veteran to health 
care services provided by the Department of Vet-
erans Affairs; 
‘‘(4) the quality of health care services provided 
by the Department of Veterans Affairs or the De-
partment of Defense; or 
‘‘(5) the eligibility of any Indian who is a vet-
eran to receive health services through the Depart-
ment of Veterans Affairs. 
‘‘(c) REIMBURSEMENT.—The Service, Indian Tribe, 
or Tribal Organization shall be reimbursed by the Depart-
ment of Veterans Affairs or the Department of Defense 
(as the case may be) where services are provided through 
the Service, an Indian Tribe, or a Tribal Organization to 
beneficiaries eligible for services from either such Depart-
ment, notwithstanding any other provision of law. 
‘‘(d) CONSTRUCTION.—Nothing in this section may 
be construed as creating any right of a non-Indian veteran 
to obtain health services from the Service. 
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CCOLEMAN on PROD1PC71 with BILLS
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‘‘SEC. 407. PAYOR OF LAST RESORT. 
‘‘Indian Health Programs and health care programs 
operated by Urban Indian Organizations shall be the 
payor of last resort for services provided to persons eligible 
for services from Indian Health Programs and Urban In-
dian Organizations, notwithstanding any Federal, State, 
or local law to the contrary. 
‘‘SEC. 408. NONDISCRIMINATION IN QUALIFICATIONS FOR 
REIMBURSEMENT FOR SERVICES. 
‘‘For purposes of determining the eligibility of an en-
tity that is operated by the Service, an Indian Tribe, Trib-
al Organization, or Urban Indian Organization to receive 
payment or reimbursement from any federally funded 
health care program for health care services the entity fur-
nishes such program must provide that such entity, meet-
ing generally applicable State or other requirements appli-
cable for participation, must be accepted as a provider on 
the same basis as any other qualified provider, except that 
any requirement that the entity be licensed or recognized 
under State or local law to furnish such services shall be 
deemed to have been met if the entity meets all the appli-
cable standards for such licensure, but the entity need not 
obtain a license or other documentation. In determining 
whether the entity meets such standards, the absence of 
licensure issued by the state in which the entity is located 
of any staff member of the entity may not be taken into 
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CCOLEMAN on PROD1PC71 with BILLS
197 
account, so long as such staff member holds a valid license 
in any state. 
‘‘SEC. 409. CONSULTATION. 
‘‘(a) 
TRIBAL
TECHNICAL
ADVISORY
GROUP 
(TTAG).—The Secretary shall maintain within the Cen-
ters for Medicaid & Medicare Services (CMS) a Tribal 
Technical Advisory Group, established in accordance with 
requirements of the charter dated September 30, 2003, 
and in such group shall include a representative of the 
Urban Indian Organizations and the Service. The rep-
resentative of the Urban Indian Organization shall be 
deemed to be an elected officer of a tribal government for 
purposes of applying section 204(b) of the Unfunded Man-
dates Reform Act of 1995 (2 U.S.C. 1534(b)). 
‘‘(b) SOLICITATION OF MEDICAID ADVICE.— 
‘‘(1) IN GENERAL.—As part of its plan under 
title XIX of the Social Security Act, a State in 
which the Service operates or funds health care pro-
grams, or in which 1 or more Indian Health Pro-
grams or Urban Indian Organizations provide health 
care in the State for which medical assistance is 
available under such title, may establish a process 
under which the State seeks advice on a regular, on-
going basis from designees of such Indian Health 
Programs and Urban Indian Organizations on mat-
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CCOLEMAN on PROD1PC71 with BILLS
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ters relating to the application of such title to and 
likely to have a direct effect on such Indian Health 
Programs and Urban Indian Organizations. 
‘‘(2) MANNER
OF
ADVICE.—The process de-
scribed in paragraph (1) should include solicitation 
of advice prior to submission of any plan amend-
ments, waiver requests, and proposals for dem-
onstration projects likely to have a direct effect on 
Indians, Indian Health Programs, or Urban Indian 
Organizations. Such process may include appoint-
ment of an advisory committee and of a designee of 
such Indian Health Programs and Urban Indian Or-
ganizations to the medical care advisory committee 
advising the State on its medicaid plan. 
‘‘(3) PAYMENT OF EXPENSES.—The reasonable 
expenses of carrying out this subsection shall be eli-
gible for reimbursement under section 1903(a) of 
the Social Security Act. 
‘‘(c) CONSTRUCTION.—Nothing in this section shall 
be construed as superseding existing advisory committees, 
working groups, or other advisory procedures established 
by the Secretary or by any State. 
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CCOLEMAN on PROD1PC71 with BILLS
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‘‘SEC. 410. STATE CHILDREN’S HEALTH INSURANCE PRO-
GRAM (SCHIP). 
‘‘(a) OPTIONAL USE OF FUNDS FOR INDIAN HEALTH 
PROGRAM PAYMENTS.—Subject to the succeeding provi-
sions of this section, a State may provide under its State 
child health plan under title XXI of the Social Security 
Act (regardless of whether such plan is implemented under 
such title, title XIX of such Act, or both) for payments 
under this section to Indian Health Programs and Urban 
Indian Organizations operating in the State. Such pay-
ments shall be treated under title XXI of the Social Secu-
rity 
Act 
as 
expenditures 
described 
in 
section 
2105(a)(1)(A) of such Act. 
‘‘(b) USE OF FUNDS.—Payments under this section 
may be used only for expenditures described in clauses (i) 
through (iii) of section 2105(a)(1)(D) of the Social Secu-
rity Act for targeted low-income children or other low-in-
come children (as defined in 2110 of such Act) who are— 
‘‘(1) Indians; or 
‘‘(2) otherwise eligible for health services from 
the Indian Health Program involved. 
‘‘(c) SPECIAL RESTRICTIONS.—The following condi-
tions apply to a State electing to provide payments under 
this section: 
‘‘(1) NO LIMITATION ON OTHER SCHIP PARTICI-
PATION OF, OR PROVIDER PAYMENTS TO, INDIAN 
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CCOLEMAN on PROD1PC71 with BILLS
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HEALTH PROGRAMS.—The State may not exclude or 
limit participation of otherwise eligible Indian 
Health Programs in its State child health program 
under title XXI of the Social Security Act or its 
medicaid program under title XIX of such Act or 
pay such Programs less than they otherwise would 
as participating providers on the basis that pay-
ments are made to such Programs under this sec-
tion. 
‘‘(2) NO LIMITATION ON OTHER SCHIP ELIGI-
BILITY OF INDIANS.—The State may not exclude or 
limit participation of otherwise eligible Indian chil-
dren in such State child health or medicaid program 
on the basis that payments are made for assistance 
for such children under this section. 
‘‘(3) LIMITATION
ON
ACCEPTANCE
OF
CON-
TRIBUTIONS.— 
‘‘(A) IN GENERAL.—The State may not ac-
cept contributions or condition making of pay-
ments under this section upon contribution of 
funds from any Indian Health Program to meet 
the State’s non-Federal matching fund require-
ments under titles XIX and XXI of the Social 
Security Act. 
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