1985 
SEC. 3202. 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 the Social Security Act (42 
U.S.C. 1397bb(b)(3)(D)) is amended by striking ‘‘(as de-
fined in section 4(c) of the Indian Health Care Improve-
ment Act, 25 U.S.C. 1603(c))’’ and inserting ‘‘, including 
how the State will ensure that payments are made to In-
dian Health Programs and urban Indian organizations op-
erating 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’’ 
and inserting ‘‘program, other than a health care program 
operated or financed by the Indian Health Service or by 
an Indian Tribe, Tribal Organization, or urban Indian or-
ganization’’. 
(c) DEFINITIONS.—Section 2110(c) of such Act (42 
U.S.C. 1397jj(c)) is amended by adding at the end the 
following new paragraph: 
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1986 
‘‘(9) INDIAN; INDIAN
HEALTH
PROGRAM; IN-
DIAN
TRIBE; ETC.—The terms ‘Indian’, ‘Indian 
Health Program’, ‘Indian Tribe’, ‘Tribal Organiza-
tion’, and ‘Urban Indian Organization’ have the 
meanings given those terms in section 4 of the In-
dian Health Care Improvement Act.’’. 
SEC. 3203. 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-
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. 
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1987 
SEC. 3204. ANNUAL REPORT ON INDIANS SERVED BY SO-
CIAL SECURITY ACT HEALTH BENEFIT PRO-
GRAMS. 
Section 1139 of the Social Security Act (42 U.S.C. 
1320b–9), as amended by the sections 3203 and 3204, 
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, 2011, 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 
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), 
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1988 
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 
made by such facilities (under plans submitted 
under 1911(b) or otherwise) toward the achievement 
and maintenance of such compliance. 
‘‘(5) Such other information as the Secretary 
determines is appropriate.’’. 
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1989 
SEC. 3205. 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-
sistance or child health assistance under such programs 
in their State of residence and who temporarily reside in 
an out-of-State boarding school or peripheral dormitory 
funded by the Bureau of Indian Affairs. 
(b) REPORT.—Not later than 18 months after the 
date of enactment of this Act, the Secretary, in consulta-
tion with directors of State Medicaid programs under title 
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