201 
‘‘(B) CONTRIBUTION DEFINED.—For pur-
poses of subparagraph (A), the term ‘contribu-
tion’ includes any tax, donation, fee, or other 
payment made, whether made voluntarily or in-
voluntarily. 
‘‘(d) APPLICATION OF SEPARATE 10 PERCENT LIMI-
TATION.—Payment may be made under section 2105(a) 
of the Social Security Act to a State for a fiscal year for 
payments under this section up to an amount equal to 10 
percent of the total amount available under title XXI of 
such Act (including allotments and reallotments available 
from previous fiscal years) to the State with respect to 
the fiscal year. 
‘‘(e) GENERAL TERMS.—A payment under this sec-
tion shall only be made upon application to the State from 
the Indian Health Program involved and under such terms 
and conditions, and in a form and manner, as the Sec-
retary determines appropriate. 
‘‘SEC. 411. SOCIAL SECURITY ACT SANCTIONS. 
‘‘(a) REQUESTS FOR WAIVER OF SANCTIONS.— 
‘‘(1) IN GENERAL.—For purposes of applying 
any authority under a provision of title XI, XVIII, 
XIX, or XXI of the Social Security Act to seek a 
waiver of a sanction imposed against a health care 
provider insofar as that provider provides services to 
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CCOLEMAN on PROD1PC71 with BILLS
202 
individuals through an Indian Health Program, the 
Indian Health Program shall request the State to 
seek such waiver, and if such State has not sought 
the waiver within 60 days of the Indian Health Pro-
gram request, the Indian Health Program itself may 
petition the Secretary for such waiver. 
‘‘(2) PROCEDURE.—In seeking a waiver under 
paragraph (1), the Indian Health Program must 
provide notice and a copy of the request, including 
the reasons for the waiver sought, to the State. The 
Secretary may consider the State’s views in the de-
termination of the waiver request, but may not with-
hold or delay a determination based on the lack of 
the State’s views. 
‘‘(b) SAFE HARBOR FOR TRANSACTIONS BETWEEN 
AND AMONG INDIAN HEALTH CARE PROGRAMS.—For 
purposes of applying section 1128B(b) of the Social Secu-
rity Act, the exchange of anything of value between or 
among the following shall not be treated as remuneration 
if the exchange arises from or relates to any of the fol-
lowing health programs: 
‘‘(1) An exchange between or among the fol-
lowing: 
‘‘(A) Any Indian Health Program. 
‘‘(B) Any Urban Indian Organization. 
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CCOLEMAN on PROD1PC71 with BILLS
203 
‘‘(2) An exchange between an Indian Tribe, 
Tribal Organization, or an Urban Indian Organiza-
tion and any patient served or eligible for service 
from an Indian Tribe, Tribal Organization, or 
Urban Indian Organization, including patients 
served or eligible for service pursuant to section 807, 
but only if such exchange— 
‘‘(A) is for the purpose of transporting the 
patient for the provision of health care items or 
services; 
‘‘(B) is for the purpose of providing hous-
ing to the patient (including a pregnant pa-
tient) and immediate family members or an es-
cort incidental to assuring the timely provision 
of health care items and services to the patient; 
‘‘(C) is for the purpose of paying pre-
miums, copayments, deductibles, or other cost- 
sharing on behalf of patients; or 
‘‘(D) consists of an item or service of small 
value that is provided as a reasonable incentive 
to secure timely and necessary preventive and 
other items and services. 
‘‘(3) Other exchanges involving an Indian 
Health Program, an Urban Indian Organization, or 
an Indian Tribe or Tribal Organization that meet 
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CCOLEMAN on PROD1PC71 with BILLS
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such standards as the Secretary of Health and 
Human Services, in consultation with the Attorney 
General, determines is appropriate, taking into ac-
count the special circumstances of such Indian 
Health Programs, Urban Indian Organizations, In-
dian Tribes, and Tribal Organizations and of pa-
tients served by Indian Health Programs, Urban In-
dian Organizations, Indian Tribes, and Tribal Orga-
nizations. 
‘‘SEC. 412. COST SHARING. 
‘‘(a) 
COINSURANCE, 
COPAYMENTS, 
AND 
DEDUCTIBLES.—Notwithstanding any other provision of 
Federal or State law— 
‘‘(1) PROTECTION
FOR
ELIGIBLE
INDIANS 
UNDER
SOCIAL
SECURITY
ACT
HEALTH
PRO-
GRAMS.—No Indian who is furnished an item or 
service for which payment may be made under title 
XIX or XXI of the Social Security Act may be 
charged a deductible, copayment, or coinsurance if 
the item or service is furnished by, or upon referral 
made by, the Service, and Indian Tribe, Tribal Or-
ganization, or Urban Indian Organization. 
‘‘(2) PROTECTION
FOR
INDIANS.—No Indian 
who is furnished an item or service by the Service 
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CCOLEMAN on PROD1PC71 with BILLS
205 
may be charged a deductible, copayment, or coinsur-
ance. 
‘‘(3) NO REDUCTION IN AMOUNT OF PAYMENT 
TO INDIAN HEALTH PROVIDERS.—The payment or 
reimbursement due to the Service, Indian Tribe, 
Tribal Organization, or Urban Indian Organization 
under title XIX or XXI of the Social Security Act 
may not be reduced by the amount of the deductible, 
copayment, or coinsurance that would be due from 
the Indian but for the operation of this section. 
‘‘(b) EXEMPTION FROM MEDICAID AND SCHIP PRE-
MIUMS.—Notwithstanding any other provision of Federal 
or State law, no Indian who is otherwise eligible for serv-
ices under title XIX of the Social Security Act (relating 
to the medicaid program) or title XXI of such Act (relat-
ing to the State children’s health insurance program) may 
be charged a premium, enrollment fee, or similar charge 
as a condition of receiving benefits under the program 
under the respective title. 
‘‘(c) TREATMENT OF CERTAIN PROPERTY FOR MED-
ICAID ELIGIBILITY.—Notwithstanding any other provision 
of Federal or State law, the following property may not 
be included when determining eligibility for services under 
title XIX of the Social Security Act: 
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