I
105TH CONGRESS
2D SESSION
H. R. 4088
To amend the Indian Health Care Improvement Act to make permanent
the demonstration program that allows for direct billing of Medicare,
Medicaid, and other third-party payors, and to expand the eligibility
under such program to other tribes and tribal organizations.
IN THE HOUSE OF REPRESENTATIVES
JUNE 18, 1998
Mr. YOUNG of Alaska (for himself and Mr. KILDEE) introduced the following
bill; which was referred to the Committee on Resources, and in addition
to the Committees on Commerce, and Ways and Means, for a period to
be subsequently determined by the Speaker, in each case for consider-
ation of such provisions as fall within the jurisdiction of the committee
concerned
A BILL
To amend the Indian Health Care Improvement Act to make
permanent the demonstration program that allows for
direct billing of Medicare, Medicaid, and other third-
party payors, and to expand the eligibility under such
program to other tribes and tribal organizations.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ‘‘Alaska Native and
American Indian Direct Reimbursement Act of 1998’’.
SEC. 2. FINDINGS.
Congress finds the following:
(1) In 1988, Congress enacted section 405 of
the Indian Health Care Improvement Act (25 U.S.C.
1645) that established a demonstration program to
authorize 4 tribally operated Indian Health Service
hospitals or clinics to test methods for direct billing
and receipt of payment for health services provided
to patients eligible for reimbursement under the
medicare or medicaid programs under titles XVIII
and XIX of the Social Security Act (42 U.S.C. 1395
et seq.; 1396 et seq.), and other third-party payors.
(2) The 4 participants selected by the Indian
Health Service for the demonstration program began
the direct billing and collection program in fiscal
year 1989 and unanimously expressed success and
satisfaction with the program. Benefits of the pro-
gram include dramatically increased collections for
services provided under the medicare and medicaid
programs, a significant reduction in the turnaround
time between billing and receipt of payments for
services provided to eligible patients, and increased
efficiency of participants being able to track their
own billings and collections.
(3) The success of the demonstration program
confirms that the direct involvement of tribes and
tribal organizations in the direct billing of, and col-
lection of payments from, the medicare and medicaid
programs, and other third-party payor reimburse-
ments, is more beneficial to Indian tribes than the
current system of Indian Health Service-managed
collections.
(4) Allowing tribes and tribal organizations to
directly manage their medicare and medicaid billings
and collections, rather than channeling all activities
through the Indian Health Service, will enable the
Indian Health Service to reduce its administrative
costs.
(5) The demonstration program was originally
to expire on September 30, 1996, but was extended
by Congress to September 30, 1998, so that the cur-
rent participants would not experience an interrup-
tion in the program while Congress awaited a rec-
ommendation from the Secretary of Health and
Human Services on whether to make the program
permanent.
(6) It would be beneficial to the Indian Health
Service and to Indian tribes, tribal organizations,
and Alaska Native organizations to provide perma-
nent authorization for direct billing and collection
and to extend participation in direct billing and col-
lection to other Indian tribes, tribal organizations,
and Alaska Native health organizations who operate
a facility of the Indian Health Service.
SEC. 3. DIRECT BILLING OF MEDICARE, MEDICAID, AND
OTHER THIRD-PARTY PAYORS.
(a) PERMANENT AUTHORIZATION.—Section 405 of
the Indian Health Care Improvement Act (25 U.S.C.
1645) is amended to read as follows:
‘‘SEC. 405. DIRECT BILLING OF MEDICARE, MEDICAID, AND
OTHER THIRD PARTY PAYORS.
‘‘(a) ESTABLISHMENT
OF DIRECT BILLING PRO-
GRAM.—
‘‘(1) IN GENERAL.—Indian tribes, tribal organi-
zations, and Alaska Native health organizations that
contract or compact for the operation of any health
program of the Service under the Indian Self-Deter-
mination and Education Assistance Act may elect to
directly bill for, and receive payment for, health care
services provided by such health programs for which
payment is made under title XVIII of the Social Se-
curity Act (42 U.S.C. 1395 et seq.) (in this section
referred to as the ‘medicare program’), under a
State plan for medical assistance approved under
title XIX of the Social Security Act (42 U.S.C. 1396
et seq.) (in this section referred to as the ‘medicaid
program’), or from any other third-party payor.
‘‘(2) APPLICATION OF 100 PERCENT FMAP.—
The third sentence of section 1905(b) of the Social
Security Act (42 U.S.C. 1396d(b)) shall apply for
purposes of reimbursement under the medicaid pro-
gram for health care services directly billed under
the program established under this section.
‘‘(b) DIRECT REIMBURSEMENT.—
‘‘(1) USE
OF
FUNDS.—Each health program
participating in the program described in subsection
(a) of this section shall be reimbursed directly under
the medicare and medicaid programs for services
furnished, without regard to the provisions of section
1880(c) of the Social Security Act (42 U.S.C.
1395qq(c)) and sections 402(a) and 813(b)(2)(A),
but all funds so reimbursed shall first be used by the
health program for the purpose of making any im-
provements in the health facilities or programs that
may be necessary to achieve or maintain compliance
with the conditions and requirements applicable gen-
erally to facilities or health programs of such type
under the medicare or medicaid programs. Any
funds so reimbursed which are in excess of the
amount necessary to achieve or maintain such condi-
tions shall be used—
‘‘(A) solely for improving the health re-
sources deficiency level of the Indian tribe; and
‘‘(B) in accordance with the regulations of
the Service applicable to funds provided by the
Service under any contract or compact entered
into under the Indian Self-Determination Act
(25 U.S.C. 450f et seq.).
‘‘(2) AUDITS.—The amounts paid to the health
programs participating in the program established
under this section shall be subject to all auditing re-
quirements applicable to programs administered di-
rectly by the Service and to facilities participating in
the medicare and medicaid programs.
‘‘(3) NO PAYMENTS FROM SPECIAL FUNDS.—
Notwithstanding section 1880(c) of the Social Secu-
rity Act (42 U.S.C. 1395qq(c)) or section 402(a), no
payment may be made out of the special funds de-
scribed in such sections for the benefit of any health
program during the period that the health program
participates in the program established under this
section.
‘‘(c) REQUIREMENTS FOR PARTICIPATION.—
‘‘(1) CERTIFICATION.—Except as provided in
paragraph (2)(B), in order to be eligible for partici-
pation in the program established under this section,
an Indian tribe, tribal organization, or Alaska Na-
tive health organization shall submit a certification
to the Secretary that—
‘‘(A) the Indian tribe, tribal organization,
or Alaska Native health organization contracts
or compacts for any part of the operation of a
health program of the Service; and
‘‘(B) the health program is eligible to par-
ticipate in the medicare or medicaid programs
under section 1880 or 1911 of the Social Secu-
rity Act (42 U.S.C. 1395qq; 1396);
‘‘(2) GRANDFATHER OF DEMONSTRATION PRO-
GRAM PARTICIPANTS.—Any participant in the pro-
gram authorized under this section as in effect on
the day before the date of enactment of the Alaska
Native and American Indian Direct Reimbursement
Act of 1998 shall be deemed to have elected to par-
ticipate in the program established under this sec-
tion and shall not be required to submit a certifi-
cation in order to participate in the program.
‘‘(3) DURATION.—A certification to the Sec-
retary of a qualified application under paragraph