To amend title XIX of the Social Security Act to provide for fair treatment of services furnished to Indians under the Medicaid Program, and for other purposes.

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Medicaid Indian Health Act of 
2005''.

SEC. 2. APPLICATION OF 100 PERCENT FMAP FOR SERVICES FURNISHED TO AN 
              INDIAN BY AN URBAN INDIAN HEALTH PROGRAM.

    (a) In General.--The third sentence of section 1905(b) of the 
Social Security Act (42 U.S.C. 1396d(b)), is amended by inserting 
before the period at the end the following: ``, or through an urban 
Indian health program receiving funds under title V of the Indian 
Health Care Improvement Act''.
    (b) Conforming Amendment.--Section 1911(c) of such Act (42 U.S.C. 
1396j(c)), is amended by inserting ``, or through an urban Indian 
health program receiving funds under title V of the Indian Health Care 
Improvement Act'' after ``facilities''.

SEC. 3. PROHIBITION ON IMPOSITION OF PREMIUMS, DEDUCTIBLES, COPAYMENTS, 
              AND OTHER COST-SHARING ON INDIANS.

    Section 1916 of the Social Security Act (42 U.S.C. 1396o) is 
amended--
            (1) in subsection (a)(3), by inserting ``(other than such 
        individuals who are Indians (as defined in section 4 of the 
        Indian Health Care Improvement Act)'' after ``other such 
        individuals'';
            (2) in subsection (b), in the matter preceding paragraph 
        (1), by inserting ``or who are Indians (as defined in section 4 
        of the Indian Health Care Improvement Act)'' after ``section 
        1902(a)(10)''; and
            (3) in subsection (c)(1), by inserting ``(other than such 
        an individual who is an Indian (as defined in section 4 of the 
        Indian Health Care Improvement Act))'' after ``section 
        1902(l)(1)''.

SEC. 4. PROHIBITION ON RECOVERY AGAINST ESTATES OF INDIANS.

    Section 1917(b)(1) of the Social Security Act (42 U.S.C. 
1396p(b)(1)) is amended, in the matter preceding subparagraph (A), by 
inserting `` who is not an Indian (as defined in section 4 of the 
Indian Health Care Improvement Act)'' after ``an individual'' the 
second place it appears.

SEC. 5. REQUIREMENT FOR CONSULTATION WITH INDIAN TRIBES PRIOR TO 
              APPROVAL OF SECTION 1115 WAIVERS.

    Section 1115 of the Social Security Act (42 U.S.C. 1315) is amended 
by adding at the end the following:
    ``(g) In the case of an application for a waiver of compliance with 
the requirements of section 1902 (or a renewal or extension of such a 
waiver) that is likely to affect members of an Indian tribe (as defined 
in section 4 of the Indian Health Care Improvement Act) or a tribal 
health program (whether operated by an Indian tribe or a tribal 
organization (as so defined) serving such members, the Secretary shall, 
prior to granting such a waiver under subsection (a) or renewing or 
extending such a waiver under subsection (e), consult with each such 
Indian tribe.''.

SEC. 6. REQUIREMENT FOR FAIR PAYMENT BY MEDICAID MANAGED CARE ENTITIES 
              TO INDIAN HEALTH PROGRAM PROVIDERS.

    Section 1903(m)(2)(A)(ii) of the Social Security Act (42 U.S.C. 
1396b(m)(2)(A)(ii)) is amended to read as follows:
                            ``(ii) such contract provides, in the case 
                        of entity that has entered into a contract for 
                        the provision of services with a facility or 
                        program of the Indian Health Service, whether 
                        operated by the Service or an Indian tribe or 
                        tribal organization (as defined in section 4 of 
                        the Indian Health Care Improvement Act) or an 
                        urban Indian health program receiving funds 
                        under title V of the Indian Health Care 
                        Improvement Act , that is not a Federally-
                        qualified health center or a rural health 
                        clinic, that the entity shall provide payment 
                        that is not less than the highest level and 
                        amount of payment that the entity would make 
                        for the services if the services were furnished 
                        by a provider that is not a facility or program 
                        of the Indian Health Service;''.

SEC. 7. TREATMENT OF MEDICAL EXPENSES PAID BY OR ON BEHALF OF AN INDIAN 
              BY AN INDIAN HEALTH PROGRAM AS COSTS INCURRED FOR MEDICAL 
              CARE FOR PURPOSES OF DETERMINING MEDICALLY NEEDY 
              ELIGIBILITY.

    Section 1902(a)(17)(D) of the Social Security Act (42 U.S.C. 
1396a(a)(17)(D)) is amended by inserting ``or by the Indian Health 
Service or an Indian tribe or tribal organization (as defined in 
section 4 of the Indian Health Care Improvement Act)'' after 
``political subdivision thereof''.

SEC. 8. STATE OPTION TO EXEMPT INDIANS FROM REDUCTIONS IN ELIGIBILITY 
              OR BENEFITS.

    Section 1902 of the Social Security Act (42 U.S.C. 1396a)) is 
amended by inserting after subsection (j) the following:
    ``(k) The Secretary shall not disapprove a State plan amendment, or 
deny a State request for a waiver under section 1115 (or a renewal or 
extension of such a waiver), on the grounds that the amendment or 
waiver would exempt Indians (as defined in section 4 of the Indian 
Health Care Improvement Act) eligible for medical assistance from--
            ``(1) any restriction on eligibility for medical assistance 
        under this title that would otherwise apply under the amendment 
        or waiver;
            ``(2) any imposition of premiums, deductibles, copayments, 
        or other cost-sharing that would otherwise apply under the 
        amendment or waiver; or
            ``(3) any reduction in covered services or supplies that 
        would otherwise apply under the amendment or waiver.''.

SEC. 9. EFFECTIVE DATE.

    (a) In General.--Except as provided in subsection (b), this Act and 
the amendments made by this Act apply to items or services furnished on 
or after January 1, 2006.
    (b) Extension of Effective Date for State Law Amendment.--In the 
case of a State plan under title XIX of the Social Security Act which 
the Secretary of Health and Human Services determines requires State 
legislation in order for the plan to meet the additional requirements 
imposed by the amendments made by a provision of this Act, the State 
plan shall not be regarded as failing to comply with the requirements 
of this Act solely on the basis of its failure to meet these additional 
requirements before the first day of the first calendar quarter 
beginning after the close of the first regular session of the State 
legislature that begins after the date of enactment of this Act. For 
purposes of the previous sentence, in the case of a State that has a 2-
year legislative session, each year of the session shall be considered 
to be a separate regular session of the State legislature.

Summary: Medicaid Indian Health Act of 2005 - Amends title XIX (Medicaid) of the Social Security Act to: (1) apply 100% of the federal medical assistance percentage (FMAP) to services furnished to an Indian by an urban Indian health program; (2) prohibit the imposition of premiums, deductibles, copayments, and other cost-sharing on Indians; (3) prohibit recovery against estates of Indians; (4) require consultation with Indian tribes prior to approval of "Section 115" waivers; (5) provide for the treatment of medical expenses paid by or on behalf of an Indian by an Indian health program as medical care costs for purposes of determining medically needy eligibility; and (6) give states the option to exempt Indians from reductions in eligibility or benefits.

Requires a Medicaid managed care organization contracting with an Indian Health Service (IHS) facility or program that is not a federally-qualified health center or a rural health clinic to provide payment at the highest level and amount that it would make for the services if they were furnished by a provider that is not an IHS facility or program.