[Pages H9957-H9959]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

ALASKA NATIVE AND AMERICAN INDIAN DIRECT REIMBURSEMENT ACT OF 1999

Mr. CALVERT. Madam Speaker, I move to suspend the rules and pass the
Senate bill (S. 406) 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 payers, and to expand the
eligibility under such program to other tribes and tribal
organizations.
The Clerk read as follows:

S. 406

Be it enacted by the Senate and House of Representatives 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 1999''.

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 program include dramatically
increased collections for services provided under the
medicare and medicaid programs, a significant reduction in
the turn-around 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 collection of payments from, the
medicare and medicaid programs, and other third payor
reimbursements, 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, is consistent with the
provisions of the Indian Self-Determination Act, and furthers
the commitment of the Secretary to enable tribes and tribal
organizations to manage and operate their health care
programs.

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(5) The demonstration program was originally to expire on
September 30, 1996, but was extended by Congress, so that the
current participants would not experience an interruption in
the program while Congress awaited a recommendation 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 permanent status to the
demonstration program and to extend participation in the
program 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:
``(a) Establishment of Direct Billing Program.--
``(1) In general.--The Secretary shall establish a program
under which Indian tribes, tribal organizations, and Alaska
Native health organizations that contract or compact for the
operation of a hospital or clinic of the Service under the
Indian Self-Determination and Education Assistance Act may
elect to directly bill for, and receive payment for, health
care services provided by such hospital or clinic for which
payment is made under title XVIII of the Social Security 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 program for health care services directly billed
under the program established under this section.
``(b) Direct Reimbursement.--
``(1) Use of funds.--Each hospital or clinic 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 hospital
or clinic for the purpose of making any improvements in the
hospital or clinic that may be necessary to achieve or
maintain compliance with the conditions and requirements
applicable generally to facilities 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 conditions shall be used--
``(A) solely for improving the health resources 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 entered into under the Indian Self-Determination Act
(25 U.S.C. 450f et seq.).
``(2) Audits.--The amounts paid to the hospitals and
clinics participating in the program established under this
section shall be subject to all auditing requirements
applicable to programs administered directly by the Service
and to facilities participating in the medicare and medicaid
programs.
``(3) Secretarial oversight.--The Secretary shall monitor
the performance of hospitals and clinics participating in the
program established under this section, and shall require
such hospitals and clinics to submit reports on the program
to the Secretary on an annual basis.
``(4) No payments from special funds.--Notwithstanding
section 1880(c) of the Social Security Act (42 U.S.C.
1395qq(c)) or section 402(a), no payment may be made out of
the special funds described in such sections for the benefit
of any hospital or clinic during the period that the hospital
or clinic participates in the program established under this
section.
``(c) Requirements for Participation.--
``(1) Application.--Except as provided in paragraph (2)(B),
in order to be eligible for participation in the program
established under this section, an Indian tribe, tribal
organization, or Alaska Native health organization shall
submit an application to the Secretary that establishes to
the satisfaction of the Secretary that--
``(A) the Indian tribe, tribal organization, or Alaska
Native health organization contracts or compacts for the
operation of a facility of the Service;
``(B) the facility is eligible to participate in the
medicare or medicaid programs under section 1880 or 1911 of
the Social Security Act (42 U.S.C. 1395qq; 1396j);
``(C) the facility meets the requirements that apply to
programs operated directly by the Service; and
``(D) the facility--
``(i) is accredited by an accrediting body as eligible for
reimbursement under the medicare or medicaid programs; or
``(ii) has submitted a plan, which has been approved by the
Secretary, for achieving such accreditation.
``(2) Approval.--
``(A) In general.--The Secretary shall review and approve a
qualified application not later than 90 days after the date
the application is submitted to the Secretary unless the
Secretary determines that any of the criteria set forth in
paragraph (1) are not met.
``(B) Grandfather of demonstration program participants.--
Any participant in the demonstration program 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 1999 shall be deemed approved for
participation in the program established under this section
and shall not be required to submit an application in order
to participate in the program.
``(C) Duration.--An approval by the Secretary of a
qualified application under subparagraph (A), or a deemed
approval of a demonstration program under subparagraph (B),
shall continue in effect as long as the approved applicant or
the deemed approved demonstration program meets the
requirements of this section.
``(d) Examination and Implementation of Changes.--
``(1) In general.--The Secretary, acting through the
Service, and with the assistance of the Administrator of the
Health Care Financing Administration, shall examine on an
ongoing basis and implement--
``(A) any administrative changes that may be necessary to
facilitate direct billing and reimbursement under the program
established under this section, including any agreements with
States that may be necessary to provide for direct billing
under the medicaid program; and
``(B) any changes that may be necessary to enable
participants in the program established under this section to
provide to the Service medical records information on
patients served under the program that is consistent with the
medical records information system of the Service.
``(2) Accounting information.--The accounting information
that a participant in the program established under this
section shall be required to report shall be the same as the
information required to be reported by participants in the
demonstration program 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 1999.
The Secretary may from time to time, after consultation with
the program participants, change the accounting information
submission requirements.
``(e) Withdrawal From Program.--A participant in the
program established under this section may withdraw from
participation in the same manner and under the same
conditions that a tribe or tribal organization may retrocede
a contracted program to the Secretary under authority of the
Indian Self-Determination Act (25 U.S.C. 450 et seq.). All
cost accounting and billing authority under the program
established under this section shall be returned to the
Secretary upon the Secretary's acceptance of the withdrawal
of participation in this program.''.
(b) Conforming Amendments.--
(1) Section 1880 of the Social Security Act (42 U.S.C.
1395qq) is amended by adding at the end the following:
``(e) For provisions relating to the authority of certain
Indian tribes, tribal organizations, and Alaska Native health
organizations to elect to directly bill for, and receive
payment for, health care services provided by a hospital or
clinic of such tribes or organizations and for which payment
may be made under this title, see section 405 of the Indian
Health Care Improvement Act (25 U.S.C. 1645).''.
(2) Section 1911 of the Social Security Act (42 U.S.C.
1396j) is amended by adding at the end the following:
``(d) For provisions relating to the authority of certain
Indian tribes, tribal organizations, and Alaska Native health
organizations to elect to directly bill for, and receive
payment for, health care services provided by a hospital or
clinic of such tribes or organizations and for which payment
may be made under this title, see section 405 of the Indian
Health Care Improvement Act (25 U.S.C. 1645).''.
(c) Effective Date.--The amendments made by this section
shall take effect on October 1, 2000.

SEC. 4. TECHNICAL AMENDMENT.

(a) In General.--Effective November 9, 1998, section 405 of
the Indian Health Care Improvement Act (25 U.S.C. 1645(e)) is
reenacted as in effect on that date.
(b) Reports.--Effective November 10, 1998, section 405 of
the Indian Health Care Improvement Act is amended by striking
subsection (e).

The SPEAKER pro tempore. Pursuant to the rule, the gentleman from
California (Mr. Calvert) and the gentleman from New Jersey (Mr. Holt)
each will control 20 minutes.
The Chair recognizes the gentleman from California (Mr. Calvert).
Mr. CALVERT. Madam Speaker, I yield myself such time as I may
consume.
Madam Speaker, S. 406 amends Section 405 of the Indian Health Care
Improvement Act to make permanent the demonstration program at four
tribally operated Indian Health Service hospitals that allows for
direct billing of Medicare, Medicaid and other third-party payers. It
will also extend the direct billing option to other tribes and tribal
organizations.

[[Page H9959]]

This demonstration program dramatically increases collections for
Medicare and Medicaid services, and significantly reduces the
turnaround time between billings and receipt of payment for Medicaid
and Medicare services. Additionally, it increased the administrative
efficiency of the participating health care providers. All the
participants, two of which are in Alaska, as well as the Department of
Health and Human Services and the Indian Health Service, report that
the program is a great success.
S. 406 will make permanent the demonstration program and will end
much of the bureaucracy for Indian Health Care Service facilities
involved with Medicare and Medicaid reimbursement. The bottom line is
that it will mean more Medicaid and Medicare dollars to Indian
facilities to use for improving health care for their members.
Madam Speaker, I urge an aye vote on this important bill for American
Indians and Alaskan Natives.
Madam Speaker, I reserve the balance of my time.
Mr. HOLT. Madam Speaker, I yield myself such time as I may consume.
(Mr. HOLT asked and was given permission to revise and extend his
remarks.)
Mr. HOLT. Madam Speaker, in 1988, a dozen years ago, Congress
authorized the Indian Health Service to select up to four tribally
controlled IHS hospitals to participate in a demonstration project
whereby the hospitals could conduct direct billing and receipt of
payment for health services to Medicare and Medicaid eligible patients.
Under the current practice, Medicare and Medicaid billings and
collections are first sent through the IHS and then redirected to
health care providers. Since 1991, the Bristol Bay Health Corporation,
the Southeast Alaska Regional Health Corporation, Mississippi Choctaw
Health Center, and the Choctaw Tribe of Oklahoma have taken part in the
demonstration project.
The participants established in-house administrative operations to
perform Medicare and Medicaid billing and collection and have been
extremely satisfied with the results. Reports have shown dramatically
increased collections which have been turned into additional health
services. The demonstration program has resulted in a much shorter
turnaround time between billing and receipt of payment, as well as
improved accreditation, ratings and an overall higher level of health
care quality for patients.
Madam Speaker, S. 406 would make permanent the demonstration program
and would authorize additional tribes and tribal organizations to
participate in the direct billing. This legislation is supported by the
administration. It is good policy, and I urge my colleagues to support
its passage.
Madam Speaker, I yield back the balance of my time.
Mr. CALVERT. Madam Speaker, I yield back the balance of my time.
The SPEAKER pro tempore. The question is on the motion offered by the
gentleman from California (Mr. Calvert) that the House suspend the
rules and pass the Senate bill, S. 406.
The question was taken; and (two-thirds having voted in favor
thereof) the rules were suspended and the Senate bill was passed.
A motion to reconsider was laid on the table.

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