Collapse to view only § 1642. Purchasing health care coverage
- § 1641. Treatment of payments under Social Security Act health benefits programs
- § 1642. Purchasing health care coverage
- § 1643. Amount and use of funds reimbursed through medicare and medicaid available to Indian Health Service
- § 1644. Grants to and contracts with the Service, Indian tribes, tribal organizations, and urban Indian organizations to facilitate outreach, enrollment, and coverage of Indians under Social Security Act health benefit programs and other health benefits programs
- § 1645. Sharing arrangements with Federal agencies
- § 1646. Authorization for emergency contract health services
- § 1647. Eligible Indian veteran services
- § 1647a. Nondiscrimination under Federal health care programs in qualifications for reimbursement for services
- § 1647b. Access to Federal insurance
- § 1647c. General exceptions
- § 1647d. Navajo Nation medicaid agency feasibility study
§ 1641. Treatment of payments under Social Security Act health benefits programs
(a) Disregard of Medicare, Medicaid, and CHIP payments in determining appropriations
(b) Nonpreferential treatment
(c) Use of funds
(1) Special fund
(A) 100 percent pass-through of payments due to facilities
(B) Use of funds
(2) Direct payment option
(d) Direct billing
(1) In general
(2) Direct reimbursement
(A) Use of funds
(B) Audits
(C) Identification of source of payments
(3) Examination and implementation of changes
(A) In general
(B) Coordination of information
(4) Withdrawal from program
(5) Termination for failure to comply with requirements
(e) Related provisions under the Social Security Act
(Pub. L. 94–437, title IV, § 401, Sept. 30, 1976, 90 Stat. 1408; Pub. L. 102–573, title IV, § 401(a), Oct. 29, 1992, 106 Stat. 4565; Pub. L. 111–148, title X, § 10221(a), Mar. 23, 2010, 124 Stat. 935.)
§ 1642. Purchasing health care coverage
(a) In general
(1) a tribally owned and operated health care plan;
(2) a State or locally authorized or licensed health care plan;
(3) a health insurance provider or managed care organization;
(4) a self-insured plan; or
(5) a high deductible or health savings account plan.
(b) Financial need
(c) Expenses for self-insured plan
(d) Construction
(Pub. L. 94–437, title IV, § 402, Sept. 30, 1976, 90 Stat. 1409; Pub. L. 100–713, title IV, § 401(a), (b), Nov. 23, 1988, 102 Stat. 4818; Pub. L. 102–573, title IV, § 401(b)(1), Oct. 29, 1992, 106 Stat. 4565; Pub. L. 111–148, title X, § 10221(a), Mar. 23, 2010, 124 Stat. 935.)
§ 1643. Amount and use of funds reimbursed through medicare and medicaid available to Indian Health Service
The Secretary shall submit to the President, for inclusion in the report required to be transmitted to the Congress under section 1671 of this title, an accounting on the amount and use of funds made available to the Service pursuant to this subchapter as a result of reimbursements through titles XVIII and XIX of the Social Security Act, as amended [42 U.S.C. 1395 et seq., 1396 et seq.].
(Pub. L. 94–437, title IV, § 403, Sept. 30, 1976, 90 Stat. 1410; Pub. L. 102–573, title IV, § 402, Oct. 29, 1992, 106 Stat. 4566.)
§ 1644. Grants to and contracts with the Service, Indian tribes, tribal organizations, and urban Indian organizations to facilitate outreach, enrollment, and coverage of Indians under Social Security Act health benefit programs and other health benefits programs
(a) Indian tribes and tribal organizations
The Secretary, acting through the Service, shall make grants to or enter into contracts with Indian tribes and tribal organizations to assist such tribes and tribal organizations in establishing and administering programs on or near reservations and trust lands, including programs to provide outreach and enrollment through video, electronic delivery methods, or telecommunication devices that allow real-time or time-delayed communication between individual Indians and the benefit program, to assist individual Indians—
(1) to enroll for benefits under a program established under title XVIII, XIX, or XXI of the Social Security Act [42 U.S.C. 1395 et seq., 1396 et seq., 1397aa et seq.] and other health benefits programs; and
(2) with respect to such programs for which the charging of premiums and cost sharing is not prohibited under such programs, to pay premiums or cost sharing for coverage for such benefits, which may be based on financial need (as determined by the Indian tribe or tribes or tribal organizations being served based on a schedule of income levels developed or implemented by such tribe, tribes, or tribal organizations).
(b) Conditions
The Secretary, acting through the Service, shall place conditions as deemed necessary to effect the purpose of this section in any grant or contract which the Secretary makes with any Indian tribe or tribal organization pursuant to this section. Such conditions shall include requirements that the Indian tribe or tribal organization successfully undertake—
(1) to determine the population of Indians eligible for the benefits described in subsection (a);
(2) to educate Indians with respect to the benefits available under the respective programs;
(3) to provide transportation for such individual Indians to the appropriate offices for enrollment or applications for such benefits; and
(4) to develop and implement methods of improving the participation of Indians in receiving benefits under such programs.
(c) Application to urban Indian organizations
(1) In general
(2) Requirements
The Secretary shall include in the grants or contracts made or provided under paragraph (1) requirements that are—
(A) consistent with the requirements imposed by the Secretary under subsection (b);
(B) appropriate to urban Indian organizations and urban Indians; and
(C) necessary to effect the purposes of this section.
(d) Facilitating cooperation
(e) Agreements relating to improving enrollment of Indians under Social Security Act health benefits programs
(f) Definition of premiums and cost sharing
In this section:
(1) Premium
(2) Cost sharing
(Pub. L. 94–437, title IV, § 404, as added Pub. L. 96–537, § 6, Dec. 17, 1980, 94 Stat. 3176; amended Pub. L. 102–573, title IV, § 403, Oct. 29, 1992, 106 Stat. 4566; Pub. L. 111–148, title X, § 10221(a), Mar. 23, 2010, 124 Stat. 935.)
§ 1645. Sharing arrangements with Federal agencies
(a) Authority
(1) In general
(2) Consultation by Secretary required
(b) Limitations
The Secretary shall not take any action under this section or under subchapter IV of chapter 81 of title 38 which would impair—
(1) the priority access of any Indian to health care services provided through the Service and the eligibility of any Indian to receive health services through the Service;
(2) the quality of health care services provided to any Indian through the Service;
(3) the priority access of any veteran to health care services provided by the Department of Veterans Affairs;
(4) the quality of health care services provided by the Department of Veterans Affairs or the Department of Defense; or
(5) the eligibility of any Indian who is a veteran to receive health services through the Department of Veterans Affairs.
(c) Reimbursement
(d) Construction
(Pub. L. 94–437, title IV, § 405, as added Pub. L. 100–713, title IV, § 402, Nov. 23, 1988, 102 Stat. 4818; amended Pub. L. 102–573, title IV, § 404, title VII, § 701(c)(3), Oct. 29, 1992, 106 Stat. 4566, 4572; Pub. L. 104–313, § 2(d),
§ 1646. Authorization for emergency contract health services
With respect to an elderly or disabled Indian receiving emergency medical care or services from a non-Service provider or in a non-Service facility under the authority of this chapter, the time limitation (as a condition of payment) for notifying the Service of such treatment or admission shall be 30 days.
(Pub. L. 94–437, title IV, § 406, as added Pub. L. 102–573, title IV, § 405, Oct. 29, 1992, 106 Stat. 4566.)
§ 1647. Eligible Indian veteran services
(a) Findings; purpose
(1) Findings
Congress finds that—
(A) collaborations between the Secretary and the Secretary of Veterans Affairs regarding the treatment of Indian veterans at facilities of the Service should be encouraged to the maximum extent practicable; and
(B) increased enrollment for services of the Department of Veterans Affairs by veterans who are members of Indian tribes should be encouraged to the maximum extent practicable.
(2) Purpose
(b) Definitions
In this section:
(1) Eligible Indian veteran
The term “eligible Indian veteran” means an Indian or Alaska Native veteran who receives any medical service that is—
(A) authorized under the laws administered by the Secretary of Veterans Affairs; and
(B) administered at a facility of the Service (including a facility operated by an Indian tribe or tribal organization through a contract or compact with the Service under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.)) 1
1 See References in Text note below.
pursuant to a local memorandum of understanding.(2) Local memorandum of understanding
(c) Eligible Indian veterans expenses
(1) In general
(2) Method of payment
(d) Tribal approval of memoranda
(e) Funding
(1) Treatment
(2) Use of funds
(Pub. L. 94–437, title IV, § 407, as added Pub. L. 111–148, title X, § 10221(a), Mar. 23, 2010, 124 Stat. 935.)
§ 1647a. Nondiscrimination under Federal health care programs in qualifications for reimbursement for services
(a) Requirement to satisfy generally applicable participation requirements
(1) In general
(2) Satisfaction of State or local licensure or recognition requirements
(b) Application of exclusion from participation in Federal health care programs
(1) Excluded entities
(2) Excluded individuals
(3) Federal health care program defined
(c) Related provisions
(Pub. L. 94–437, title IV, § 408, as added Pub. L. 111–148, title X, § 10221(a), Mar. 23, 2010, 124 Stat. 935.)
§ 1647b. Access to Federal insurance
Notwithstanding the provisions of title 5, Executive order, or administrative regulation, an Indian tribe or tribal organization carrying out programs under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 5301 et seq.) or the Tribally Controlled Schools Act of 1988 (25 U.S.C. 2501 et seq.) or an urban Indian organization carrying out programs under subchapter IV of this chapter shall be entitled to purchase coverage, rights, and benefits for the employees of such Indian tribe or tribal organization, or urban Indian organization, under chapter 89 of title 5 and chapter 87 of such title if necessary employee deductions and agency contributions in payment for the coverage, rights, and benefits for the period of employment with such Indian tribe or tribal organization, or urban Indian organization, are currently deposited in the applicable Employee’s Fund under such title.
(Pub. L. 94–437, title IV, § 409, as added Pub. L. 111–148, title X, § 10221(a), Mar. 23, 2010, 124 Stat. 935; amended Pub. L. 116–260, div. FF, title XI, § 1114, Dec. 27, 2020, 134 Stat. 3251.)
§ 1647c. General exceptions
The requirements of this subchapter shall not apply to any excepted benefits described in paragraph (1)(A) or (3) of section 300gg–91(c) of title 42.
(Pub. L. 94–437, title IV, § 410, as added Pub. L. 111–148, title X, § 10221(a), Mar. 23, 2010, 124 Stat. 935.)
§ 1647d. Navajo Nation medicaid agency feasibility study
(a) Study
(b) Considerations
In conducting the study, the Secretary shall consider the feasibility of—
(1) assigning and paying all expenditures for the provision of services and related administration funds, under title XIX of the Social Security Act [42 U.S.C. 1396 et seq.], to Indians living within the boundaries of the Navajo Nation that are currently paid to or would otherwise be paid to the State of Arizona, New Mexico, or Utah;
(2) providing assistance to the Navajo Nation in the development and implementation of such entity for the administration, eligibility, payment, and delivery of medical assistance under title XIX of the Social Security Act;
(3) providing an appropriate level of matching funds for Federal medical assistance with respect to amounts such entity expends for medical assistance for services and related administrative costs; and
(4) authorizing the Secretary, at the option of the Navajo Nation, to treat the Navajo Nation as a State for the purposes of title XIX 1
1 See References in Text note below.
of the Social Security Act (relating to the State children’s health insurance program) under terms equivalent to those described in paragraphs (2) through (4).22 So in original. Probably should be paragraphs “(1) through (3).”.
(c) Report
Not later then 3 years after March 23, 2010, the Secretary shall submit to the Committee on Indian Affairs and Committee on Finance of the Senate and the Committee on Natural Resources and Committee on Energy and Commerce of the House of Representatives a report that includes—
(1) the results of the study under this section;
(2) a summary of any consultation that occurred between the Secretary and the Navajo Nation, other Indian Tribes, the States of Arizona, New Mexico, and Utah, counties which include Navajo Lands, and other interested parties, in conducting this study;
(3) projected costs or savings associated with establishment of such entity, and any estimated impact on services provided as described in this section in relation to probable costs or savings; and
(4) legislative actions that would be required to authorize the establishment of such entity if such entity is determined by the Secretary to be feasible.
(Pub. L. 94–437, title IV, § 411, as added Pub. L. 111–148, title X, § 10221(a), Mar. 23, 2010, 124 Stat. 935.)