25 U.S.C. § 1641 — Treatment of payments under Social Secu-

Page 300 TITLE 25—INDIANS § 1641 1 So in original. The comma probably should not appear. 1 So in original. Probably should be ‘‘XXI’’. (B) Inclusions The term ‘‘specialty health care service’’ includes any service relating to— (i) dialysis; (ii) surgery; (iii) mammography; (iv) dentistry; or (v) any other specialty health care serv- ice. (b) Establishment The Secretary, acting through the Service, shall establish a demonstration program under which the Secretary shall provide at least 3 mo- bile health station projects. (c) Petition To be eligible to receive a mobile health sta- tion under the demonstration program, an eligi- ble tribal consortium shall submit to the Sec- retary, 1 a petition at such time, in such manner, and containing— (1) a description of the Indian population to be served; (2) a description of the specialty service or services for which the mobile health station is requested and the extent to which such service or services are currently available to the In- dian population to be served; and (3) such other information as the Secretary may require. (d) Use of funds The Secretary shall use amounts made avail- able to carry out the demonstration program under this section— (1)(A) to establish, purchase, lease, or main- tain mobile health stations for the eligible tribal consortia selected for projects; and (B) to provide, through the mobile health station, such specialty health care services as the affected eligible tribal consortium deter- mines to be necessary for the Indian popu- lation served; (2) to employ an existing mobile health sta- tion (regardless of whether the mobile health station is owned or rented and operated by the Service) to provide specialty health care serv- ices to an eligible tribal consortium; and (3) to establish, purchase, or maintain dock- ing equipment for a mobile health station, in- cluding the establishment or maintenance of such equipment at a modular component health care facility (as defined in section 1638f(a) of this title), if applicable. (e) Reports Not later than 1 year after the date on which the demonstration program is established under subsection (b) and annually thereafter, the Sec- retary, acting through the Service, shall submit to Congress a report describing— (1) each activity carried out under the dem- onstration program including an evaluation of the success of the activity; and (2) the potential benefits of increased use of mobile health stations to provide specialty health care services for Indian communities. (f) Authorization of appropriations There are authorized to be appropriated $5,000,000 per year to carry out the demonstra- tion program under this section for the first 5 fiscal years, and such sums as may be needed to carry out the program in subsequent fiscal years. (Pub. L. 94–437, title III, § 313, as added Pub. L. 111–148, title X, § 10221(a), Mar. 23, 2010, 124 Stat. 935.) Editorial Notes CODIFICATION Section 313 of Pub. L. 94–437 is based on section 147 of title I of S. 1790, One Hundred Eleventh Congress, as re- ported by the Committee on Indian Affairs of the Sen- ate in Dec. 2009, which was enacted into law by section 10221(a) of Pub. L. 111–148. SUBCHAPTER III–A—ACCESS TO HEALTH SERVICES Editorial Notes CODIFICATION This subchapter was in the original title IV of Pub. L. 94–437, as amended. Prior to amendment by Pub. L. 102–573, title IV enacted section 1622 of this title and sections 1395qq and 1396j of Title 42, The Public Health and Welfare, amended sections 1395f, 1395n, and 1396d of Title 42, and enacted provisions set out as notes under section 1671 of this title and sections 1395qq and 1396j of Title 42. § 1641. Treatment of payments under Social Secu- rity Act health benefits programs (a) Disregard of Medicare, Medicaid, and CHIP payments in determining appropriations Any payments received by an Indian health program or by an urban Indian organization under title XVIII, XIX, or XXI of the Social Se- curity Act [42 U.S.C. 1395 et seq., 1396 et seq., 1397aa et seq.] for services provided to Indians eligible for benefits under such respective titles shall not be considered in determining appro- priations for the provision of health care and services to Indians. (b) Nonpreferential treatment Nothing in this chapter authorizes the Sec- retary to provide services to an Indian with cov- erage under title XVIII, XIX, or XI 1 of the So- cial Security Act in preference to an Indian without such coverage. (c) Use of funds (1) Special fund (A) 100 percent pass-through of payments due to facilities Notwithstanding any other provision of law, but subject to paragraph (2), payments to which a facility of the Service is entitled by reason of a provision of title XVIII or XIX of the Social Security Act [42 U.S.C. 1395 et seq., 1396 et seq.] shall be placed in a special fund to be held by the Secretary. In making payments from such fund, the Secretary shall ensure that each Service unit of the Service receives 100 percent of the amount to which the facilities of the Service, for which such Service unit makes collections, Page 301 TITLE 25—INDIANS § 1641 2 See References in Text note below. are entitled by reason of a provision of ei- ther such title. (B) Use of funds Amounts received by a facility of the Serv- ice under subparagraph (A) by reason of a provision of title XVIII or XIX of the Social Security Act shall first be used (to such ex- tent or in such amounts as are provided in appropriation Acts) for the purpose of mak- ing any improvements in the programs of the Service operated by or through such fa- cility which may be necessary to achieve or maintain compliance with the applicable conditions and requirements of such respec- tive title. Any amounts so received that are in excess of the amount necessary to achieve or maintain such conditions and require- ments shall, subject to consultation with the Indian tribes being served by the Service unit, be used for reducing the health re- source deficiencies (as determined in section 1621(c) of this title) of such Indian tribes, in- cluding the provision of services pursuant to section 1621d of this title. (2) Direct payment option Paragraph (1) shall not apply to a tribal health program upon the election of such pro- gram under subsection (d) to receive payments directly. No payment may be made out of the special fund described in such paragraph with respect to reimbursement made for services provided by such program during the period of such election. (d) Direct billing (1) In general Subject to complying with the requirements of paragraph (2), a tribal health program may elect to directly bill for, and receive payment for, health care items and services provided by such program for which payment is made under title XVIII, XIX, or XXI of the Social Security Act [42 U.S.C. 1395 et seq., 1396 et seq., 1397aa et seq.] or from any other third party payor. (2) Direct reimbursement (A) Use of funds Each tribal health program making the election described in paragraph (1) with re- spect to a program under a title of the So- cial Security Act [42 U.S.C. 301 et seq.] shall be reimbursed directly by that program for items and services furnished without regard to subsection (c)(1), except that all amounts so reimbursed shall be used by the tribal health program for the purpose of making any improvements in facilities of the tribal health program that may be necessary to achieve or maintain compliance with the conditions and requirements applicable gen- erally to such items and services under the program under such title and to provide ad- ditional health care services, improvements in health care facilities and tribal health programs, any health care-related purpose (including coverage for a service or service within a contract health service delivery area or any portion of a contract health service delivery area that would otherwise be provided as a contract health service), or otherwise to achieve the objectives provided in section 1602 of this title. (B) Audits The amounts paid to a tribal health pro- gram making the election described in para- graph (1) with respect to a program under title XVIII, XIX, or XXI of the Social Secu- rity Act shall be subject to all auditing re- quirements applicable to the program under such title, as well as all auditing require- ments applicable to programs administered by an Indian health program. Nothing in the preceding sentence shall be construed as limiting the application of auditing require- ments applicable to amounts paid under title XVIII, XIX, or XXI of the Social Secu- rity Act. (C) Identification of source of payments Any tribal health program that receives reimbursements or payments under title XVIII, XIX, or XXI of the Social Security Act shall provide to the Service a list of each provider enrollment number (or other identifier) under which such program re- ceives such reimbursements or payments. (3) Examination and implementation of changes (A) In general The Secretary, acting through the Service and with the assistance of the Administrator of the Centers for Medicare & Medicaid Serv- ices, shall examine on an ongoing basis and implement any administrative changes that may be necessary to facilitate direct billing and reimbursement under the program es- tablished under this subsection, including any agreements with States that may be necessary to provide for direct billing under a program under title XIX or XXI of the So- cial Security Act [42 U.S.C. 1396 et seq., 1397aa et seq.]. (B) Coordination of information The Service shall provide the Adminis- trator of the Centers for Medicare & Med- icaid Services with copies of the lists sub- mitted to the Service under paragraph (2)(C), enrollment data regarding patients served by the Service (and by tribal health pro- grams, to the extent such data is available to the Service), and such other information as the Administrator may require for pur- poses of administering title XVIII, XIX, or XXI of the Social Security Act. (4) Withdrawal from program A tribal health program that bills directly under the program established under this sub- section may withdraw from participation in the same manner and under the same condi- tions that an Indian tribe or tribal organiza- tion may retrocede a contracted program to the Secretary under the authority of the In- dian Self-Determination and Education Assist- ance Act (25 U.S.C. 450 et seq.).2 All cost ac- counting and billing authority under the pro- Page 302 TITLE 25—INDIANS § 1642 3 So in original. The word ‘‘or’’ probably should not appear. 1 See References in Text note below. 2 So in original. Probably should be ‘‘or’’. gram established under this subsection shall be returned to the Secretary upon the Sec- retary’s acceptance of the withdrawal of par- ticipation in this program. (5) Termination for failure to comply with re- quirements The Secretary may terminate the participa- tion of a tribal health program or 3 in the di- rect billing program established under this subsection if the Secretary determines that the program has failed to comply with the re- quirements of paragraph (2). The Secretary shall provide a tribal health program with no- tice of a determination that the program has failed to comply with any such requirement and a reasonable opportunity to correct such noncompliance prior to terminating the pro- gram’s participation in the direct billing pro- gram established under this subsection. (e) Related provisions under the Social Security Act For provisions related to subsections (c) and (d), see sections 1880, 1911, and 2107(e)(1)(D) 2 of the Social Security Act [42 U.S.C. 1395qq, 1396j, 1397gg(e)(1)(D)]. (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.) Editorial Notes REFERENCES IN TEXT The Social Security Act, referred to in subsecs. (a) to (d), is act Aug. 14, 1935, ch. 531, 49 Stat. 620, which is classified generally to chapter 7 (§ 301 et seq.) of Title 42, The Public Health and Welfare. Titles XVIII, XIX, and XXI of the Act are classified generally to sub- chapters XVIII (§ 1395 et seq.), XIX (§ 1396 et seq.), and XXI (§ 1397aa et seq.), respectively, of chapter 7 of Title 42. Section 2107(e)(1)(D) of the Social Security Act, re- ferred to in subsec. (e), is section 2107(e)(1)(D) of act Aug. 14, 1935, ch. 531, as added by Pub. L. 111–148, which was redesignated section 2107(e)(1)(F) of act Aug. 14, 1935, ch. 531, by Pub. L. 114–255, div. A, title V, § 5005(c)(1)(A), Dec. 13, 2016, 130 Stat. 1194, and which was redesignated section 2107(e)(1)(G) of act Aug. 14, 1935, ch. 531, by Pub. L. 115–123, div. E, title XII, § 53102(d)(1)(A), Feb. 9, 2018, 132 Stat. 299. For complete classification of this Act to the Code, see section 1305 of Title 42 and Tables. This chapter, referred to in subsec. (b), was in the original ‘‘this Act’’, meaning Pub. L. 94–437, Sept. 30, 1976, 90 Stat. 1400, known as the Indian Health Care Im- provement Act, which is classified principally to this chapter. For complete classification of this Act to the Code, see Short Title note set out under section 1601 of this title and Tables. The Indian Self-Determination and Education Assist- ance Act (25 U.S.C. 450 et seq.), referred to in subsec. (d)(4), is Pub. L. 93–638, Jan. 4, 1975, 88 Stat. 2203, which was classified principally to subchapter II (§ 450 et seq.) of chapter 14 of this title prior to editorial reclassifica- tion as chapter 46 (§ 5301 et seq.) of this title. For com- plete classification of this Act to the Code, see Short Title note set out under section 5301 of this title and Tables. CODIFICATION Amendment by Pub. L. 111–148 is based on section 151 of title I of S. 1790, One Hundred Eleventh Congress, as reported by the Committee on Indian Affairs of the Senate in Dec. 2009, which was enacted into law by sec- tion 10221(a) of Pub. L. 111–148. Prior to general amendment by Pub. L. 102–573, sec- tion 401 of Pub. L. 94–437, in subsec. (a) amended sec- tions 1395f and 1395n of Title 42, The Public Health and Welfare, in subsec. (b) enacted section 1395qq of Title 42, and in subsecs. (c) and (d) enacted provisions set out as notes under section 1395qq of Title 42 which were re- stated in this section. AMENDMENTS 2010—Pub. L. 111–148 amended section generally. Prior to amendment, section related to treatment of pay- ments received by a hospital or skilled nursing facility of the Service for services to Indians under medicare program in determining appropriations for health care and services to Indians. 1992—Pub. L. 102–573 amended section generally, sub- stituting subsecs. (a) and (b) for former subsecs. (a) to (d). See Codification note above. § 1642. Purchasing health care coverage (a) In general Insofar as amounts are made available under law (including a provision of the Social Security Act [42 U.S.C. 301 et seq.], the Indian Self-Deter- mination and Education Assistance Act (25 U.S.C. 450 et seq.),1 or other law, other than under section 1644 of this title) to Indian tribes, tribal organizations, and urban Indian organiza- tions for health benefits for Service bene- ficiaries, Indian tribes, tribal organizations, and urban Indian organizations may use such amounts to purchase health benefits coverage (including coverage for a service, or service within a contract health service delivery area, or any portion of a contract health service deliv- ery area that would otherwise be provided as a contract health service) for such beneficiaries in any manner, including through— (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 ac- count plan. (b) Financial need The purchase of coverage under subsection (a) by an Indian tribe, tribal organization, or urban Indian organization may be based on the finan- cial needs of such beneficiaries (as determined by the 1 or more Indian tribes being served based on a schedule of income levels developed or implemented by such 1 ore 2 more Indian tribes). (c) Expenses for self-insured plan In the case of a self-insured plan under sub- section (a)(4), the amounts may be used for ex- penses of operating the plan, including adminis- tration and insurance to limit the financial risks to the entity offering the plan. (d) Construction Nothing in this section shall be construed as affecting the use of any amounts not referred to in subsection (a).