25 U.S.C. § 1621s — Prompt action on payment of claims

Page 284 TITLE 25—INDIANS § 1621r 1 See References in Text note below. section and on the progress made toward the prevention, control, and elimination of com- municable and infectious diseases among Indi- ans and urban Indians. (Pub. L. 94–437, title II, § 218, as added Pub. L. 102–573, title II, § 214, Oct. 29, 1992, 106 Stat. 4556; amended Pub. L. 103–437, § 10(e)(1), (2)(B), Nov. 2, 1994, 108 Stat. 4589; Pub. L. 111–148, title X, § 10221(a), Mar. 23, 2010, 124 Stat. 935.) Editorial Notes CODIFICATION Amendment by Pub. L. 111–148 is based on section 133 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. AMENDMENTS 2010—Pub. L. 111–148 amended section generally. Prior to amendment, section related to grants to Indian tribes and tribal organizations for prevention, control, and elimination of tuberculosis. 1994—Subsec. (d)(4). Pub. L. 103–437 substituted ‘‘Com- mittee on Indian’’ for ‘‘Select Committee on Indian’’ and ‘‘Natural Resources’’ for ‘‘Interior and Insular Af- fairs’’. Statutory Notes and Related Subsidiaries COVERAGE OF TESTING FOR COVID–19 AT NO COST SHARING FOR INDIANS RECEIVING PURCHASED/RE- FERRED CARE Pub. L. 116–127, div. F, § 6007, Mar. 18, 2020, 134 Stat. 208, provided that: ‘‘The Secretary of Health and Human Services shall cover, without the imposition of any cost sharing requirements, the cost of providing any COVID–19 related items and services as described in paragraph (1) of section 6001(a) [of Pub. L. 116–127, 42 U.S.C. 1320b–5 note] (or the administration of such products) or visits described in paragraph (2) of such section furnished during any portion of the emergency period defined in paragraph (1)(B) of section 1135(g) of the Social Security Act (42 U.S.C. 320b–5(g) [1320b–5(g)]) beginning on or after the date of the enactment of this Act [Mar. 18, 2020] to Indians (as defined in section 4 of the Indian Health Care Improvement Act (25 U.S.C. 1603)) receiving health services through the Indian Health Service, including through an Urban Indian Or- ganization, regardless of whether such items or services have been authorized under the purchased/referred care system funded by the Indian Health Service or is cov- ered as a health service of the Indian Health Service.’’ § 1621r. Contract health services payment study (a) Duty of Secretary The Secretary, acting through the Service and in consultation with representatives of Indian tribes and tribal organizations operating con- tract health care programs under the Indian Self-Determination Act (25 U.S.C. 450f et seq.) 1 or under self-governance compacts, Service per- sonnel, private contract health services pro- viders, the Indian Health Service Fiscal Inter- mediary, and other appropriate experts, shall conduct a study— (1) to assess and identify administrative bar- riers that hinder the timely payment for serv- ices delivered by private contract health serv- ices providers to individual Indians by the Service and the Indian Health Service Fiscal Intermediary; (2) to assess and identify the impact of such delayed payments upon the personal credit histories of individual Indians who have been treated by such providers; and (3) to determine the most efficient and effec- tive means of improving the Service’s contract health services payment system and ensuring the development of appropriate consumer pro- tection policies to protect individual Indians who receive authorized services from private contract health services providers from billing and collection practices, including the devel- opment of materials and programs explaining patients’ rights and responsibilities. (b) Functions of study The study required by subsection (a) shall— (1) assess the impact of the existing contract health services regulations and policies upon the ability of the Service and the Indian Health Service Fiscal Intermediary to process, on a timely and efficient basis, the payment of bills submitted by private contract health services providers; (2) assess the financial and any other bur- dens imposed upon individual Indians and pri- vate contract health services providers by de- layed payments; (3) survey the policies and practices of col- lection agencies used by contract health serv- ices providers to collect payments for services rendered to individual Indians; (4) identify appropriate changes in Federal policies, administrative procedures, and regu- lations, to eliminate the problems experienced by private contract health services providers and individual Indians as a result of delayed payments; and (5) compare the Service’s payment proc- essing requirements with private insurance claims processing requirements to evaluate the systemic differences or similarities em- ployed by the Service and private insurers. (c) Report to Congress Not later than 12 months after October 29, 1992, the Secretary shall transmit to the Con- gress a report that includes— (1) a detailed description of the study con- ducted pursuant to this section; and (2) a discussion of the findings and conclu- sions of such study. (Pub. L. 94–437, title II, § 219, as added Pub. L. 102–573, title II, § 215, Oct. 29, 1992, 106 Stat. 4557.) Editorial Notes REFERENCES IN TEXT The Indian Self-Determination Act (25 U.S.C. 450f et seq.), referred to in subsec. (a), is title I of Pub. L. 93–638, Jan. 4, 1975, 88 Stat. 2206, which was classified principally to part A (§ 450f et seq.) of subchapter II of chapter 14 of this title prior to editorial reclassifica- tion as subchapter I (§ 5321 et seq.) of chapter 46 of this title. For complete classification of this Act to the Code, see Short Title note set out under section 5301 of this title and Tables. § 1621s. Prompt action on payment of claims (a) Time of response The Service shall respond to a notification of a claim by a provider of a contract care service Page 285 TITLE 25—INDIANS § 1621v 1 See References in Text note below. with either an individual purchase order or a de- nial of the claim within 5 working days after the receipt of such notification. (b) Failure to timely respond If the Service fails to respond to a notification of a claim in accordance with subsection (a), the Service shall accept as valid the claim sub- mitted by the provider of a contract care serv- ice. (c) Time of payment The Service shall pay a completed contract care service claim within 30 days after comple- tion of the claim. (Pub. L. 94–437, title II, § 220, as added Pub. L. 102–573, title II, § 215, Oct. 29, 1992, 106 Stat. 4558.) § 1621t. Licensing Licensed health professionals employed by a tribal health program shall be exempt, if li- censed in any State, from the licensing require- ments of the State in which the tribal health program performs the services described in the contract or compact of the tribal health pro- gram under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.).1 (Pub. L. 94–437, title II, § 221, as added Pub. L. 102–573, title II, § 215, Oct. 29, 1992, 106 Stat. 4559; amended Pub. L. 111–148, title X, § 10221(a), Mar. 23, 2010, 124 Stat. 935.) Editorial Notes REFERENCES IN TEXT The Indian Self-Determination and Education Assist- ance Act (25 U.S.C. 450 et seq.), referred to in text, is Pub. L. 93–638, Jan. 4, 1975, 88 Stat. 2203, which was clas- sified principally to subchapter II (§ 450 et seq.) of chap- ter 14 of this title prior to editorial reclassification as chapter 46 (§ 5301 et seq.) of this title. For complete 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 134(a) of title I of S. 1790, One Hundred Eleventh Con- gress, as reported by the Committee on Indian Affairs of the Senate in Dec. 2009, which was enacted into law by section 10221(a) of Pub. L. 111–148. AMENDMENTS 2010—Pub. L. 111–148 amended section generally. Prior to amendment, section related to demonstration of electronic claims processing. § 1621u. Liability for payment (a) No patient liability A patient who receives contract health care services that are authorized by the Service shall not be liable for the payment of any charges or costs associated with the provision of such serv- ices. (b) Notification The Secretary shall notify a contract care pro- vider and any patient who receives contract health care services authorized by the Service that such patient is not liable for the payment of any charges or costs associated with the pro- vision of such services not later than 5 business days after receipt of a notification of a claim by a provider of contract care services. (c) No recourse Following receipt of the notice provided under subsection (b), or, if a claim has been deemed ac- cepted under section 1621s(b) of this title, the provider shall have no further recourse against the patient who received the services. (Pub. L. 94–437, title II, § 222, as added Pub. L. 102–573, title II, § 215, Oct. 29, 1992, 106 Stat. 4559; amended Pub. L. 111–148, title X, § 10221(a), Mar. 23, 2010, 124 Stat. 935.) Editorial Notes CODIFICATION Amendment by Pub. L. 111–148 is based on section 135 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. AMENDMENTS 2010—Pub. L. 111–148 amended section generally. Prior to amendment, section related to absence of patient li- ability for payment of charges or costs for contract health care services and requirement that Secretary notify contract care provider and patient of absence of patient’s liability. Statutory Notes and Related Subsidiaries RULE OF CONSTRUCTION Pub. L. 116–260, div. BB, title I, § 102(d)(3), Dec. 27, 2020, 134 Stat. 2797, provided that: ‘‘Nothing in this title [probably means ‘‘this section’’, enacting sections 9816 and 9822 of Title 26, Internal Revenue Code, sections 1185e and 1185k of Title 29, Labor, and sections 300gg–111 and 300gg–117 of Title 42, The Public Health and Wel- fare, amending section 8902 of Title 5, Government Or- ganization and Employees, section 223 of Title 26, and sections 300gg–19a, 300gg–21, 300gg–22, 300gg–23, and 18011 of Title 42, and enacting provisions set out as notes under section 8902 of Title 5 and section 223 of Title 26], including the amendments made by this title [probably means ‘‘this section’’] may be construed as modifying, reducing, or eliminating— ‘‘(A) the protections under section 222 of the Indian Health Care Improvement Act (25 U.S.C. 1621u) and under subpart I of part 136 of title 42, Code of Federal Regulations (or any successor regulation), against payment liability for a patient who receives contract health services that are authorized by the Indian Health Service; or ‘‘(B) the requirements under section 1866(a)(1)(U) of the Social Security Act (42 U.S.C. 1395cc(a)(1)(U)).’’ § 1621v. Offices of Indian Men’s Health and In- dian Women’s Health (a) Office of Indian Men’s Health (1) Establishment The Secretary may establish within the Service an office, to be known as the ‘‘Office of Indian Men’s Health’’. (2) Director (A) In general The Office of Indian Men’s Health shall be headed by a director, to be appointed by the Secretary. (B) Duties The director shall coordinate and promote the health status of Indian men in the United States.