42 U.S.C. § 1396j — Indian Health Service facilities

Page 4219 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1396j 1 See References in Text note below. skilled nursing facilities before, on, or after Oct. 30, 1972, but accepted by him on or after such date, see sec- tion 249A(e) of Pub. L. 92–603, set out as an Effective Date of 1972 Amendment note under section 1395cc of this title. § 1396j. Indian Health Service facilities (a) Eligibility for reimbursement for medical as- sistance A facility of the Indian Health Service (includ- ing a hospital, nursing facility, or any other type of facility which provides services of a type otherwise covered under the State plan), wheth- er operated by such Service or by an Indian tribe or tribal organization (as those terms are de- fined in section 1603 of title 25), shall be eligible for reimbursement for medical assistance pro- vided under a State plan if and for so long as it meets all of the conditions and requirements which are applicable generally to such facilities under this subchapter. (b) Facilities deemed to meet requirements upon submission of acceptable plan for achieving compliance Notwithstanding subsection (a), a facility of the Indian Health Service (including a hospital, nursing facility, or any other type of facility which provides services of a type otherwise cov- ered under the State plan) which does not meet all of the conditions and requirements of this subchapter which are applicable generally to such facility, but which submits to the Sec- retary within six months after September 30, 1976, an acceptable plan for achieving compli- ance with such conditions and requirements, shall be deemed to meet such conditions and re- quirements (and to be eligible for reimburse- ment under this subchapter), without regard to the extent of its actual compliance with such conditions and requirements, during the first twelve months after the month in which such plan is submitted. (c) Agreement to reimburse State agency for pro- viding care and services The Secretary is authorized to enter into agreements with the State agency for the pur- pose of reimbursing such agency for health care and services provided in Indian Health Service facilities to Indians who are eligible for medical assistance under the State plan. (d) Cross reference For provisions relating to the authority of cer- tain 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 pay- ment may be made under this subchapter, see section 1645 of title 25.1 (Aug. 14, 1935, ch. 531, title XIX, § 1911, as added Pub. L. 94–437, title IV, § 402(a), Sept. 30, 1976, 90 Stat. 1409; amended Pub. L. 100–203, title IV, §§ 4118(f)(1), 4211(h)(8), Dec. 22, 1987, 101 Stat. 1330–155, 1330–206; Pub. L. 100–360, title IV, § 411(k)(10)(E), July 1, 1988, 102 Stat. 796; Pub. L. 106–417, § 3(b)(2), Nov. 1, 2000, 114 Stat. 1815.) Editorial Notes REFERENCES IN TEXT Section 1645 of title 25, referred to in subsec. (d), was amended generally by Pub. L. 111–148, title X, § 10221(a), Mar. 23, 2010, 124 Stat. 935, and, as so amended, no longer contains provisions relating to direct billing of medicare, medicaid, and other third party payors. AMENDMENTS 2000—Subsec. (d). Pub. L. 106–417 added subsec. (d). 1988—Subsecs. (a), (b). Pub. L. 100–360, § 411(k)(10)(E), made technical correction to directory language of Pub. L. 100–203, § 4118(f)(1)(A), see 1987 Amendment note below. 1987—Subsecs. (a), (b). Pub. L. 100–203, § 4118(f)(1)(A), as amended by Pub. L. 100–360, § 411(k)(10)(E), sub- stituted ‘‘, nursing facility, or any other type of facil- ity which provides services of a type otherwise covered under the State plan’’ for ‘‘or nursing facility’’. Pub. L. 100–203, § 4211(h)(8), substituted ‘‘or nursing fa- cility’’ for ‘‘, intermediate care facility, or skilled nursing facility’’ wherever appearing. Subsec. (c). Pub. L. 100–203, § 4118(f)(1)(B), added sub- sec. (c). Statutory Notes and Related Subsidiaries EFFECTIVE DATE OF 2000 AMENDMENT Amendment by Pub. L. 106–417 effective Oct. 1, 2000, see section 3(c) of Pub. L. 106–417, set out as a note under section 1645 of Title 25, Indians. EFFECTIVE DATE OF 1988 AMENDMENT Except as specifically provided in section 411 of Pub. L. 100–360, amendment by Pub. L. 100–360, as it relates to a provision in the Omnibus Budget Reconciliation Act of 1987, Pub. L. 100–203, effective as if included in the enactment of that provision in Pub. L. 100–203, see section 411(a) of Pub. L. 100–360, set out as a Reference to OBRA; Effective Date note under section 106 of Title 1, General Provisions. EFFECTIVE DATE OF 1987 AMENDMENT Pub. L. 100–203, title IV, § 4118(f)(2), Dec. 22, 1987, 101 Stat. 1330–156, provided that: ‘‘The amendments made by paragraph (1) [amending this section] shall apply to health care services performed on or after the date of the enactment of this Act [Dec. 22, 1987].’’ Amendment by section 4211(h)(8) of Pub. L. 100–203 ap- plicable to nursing facility services furnished on or after Oct. 1, 1990, without regard to whether regulations implementing such amendment are promulgated by such date, except as otherwise specifically provided in section 1396r of this title, with transitional rule, see section 4214(a), (b)(2) of Pub. L. 100–203, as amended, set out as an Effective Date note under section 1396r of this title. AGREEMENTS TO REIMBURSE STATE AGENCY FOR HEALTH CARE AND SERVICES PROVIDED BY AGENCY TO INDIANS Pub. L. 94–437, title IV, § 402(b), Sept. 30, 1976, 90 Stat. 1409, which authorized Secretary to enter into agree- ments to reimburse State agencies for health care and services provided in Service facilities to Indians eligi- ble for medical assistance under this subchapter, was repealed by Pub. L. 100–713, title IV, § 401(b), Nov. 23, 1988, 102 Stat. 4818, applicable to services performed on or after the Nov. 23, 1988. PAYMENTS INTO SPECIAL FUND TO IMPROVE INDIAN HEALTH SERVICE FACILITIES TO ACHIEVE COMPLIANCE WITH CONDITIONS AND REQUIREMENTS Pub. L. 94–437, title IV, § 402(c), Sept. 30, 1976, 90 Stat. 1409, as amended by Pub. L. 100–713, title IV, § 401(a), Nov. 23, 1988, 102 Stat. 4818, provided that payments to which any Indian Health Service facility was entitled Page 4220 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1396k by reason of this section were to be placed in a special fund of the Secretary for improvements of facilities of the Service to comply with requirements of this sub- chapter, required minimum funding for each service unit making collections for such facilities, and pro- vided for section 402(c) of Pub. L. 94–437 to cease to apply when Secretary determined that substantially all such facilities complied with requirements of this sub- chapter, prior to the general amendment of section 402 of Pub. L. 94–437 by Pub. L. 102–573, title IV, § 401(b)(1), Oct. 29, 1992, 106 Stat. 4565. Similar provisions are con- tained in section 401(c) of Pub. L. 94–437, which is clas- sified to section 1641(c) of Title 25, Indians. MEDICAID PAYMENTS NOT CONSIDERED IN DETERMINING APPROPRIATIONS FOR INDIAN HEALTH CARE Pub. L. 94–437, title IV, § 402(d), Sept. 30, 1976, 90 Stat. 1410, provided that any payments received for services provided recipients under this section were not to be considered in determining appropriations for the provi- sion of health care and services to Indians, prior to the general amendment of section 402 of Pub. L. 94–437 by Pub. L. 102–573, title IV, § 401(b)(1), Oct. 29, 1992, 106 Stat. 4565. Similar provisions are contained in section 401(a) of Pub. L. 94–437, which is classified to section 1641(a) of Title 25, Indians. § 1396k. Assignment, enforcement, and collection of rights of payments for medical care; estab- lishment of procedures pursuant to State plan; amounts retained by State (a) For the purpose of assisting in the collec- tion of medical support payments and other pay- ments for medical care owed to recipients of medical assistance under the State plan ap- proved under this subchapter, a State plan for medical assistance shall— (1) provide that, as a condition of eligibility for medical assistance under the State plan to an individual who has the legal capacity to execute an assignment for himself, the indi- vidual is required— (A) to assign the State any rights, of the individual or of any other person who is eli- gible for medical assistance under this sub- chapter and on whose behalf the individual has the legal authority to execute an assign- ment of such rights, to support (specified as support for the purpose of medical care by a court or administrative order) and to pay- ment for medical care from any third party; (B) to cooperate with the State (i) in es- tablishing the paternity of such person (re- ferred to in subparagraph (A)) if the person is a child born out of wedlock, and (ii) in ob- taining support and payments (described in subparagraph (A)) for himself and for such person, unless (in either case) the individual is described in section 1396a(l)(1)(A) of this title or the individual is found to have good cause for refusing to cooperate as deter- mined by the State agency in accordance with standards prescribed by the Secretary, which standards shall take into consider- ation the best interests of the individuals in- volved; and (C) to cooperate with the State in identi- fying, and providing information to assist the State in pursuing, any third party who may be liable to pay for care and services available under the plan, unless such indi- vidual has good cause for refusing to cooper- ate as determined by the State agency in ac- cordance with standards prescribed by the Secretary, which standards shall take into consideration the best interests of the indi- viduals involved; and (2) provide for entering into cooperative ar- rangements (including financial arrange- ments), with any appropriate agency of any State (including, with respect to the enforce- ment and collection of rights of payment for medical care by or through a parent, with a State’s agency established or designated under section 654(3) of this title) and with appro- priate courts and law enforcement officials, to assist the agency or agencies administering the State plan with respect to (A) the enforce- ment and collection of rights to support or payment assigned under this section and (B) any other matters of common concern. (b) Such part of any amount collected by the State under an assignment made under the pro- visions of this section shall be retained by the State as is necessary to reimburse it for medical assistance payments made on behalf of an indi- vidual with respect to whom such assignment was executed (with appropriate reimbursement of the Federal Government to the extent of its participation in the financing of such medical assistance), and the remainder of such amount collected shall be paid to such individual. (Aug. 14, 1935, ch. 531, title XIX, § 1912, as added Pub. L. 95–142, § 11(b), Oct. 25, 1977, 91 Stat. 1196; amended Pub. L. 98–369, div. B, title III, § 2367(b), July 18, 1984, 98 Stat. 1109; Pub. L. 99–272, title IX, § 9503(e), Apr. 7, 1986, 100 Stat. 207; Pub. L. 101–508, title IV, § 4606(a), Nov. 5, 1990, 104 Stat. 1388–170; Pub. L. 113–67, div. A, title II, § 202(b)(2), Dec. 26, 2013, 127 Stat. 1177; Pub. L. 115–123, div. E, title XII, § 53102(b)(1), Feb. 9, 2018, 132 Stat. 298.) Editorial Notes AMENDMENTS 2018—Subsec. (a)(1)(A). Pub. L. 115–123, § 53102(b)(1), re- pealed Pub. L. 113–67, § 202(b)(2), and provided that the provisions amended by section 202(b) shall be applied and administered as if such amendment had never been enacted. See 2013 Amendment note below. 2013—Subsec. (a)(1)(A). Pub. L. 113–67, § 202(b)(2), which directed substitution of ‘‘any payment from a third party that has a legal liability to pay for care and services available under the plan’’ for ‘‘payment for medical care from any third party’’, was repealed by Pub. L. 115–123, § 53102(b)(1). 1990—Subsec. (a)(1)(B). Pub. L. 101–508 inserted ‘‘the individual is described in section 1396a(l)(1)(A) of this title or’’ after ‘‘unless (in either case)’’. 1986—Subsec. (a)(1)(C). Pub. L. 99–272 added subpar. (C). 1984—Subsec. (a). Pub. L. 98–369 substituted ‘‘State plan for medical assistance shall’’ for ‘‘State plan for medical assistance may’’. Statutory Notes and Related Subsidiaries EFFECTIVE DATE OF 2018 AMENDMENT Pub. L. 115–123, div. E, title XII, § 53102(b)(1), Feb. 9, 2018, 132 Stat. 298, provided that the repeal of section 202(b) of Pub. L. 113–67 is effective Sept. 30, 2017, and the provisions amended by section 202(b) shall be applied and administered as if such amendments had never been enacted. In addition, such repeal by section