Title 42 — The Public Health and Welfare
Part E · Chapter 7 — Social Security
§ 1395qq. Indian Health Service facilities
Statutory text
Eligibility for payments; conditions and requirements
A hospital or skilled nursing facility of the Indian Health Service, whether operated by such Service or by an Indian tribe or tribal organization (as those terms are defined in section 1603 of title 25), shall be eligible for payments under this subchapter, notwithstanding sections 1395f(c) and 1395n(d) of this title, if and for so long as it meets all of the conditions and requirements for such payments which are applicable generally to hospitals or skilled nursing facilities (as the case may be) under this subchapter.
Eligibility based on submission of plan to achieve compliance with conditions and requirements; twelve-month period
Notwithstanding subsection (a), a hospital or skilled nursing facility of the Indian Health Service which does not meet all of the conditions and requirements of this subchapter which are applicable generally to hospitals or skilled nursing facilities (as the case may be), but which submits to the Secretary within six months after , an acceptable plan for achieving compliance with such conditions and requirements, shall be deemed to meet such conditions and requirements (and to be eligible for payments under this subchapter), without regard to the extent of its actual compliance with such conditions and requirements, during the first 12 months after the month in which such plan is submitted.
Payments into special fund for improvements to achieve compliance with conditions and requirements; certification of compliance by Secretary
Notwithstanding any other provision of this subchapter, payments to which any hospital or skilled nursing facility of the Indian Health Service is entitled by reason of this section shall be placed in a special fund to be held by the Secretary and used by him (to such extent or in such amounts as are provided in appropriation Acts) exclusively for the purpose of making any improvements in the hospitals and skilled nursing facilities of such Service which may be necessary to achieve compliance with the applicable conditions and requirements of this subchapter. The preceding sentence shall cease to apply when the Secretary determines and certifies that substantially all of the hospitals and skilled nursing facilities of such Service in the United States are in compliance with such conditions and requirements.
Report by Secretary; status of facilities in complying with conditions and requirements
The annual report of the Secretary which is required by section 1671 of title 25 shall include (along with the matters specified in section 1643 of title 25) a detailed statement of the status of the hospitals and skilled nursing facilities of the Service in terms of their compliance with the applicable conditions and requirements of this subchapter and of the progress being made by such hospitals and facilities (under plans submitted under subsection (b) and otherwise) toward the achievement of such compliance.
Services provided by Indian Health Service, Indian tribe, or tribal organization
Notwithstanding section 1395n(d) of this title, subject to subparagraph (B), the Secretary shall make payment under part B to a hospital or an ambulatory care clinic (whether provider-based or freestanding) that is operated by the Indian Health Service or by an Indian tribe or tribal organization (as defined for purposes of subsection (a)) for services described in paragraph (2) (and for items and services furnished on or after , all items and services for which payment may be made under part B) furnished in or at the direction of the hospital or clinic under the same situations, terms, and conditions as would apply if the services were furnished in or at the direction of such a hospital or clinic that was not operated by such Service, tribe, or organization.
Payment shall not be made for services under subparagraph (A) to the extent that payment is otherwise made for such services under this subchapter.
The services described in this paragraph are the following:
Services for which payment is made under section 1395w–4 of this title.
Services furnished by a practitioner described in section 1395u(b)(18)(C) of this title for which payment under part B is made under a fee schedule.
Services furnished by a physical therapist or occupational therapist as described in section 1395x(p) of this title for which payment under part B is made under a fee schedule.
Subsection (c) shall not apply to payments made under this subsection.
Cross reference
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 subchapter, see section 1645 of title 25.1
Footnotes
- 1 See References in Text note below.
Legislative history
Reconstructed from this section’s Code source credit and amendment notes, resolved against the local Statutes at Large. Editorial notes are evidence, not the law that made the change.
Indian Health Care Improvement Act
Pub. L. 94–437 title IV § 401(b) · 90 Stat. 1400
Enacted · 42 U.S.C. § 1395qq
Aug. 14, 1935, ch. 531, title XVIII, § 1880, as added Pub. L. 94–437, title IV, § 401(b), Sept. 30, 1976, 90 Stat. 1408
Source evidence
Code source credit
Aug. 14, 1935, ch. 531, title XVIII, § 1880, as added Pub. L. 94–437, title IV, § 401(b), Sept. 30, 1976, 90 Stat. 1408Enacted provision · exact public law section
(b) Part C of title XVIII of such Act is amended by adding at the end thereof the following new section: “Sec. 1880. “indian health service facilities (a) A hospital or skilled nursing facility of the Indian Health Service, whether operated by such Service or by an Indian tribe or tribal organization (as those terms are defined in section 4 of the Indian Health Care Improvement Act), shall be eligible for payments under this title, notwithstanding sections 1814(c) and 1835 (d), if and for so long as it meets all of the conditions and requirements for such payments which are applicable generally to hospitals or skilled nursing facilities (as the case may be) under this title. “(b) Notwithstanding subsection (a), a hospital or skilled nursing facility of the Indian Health Service which does not meet all of the conditions and requirements of this title which are applicable generally to hospitals or skilled nursing facilities (as the case may be), but which submits to the Secretary within six months after the date of the enactment of this section an acceptable plan for achieving compliance with such conditions and requirements, shall be deemed to meet such conditions and requirements (and to be eligible for payments under this title), without regard to the extent of its actual compliance with such conditions and requirements, during the first 12 months after the month in which such plan is submitted. “(c) Notwithstanding any other provision of this title, payments to which any hospital or skilled nursing facility of the Indian Health Service is entitled by reason of this section shall be placed in a special fund to be held by the Secretary and used by him (to such extent or in such amounts as are provided in appropriation Acts) exclusively for the purpose of making any improvements in the hospitals and skilled nursing facilities of such Service which may be necessary to achieve compliance with the applicable conditions and requirements of this title. The preceding sentence shall cease to apply when the Secretary determines and certifies that substantially all of the hospitals and skilled nursing facilities of such Service in the United States are in compliance with such conditions and requirements. “(d) The annual report of the Secretary which is required by section 701 of the Indian Health Care Improvement Act shall include (along with the matters specified in section 403 of such Act) a detailed statement of the status of the hospitals and skilled nursing facilities of the Service in terms of their compliance with the applicable, conditions and requirements of this title and of the progress being made by such hospitals and facilities (under plans submitted under subsection (b) and otherwise) toward the achievement of such compliance.”.Indian Health Amendments of 1992
Pub. L. 102–573 title VII § 701(d) · 106 Stat. 4526
Changed · 42 U.S.C. § 1395qq(d)
Pub. L. 102–573 made technical amendment to the reference to section 1671 of title 25 to reflect renumbering of corresponding section of original act
Source evidence
Code amendment note
Subsec. (d). Pub. L. 102–573 made technical amendment to the reference to section 1671 of title 25 to reflect renumbering of corresponding section of original act.Enacted provision · exact public law section
(d) References.— Any reference in a provision of law other than the Indian Health Care Improvement Act to sections redesignated by subsection (b) shall be deemed to refer to the section as so redesignated.Alaska Native and American Indian Direct Reimbursement Act of 2000
Pub. L. 106–417 § 3(b)(1) · 114 Stat. 1812
Added · 42 U.S.C. § 1395qq(e)
Pub. L. 106–417 added subsec. (e)
Target inherited from the preceding amendment note.
Source evidence
Code amendment note
Pub. L. 106–417 added subsec. (e).Enacted provision · exact public law section
(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).”.Consolidated Appropriations Act, 2001
Pub. L. 106–554 § 1(a)(6)(tIV)(s432)(a)(2) · 114 Stat. 2763
Redesignated · 42 U.S.C. § 1395qq(e)
Pub. L. 106–554, § 1(a)(6) [title IV, § 432(a)(2)], added subsec. (e). Former subsec. (e) redesignated (f)
Source evidence
Code amendment note
Subsec. (e). Pub. L. 106–554, § 1(a)(6) [title IV, § 432(a)(2)], added subsec. (e). Former subsec. (e) redesignated (f).Enacted provision · exact public law section
(6) H.R. 5661, as introduced on December 14, 2000.Consolidated Appropriations Act, 2001
Pub. L. 106–554 § 1(a)(6)(tIV)(s432)(a)(1) · 114 Stat. 2763
Redesignated · 42 U.S.C. § 1395qq(f)
Pub. L. 106–554, § 1(a)(6) [title IV, § 432(a)(1)], redesignated subsec. (e) as (f)
Source evidence
Code amendment note
Subsec. (f). Pub. L. 106–554, § 1(a)(6) [title IV, § 432(a)(1)], redesignated subsec. (e) as (f).Enacted provision · exact public law section
(6) H.R. 5661, as introduced on December 14, 2000.Medicare Prescription Drug, Improvement, and Modernization Act of 2003
Pub. L. 108–173 title VI § 630 · 117 Stat. 2066
Inserted · 42 U.S.C. § 1395qq(e)(1)(A)
Pub. L. 108–173 inserted “(and for items and services furnished during the 5-year period beginning on January 1, 2005, all items and services for which payment may be made under part B)” after “for services described in paragraph (2)”
Source evidence
Code amendment note
Subsec. (e)(1)(A). Pub. L. 108–173 inserted “(and for items and services furnished during the 5-year period beginning on January 1, 2005, all items and services for which payment may be made under part B)” after “for services described in paragraph (2)”.Enacted provision · exact public law section
SEC. 630. FIVE-YEAR AUTHORIZATION OF REIMBURSEMENT FOR ALL MEDICARE PART B SERVICES FURNISHED BY CERTAIN INDIAN HOSPITALS AND CLINICS. Section 1880(e)(1)(A) (42 U.S.C. 1395qq(e)(1)(A)) is amended by inserting “(and for items and services furnished during the 5-year period beginning on January 1, 2005, all items and services for which payment may be made under part B)” after “for services described in paragraph (2)”.Patient Protection and Affordable Care Act
Pub. L. 111–148 § 2902(a) · 124 Stat. 119
Substituted · 42 U.S.C. § 1395qq(e)(1)(A)
Pub. L. 111–148, § 2902(a), substituted “on or after” for “during the 5-year period beginning on”
Source evidence
Code amendment note
Subsec. (e)(1)(A). Pub. L. 111–148, § 2902(a), substituted “on or after” for “during the 5-year period beginning on”.Enacted provision · exact public law section
(a) Reimbursement for All Medicare Part B Services Furnished by Certain Indian Hospitals and Clinics.— Section 1880(e)(1)(A) of the Social Security Act (42 U.S.C. 1395qq(e)(1)(A)) is amended by striking “during the 5-year period beginning on” and inserting “on or after”.Effective date note
Pub. L. 111–148, title II, § 2902(b), Mar. 23, 2010, 124 Stat. 333, provided that: “The amendments made by this section [amending this section] shall apply to items or services furnished on or after January 1, 2010.”
7 of 7 references resolved to an enrolled provision
Editorial Notes
References in Text
Section 1645 of title 25, referred to in subsec. (f), was amended generally by section 10221(a) of title X of Pub. L. 111–148, , 124 Stat. 935, and, as so amended, no longer contains provisions relating to direct billing of medicare, medicaid, and other third party payors.
Codification
Pub. L. 111–148, § 10221(a), enacted into law S. 1790, One Hundred Eleventh Congress, as reported by the Committee on Indian Affairs of the Senate in Dec. 2009, “[e]xcept as provided in” section 10221(b) of Pub. L. 111–148. Section 201(a) of S. 1790 would have amended this section but was stricken out by section 10221(b)(4) of Pub. L. 111–148.
Amendments1992–2010 · 4 rounds
2010
Subsec. (e)(1)(A). Pub. L. 111–148, § 2902(a), substituted “on or after” for “during the 5-year period beginning on”.
2003
Subsec. (e)(1)(A). Pub. L. 108–173 inserted “(and for items and services furnished during the 5-year period beginning on , all items and services for which payment may be made under part B)” after “for services described in paragraph (2)”.
2000
Subsec. (e). Pub. L. 106–554, § 1(a)(6) [title IV, § 432(a)(2)], added subsec. (e). Former subsec. (e) redesignated (f).
Pub. L. 106–417 added subsec. (e).
Subsec. (f). Pub. L. 106–554, § 1(a)(6) [title IV, § 432(a)(1)], redesignated subsec. (e) as (f).
1992
Subsec. (d). Pub. L. 102–573 made technical amendment to the reference to section 1671 of title 25 to reflect renumbering of corresponding section of original act.
Statutory Notes and Related Subsidiaries
Effective Date of 2010 Amendment
Pub. L. 111–148, title II, § 2902(b), , 124 Stat. 333, provided that: “The amendments made by this section [amending this section] shall apply to items or services furnished on or after .”
Effective Date of 2000 Amendment
Amendment by section 1(a)(6) [title IV, § 432(a)] of Pub. L. 106–554 applicable to services furnished on or after , see section 1(a)(6) [title IV, § 432(c)] of Pub. L. 106–554, set out as a note under section 1395u of this title.
Amendment by Pub. L. 106–417 effective , see section 3(c) of Pub. L. 106–417, set out as a note under section 1645 of Title 25, Indians.
Medicare Payments Not Considered in Determining Appropriations for Indian Health Care
Pub. L. 94–437, title IV, § 401(c), , 90 Stat. 1409, provided that any payments received for services provided to beneficiaries under this section were not to be considered in determining appropriations for health care and services to Indians, prior to the general amendment of section 401 of Pub. L. 94–437 by Pub. L. 102–573, title IV, § 401(a), , 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.
Preference in Services for Indians With Medicare Coverage Not Authorized
Pub. L. 94–437, title IV, § 401(d), , 90 Stat. 1409, which provided that nothing in this section authorized the Secretary to provide services to an Indian beneficiary with coverage under this subchapter, in preference to an Indian beneficiary without such coverage, prior to the general amendment of section 401 of Pub. L. 94–437 by Pub. L. 102–573, title IV, § 401(a), , 106 Stat. 4565. Similar provisions are contained in section 401(b) of Pub. L. 94–437, which is classified to section 1641(b) of Title 25, Indians.
Credits
1935–2010 · 6 acts
- 1935Aug. 14, 1935, ch. 531, title XVIII, § 1880, as added Pub. L. 94–437, title IV, § 401(b), , 90 Stat. 1408
- 1992amended Pub. L. 102–573, title VII, § 701(d), , 106 Stat. 4572
- 2000Pub. L. 106–417, § 3(b)(1), , 114 Stat. 1815
- 2000Pub. L. 106–554, § 1(a)(6) [title IV, § 432(a)], , 114 Stat. 2763, 2763A–525
- 2003Pub. L. 108–173, title VI, § 630, , 117 Stat. 2321
- 2010Pub. L. 111–148, title II, § 2902(a), title X, § 10221(a), (b)(4), , 124 Stat. 333, 935, 936.
Show as published
(Aug. 14, 1935, ch. 531, title XVIII, § 1880, as added Pub. L. 94–437, title IV, § 401(b), , 90 Stat. 1408; amended Pub. L. 102–573, title VII, § 701(d), , 106 Stat. 4572; Pub. L. 106–417, § 3(b)(1), , 114 Stat. 1815; Pub. L. 106–554, § 1(a)(6) [title IV, § 432(a)], , 114 Stat. 2763, 2763A–525; Pub. L. 108–173, title VI, § 630, , 117 Stat. 2321; Pub. L. 111–148, title II, § 2902(a), title X, § 10221(a), (b)(4), , 124 Stat. 333, 935, 936.)