Title 42 — The Public Health and Welfare
Chapter 7 — Social Security
§ 1396j. Indian Health Service facilities
Statutory text
Eligibility for reimbursement for medical assistance
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 covered under the State plan), 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 reimbursement for medical assistance provided 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.
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 covered 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 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 reimbursement 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.
Agreement to reimburse State agency for providing care and services
The Secretary is authorized to enter into agreements with the State agency for the purpose 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.
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 § 402(a) · 90 Stat. 1400
Enacted · 42 U.S.C. § 1396j
Aug. 14, 1935, ch. 531, title XIX, § 1911, as added Pub. L. 94–437, title IV, § 402(a), Sept. 30, 1976, 90 Stat. 1409
Source evidence
Code source credit
Aug. 14, 1935, ch. 531, title XIX, § 1911, as added Pub. L. 94–437, title IV, § 402(a), Sept. 30, 1976, 90 Stat. 1409Enacted provision · exact public law section
(a) Title XIX of the Social Security Act is amended by adding at the end thereof the following new section: “Sec. 1011. “indian health service facilities (a) A facility of the Indian Health Service (including Eligibility for reimbursement. 42 USC 1396j. a hospital, intermediate care facility, or skilled nursing facility), 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 reimbursement for Ante, p. 1401. medical assistance provided 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 title. “(b) Notwithstanding subsection (a), a facility of the Indian Facilities, submittal of plan for compliance. 42 USC 1396j note. Health Service (including a hospital, intermediate care facility, or skilled nursing facility) which does not meet all of the conditions and requirements of this title which are applicable generally to such facility, 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 reimbursement under this title), 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.”.Pub. L. 100–203 § 4118(f)(1)(A) · 101 Stat. 1330
Amended · 42 U.S.C. § 1396j(a); 42 U.S.C. § 1396j(b)
Pub. L. 100–203, § 4118(f)(1)(A), as amended by Pub. L. 100–360, § 411(k)(10)(E)
Substituted · 42 U.S.C. § 1396j(a); 42 U.S.C. § 1396j(b)
Pub. L. 100–203, § 4118(f)(1)(A), as substituted “, nursing facility, or any other type of facility which provides services of a type otherwise covered under the State plan” for “or nursing facility”
Source evidence
Code amendment note
Subsecs. (a), (b). Pub. L. 100–203, § 4118(f)(1)(A), as amended by Pub. L. 100–360, § 411(k)(10)(E), substituted “, nursing facility, or any other type of facility which provides services of a type otherwise covered under the State plan” for “or nursing facility”.Enacted provision · exact public law section
(A) by striking “or nursing facility” each place it appears and inserting “, nursing facility, or any other type of facility which provides services of a type otherwise covered under the State plan”; andPub. L. 100–203 § 4211(h)(8) · 101 Stat. 1330
Substituted · 42 U.S.C. § 1396j(a); 42 U.S.C. § 1396j(b)
Pub. L. 100–203, § 4211(h)(8), substituted “or nursing facility” for “, intermediate care facility, or skilled nursing facility” wherever appearing
Target inherited from the preceding amendment note.
Source evidence
Code amendment note
Pub. L. 100–203, § 4211(h)(8), substituted “or nursing facility” for “, intermediate care facility, or skilled nursing facility” wherever appearing.Enacted provision · exact public law section
(8) Section 1911 of such Act (42 U.S.C. 1396j) is amended by striking “, intermediate care facility, or skilled nursing facility” each place it appears and inserting “or nursing facility”.Pub. L. 100–203 § 4118(f)(1)(B) · 101 Stat. 1330
Added · 42 U.S.C. § 1396j(c)
Pub. L. 100–203, § 4118(f)(1)(B), added subsec. (c)
Source evidence
Code amendment note
Subsec. (c). Pub. L. 100–203, § 4118(f)(1)(B), added subsec. (c).Enacted provision · exact public law section
(B) by adding at the end the following new subsection:Medicare Catastrophic Coverage Act of 1988
Pub. L. 100–360 § 411(k)(10)(E) · 102 Stat. 683
Changed · 42 U.S.C. § 1396j(a); 42 U.S.C. § 1396j(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
Source evidence
Code amendment note
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.Enacted provision · exact public law section
(E) Section 4118(f)(1) of OBRA is amended by striking “4111(g)(8)” and inserting “4211(h)(8)”.Alaska Native and American Indian Direct Reimbursement Act of 2000
Pub. L. 106–417 § 3(b)(2) · 114 Stat. 1812
Added · 42 U.S.C. § 1396j(d)
Pub. L. 106–417 added subsec. (d)
Source evidence
Code amendment note
Subsec. (d). Pub. L. 106–417 added subsec. (d).Enacted provision · exact public law section
(2) Section 1911 of the Social Security Act (42 U.S.C. 1396j) is amended by adding at the end the following: “(d) 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).”.Effective date note
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.
7 of 7 references resolved to an enrolled provision
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), , 124 Stat. 935, and, as so amended, no longer contains provisions relating to direct billing of medicare, medicaid, and other third party payors.
Amendments1987–2000 · 3 rounds
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), substituted “, nursing facility, or any other type of facility 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 facility” for “, intermediate care facility, or skilled nursing facility” wherever appearing.
Subsec. (c). Pub. L. 100–203, § 4118(f)(1)(B), added subsec. (c).
Statutory Notes and Related Subsidiaries
Effective Date of 2000 Amendment
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.
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), , 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 [].”
Amendment by section 4211(h)(8) of Pub. L. 100–203 applicable to nursing facility services furnished on or after , 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), , 90 Stat. 1409, which authorized Secretary to enter into agreements to reimburse State agencies for health care and services provided in Service facilities to Indians eligible for medical assistance under this subchapter, was repealed by Pub. L. 100–713, title IV, § 401(b), , 102 Stat. 4818, applicable to services performed on or after the .
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), , 90 Stat. 1409, as amended by Pub. L. 100–713, title IV, § 401(a), , 102 Stat. 4818, provided that payments to which any Indian Health Service facility was entitled 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 subchapter, required minimum funding for each service unit making collections for such facilities, and provided 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 subchapter, prior to the general amendment of section 402 of Pub. L. 94–437 by Pub. L. 102–573, title IV, § 401(b)(1), , 106 Stat. 4565. Similar provisions are contained in section 401(c) of Pub. L. 94–437, which is classified 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), , 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 provision 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), , 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.
Credits
1935–2000 · 4 acts
- 1935Aug. 14, 1935, ch. 531, title XIX, § 1911, as added Pub. L. 94–437, title IV, § 402(a), , 90 Stat. 1409
- 1987amended Pub. L. 100–203, title IV, §§ 4118(f)(1), 4211(h)(8), , 101 Stat. 1330–155, 1330–206
- 1988Pub. L. 100–360, title IV, § 411(k)(10)(E), , 102 Stat. 796
- 2000Pub. L. 106–417, § 3(b)(2), , 114 Stat. 1815.
Show as published
(Aug. 14, 1935, ch. 531, title XIX, § 1911, as added Pub. L. 94–437, title IV, § 402(a), , 90 Stat. 1409; amended Pub. L. 100–203, title IV, §§ 4118(f)(1), 4211(h)(8), , 101 Stat. 1330–155, 1330–206; Pub. L. 100–360, title IV, § 411(k)(10)(E), , 102 Stat. 796; Pub. L. 106–417, § 3(b)(2), , 114 Stat. 1815.)