[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4843 Introduced in House (IH)]
113th CONGRESS
2d Session
H. R. 4843
To amend title XVIII of the Social Security Act to provide for a
limitation under the Medicare program on charges for contract health
services provided to Indians by Medicare providers of services and
suppliers.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
June 11, 2014
Ms. McCollum (for herself, Mr. Cole, Mr. Ben Ray Lujan of New Mexico,
Mr. Issa, Mr. Grijalva, Mr. Kline, Mr. Pallone, Mr. Young of Alaska,
Mr. Huffman, and Mr. Kind) introduced the following bill; which was
referred to the Committee on Energy and Commerce, and in addition to
the Committees on Ways and Means and Natural Resources, for a period to
be subsequently determined by the Speaker, in each case for
consideration of such provisions as fall within the jurisdiction of the
committee concerned
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to provide for a
limitation under the Medicare program on charges for contract health
services provided to Indians by Medicare providers of services and
suppliers.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Native Contract and Rate Expenditure
Act of 2014'' or the ``Native CARE Act of 2014''.
SEC. 2. FINDINGS.
Congress makes the following findings:
(1) Federal health services to maintain and improve the
health of American Indians and Alaska Natives are consonant
with and required by the Federal Government's historical and
unique legal relationship with, and resulting trust
responsibility to, the American Indian and Alaska Native
people.
(2) The unmet health needs of American Indians and Alaska
Natives are severe and the health status of American Indians
and Alaska Natives is far below that of the general population
of the United States, resulting in an average life expectancy
for American Indians and Alaska Natives 4.2 years less than
that for the all races population of the United States.
(3) The Indian Health Service and tribal Purchased/Referred
Care programs purchase primary and specialty care services from
private health care providers when those services are not
available at Indian Health Service or Tribal health facilities.
(4) Available Purchased/Referred Care funds have been
insufficient to ensure access to care for American Indians and
Alaska Natives, resulting in rationed care and diagnosis and
treatment delays that lead to the need for more intensive and
expensive treatment, further reducing already scarce Purchased/
Referred Care funds.
(5) In 2003, Congress amended title XVIII of the Social
Security Act to require Medicare-participating hospitals to
accept patients referred from the Indian Health Service and
Tribal Purchased/Referred Care programs and to accept payment
at no more than Medicare rates--the Medicare-like rate cap--for
the services provided.
(6) The Medicare-like rate cap only applies to hospital
services, and does not apply to other types of Medicare-
participating providers and suppliers.
(7) Unlike other Federal health care programs, the Indian
Health Service and Tribal Purchased/Referred Care programs
continue to pay full billed charges for non-hospital services.
(8) Because Purchased/Referred programs continue to pay
full billed charges for non-hospital services, in many cases
the Indian Health Service may only treat the most desperate
``Life'' or ``Limb'' cases, leading to many undesirable health
outcomes for American Indians and Alaska Natives, and
ultimately increasing costs to the Purchased/Referred Care
programs.
(9) On April 11, 2013, the Government Accountability Office
released a report finding that capping Purchased/Referred Care
reimbursement at Medicare-like rates for nonhospital services
would enable the Indian Health Service to double the number of
physician services provided by adding an additional 253,000
patient visits annually.
SEC. 3. LIMITATION ON CHARGES FOR CERTAIN CONTRACT HEALTH SERVICES
PROVIDED TO INDIANS BY MEDICARE PROVIDERS OF SERVICES AND
SUPPLIERS.
(a) Application to All Providers of Services.--
(1) In general.--Section 1866(a)(1)(U) of the Social
Security Act (42 U.S.C. 1395cc(a)(1)(U)) is amended, in the
matter preceding clause (i), by striking ``in the case of
hospitals which furnish inpatient hospital services for which
payment may be made under this title,''.
(2) Regulations.--The Secretary of Health and Human
Services shall promulgate regulations to account for the
amendment made by paragraph (1).
(3) Effective date.--The amendment made by paragraph (1)
shall apply to Medicare participation agreements in effect (or
entered into) on or after the date that is 90 days after the
date of enactment of this Act.
(b) Application to All Suppliers.--
(1) In general.--Section 1834 of the Social Security Act
(42 U.S.C. 1395m) is amended by adding at the end the following
new subsection:
``(r) Limitation on Charges for Certain Contract Health Services
Provided to Indians by Suppliers.--No payment may be made under this
title for an item or service furnished by a supplier (as defined in
section 1861(d)) unless the supplier agrees (pursuant to a process
established by the Secretary) to be a participating provider of medical
and other health services both--
``(1) under the Purchased/Referred Care program (formerly
referred to as the `contract health services program') funded
by the Indian Health Service and operated by the Indian Health
Service, an Indian tribe, or tribal organization (as those
terms are defined in section 4 of the Indian Health Care
Improvement Act), with respect to items and services that are
covered under such program and furnished to an individual
eligible for such items and services under such program; and
``(2) under any program funded by the Indian Health Service
and operated by an urban Indian organization with respect to
the purchase of items and services for an eligible urban Indian
(as those terms are defined in such section 4),
in accordance with regulations promulgated by the Secretary regarding
payment methodology and rates of payment (including the acceptance of
no more than such payment rate as payment in full for such items and
services).''.
(2) Effective date.--The amendment made by paragraph (1)
shall apply to items and services furnished on or after the
date that is 90 days after the date of enactment of this Act.
(c) Limitation.--There shall be no reduction, offset, or limitation
to any appropriations made to the Indian Health Service under the
Indian Health Care Improvement Act (25 U.S.C. 1621 et seq.), the Act of
November 2, 1921 (25 U.S.C. 13) (commonly known as the ``Snyder Act''),
or any other provision of law as a result of the provisions of,
including amendments made by, this Act.
(d) Studies and Reports.--
(1) Study.--The Secretary of Health and Human Services (in
this subsection referred to as the ``Secretary''), acting
through the Director of the Indian Health Service, shall
conduct a study on the impact of the amendments made by this
section on access to care under the Purchased/Referred Care
program of the Indian Health Service.
(2) Report.--Not later than 2 years after the date of
enactment of this Act, the Secretary shall submit to Congress a
report containing the results of the study conducted under
paragraph (1), including recommendations for such legislation
and administrative action as the Secretary determines
appropriate.
(3) Section 219(c) study and report.--Section 219(c) of the
Indian Health Care Improvement Act (25 U.S.C. 1621r(c)) is
amended by striking ``12 months after the date of the enactment
of this section'' and inserting ``12 months after the date of
the enactment of the Native Contract and Rate Expenditure Act
of 2014, and biennially thereafter through 2020''.
<all>