42 U.S.C. § 1395qq — Indian Health Service facilities

(a) Eligibility for payments; conditions and requirements. An Indian Health Service hospital or skilled nursing facility, whether operated by the Service or by an Indian tribe or tribal organization, as defined in section 1603 of title 25, is eligible for payments under this subchapter despite sections 1395f(c) and 1395n(d), as long as it meets all conditions and requirements generally applicable under this subchapter to hospitals or skilled nursing facilities of that type. (b) Eligibility based on submission of plan to achieve compliance with conditions and requirements; twelve-month period. Despite (a), a facility that does not meet all generally applicable conditions and requirements is treated as meeting them, and as eligible for payments, without regard to actual compliance during the first 12 months after the month in which it submits an acceptable compliance plan to the Secretary within six months after September 30, 1976. (c) Payments into special fund for improvements to achieve compliance with conditions and requirements; certification of compliance by Secretary. Despite any other provision, payments owed because of this section must be placed in a special fund held by the Secretary. The Secretary must use the fund, only to the extent and in the amounts provided by appropriation Acts, exclusively for improvements needed to bring the Service’s hospitals and skilled nursing facilities into compliance. This rule ends when the Secretary determines and certifies that substantially all of the Service’s hospitals and skilled nursing facilities in the United States comply. (d) Report by Secretary; status of facilities in complying with conditions and requirements. The Secretary’s annual report required by section 1671 of title 25 must include, in addition to the matters in section 1643 of title 25, a detailed statement of the facilities’ compliance status and their progress, under subsection (b) plans and otherwise, toward compliance. (e) Services provided by Indian Health Service, Indian tribe, or tribal organization. (1)(A) Despite section 1395n(d), and subject to (B), the Secretary must pay under part B to a hospital or ambulatory care clinic, whether provider-based or freestanding, operated by the Service, an Indian tribe, or a tribal organization, for paragraph (2) services and, for items and services furnished on or after January 1, 2005, all items and services payable under part B. They must be furnished in or at the direction of the hospital or clinic. Payment uses the same situations, terms, and conditions that would apply if it were not operated by the Service, tribe, or organization. (B) Payment is not made to the extent it is otherwise made under this subchapter. (2) The services are: (A) services paid under section 1395w–4; (B) services by a practitioner described in section 1395u(b)(18)(C) for which part B pays under a fee schedule; and (C) services by a physical or occupational therapist described in section 1395x(p) for which part B pays under a fee schedule. (3) Subsection (c) does not apply to payments under this subsection. (f) Cross reference. Section 1645 of title 25 contains provisions about certain Indian tribes’, tribal organizations’, and Alaska Native health organizations’ authority to choose direct billing and direct payment for health care services from their hospitals or clinics when payment is allowed under this subchapter.