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42 U.S.C. § 1396jIndian Health Service facilities

submitted 91 years ago by Pub. L. 94-437 to r/title-42-THE-PUBLIC-HEALTH-AND-WELFARE · 352 words · no verdicts yet

in plain englishAI-generated · not legal advice

An Indian Health Service facility may receive reimbursement under a State plan if it meets the conditions that generally apply to facilities of that type. A facility that submitted an acceptable compliance plan within the specified historical period was temporarily treated as meeting those conditions, and the Secretary may agree to reimburse a State agency for care in Indian Health Service facilities.

(a) Eligibility for reimbursement for medical assistance. An Indian Health Service facility—including a hospital, nursing facility, or any other facility providing a type of service otherwise covered by the State plan—may receive reimbursement for medical assistance under the plan if, and for as long as, it meets all conditions and requirements that generally apply to that type of facility under this subchapter. This includes a facility operated by the Indian Health Service and one operated by an Indian tribe or tribal organization, as those terms are defined in section 1603 of title 25. (b) Facilities treated as meeting requirements after submitting an acceptable compliance plan. Despite subsection (a), an Indian Health Service facility of the types described there that did not meet all generally applicable conditions and requirements, but submitted an acceptable plan to the Secretary within six months after September 30, 1976, was treated as meeting those conditions and requirements, and as eligible for reimbursement, during the first 12 months after the month in which it submitted the plan. This treatment applied regardless of how much the facility actually complied during that period. (c) Agreement to reimburse State agency for care and services. The Secretary may enter into agreements with a State agency to reimburse the agency for health care and services provided in Indian Health Service facilities to Indians eligible for medical assistance under the State plan. (d) Cross-reference. Section 1645 of title 25 addresses the authority of certain Indian tribes, tribal organizations, and Alaska Native health organizations to choose to bill directly and receive payment directly for health care services provided by their hospitals or clinics when payment may be made under this subchapter. This section does not define “Indian Health Service facility,” “Indian tribe,” or “tribal organization.”
the actual law source: uscode.house.gov ↗public domain
(a) 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.

(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 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 September 30, 1976, 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.

(c) 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.

(d) 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

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. 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.)

history & why it existsrecord from the source credit
  • 1935Enacted · Pub. L. 94-437 · 90 Stat. 1409
  • 1987Amended · Pub. L. 100-203 · 101 Stat. 1330
  • 1988Amended · Pub. L. 100-360 · 102 Stat. 796
  • 2000Amended · Pub. L. 106-417 · 114 Stat. 1815

A history note hasn’t been published yet. The record shows enactment by Pub. L. 94-437 on 1935-08-14.

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