,i #aacth ,,congress #b;d ,session ,h4 ,r4 #dhdc ,,in ,,the ,,house ,,of ,,representatives ,june #aa1 #bjad ,ms4 ,mc,collum 7for herself1 ,mr4 ,cole1 ,mr4 ,ben ,ray ,lujn of ,new ,mexico1 ,mr4 ,issa1 ,mr4 ,grijalva1 ,mr4 ,kline1 ,mr4 ,pallone1 ,mr4 ,young of ,alaska1 ,mr4 ,huffman1 and ,mr4 ,kind7 introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce1 and in addition to the ,committees on ,ways and ,means and ,natural ,resources1 for a period to be subsequently determined by the ,speaker1 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 suppliers4 #a4 ,short title ,this ,act may be cited as the ,native ,contract and ,rate ,expenditure ,act of #bjad or the ,native ,,care ,act of #bjad4 #b4 ,findings ,congress makes the following findings3 7#a7 ,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 with1 and resulting trust responsibility to1 the ,american ,indian and ,alaska ,native people4 7#b7 ,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 ,states1 resulting in an average life expectancy for ,american ,indians and ,alaska ,natives #d4b years less than that for the all races population of the ,united ,states4 7#c7 ,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 facilities4 7#d7 ,available ,purchased_/,referred ,care funds have been insufficient to ensure access to care for ,american ,indians and ,alaska ,natives1 resulting in rationed care and diagnosis and treatment delays that lead to the need for more intensive and expensive treatment1 further reducing already scarce ,purchased_/,referred ,care funds4 7#e7 ,in #bjjc1 ,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 provided4 7#f7 ,the ,medicare-like rate cap only applies to hospital services1 and does not apply to other types of ,medicare-participating providers and suppliers4 7#g7 ,unlike other ,federal health care programs1 the ,indian ,health ,service and ,tribal ,purchased_/,referred ,care programs continue to pay full billed charges for non-hospital services4 7#h7 ,because ,purchased_/,referred programs continue to pay full billed charges for non-hospital services1 in many cases the ,indian ,health ,service may only treat the most desperate ,life or ,limb cases1 leading to many undesirable health outcomes for ,american ,indians and ,alaska ,natives1 and ultimately increasing costs to the ,purchased_/,referred ,care programs4 7#i7 ,on ,april #aa1 #bjac1 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 #bec1jjj patient visits annually4 #c4 ,limitation on charges for certain contract health services provided to ,indians by ,medicare providers of services and suppliers 7a7 ,application to all providers of services 7#a7 ,in general ,section #ahff7;a77#a77,u7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc7a77#a77,u77 is amended1 in the matter preceding clause 7i71 by striking in the case of hospitals which furnish inpatient hospital services for which payment may be made under this title14 7#b7 ,regulations ,the ,secretary of ,health and ,human ,services shall promulgate regulations to account for the amendment made by paragraph 7#a74 7#c7 ,effective date ,the amendment made by paragraph 7#a7 shall apply to ,medicare participation agreements in effect 7or entered into7 on or after the date that is #ij days after the date of enactment of this ,act4 7b7 ,application to all suppliers 7#a7 ,in general ,section #ahcd of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7 is amended by adding at the end the following new subsection3 7r7 ,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 7as defined in section #ahfa7;d77 unless the supplier agrees 7pursuant to a process established by the ,secretary7 to be a participating provider of medical and other health services both-- 7#a7 under the ,purchased_/,referred ,care program 7formerly referred to as the contract health services program7 funded by the ,indian ,health ,service and operated by the ,indian ,health ,service1 an ,indian tribe1 or tribal organization 7as those terms are defined in section #d of the ,indian ,health ,care ,improvement ,act71 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 program2 and 7#b7 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 7as those terms are defined in such section #d71 in accordance with regulations promulgated by the ,secretary regarding payment methodology and rates of payment 7including the acceptance of no more than such payment rate as payment in full for such items and services74 4 7#b7 ,effective date ,the amendment made by paragraph 7#a7 shall apply to items and services furnished on or after the date that is #ij days after the date of enactment of this ,act4 7c7 ,limitation ,there shall be no reduction1 offset1 or limitation to any appropriations made to the ,indian ,health ,service under the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afba et seq471 the ,act of ,november #b1 #aiba 7#be ,u4,s4,c4 #ac7 7commonly known as the ,snyder ,act71 or any other provision of law as a result of the provisions of1 including amendments made by1 this ,act4 7d7 ,studies and reports 7#a7 ,study ,the ,secretary of ,health and ,human ,services 7in this subsection referred to as the ,secretary71 acting through the ,director of the ,indian ,health ,service1 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 ,service4 7#b7 ,report ,not later than #b years after the date of enactment of this ,act1 the ,secretary shall submit to ,congress a report containing the results of the study conducted under paragraph 7#a71 including recommendations for such legislation and administrative action as the ,secretary determines appropriate4 7#c7 ,section #bai7;c7 study and report ,section #bai7;c7 of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afbar7c77 is amended by striking #ab months after the date of the enactment of this section and inserting #ab months after the date of the enactment of the ,native ,contract and ,rate ,expenditure ,act of #bjad1 and biennially thereafter through #bjbj4