Title 42 — The Public Health and WelfareRelease 119-73
§1395qq Indian Health Service facilities
Title 42 › Chapter CHAPTER 7— - SOCIAL SECURITY › Subchapter SUBCHAPTER XVIII— - HEALTH INSURANCE FOR AGED AND DISABLED › Part Part E— - Miscellaneous Provisions › § 1395qq
Summary
Indian Health Service hospitals and skilled nursing homes, including those run by Indian tribes or tribal organizations, can get payments under this Medicare law if they meet the same rules that apply to other hospitals and nursing homes. If an IHS facility did not meet those rules but turned in an acceptable plan within six months after September 30, 1976, it is treated as meeting the rules for the first 12 months after the month the plan was filed. Payments to which these IHS facilities are entitled must be put into a special fund held by the Secretary and used (as money is provided by Congress) only to fix and improve those facilities so they meet the rules. That special fund rule ends when the Secretary certifies that substantially all IHS hospitals and nursing facilities are in compliance. The Secretary’s yearly report under title 25 must say how these facilities are doing and how their plans are progressing. Starting January 1, 2005, the Secretary must also pay under Medicare Part B to IHS or tribe-run hospitals and ambulatory clinics for certain services on the same terms a non-IHS hospital or clinic would get, except where payment is already made under this part. Those services include ones covered under section 1395w–4, services by certain practitioners paid under a fee schedule, and physical or occupational therapy services paid under a fee schedule. The special fund rule does not apply to these Part B payments. Tribes and similar organizations may have separate billing rules under section 1645 of title 25.
Full Legal Text
Title 42, §1395qq
The Public Health and Welfare — Source: USLM XML via OLRC
(a)A hospital or skilled nursing facility of the Indian Health Service, 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 payments under this subchapter, notwithstanding section 1395f(c) and 1395n(d) of this title, if and for so long as it meets all of the conditions and requirements for such payments which are applicable generally to hospitals or skilled nursing facilities (as the case may be) under this subchapter.
(b)Notwithstanding subsection (a), a hospital or skilled nursing facility of the Indian Health Service which does not meet all of the conditions and requirements of this subchapter which are applicable generally to hospitals or skilled nursing facilities (as the case may be), 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 payments under this subchapter), without regard to the extent of its actual compliance with such conditions and requirements, during the first 12 months after the month in which such plan is submitted.
(c)Notwithstanding any other provision of this subchapter, payments to which any hospital or skilled nursing facility of the Indian Health Service is entitled by reason of this section shall be placed in a special fund to be held by the Secretary and used by him (to such extent or in such amounts as are provided in appropriation Acts) exclusively for the purpose of making any improvements in the hospitals and skilled nursing facilities of such Service which may be necessary to achieve compliance with the applicable conditions and requirements of this subchapter. The preceding sentence shall cease to apply when the Secretary determines and certifies that substantially all of the hospitals and skilled nursing facilities of such Service in the United States are in compliance with such conditions and requirements.
(d)The annual report of the Secretary which is required by section 1671 of title 25 shall include (along with the matters specified in section 1643 of title 25) a detailed statement of the status of the hospitals and skilled nursing facilities of the Service in terms of their compliance with the applicable conditions and requirements of this subchapter and of the progress being made by such hospitals and facilities (under plans submitted under subsection (b) and otherwise) toward the achievement of such compliance.
(e)(1)(A)Notwithstanding section 1395n(d) of this title, subject to subparagraph (B), the Secretary shall make payment under part B to a hospital or an ambulatory care clinic (whether provider-based or freestanding) that is operated by the Indian Health Service or by an Indian tribe or tribal organization (as defined for purposes of subsection (a)) for services described in paragraph (2) (and for items and services furnished on or after January 1, 2005, all items and services for which payment may be made under part B) furnished in or at the direction of the hospital or clinic under the same situations, terms, and conditions as would apply if the services were furnished in or at the direction of such a hospital or clinic that was not operated by such Service, tribe, or organization.
(B)Payment shall not be made for services under subparagraph (A) to the extent that payment is otherwise made for such services under this subchapter.
(2)The services described in this paragraph are the following:
(A)Services for which payment is made under section 1395w–4 of this title.
(B)Services furnished by a practitioner described in section 1395u(b)(18)(C) of this title for which payment under part B is made under a fee schedule.
(C)Services furnished by a physical therapist or occupational therapist as described in section 1395x(p) of this title for which payment under part B is made under a fee schedule.
(3)Subsection (c) shall not apply to payments made under this subsection.
(f)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 25.11 See References in Text note below.
Legislative History
Notes & Related Subsidiaries
Editorial Notes
References in Text
Section 1645 of title 25, referred to in subsec. (f), was amended generally by section 10221(a) of title X of Pub. L. 111–148, Mar. 23, 2010, 124 Stat. 935, and, as so amended, no longer contains provisions relating to direct billing of medicare, medicaid, and other third party payors. Codification Pub. L. 111–148, § 10221(a), enacted into law S. 1790, One Hundred Eleventh Congress, as reported by the Committee on Indian Affairs of the Senate in Dec. 2009, “[e]xcept as provided in” section 10221(b) of Pub. L. 111–148. section 201(a) of S. 1790 would have amended this section but was stricken out by section 10221(b)(4) of Pub. L. 111–148.
Amendments
2010—Subsec. (e)(1)(A). Pub. L. 111–148, § 2902(a), substituted “on or after” for “during the 5-year period beginning on”. 2003—Subsec. (e)(1)(A). Pub. L. 108–173 inserted “(and for items and services furnished during the 5-year period beginning on January 1, 2005, all items and services for which payment may be made under part B)” after “for services described in paragraph (2)”. 2000—Subsec. (e). Pub. L. 106–554, § 1(a)(6) [title IV, § 432(a)(2)], added subsec. (e). Former subsec. (e) redesignated (f). Pub. L. 106–417 added subsec. (e). Subsec. (f). Pub. L. 106–554, § 1(a)(6) [title IV, § 432(a)(1)], redesignated subsec. (e) as (f). 1992—Subsec. (d). Pub. L. 102–573 made technical amendment to the reference to section 1671 of title 25 to reflect renumbering of corresponding section of original act.
Statutory Notes and Related Subsidiaries
Effective Date
of 2010 Amendment Pub. L. 111–148, title II, § 2902(b), Mar. 23, 2010, 124 Stat. 333, provided that: “The
Amendments
made by this section [amending this section] shall apply to items or services furnished on or after January 1, 2010.”
Effective Date
of 2000 AmendmentAmendment by section 1(a)(6) [title IV, § 432(a)] of Pub. L. 106–554 applicable to services furnished on or after July 1, 2001, see section 1(a)(6) [title IV, § 432(c)] of Pub. L. 106–554, set out as a note under section 1395u of this title. 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. Medicare Payments Not Considered in Determining Appropriations for Indian Health Care Pub. L. 94–437, title IV, § 401(c), Sept. 30, 1976, 90 Stat. 1409, provided that any payments received for services provided to beneficiaries under this section were not to be considered in determining appropriations for health care and services to Indians, prior to the general amendment of section 401 of Pub. L. 94–437 by Pub. L. 102–573, title IV, § 401(a), Oct. 29, 1992, 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. Preference in Services for Indians With Medicare Coverage Not Authorized Pub. L. 94–437, title IV, § 401(d), Sept. 30, 1976, 90 Stat. 1409, which provided that nothing in this section authorized the Secretary to provide services to an Indian beneficiary with coverage under this subchapter, in preference to an Indian beneficiary without such coverage, prior to the general amendment of section 401 of Pub. L. 94–437 by Pub. L. 102–573, title IV, § 401(a), Oct. 29, 1992, 106 Stat. 4565. Similar provisions are contained in section 401(b) of Pub. L. 94–437, which is classified to section 1641(b) of Title 25, Indians.
Reference
Citations & Metadata
Citation
42 U.S.C. § 1395qq
Title 42 — The Public Health and Welfare
Last Updated
Apr 6, 2026
Release point: 119-73