PRIA, Government Policy, Made Personal

Summary

Set up a test program to try using a contractor who helps arrange care so California Indians can get health services more easily. The Secretary must make an agreement with the California Rural Indian Health Board to pay back the Board for costs, including reasonable administrative costs, when the Board provides contracted medical care for high-cost cases across the California contract health services area. No more than 5 percent of the money given to the Board each fiscal year may pay for the Board's administrative costs. The program cannot pay for care that can be paid by the Catastrophic Health Emergency Fund or by amounts already provided for the California contract health services area. An advisory board made up of representatives from at least 8 tribal health programs (at least half not tied to the Board) will advise the Board. The program runs from January 1, 1993, to September 30, 1997. By July 1, 1998, the Board must send the Secretary a report on how the test worked, including effects on access to care, waiting times, and management of high-cost cases. A "high-cost contract care case" means treatment that costs more than $1,000 and would otherwise qualify for the Catastrophic Health Emergency Fund except it does not meet that fund’s threshold cost rule.

Title 25, §1621j

Indians, Source: USLM XML via OLRC

(a)Establishment

The Secretary shall establish a demonstration program to evaluate the use of a contract care intermediary to improve the accessibility of health services to California Indians.

(b)Agreement with California Rural Indian Health Board

(1)In establishing such program, the Secretary shall enter into an agreement with the California Rural Indian Health Board to reimburse the Board for costs (including reasonable administrative costs) incurred, during the period of the demonstration program, in providing medical treatment under contract to California Indians described in section 1679(b) of this title throughout the California contract health services delivery area described in section 1680 of this title with respect to high-cost contract care cases.

(2)Not more than 5 percent of the amounts provided to the Board under this section for any fiscal year may be for reimbursement for administrative expenses incurred by the Board during such fiscal year.

(3)No payment may be made for treatment provided under the demonstration program to the extent payment may be made for such treatment under the Catastrophic Health Emergency Fund described in section 1621a of this title or from amounts appropriated or otherwise made available to the California contract health service delivery area for a fiscal year.

(c)Advisory board

There is hereby established an advisory board which shall advise the California Rural Indian Health Board in carrying out the demonstration pursuant to this section. The advisory board shall be composed of representatives, selected by the California Rural Indian Health Board, from not less than 8 tribal health programs serving California Indians covered under such demonstration, at least one half of whom are not affiliated with the California Rural Indian Health Board.

(d)Commencement and termination dates

The demonstration program described in this section shall begin on January 1, 1993, and shall terminate on September 30, 1997.

(e)Report

Not later than July 1, 1998, the California Rural Indian Health Board shall submit to the Secretary a report on the demonstration program carried out under this section, including a statement of its findings regarding the impact of using a contract care intermediary on—

(1)access to needed health services;

(2)waiting periods for receiving such services; and

(3)the efficient management of high-cost contract care cases.

(f)“High-cost contract care cases” defined

For the purposes of this section, the term “high-cost contract care cases” means those cases in which the cost of the medical treatment provided to an individual—

(1)would otherwise be eligible for reimbursement from the Catastrophic Health Emergency Fund established under section 1621a of this title, except that the cost of such treatment does not meet the threshold cost requirement established pursuant to section 1621a(b)(2) 1 of this title; and

(2)exceeds $1,000.

Notes & Related Subsidiaries

Editorial Notes

References in Text

section 1679 of this title, referred to in subsec. (b)(1), was repealed and a new section 1679 was enacted by Pub. L. 111–148, title X, § 10221(a), Mar. 23, 2010, 124 Stat. 935. Provisions describing California Indians, similar to those that appeared in former section 1679(b) are now contained in new section 1679(a). section 1621a of this title, referred to in subsec. (f)(1), was amended generally by Pub. L. 111–148, title X, § 10221(a), Mar. 23, 2010, 124 Stat. 935, and, as so amended, no longer contains a subsec. (b)(2). Codification Amendment by Pub. L. 111–148 is based on section 101(b)(3) of title I of S. 1790, One Hundred Eleventh Congress, as reported by the Committee on Indian Affairs of the Senate in Dec. 2009, which was enacted into law by section 10221(a) of Pub. L. 111–148.

Amendments

2010—Subsec. (g). Pub. L. 111–148 struck out subsec. (g) which authorized appropriations for fiscal years 1996 through 2000. 1996—Subsec. (g). Pub. L. 104–313 substituted “1996 through 2000” for “1993, 1994, 1995, 1996, and 1997”.

Statutory Notes and Related Subsidiaries

Termination of Advisory BoardsAdvisory boards established after Jan. 5, 1973, to terminate not later than the expiration of the 2-year period beginning on the date of their establishment, unless, in the case of a board established by the President or an officer of the Federal Government, such board is renewed by appropriate action prior to the expiration of such 2-year period, or in the case of a board established by Congress, its duration is otherwise provided by law. See section 1001(2) and 1013 of Title 5, Government Organization and Employees.

§1621j California Contract Health Services Demonstration Program