§1621r — Title 25 Indians | U.S. Code

Summary

The Secretary, working through the Indian Health Service and after talking with tribal representatives, Service staff, private contract health providers, the Indian Health Service Fiscal Intermediary, and other experts, must carry out a study. The study must find administrative reasons why the Service and its fiscal intermediary pay private providers late for care given to individual Indians, check how late payments hurt patients’ credit histories, and figure out better ways to run the payment system and protect patients from unfair billing and collection. It must also review current rules, measure financial and other harms to patients and providers, look at collection agency practices, suggest federal policy or rule changes, and compare the Service’s billing rules with private insurers’ rules. Not later than 12 months after October 29, 1992, the Secretary must send Congress a report describing the study and its findings and conclusions.

Title 25, §1621r

Indians — Source: USLM XML via OLRC

(a)The Secretary, acting through the Service and in consultation with representatives of Indian tribes and tribal organizations operating contract health care programs under the Indian Self-Determination Act (25 U.S.C. 450f et seq.) 11 See References in Text note below. or under self-governance compacts, Service personnel, private contract health services providers, the Indian Health Service Fiscal Intermediary, and other appropriate experts, shall conduct a study—

(1)to assess and identify administrative barriers that hinder the timely payment for services delivered by private contract health services providers to individual Indians by the Service and the Indian Health Service Fiscal Intermediary;

(2)to assess and identify the impact of such delayed payments upon the personal credit histories of individual Indians who have been treated by such providers; and

(3)to determine the most efficient and effective means of improving the Service’s contract health services payment system and ensuring the development of appropriate consumer protection policies to protect individual Indians who receive authorized services from private contract health services providers from billing and collection practices, including the development of materials and programs explaining patients’ rights and responsibilities.

(b)The study required by subsection (a) shall—

(1)assess the impact of the existing contract health services regulations and policies upon the ability of the Service and the Indian Health Service Fiscal Intermediary to process, on a timely and efficient basis, the payment of bills submitted by private contract health services providers;

(2)assess the financial and any other burdens imposed upon individual Indians and private contract health services providers by delayed payments;

(3)survey the policies and practices of collection agencies used by contract health services providers to collect payments for services rendered to individual Indians;

(4)identify appropriate changes in Federal policies, administrative procedures, and regulations, to eliminate the problems experienced by private contract health services providers and individual Indians as a result of delayed payments; and

(5)compare the Service’s payment processing requirements with private insurance claims processing requirements to evaluate the systemic differences or similarities employed by the Service and private insurers.

(c)Not later than 12 months after October 29, 1992, the Secretary shall transmit to the Congress a report that includes—

(1)a detailed description of the study conducted pursuant to this section; and

(2)a discussion of the findings and conclusions of such study.

Notes & Related Subsidiaries

Editorial Notes

References in Text

The Indian Self-Determination Act (25 U.S.C. 450f et seq.), referred to in subsec. (a), is title I of Pub. L. 93–638, Jan. 4, 1975, 88 Stat. 2206, which was classified principally to part A (§ 450f et seq.) of subchapter II of chapter 14 of this title prior to editorial reclassification as subchapter I (§ 5321 et seq.) of chapter 46 of this title. For complete classification of this Act to the Code, see

Short Title

note set out under section 5301 of this title and Tables.

§1621r Contract Health Services Payment Study