25 U.S.C. § 1621r: Contract health services…

Summary

The Secretary must lead a study, working with tribal leaders, tribal health programs, Service staff, private contract health providers, the Indian Health Service Fiscal Intermediary, and other experts. The study must find what administrative problems slow down payments from the Service and the IHS Fiscal Intermediary to private providers, check how late payments affect the credit records of individual Indians who get care, and identify the best ways to fix the payment system and protect patients from unfair billing and collections. It must also include plans for materials or programs that explain patients’ rights and responsibilities. The study must look at how current rules affect timely bill processing, measure the financial and other burdens on patients and providers from delayed payments, review how collection agencies operate, suggest needed changes to federal policies, procedures, and regulations, and compare the Service’s claims rules with private insurance claim rules. The Secretary must send Congress a report describing the study and its findings within 12 months after October 29, 1992.

Title 25, §1621r

Indians, Source: USLM XML via OLRC

(a)Duty of Secretary

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.) 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)Functions of study

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)Report to Congress

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