PRIA, Government Policy, Made Personal

Summary

The Secretary must give grants or make contracts through the Indian Health Service to tribes and tribal groups to help them set up and run programs on or near reservations and trust lands. These programs can use video, phone, or other electronic tools that work in real time or with a delay. The help is meant to get people signed up for health benefits under titles XVIII, XIX, or XXI of the Social Security Act and other health programs. Where the programs allow it, the grants can also pay premiums or cost sharing for coverage. Tribes can decide financial need and set income rules for that help. Grants must include steps the tribe or group will take. They must find who is eligible, teach people about the benefits, give transportation to enrollment offices, and work to get more people enrolled. Urban Indian organizations can get the same funding for the people they serve, but the rules must fit cities. The Centers for Medicare & Medicaid Services must create and share best practices to help States and tribes or urban Indian groups work together. Premium means any enrollment fee or similar charge. Cost sharing means deductions like deductibles, copayments, coinsurance, or similar charges.

Title 25, §1644

Indians, Source: USLM XML via OLRC

(a)Indian tribes and tribal organizations

The Secretary, acting through the Service, shall make grants to or enter into contracts with Indian tribes and tribal organizations to assist such tribes and tribal organizations in establishing and administering programs on or near reservations and trust lands, including programs to provide outreach and enrollment through video, electronic delivery methods, or telecommunication devices that allow real-time or time-delayed communication between individual Indians and the benefit program, to assist individual Indians—

(1)to enroll for benefits under a program established under title XVIII, XIX, or XXI of the Social Security Act [42 U.S.C. 1395 et seq., 1396 et seq., 1397aa et seq.] and other health benefits programs; and

(2)with respect to such programs for which the charging of premiums and cost sharing is not prohibited under such programs, to pay premiums or cost sharing for coverage for such benefits, which may be based on financial need (as determined by the Indian tribe or tribes or tribal organizations being served based on a schedule of income levels developed or implemented by such tribe, tribes, or tribal organizations).

(b)Conditions

The Secretary, acting through the Service, shall place conditions as deemed necessary to effect the purpose of this section in any grant or contract which the Secretary makes with any Indian tribe or tribal organization pursuant to this section. Such conditions shall include requirements that the Indian tribe or tribal organization successfully undertake—

(1)to determine the population of Indians eligible for the benefits described in subsection (a);

(2)to educate Indians with respect to the benefits available under the respective programs;

(3)to provide transportation for such individual Indians to the appropriate offices for enrollment or applications for such benefits; and

(4)to develop and implement methods of improving the participation of Indians in receiving benefits under such programs.

(c)Application to urban Indian organizations

(1)In general

The provisions of subsection (a) shall apply with respect to grants and other funding to urban Indian organizations with respect to populations served by such organizations in the same manner they apply to grants and contracts with Indian tribes and tribal organizations with respect to programs on or near reservations.

(2)Requirements

The Secretary shall include in the grants or contracts made or provided under paragraph (1) requirements that are—

(A)consistent with the requirements imposed by the Secretary under subsection (b);

(B)appropriate to urban Indian organizations and urban Indians; and

(C)necessary to effect the purposes of this section.

(d)Facilitating cooperation

The Secretary, acting through the Centers for Medicare & Medicaid Services, shall develop and disseminate best practices that will serve to facilitate cooperation with, and agreements between, States and the Service, Indian tribes, tribal organizations, or urban Indian organizations with respect to the provision of health care items and services to Indians under the programs established under title XVIII, XIX, or XXI of the Social Security Act [42 U.S.C. 1395 et seq., 1396 et seq., 1397aa et seq.].

(e)Agreements relating to improving enrollment of Indians under Social Security Act health benefits programs

For provisions relating to agreements of the Secretary, acting through the Service, for the collection, preparation, and submission of applications by Indians for assistance under the Medicaid and children’s health insurance programs established under titles XIX and XXI of the Social Security Act [42 U.S.C. 1396 et seq., 1397aa et seq.], and benefits under the Medicare program established under title XVIII of such Act [42 U.S.C. 1395 et seq.], see subsections (a) and (b) of section 1139 of the Social Security Act [42 U.S.C. 1320b–9].

(f)Definition of premiums and cost sharing

In this section: (1) Premium

(2)Cost sharing

The term “cost sharing” includes any deduction, deductible, copayment, coinsurance, or similar charge.

Notes & Related Subsidiaries

Editorial Notes

References in Text

The Social Security Act, referred to in subsecs. (a)(1), (d), and (e), is act Aug. 14, 1935, ch. 531, 49 Stat. 620. Titles XVIII, XIX, and XXI of the Act are classified generally to subchapters XVIII (§ 1395 et seq.), XIX (§ 1396 et seq.), and XXI (§ 1397aa et seq.), respectively, of chapter 7 of Title 42, The Public Health and Welfare. For complete classification of this Act to the Code, see section 1305 of Title 42 and Tables. Codification Amendment by Pub. L. 111–148 is based on section 153 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. Section was formerly classified to section 1622 of this title.

Amendments

2010—Pub. L. 111–148 amended section generally. Prior to amendment, section related to grants to and contracts with tribal organizations. 1992—Subsec. (b)(4). Pub. L. 102–573, § 403(1), amended par. (4) generally. Prior to amendment, par. (4) read as follows: “develop and implement a schedule of income levels to determine the extent of payment of premiums by such organization for coverage of needy individuals; and methods of improving the participation of Indians in receiving the benefits provided pursuant to titles XVIII and XIX of the Social Security Act.” Subsec. (c). Pub. L. 102–573, § 403(2), amended subsec. (c) generally. Prior to amendment, subsec. (c) read as follows: “There are authorized to be appropriated $5,000,000 for the fiscal year ending

September 30, 1981, $5,750,000 for the fiscal year ending

September 30, 1982, $6,615,000 for the fiscal year ending

September 30, 1983, and $7,610,000 for the fiscal year ending

September 30, 1984.”

§1644 Grants to and Contracts with the Service, Indian Tribes, Tribal Organizations, and Urban Indian Organizations to Facilitate Outreach, Enrollment, and Coverage of Indians Under Social Security Act Health Benefit Programs and Other Health Benefits Programs