PRIA, Government Policy, Made Personal

Summary

Federal health care programs must accept providers run by the Indian Health Service, an Indian tribe, a tribal organization, or an urban Indian organization for payment the same as any other qualified provider, as long as they meet the normal state or program rules to participate. If such an entity meets the state standards for licensing or recognition, it is treated as meeting those licensing rules even if it does not hold a state license or paperwork. Also, if a clinician working for the entity is not licensed in that state but is licensed in another state, that missing state license cannot be used against the entity. If an entity or an individual has been officially excluded from federal health programs, or if the state has suspended or revoked their license, they cannot get paid under any federal health care program for services to an Indian. For this part, “Federal health care program” uses the usual federal definition and also covers the federal employees’ health insurance program.

Title 25, §1647a

Indians, Source: USLM XML via OLRC

(a)Requirement to satisfy generally applicable participation requirements

(1)In general

A Federal health care program must accept an entity that is operated by the Service, an Indian tribe, tribal organization, or urban Indian organization as a provider eligible to receive payment under the program for health care services furnished to an Indian on the same basis as any other provider qualified to participate as a provider of health care services under the program if the entity meets generally applicable State or other requirements for participation as a provider of health care services under the program.

(2)Satisfaction of State or local licensure or recognition requirements

Any requirement for participation as a provider of health care services under a Federal health care program that an entity be licensed or recognized under the State or local law where the entity is located to furnish health care services shall be deemed to have been met in the case of an entity operated by the Service, an Indian tribe, tribal organization, or urban Indian organization if the entity meets all the applicable standards for such licensure or recognition, regardless of whether the entity obtains a license or other documentation under such State or local law. In accordance with section 1621t of this title, the absence of the licensure of a health professional employed by such an entity under the State or local law where the entity is located shall not be taken into account for purposes of determining whether the entity meets such standards, if the professional is licensed in another State.

(b)Application of exclusion from participation in Federal health care programs

(1)Excluded entities

No entity operated by the Service, an Indian tribe, tribal organization, or urban Indian organization that has been excluded from participation in any Federal health care program or for which a license is under suspension or has been revoked by the State where the entity is located shall be eligible to receive payment or reimbursement under any such program for health care services furnished to an Indian.

(2)Excluded individuals

No individual who has been excluded from participation in any Federal health care program or whose State license is under suspension shall be eligible to receive payment or reimbursement under any such program for health care services furnished by that individual, directly or through an entity that is otherwise eligible to receive payment for health care services, to an Indian.

(3)Federal health care program defined

In this subsection, the term, “Federal health care program” has the meaning given that term in section 1320a–7b(f) of title 42, except that, for purposes of this subsection, such term shall include the health insurance program under chapter 89 of title 5.

(c)Related provisions

For provisions related to nondiscrimination against providers operated by the Service, an Indian tribe, tribal organization, or urban Indian organization, see section 1320b–9(c) of title 42.

Notes & Related Subsidiaries

Editorial Notes

References in Text

Section 1320b–9 of title 42, referred to in subsec. (c), relates to improved access to, and delivery of, health care for Indians under subchapters XIX and XXI of chapter 7 of Title 42, The Public Health and Welfare. Subsec. (c) of section 1320b–9 of Title 42 contains definitions of terms. Codification section 408 of Pub. L. 94–437 is based on section 156 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.

§1647a Nondiscrimination Under Federal Health Care Programs in Qualifications for Reimbursement for Services

Summary

Title 25, §1647a

Notes & Related Subsidiaries

Editorial Notes

References in Text

Citations & Metadata