42 U.S.C. § 238m: Use of fiscal agents

Summary

The Secretary can hire fiscal agents to handle payments for certain health care. These agents decide how much to pay people who provide care for eligible Indians under the Indian Health Service and for some Public Health Service programs (sections 247d and 249). They can receive, pay out, and keep records of funds, audit records to make sure payments are correct, and do other tasks needed. Contracts may let the Secretary give agents advance funds. These contracts can be made without the usual competitive bidding rules, but only if the Secretary finds the entity will work efficiently and meet financial, legal, and other requirements. Subsections (d) and (e) of section 1395u apply the same way. “Fiscal agent” means the carrier in section 1395u(f)(1) and can include an Indian tribe or tribal organization acting under the Indian Self-Determination Act (Public Law 93–638).

Title 42, §238m

The Public Health and Welfare, Source: USLM XML via OLRC

(a)Contracting authority

The Secretary may enter into contracts with fiscal agents—

(1)(A)to determine the amounts payable to persons who, on behalf of the Indian Health Service, furnish health services to eligible Indians,

(B)to determine the amounts payable to persons who, on behalf of the Public Health Service, furnish health services to individuals pursuant to section 247d or 249 of this title,

(2)to receive, disburse, and account for funds in making payments described in paragraph (1),

(3)to make such audits of records as may be necessary to assure that these payments are proper, and

(4)to perform such additional functions as may be necessary to carry out the functions described in paragraphs (1) through (3).

(b)Contracting prerequisites

(1)Contracts under subsection (a) may be entered into without regard to section 6101 of title 41 or any other provision of law requiring competition.

(2)No such contract shall be entered into with an entity unless the Secretary finds that the entity will perform its obligations under the contract efficiently and effectively and will meet such requirements as to financial responsibility, legal authority, and other matters as he finds pertinent.

(c)Advances under contracts

A contract under subsection (a) may provide for advances of funds to enable entities to make payments under the contract.

(d)Applicable statutory provisions

Subsections (d) and (e) of section 1395u of this title shall apply to contracts with entities under subsection (a) in the same manner as they apply to contracts with carriers under that section.

(e)“Fiscal agent” defined

In this section, the term “fiscal agent” means a carrier described in section 1395u(f)(1) 1 of this title and includes, with respect to contracts under subsection (a)(1)(A), an Indian tribe or tribal organization acting under contract with the Secretary under the Indian Self-Determination Act (Public Law 93–638) [25 U.S.C. 5321 et seq.].

Notes & Related Subsidiaries

Editorial Notes

References in Text

Subsections (d), (e), and (f) of section 1395u of this title, referred to in subsecs. (d) and (e), were repealed by Pub. L. 108–173, title IX, § 911(c)(5), Dec. 8, 2003, 117 Stat. 2384. The Indian Self-Determination Act, referred to in subsec. (e), is title I of Pub. L. 93–638, Jan. 4, 1975, 88 Stat. 2206, which is classified principally to subchapter I (§ 5321 et seq.) of chapter 46 of Title 25, Indians. For complete classification of this Act to the Code, see

Short Title

note set out under section 5301 of Title 25 and Tables. Codification In subsec. (b)(1), “section 6101 of title 41” substituted for “section 3709 of the Revised Statutes (41 U.S.C. 5)” on authority of Pub. L. 111–350, § 6(c), Jan. 4, 2011, 124 Stat. 3854, which Act enacted Title 41, Public Contracts. Section was classified to section 300aaa–13 of this title prior to renumbering by Pub. L. 103–43, to section 300cc–15 of this title prior to renumbering by Pub. L. 100–607, and to section 300aa–15 of this title prior to renumbering by Pub. L. 99–660.

§238m Use of Fiscal Agents