US Code

Public Law 119-87 (04/30/2026)

42 U.S.C. § 1395qq

Indian Health Service facilities

(a)

Eligibility for payments; conditions and requirements

section 1603 of title 25A hospital or skilled nursing facility of the Indian Health Service, whether operated by such Service or by an Indian tribe or tribal organization (as those terms are defined in ), shall be eligible for payments under this subchapter, notwithstanding sections 1395f(c) and 1395n(d) of this title, if and for so long as it meets all of the conditions and requirements for such payments which are applicable generally to hospitals or skilled nursing facilities (as the case may be) under this subchapter.

(b)

Eligibility based on submission of plan to achieve compliance with conditions and requirements; twelve-month period

Notwithstanding subsection (a), a hospital or skilled nursing facility of the Indian Health Service which does not meet all of the conditions and requirements of this subchapter which are applicable generally to hospitals or skilled nursing facilities (as the case may be), but which submits to the Secretary within six months after , an acceptable plan for achieving compliance with such conditions and requirements, shall be deemed to meet such conditions and requirements (and to be eligible for payments under this subchapter), without regard to the extent of its actual compliance with such conditions and requirements, during the first 12 months after the month in which such plan is submitted.

(c)

Payments into special fund for improvements to achieve compliance with conditions and requirements; certification of compliance by Secretary

Notwithstanding any other provision of this subchapter, payments to which any hospital or skilled nursing facility of the Indian Health Service is entitled by reason of this section shall be placed in a special fund to be held by the Secretary and used by him (to such extent or in such amounts as are provided in appropriation Acts) exclusively for the purpose of making any improvements in the hospitals and skilled nursing facilities of such Service which may be necessary to achieve compliance with the applicable conditions and requirements of this subchapter. The preceding sentence shall cease to apply when the Secretary determines and certifies that substantially all of the hospitals and skilled nursing facilities of such Service in the United States are in compliance with such conditions and requirements.

(d)

Report by Secretary; status of facilities in complying with conditions and requirements

section 1671 of title 25section 1643 of title 25The annual report of the Secretary which is required by shall include (along with the matters specified in ) a detailed statement of the status of the hospitals and skilled nursing facilities of the Service in terms of their compliance with the applicable conditions and requirements of this subchapter and of the progress being made by such hospitals and facilities (under plans submitted under subsection (b) and otherwise) toward the achievement of such compliance.

(e)

Services provided by Indian Health Service, Indian tribe, or tribal organization

(1)
(A)
section 1395n(d) of this title Notwithstanding , subject to subparagraph (B), the Secretary shall make payment under part B to a hospital or an ambulatory care clinic (whether provider-based or freestanding) that is operated by the Indian Health Service or by an Indian tribe or tribal organization (as defined for purposes of subsection (a)) for services described in paragraph (2) (and for items and services furnished on or after , all items and services for which payment may be made under part B) furnished in or at the direction of the hospital or clinic under the same situations, terms, and conditions as would apply if the services were furnished in or at the direction of such a hospital or clinic that was not operated by such Service, tribe, or organization.
(B)
Payment shall not be made for services under subparagraph (A) to the extent that payment is otherwise made for such services under this subchapter.
(2)
The services described in this paragraph are the following:
(A)
section 1395w–4 of this title Services for which payment is made under .
(B)
section 1395u(b)(18)(C) of this title Services furnished by a practitioner described in for which payment under part B is made under a fee schedule.
(C)
section 1395x(p) of this title Services furnished by a physical therapist or occupational therapist as described in for which payment under part B is made under a fee schedule.
(3)
Subsection (c) shall not apply to payments made under this subsection.
(f)

Cross reference

section 1645 of title 251

1 See References in Text note below.
For provisions relating to the authority of certain Indian tribes, tribal organizations, and Alaska Native health organizations to elect to directly bill for, and receive payment for, health care services provided by a hospital or clinic of such tribes or organizations and for which payment may be made under this subchapter, see .

Aug. 14, 1935, ch. 531 Pub. L. 94–437, title IV, § 401(b)90 Stat. 1408 Pub. L. 102–573, title VII, § 701(d)106 Stat. 4572 Pub. L. 106–417, § 3(b)(1)114 Stat. 1815 Pub. L. 106–554, § 1(a)(6) [title IV, § 432(a)]114 Stat. 2763 Pub. L. 108–173, title VI, § 630117 Stat. 2321 Pub. L. 111–148, title II, § 2902(a)124 Stat. 333 (, title XVIII, § 1880, as added , , ; amended , , ; , , ; , , , 2763A–525; , , ; , title X, § 10221(a), (b)(4), , , 935, 936.)

Editorial Notes

References in Text

Section 1645 of title 25section 10221(a) of title X of Pub. L. 111–148124 Stat. 935 , referred to in subsec. (f), was amended generally by , , , and, as so amended, no longer contains provisions relating to direct billing of medicare, medicaid, and other third party payors.

Codification

Pub. L. 111–148, § 10221(a)section 10221(b) of Pub. L. 111–148section 10221(b)(4) of Pub. L. 111–148, enacted into law S. 1790, One Hundred Eleventh Congress, as reported by the Committee on Indian Affairs of the Senate in Dec. 2009, “[e]xcept as provided in” . Section 201(a) of S. 1790 would have amended this section but was stricken out by .

Amendments

Pub. L. 111–148, § 2902(a)2010—Subsec. (e)(1)(A). , substituted “on or after” for “during the 5-year period beginning on”.

Pub. L. 108–1732003—Subsec. (e)(1)(A). inserted “(and for items and services furnished during the 5-year period beginning on , all items and services for which payment may be made under part B)” after “for services described in paragraph (2)”.

Pub. L. 106–554, § 1(a)(6) [title IV, § 432(a)(2)]2000—Subsec. (e). , added subsec. (e). Former subsec. (e) redesignated (f).

Pub. L. 106–417 added subsec. (e).

Pub. L. 106–554, § 1(a)(6) [title IV, § 432(a)(1)]Subsec. (f). , redesignated subsec. (e) as (f).

Pub. L. 102–573section 1671 of title 251992—Subsec. (d). made technical amendment to the reference to to reflect renumbering of corresponding section of original act.

Statutory Notes and Related Subsidiaries

Effective Date of 2010 Amendment

Pub. L. 111–148, title II, § 2902(b)124 Stat. 333

“The amendments made by this section [amending this section] shall apply to items or services furnished on or after .”
, , , provided that:

Effective Date of 2000 Amendment

Pub. L. 106–554Pub. L. 106–554section 1395u of this titleAmendment by section 1(a)(6) [title IV, § 432(a)] of applicable to services furnished on or after , see section 1(a)(6) [title IV, § 432(c)] of , set out as a note under .

Pub. L. 106–417section 3(c) of Pub. L. 106–417section 1645 of Title 25Amendment by effective , see , set out as a note under , Indians.

Medicare Payments Not Considered in Determining Appropriations for Indian Health Care

Pub. L. 94–437, title IV, § 401(c)90 Stat. 1409 section 401 of Pub. L. 94–437Pub. L. 102–573, title IV, § 401(a)106 Stat. 4565 section 401(a) of Pub. L. 94–437section 1641(a) of Title 25, , , provided that any payments received for services provided to beneficiaries under this section were not to be considered in determining appropriations for health care and services to Indians, prior to the general amendment of by , , . Similar provisions are contained in , which is classified to , Indians.

Preference in Services for Indians With Medicare Coverage Not Authorized

Pub. L. 94–437, title IV, § 401(d)90 Stat. 1409 section 401 of Pub. L. 94–437Pub. L. 102–573, title IV, § 401(a)106 Stat. 4565 section 401(b) of Pub. L. 94–437section 1641(b) of Title 25, , , which provided that nothing in this section authorized the Secretary to provide services to an Indian beneficiary with coverage under this subchapter, in preference to an Indian beneficiary without such coverage, prior to the general amendment of by , , . Similar provisions are contained in , which is classified to , Indians.