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Indian Health Service The Federal Health Program for American Indians and Alaska Natives


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Part 2, Chapter 4:  Manual Appendix F

Indian Health Care Improvement Act
Public Law 94-437, as Amended

(This is not an exact replica of the Indian Health Care Improvement Act, Public Law 94-437, as Amended)

Indian Health Care Improvement Act, Public Law 94-437, as Amended, HEALTH SERVICES FOR INELIGIBLE PERSONS

Sec. 813. (a)(1) Any individual who --
(A)  has not attained 19 years of age,

(B)  is the natural or adopted child, step-child, foster-child, legal ward, or orphan of an eligible Indian, and
(C)  is not otherwise eligible for health services provided by the Service,

shall be eligible for all health services provided by the Service on the same basis and subject to the same rules that apply to eligible Indians until such individual attains 19 years of age.  The existing and potential health needs of all such individuals shall be taken into consideration by the Service in determining the need for, or the allocation of, the health resources of the service.  If such an individual has been determined to be legally incompetent prior to attaining 19 years of age, such individual shall remain eligible for such services until one year after the date of such disability has been removed.

    (2)Any spouse of an eligible Indian who is not an Indian, or who is of Indian descent but not otherwise eligible for the health services provided by the Service, shall be eligible for such health services if all of such spouses are made eligible, as a class, by an appropriate resolution of the governing body of the Indian tribe of the eligible Indian.  The health needs of persons made eligible under this paragraph shall not be taken into consideration by the Service in determining the need for, or allocation of, its health resources.

    (b)(1)(A) The Secretary is authorized to provide health services under this subsection through health facilities operated directly by the Service to individuals who reside within the service area of a service unit and who are not eligible for such health services under any other subsection of this section or under any other provision of law if -

  1. the Indian tribe (or, in the case of a multi-tribal service area, all the Indian tribes) served by such service unit requests such provision of health services to such individuals, and
  2. the Secretary and the Indian tribe or tribes have jointly determined that -- I.  the provision of such health services will not result in a denial or diminution of health services to eligible Indians, and

    II.  there is no reasonable alternative health facility or services, within or without the service area of such service unit, available to meet the health needs of such individuals.

    (B)In the case of health facilities operated under a contract entered into under the Indian Self-Determination Act, the governing body of the Indian tribe or tribal organization providing health services under such contract is authorized to determine whether health services should be provided under such contract to individuals who are not eligible for such health services under any other subsection in this section or under any other provision of law.  In making such determinations, the governing body of the Indian tribe or tribal organization shall take into account the considerations described in subparagraph (A)(ii).

    (2)(a)  Persons receiving health services provided by the Service by reason of this subsection shall be liable for payment of such health services under a schedule of charges prescribed by the Secretary which, in the judgment of the Secretary, results in reimbursement in an amount not less than the actual cost of providing the health services.  Notwithstanding section 1880(c) of the Social Security Act, section 402(a) of this Act, or any other provision of law, amounts collected under this subsection, including Medicare or Medicaid reimbursements under titles XVIII and XIX of the Social Security Act, shall be credited to the account of the facility providing the service and shall be used solely for the provision of health services within that facility.  Amounts collected under this subsection shall be available for expenditure within such facility for not to exceed one fiscal year after the fiscal year in which collected.

    (B)  Health services may be provided by the Secretary through the Service under this subsection to an indigent person who would not be eligible for such health services but for the provisions of paragraph (1) only if an agreement has been entered into with a State or local government under which the State or local government agrees to reimburse the Service for the expenses incurred by the Service in providing such health services to such indigent person.

    (3)(A)  In the case of a service area which serves only one Indian tribe, the authority of the Secretary to provide health services under paragraph (1)(A) shall terminate at the end of the fiscal year succeeding the fiscal year in which the governing body of the Indian tribe revokes its concurrence to the provision of such health services.

    (B)  In the case of a multi-tribal service area, the authority of the Secretary to provide health services under paragraph (1)(A) shall terminate at the end of the fiscal year succeeding the fiscal year in which at least 51 percent of the number of Indian tribes in the service area revoke their concurrence to the provisions of such health services.

    (c)  The Service may provide health services under this subsection to individuals who are not eligible for health services provided by the Service under any other subsection of this section or under any other provision of law in order to --
  (1)  achieve stability in a medical emergency,

  (2)  prevent the spread of a communicable disease or otherwise deal with a public health hazard,

  (3)  provide care to non-Indian women pregnant with an eligible Indian's child for the duration of the pregnancy through post partum, or
  (4)  provide care to immediate family members of an eligible person if such care is directly related to the treatment of the eligible person.

    (d)  Hospital privileges in health facilities operated and maintained by the Service or operated under a contract entered into under the Indian Self-Determination Act may be extended to non-service health care practitioners who provide services to persons described in subsection (a) or (b).  Such non-Service health care practitioners may be regarded as employees of the Federal Government for purposes of section 1346(b) and chapter 171 of title 28, United States Code (relating to Federal tort claims) only with respect to acts or omissions which occur in the course of providing services to eligible persons as a part of the conditions under which such hospital privileges are extended.

    (e)  For purposes of this section, the term "eligible Indian" means any Indian who is eligible for health services provided by the Service without regard to the provisions of this section.


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