to encourage Indians to pursue careers related to behavioral health, a demonstration project to provide suicide prevention services, a commission on Indian health care, and administrative costs for a new nonprofit corporation. In addition, the bill also would affect direct spending, primarily through provisions affecting the Medicaid program. CBO estimates that implementing S. 1200 would cost $2.6 billion in 2007 and $30.4 billion over the period 2008-2017. Current law II. SECTION-BY-SECTION ANALYSIS No provision. Description of provision This act may be cited as the "Medicare, Medicaid, and SCHIP Indian Health Care Improvement Act of 2007." SECTION 2. EXPANSION OF PAYMENTS UNDER MEDICARE, MEDICAID AND SCHIP FOR ALL COVERED SERVICES FURNISHED BY INDIAN HEALTH PROGRAMS (a) Medicaid Current law A facility of the Indian Health Service (IHS) (including hospitals, nursing facilities or any other type of facility that provides services that are coverable under the Medicaid State plan), whether operated by the IHS or by an Indian tribe (IT) or a tribal organization (TO), as defined in Section 4 of the Indian Health Care Improvement Act (IHCIA), is eligible for Medicaid reimbursement under the State Medicaid plan, if and for so long as it meets all of the conditions and requirements generally applicable to such facilities under Title XIX of the Social Security Act (SSA). Section 1911(b) of the SSA provides that if a facility of the IHS which does not meet all of the conditions and requirements of Title XIX which are generally applicable to such a facility, that submits to the Secretary of Health and Human Services (HHS), an acceptable plan for achieving compliance with such conditions and requirements, must be deemed to meet such conditions and requirements, and to be eligible for Medicaid reimbursement, 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. Under Section 1911(c) of the SSA, the Secretary of HHS is authorized to enter into agreements with the State Medicaid agency for purpose of reimbursing such agency for Medicaid services provided in IHS facilities to Indians who are eligible for Medicaid under the State Medicaid plan. The Medicaid statute (Section 1911(d) of the SSA) points to Section 405 of the IHCIA, which describes the provisions relating to the authority of certain ITS tive health organiyment for, health zations to elect to directly care services covered by Medicaid and provided by a hospital or clinic of such entities. Description of provision These provisions would completely replace their counterparts (described above) in current law. The provision would require that the IHS and ITs, TOs and Urban Indian Organizations (UIOs) be reimbursed for Medicaid items and services provided under the State plan or a waiver, if the provision of those services meets all the conditions and requirements generally applicable to the delivery of such care. A facility of the IHS or an IT, TO, or UIO which is eligible for Medicaid reimbursement, but which does not meet all of the conditions and requirements of Medicaid under the State plan or a waiver which are generally applicable to such a facility, must make such improvements as are necessary to achieve or maintain compliance in accordance with a plan submitted to and accepted by the Secretary for meeting such conditions and requirements. The Secretary may deem a facility compliant for an initial 12-month period as under current law. The provision would also allow the Secretary of HHS to enter into an agreement with a State for the purpose of reimbursing that State for Medicaid services provided by the IHS, an IT, TO or UIO, directly, through referral, or under contracts or other arrangements between these entities and another health care provider to Indians eligible for Medicaid under the State Medicaid plan or a waiver. The provision would also provide a cross-reference to a special fund into which are placed payments to which a facility of the Indian Health Service is entitled under Medicaid. These provisions describe the authority of the Secretary to place Medicaid payments for which IHS facilities are eligible into a special fund, requires the Secretary to ensure that 100 percent of the payment for which facilities are eligible are paid out, and further requires facilities to use any amounts in excess of the amount necessary to achieve or maintain compliance for the purposes of improving IHS facilities. These requirements are outlined in subparagraphs (A) and (B) of Section 401(c)(1) of the IHCIA. The provision would also point to Section 401(d) of the IHCIA for rules relating to the authority of a Tribal Health Program (THP) or UIO to elect to directly bill for, and receive payment for, health care items and services reimbursable under Medicaid. Finally, the bill would point to Section 4 of the IHCIA for definitions of the following terms: Indian Health Program, Indian Tribe, Tribal Health Program, Tribal Organization, and Urban Indian Organization. (b) Medicare Current law The Social Security Act generally prohibits payment to any Federal agency for services which would otherwise be covered under Medicare. However, Section 1880 of the Act provides an exception for IHS facilities. Section 1880(a) provides an exception for hospitals and skilled nursing facilities (SNF) whether operated by the Service or by an Indian tribe or tribal organization if and for so long as the entity meets the conditions and requirements for payments generally applicable to such facilities under Medicare. Section 1880(b) established a temporary provision for submission of an acceptable compliance plan for a hospital or SNF not meeting all of these conditions and requirements in 1976. Section 1880(c) specifies that payments to which any hospital or SNF of the IHS is otherwise entitled is to be placed in a special fund to be held by the Secretary. The Secretary is to use the payments (to the extent provided in appropriations Acts) exclusively for the purpose of making improvements in hospitals and SNFs which may be needed to achieve compliance with Medicare conditions and requirements. The provision would cease to apply when the Secretary determined and certified that substantially all the hospitals and SNFs of the IHS are in compliance. Section 1880(d) specifies that the annual report of the Secretary (required by the Indian Health Care Improvement Act) is to include a detailed statement of the status of hospitals and SNFs in terms of their compliance and of their progress toward achievement of such compliance. Section 1880(e) extends payment, effective July 1, 2001, to certain services furnished in hospitals and ambulatory care clinics (whether provider-based or free-standing) operated by the IHS or by an Indian tribe (IT) or tribal organization (TO). The specified services are those provided by physicians, nonphysician practitioners, and physical and occupational therapists and which are paid for under the physician fee schedule. Effective for the 5-year period beginning January 1, 2005, the authority is extended to all services for which payment may be made under Medicare Part B. Section 1880(f) provides a cross-reference to Section 405 of the IHCIA 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 payments for health care services provided by a hospital or clinic of such tribe or organization. Description of provision The provision would rewrite Section 1880 of the Social Security Act. New Section 1880(a) would specify that the Indian Health Service, and an Indian Tribe, Tribal Organization, or an Urban Indian Organization would be eligible for Medicare payments for services furnished by such entities, provided such services met all the conditions and requirements generally applicable to the furnishing of such services under Medicare. Application of the provision would be subject to the revised Section 1880(e). New Section 1880(b) would require facilities of the Indian Health Service, or an Indian Tribe, Tribal Organization, or an Urban Indian Organization, which are eligible for reimbursement under Medicare, but which do not meet all of the conditions and requirements generally applicable to such facilities, to make improvements. The improvements would be in accordance with a plan submitted to and accepted by the Secretary for achieving or maintaining compliance with such conditions and requirements. The Secretary may deem a facility compliant for initial 12-month period as under current law. New Section 1880(c) would provide a cross reference to the special fund established under Section 401(c)(1) of the IHCIA for pro |