Sec. 2. Findings

371 words·~2 min read·/bill/113/hr/4843/ih/section-2

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Congress makes the following findings: Federal health services to maintain and improve the health of American Indians and Alaska Natives are consonant with and required by the Federal Government’s historical and unique legal relationship with, and resulting trust responsibility to, the American Indian and Alaska Native people. The unmet health needs of American Indians and Alaska Natives are severe and the health status of American Indians and Alaska Natives is far below that of the general population of the United States, resulting in an average life expectancy for American Indians and Alaska Natives 4.2 years less than that for the all races population of the United States.

The Indian Health Service and tribal Purchased/Referred Care programs purchase primary and specialty care services from private health care providers when those services are not available at Indian Health Service or Tribal health facilities. Available Purchased/Referred Care funds have been insufficient to ensure access to care for American Indians and Alaska Natives, resulting in rationed care and diagnosis and treatment delays that lead to the need for more intensive and expensive treatment, further reducing already scarce Purchased/Referred Care funds.

In 2003, Congress amended title XVIII of the Social Security Act to require Medicare-participating hospitals to accept patients referred from the Indian Health Service and Tribal Purchased/Referred Care programs and to accept payment at no more than Medicare rates—the Medicare-like rate cap—for the services provided. The Medicare-like rate cap only applies to hospital services, and does not apply to other types of Medicare-participating providers and suppliers. Unlike other Federal health care programs, the Indian Health Service and Tribal Purchased/Referred Care programs continue to pay full billed charges for non-hospital services.

Because Purchased/Referred programs continue to pay full billed charges for non-hospital services, in many cases the Indian Health Service may only treat the most desperate Life or Limb cases, leading to many undesirable health outcomes for American Indians and Alaska Natives, and ultimately increasing costs to the Purchased/Referred Care programs. On April 11, 2013, the Government Accountability Office released a report finding that capping Purchased/Referred Care reimbursement at Medicare-like rates for nonhospital services would enable the Indian Health Service to double the number of physician services provided by adding an additional 253,000 patient visits annually.