PUBLIC LAW 100-713—NOV. 23, 1988
102 STAT. 4819
under the medicare and medicaid programs for services furnished, without r^ard to the provisions of section 1880(c) of the Social Security Act and sections 402(c) and 713(b)(2)(A) of this Act, but all funds so reimbursed shall first be used by the hospital or clinic for the purpose of making any improvements in the hospital or clinic that may be necessary to achieve or maintain compliance with the conditions and requirements applicable generally to facilities of such type under the medicare or medicaid program. Any funds so reimbursed which are in excess of the amount necessary to achieve or maintain such conditions or requirements shall be used— "(A) solely for improving the health resources deficiency level of the Indian tribe, and "(B) in accordance with the r^ulations of the Service applicable to funds provided by the Service under any contract entered into under the Indian Self-Determination Act. "(2) The amounts paid to the hospitals and clinics participating in the demonstration program desmbed in subsection (a) shall be subject to all auditing requirements applicable to programs administered directly by the Service and to facilities participating in the medicare and medicaid programs. "(3) The Secretary shall monitor the performance of hospitals and clinics participating in the demonstration program described in subsection (a), and shall require such hospitals and clinics to submit reports on the pr(^ram to the Secretary on a quarterly basis (or more frequently if the Secretary deems it to be necessary). "(4) Notwithstanding section 1880(c) of the Social Security Act or section 402(c) of this Act, no payment may be made out of the special fund described in section 188(Kc) of the Social Security Act, or section 402(c) of this Act, for the benefit of any hospital or clinic participatii^ in the demonstration pn^ram described in subsection (a) during the period of such participation. "(c)(1) In order to be considered for participation in the demonstration program described in subsection (a), a hospital or clinic must submit an application to the Secretary which establishes to the satisfaction of the Secretary that— "(A) the Indian tribe, tribal organization, or Alaska Native health organization contracts the entire operation of the Service facility; "(B) the facility is eligible to participate in the medicare and medicaid programs under sections 1880 and 1911 of the Social Security Act; "(Q the fadlity meets any requirements which apply to programs operated directly by the Service; and "(D) the facility is acoredited by the Joint Commission on Accreditation of Hospitals, or has submitted a plan, which has been approved by the Secretary, for achieving such accreditation prior to October 1, 1990. "(2) From among the qualified applicants, the Secretary shall, prior to October 1, 1989, select no more than 4 facilities to participate in the demonstration program described in subsection (a). The demonstration program described in subsection (a) shall b ^ i n by no later than October 1, 1991, and end on September 30, 1995. "(d)(l) Upon the enactment of the Indian Health d^are Amendments of 1988, the Secretary, acting through the Service, shall commence an examination of— "(A) any administrative changes which may be necessary to allow direct billing and reimbursement under the demonstra-
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