123STA T .509PUBLIC LA W 111 – 5 —FE B.1 7, 2009 ofwhet he r the fe d er al l y-qu al i fied health c e n ter i s orisnota p articipatin g pro v ider with the entity ).‘ ‘ ( ii) PAYMENTR ATE FO R S ER VIC ES P ROVI D ED B Y CERTAIN INDIAN H EA L TH CARE PROVIDERS. —I f the a m ount paid b y a managed care entity to an Indian health care provider that is not a federally-qualified health center for services provided by the provider to an Indian enrollee with the managed care entity is less than the rate that applies to the provision of such services by the provider under the S tate plan , the plan shall provide for payment to the Indian health care provider, whether the provider is a participating or nonparticipating provider with respect to the entity, of the difference between such applicable rate and the amount paid by the managed care entity to the provider for such services. ‘‘( D ) C ONSTR U CTION.— N othing in this paragraph shall be construed as waiving the application of section 1902 (a)( 3 0)( A ) (relating to application of standards to assure that payments are consistent with efficiency, economy, and quality of care). ‘‘(3) SPECIAL RULE FOR ENROLLMENT FOR INDIAN MANA G ED CARE ENTITIES.— R egarding the application of a M edicaid man- aged care program to Indian Medicaid managed care entities, an Indian Medicaid managed care entity may restrict enroll- ment under such program to Indians in the same manner as Indian H ealth Programs may restrict the delivery of services to Indians. ‘‘( 4 ) DEFINITIONS.— F or purposes of this subsection
‘‘(A) INDIAN HEALTH CARE PROVIDER.— T he term ‘Indian health care provider ’ means an Indian Health Program or an U rban Indian O rgani z ation. ‘‘( B ) INDIAN MEDICAID MANAGED CARE ENTITY.—The term ‘Indian Medicaid managed care entity’ means a man- aged care entity that is controlled (within the meaning of the last sentence of section 1903(m)(1)(C)) by the Indian Health Service, a Tribe, Tribal Organization, or Urban Indian Organization, or a consortium, which may be com- posed of 1 or more Tribes, Tribal Organizations, or Urban Indian Organizations, and which also may include the Service. ‘‘(C) NON-INDIAN MEDICAID MANAGED CARE ENTITY.— The term ‘non-Indian Medicaid managed care entity’ means a managed care entity that is not an Indian Medicaid managed care entity. ‘‘(D) COVERED MEDICAID MANAGED CARE SERVICES.— The term ‘covered Medicaid managed care services’ means, with respect to an individual enrolled with a managed care entity, items and services for which benefits are avail- able with respect to the individual under the contract between the entity and the State involved. ‘‘( E ) MEDICAID MANAGED CARE PROGRAM.—The term ‘Medicaid managed care program’ means a program under sections 1903(m), 190 5 (t), and 1932 and includes a man- aged care program operating under a waiver under section 1915(b) or 1115 or otherwise.’’.
