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S. 1055 · Senate bill · 119th Congress
This bill extends from 72 hours to 15 days the time period to notify the Purchased/Referred Care (PRC) program of emergency medical care received from a non-Indian Health Service (IHS) medical provider or at a non-IHS medical facility. This bill does not apply to individuals who are elderly or disabled, who continue to have a 30-day notification requirement for emergency services.
The IHS provides medical and dental services directly to American Indian and Alaska Native patients whenever possible. The PRC program pays for medical or dental care that is provided away from an IHS or tribal health care facility. The PRC program must be notified of requests for authorization of payment for health care services from a non-IHS provider.
Currently in emergency cases, the patient, an individual on behalf of the patient, or the medical care provider must, within 72 hours after the beginning of treatment for the condition or after admission to a health care facility, notify a PRC authorizing official of the need for the emergency medical care. This bill instead allows the patient, other individual, or provider to notify PRC within 15 days of the treatment or admission.
This Act may be cited as the “Indian Health Service Emergency Claims Parity Act”.
Section 406 of the Indian Health Care Improvement Act (25 U.S.C. 1646) is amended—
(1) by striking “With respect to” and inserting the following:
“(b) Elderly or disabled Indians.— With respect to”; and
(2) by inserting before subsection (b) (as so designated) the following:
“(a) In general.— Except as provided in subsection (b), with respect to an Indian receiving emergency medical care or services from a non-Service provider or in a non-Service facility under the authority of this Act, the time limitation (as a condition of payment) for notifying the Service of such treatment or admission shall be 15 days.”.