NEW STUDIES AND DEMONSTRATION PROGRAM.

SEC. 206. NEW STUDIES AND DEMONSTRATION PROGRAM. (a) Hospice Care.—Title II of the Act is amended by inserting after section 204 the following: “hospice care feasibility study “Sec. 205. (a) The Secretary, acting through the Service and in consultation with representatives of Indian tribes, tribal organizations, Indian Health Service personnel, and hospice providers, shall conduct a study— “(1) to assess the feasibility and desirability of furnishing hospice care to terminally ill Indians; and “(2) to determine the most efficient and effective means of furnishing such care. “(b) Such study shall— “(1) assess the impact of Indian culture and beliefs concerning death and dying on the provision of hospice care to Indians; “(2) estimate the number of Indians for whom hospice care may be appropriate and determine the geographic distribution of such individuals; “(3) determine the most appropriate means to facilitate the participation of Indian tribes and tribal organizations in providing hospice care; 106 STAT. 4549 “(4) identify and evaluate various means for providing hospice care, including— “(A) the provision of such care by the personnel of a Service hospital pursuant to a hospice program established by the Secretary at such hospital; and “(B) the provision of such care by a community-based hospice program under contract to the Service; and “(5) identify and assess any difficulties in furnishing such care and the actions needed to resolve such difficulties. “(c) Not later than the date which is 12 months after the date of the enactment of this section, the Secretary shall transmit to the Congress a report containing— “(1) a detailed description of the study conducted pursuant to this section; and “(2) a discussion of the findings and conclusions of such study. “(d) For the purposes of this section— “(1) the term ‘terminally ill’ means any Indian who has a medical prognosis (as certified by a physician) of a life expectancy of six months or less; and “(2) the term ‘hospice program’ means any program which satisfies the requirements of section 1861(dd)(2) of the Social Security Act (42 U.S.C. 1395x(dd)(2)); and “(3) the term ‘hospice care’ means the items and services specified in subparagraphs (A) through (H) of section 1861(dd)(1) of the Social Security Act (42 U.S.C. 1395x(dd)(1)).”. (b) Managed Care.—Title II of the Act is amended by adding at the end the following new section: “managed care feasibility study “Sec. 210. (a) The Secretary, acting through the Service, shall conduct a study to assess the feasibility of allowing an Indian tribe to purchase, directly or through the Service, managed care coverage for all members of the tribe from— “(1) a tribally owned and operated managed care plan; or “(2) a State licensed managed care plan. “(b) Not later than the date which is 12 months after the date of the enactment of this section, the Secretary shall transmit to the Congress a report containing— “(1) a detailed description of the study conducted pursuant to this section; and “(2) a discussion of the findings and conclusions of such study.”. (c) Contract Care.—Title II of the Act (as amended by subsection (b) of this Act) is amended by adding at the end the following new section: “california contract health services demonstration program “Sec. 211. (a) The Secretary shall establish a demonstration program to evaluate the use of a contract care intermediary to improve the accessibility of health services to California Indians. “(b) (1) In establishing such program, the Secretary shall enter into an agreement with the California Rural Indian Health Board to reimburse the Board for costs (including reasonable administrative costs) incurred, during the period of the demonstration pro-106 STAT. 4550gram, in providing medical treatment under contract to California Indians described in section 809(b) throughout the California contract health services delivery area described in section 810 with respect to high-cost contract care cases. “(2) Not more than 5 percent of the amounts provided to the Board under this section for any fiscal year may be for reimbursement for administrative expenses incurred by the Board during such fiscal year. “(3) No payment may be made for treatment provided under the demonstration program to the extent payment may be made for such treatment under the Catastrophic Health Emergency Fund described in section 202 or from amounts appropriated or otherwise made available to the California contract health service delivery area for a fiscal year. “(c) There is hereby established an advisory board which shall advise the California Rural Indian Health Board in carrying out the demonstration pursuant to this section. The advisory board shall be composed of representatives, selected by the California Rural Indian Health Board, from not less than 8 tribal health programs serving California Indians covered under such demonstration, at least one half of whom are not affiliated with the California Rural Indian Health Board. “(d) The demonstration program described in this section shall begin on January 1, 1993, and shall terminate on September 30, 1997. “(e) Not later than July 1, 1998, the California Rural Indian Health Board shall submit to the Secretary a report on the demonstration program carried out under this section, including a statement of its findings regarding the impact of using a contract care intermediary on— “(1) access to needed health services; “(2) waiting periods for receiving such services; and “(3) the efficient management of high-cost contract care cases. “(f) For the purposes of this section, the term ‘high-cost contract care cases’ means those cases in which the cost of the medical treatment provided to an individual— “(1) would otherwise be eligible for reimbursement from the Catastrophic Health Emergency Fund established under section 202, except that the cost of such treatment does not meet the threshold cost requirement established pursuant to section 202(b)(2); and “(2) exceeds $1,000. “(g) There are authorized to be appropriated for each of the fiscal years 1993, 1994, 1995, 1996, and 1997 such sums as may be necessary to carry out the purposes of this section.”.