PUBLIC LAW 102-573—OCT. 29, 1992

106 STAT. 4549

"(4) identify and evaluate various means for providing hos-
pice care, including—

"(A) the provision of such care by the personnel of

a Service hospital pursuant to a hospice program estab-
lished 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 Reports,
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 expect-
ancy 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)(l) of the Social Security Act (42 U.S.C. 1395x(dd)(l)).".

(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 25 use 16211.
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 Reports,
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 sub-
section (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 25 USC1621J.
program to evaluate the use of a contract care intermediary to
improve the accessibility of health services to California Indians.

"(b)(l) 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 administra-
tive costs) incurred, during the period of the demonstration pro-