+------------------------------------------------------+---+-------------+
| TITLE II - HEALTH SERVICES                           |   | P.L.100-713 |
|                                                      |   |             |
| HEALTH SERVICES                                      |   | P.L.100-713 |
|                                                      |   |             |
| ~~SEC. 201. (a) For the purpose of eliminating       |   | P.L.102-573 |
| backlogs in Indian health care services and to       |   |             |
| supply known, unmet medical, surgical, dental,       |   | P.L.102-573 |
| optometrical, and other Indian health needs, the     |   |             |
| Secretary is authorized to expend, through the       |   | P.L.102-573 |
| Service, over the seven fiscal year period beginning |   |             |
| after the date of the enactment of this Act the      |   | P.L.102-573 |
| amounts authorized to be appropriated by subsection  |   |             |
| (e). Funds appropriated pursuant to this section for |   | P.L.102-573 |
| each fiscal year shall not be used to offset or      |   |             |
| limit the appropriations required by the Service     |   | P.L.102-573 |
| under other Federal laws to continue to serve the    |   |             |
| health needs of Indians during and subsequent to     |   | P.L.102-573 |
| such seven fiscal year period, but shall be in       |   |             |
| addition to the level of appropriations provided to  |   | P.L.102-573 |
| the Service under this Act and such other Federal    |   |             |
| laws in the preceding fiscal year plus an amount     |   | P.L.102-573 |
| equal to the amount required to cover pay increases  |   |             |
| and employee benefits for personnel employed under   |   | P.L.102-573 |
| this Act and such laws and increases in the costs of |   |             |
| serving the health needs of Indians under this Act   |   | P.L.102-573 |
| and such laws, which increases are caused by         |   |             |
| inflation.~~                                         |   | P.L.102-573 |
|                                                      |   |             |
| ~~(b) The Secretary, acting through the Service, is  |   | P.L.102-573 |
| authorized to employ persons to implement the        |   |             |
| provisions of this section during the seven fiscal   |   | P.L.102-573 |
| year period in accordance with the schedule provided |   |             |
| in subsection (c). Such positions authorized each    |   | P.L.102-573 |
| fiscal year pursuant to this section shall not be    |   |             |
| considered as offsetting or limiting the personnel   |   | P.L.102-573 |
| required by the Service to serve the health needs of |   |             |
| Indians during and subsequent to such seven fiscal   |   | P.L.102-573 |
| year period but shall be in addition to the          |   |             |
| positions authorized in the previous fiscal year.~~  |   | P.L.102-573 |
|                                                      |   |             |
| ~~(c) The following amounts and positions are        |   | P.L.102-573 |
| authorized, in accordance with the provisions of     |   |             |
| subsections (a) and (b), for specific purposes       |   | P.L.102-573 |
| noted:~~                                             |   |             |
|                                                      |   | P.L.102-573 |
| > ~~(1) Patient care (direct and indirect): sums and |   |             |
| > positions as provided in subsection (e) for fiscal |   | P.L.102-573 |
| > year 1978, \$8,500,000 and two hundred and         |   |             |
| > twenty-five positions for fiscal year 1979, and    |   | P.L.102-573 |
| > \$16,200,000 and three hundred positions for       |   |             |
| > fiscal year 1980.~~                                |   | P.L.100-713 |
| >                                                    |   |             |
| > ~~(1) There are authorized to be appropriated      |   | P.L.102-573 |
| > \$20,250,000 for fiscal year ending September 30,  |   |             |
| > 1981, \$23,000,000 for the fiscal year ending      |   | P.L.102-573 |
| > September 30, 1982, \$26,500,000 for the fiscal    |   |             |
| > year ending September 30, 1983, and \$30,500,000   |   | P.L.102-573 |
| > for the fiscal year ending September 30, 1984, and |   |             |
| > such further additional positions are authorized   |   | P.L.102-573 |
| > as may be necessary for each such fiscal year.~~   |   |             |
| >                                                    |   | P.L.100-713 |
| > ~~(2) field health, excluding dental care (direct  |   |             |
| > and indirect): sums and positions as provided in   |   | P.L.102-573 |
| > subsection (e) for fiscal year 1978, \$3,350,000   |   |             |
| > and eighty-five positions for fiscal year 1979,    |   | P.L.102-573 |
| > and \$5,550,000 and one hundred and thirteen       |   |             |
| > positions for fiscal year 1980.~~                  |   | P.L.102-573 |
| >                                                    |   |             |
| > ~~(2) There are authorized to be appropriated      |   | P.L.100-713 |
| > \$6,400,000 for the fiscal year ending September   |   |             |
| > 30, 1981, \$7,350,000 for the fiscal year ending   |   | P.L.102-573 |
| > September 30, 1982, \$8,450,000 for the fiscal     |   |             |
| > year ending September 30, 1983, and \$9,700,000    |   | P.L.102-573 |
| > for the fiscal year ending September 30, 1984, and |   |             |
| > such further additional positions are authorized   |   | P.L.102-573 |
| > as may be necessary for each such fiscal year.~~   |   |             |
| >                                                    |   | P.L.102-573 |
| > ~~(3) Dental care (direct and indirect); sums and  |   |             |
| > positions as provided in subsection (e) for fiscal |   | P.L.102-573 |
| > year 1978, \$1,500,000 and eighty positions for    |   |             |
| > fiscal year 1979, and \$1,500,000 and fifty        |   | P.L.102-573 |
| > positions for fiscal year 1980.~~                  |   |             |
| >                                                    |   | P.L.102-573 |
| > ~~(3) There are authorized to be appropriated      |   |             |
| > \$1,875,000, for the fiscal year ending September  |   | P.L.100-579 |
| > 30, 1981, \$2,150,000 for the fiscal year ending   |   |             |
| > September 30, 1982, \$2,500,000 for the fiscal     |   | P.L.100-690 |
| > year ending September 30, 1983, and \$2,875,000    |   |             |
| > for the fiscal year ending September 30, 1984, and |   | P.L.102-573 |
| > such further additional positions are authorized   |   |             |
| > as may be necessary for each such fiscal year.~~   |   | P.L.100-    |
| >                                                    |   |             |
| > ~~(4) Mental health: (A) Community mental health   |   | P.L.102-573 |
| > services: sums and positions as provided in        |   |             |
| > subsection (e) for fiscal year 1978, \$1,300,000   |   | P.L.102-573 |
| > and thirty positions for fiscal year 1979, and     |   |             |
| > \$2,000,000 and thirty positions for fiscal year   |   | P.L.102-573 |
| > 1980.~~                                            |   |             |
| >                                                    |   | P.L.102-573 |
| > ~~(A) There are authorized to be appropriated      |   |             |
| > \$2,500,000 for the fiscal year ending September   |   | P.L.102-573 |
| > 30, 1981, \$2,875,000 for the fiscal year ending   |   |             |
| > September 30, 1982, \$3,300,000 for the fiscal     |   | P.L.102-573 |
| > year ending September 30, 1983, and \$3,800,000    |   |             |
| > for the fiscal year ending September 30, 1984, and |   | P.L.102-573 |
| > such further additional positions are authorized   |   |             |
| > as may be necessary for each such fiscal year.~~   |   | P.L.102-573 |
| >                                                    |   |             |
| > ~~(B) Inpatient mental health services: sums and   |   | P.L.100-713 |
| > positions as provided in subsection (e) for fiscal |   |             |
| > year 1978, \$400,000 and fifteen positions for     |   | P.L.102-573 |
| > fiscal yea 1979, and \$600,000 and fifteen         |   |             |
| > positions for fiscal year 1980.~~                  |   | P.L.100-713 |
| >                                                    |   |             |
| > ~~(B) There are authorized to be appropriated      |   | P.L.101-630 |
| > \$750,000 for the fiscal year ending September 30, |   |             |
| > 1981, \$870,000 for the fiscal year ending         |   | P.L.101-630 |
| > September 30, 1982, \$1,000,000 for the fiscal     |   |             |
| > year ending September 30, 1983, and \$1,150,000    |   | P.L.102-573 |
| > for the fiscal year ending September 30, 1984, and |   |             |
| > such further additional positions are authorized   |   | P.L.102-573 |
| > as may be necessary for each such fiscal year.~~   |   |             |
| >                                                    |   | **[NOTE:    |
| > ~~(C) Model dormitory mental health services: sums |   | ]{.underlin |
| > and positions as provided in subsection (e) for    |   | e}Reference |
| > fiscal year 1978, \$1,250,000 and fifty positions  |   | to          |
| > for fiscal year 1979, and \$1,8750,000 and fifty   |   | subsection  |
| > positions for fiscal year 1980.~~                  |   | (d) should  |
| >                                                    |   | be to (c)** |
| > ~~(C) There are authorized to be appropriated      |   |             |
| > \$2,350,000 for the fiscal year ending September   |   | P.L.102-573 |
| > 30, 1981, \$2,700,000 for the fiscal year ending   |   |             |
| > September 30, 1982, \$3,100,000 for the fiscal     |   | **[Note:    |
| > year ending September 30, 1983, and \$3,600,000    |   | ]{.underlin |
| > for the fiscal year ending September 30,1984, and  |   | e}Reference |
| > such further positions are authorized as may be    |   | to          |
| > necessary for each such fiscal year.~~             |   | subsection  |
| >                                                    |   | (c) should  |
| > ~~(D) Therapeutic and residential treatment        |   | be to (b)** |
| > centers: sums and positions as provided in         |   |             |
| > subsection (e) for fiscal year 1978, \$300,000 and |   | P.L.102-573 |
| > ten positions for fiscal year 1979, and \$400,000  |   |             |
| > and five positions for fiscal year 1980.~~         |   | P.L.102-573 |
| >                                                    |   |             |
| > ~~(D) There are authorized to be appropriated      |   | P.L.102-573 |
| > \$460,000 for the fiscal year ending September 30, |   |             |
| > 1981, \$525,000 for the fiscal year ending         |   | **[NOTE:    |
| > September 30, 1982, \$600,000 for the fiscal year  |   | ]{.underlin |
| > ending September 30, 1983, and \$690,000 for the   |   | e}Reference |
| > fiscal year ending September 30, 1984, and such    |   | to          |
| > further additional positions are authorized as may |   | subsection  |
| > be necessary for each such fiscal year.~~          |   | (d) should  |
| >                                                    |   | be to (c)** |
| > ~~(E) Training of traditional Indian practitioners |   |             |
| > in mental health: sums as provided in subsection   |   | **[NOTE:    |
| > (e) for fiscal year 1978, \$150,000 for fiscal     |   | ]{.underlin |
| > year 1979, and \$200,000 for fiscal year 1980.~~   |   | e}Reference |
| >                                                    |   | to          |
| > ~~(E) There are authorized to be appropriated      |   | subsection  |
| > \$250,000 for the fiscal year ending September 30, |   | (d) should  |
| > 1981, \$285,000 for the fiscal year ending         |   | be to (c)** |
| > September 30, 1982, \$325,000 for the fiscal year  |   |             |
| > ending September 30, 1983, and \$375,000 for the   |   | P.L.102-573 |
| > fiscal year ending September 30, 1984.~~           |   |             |
| >                                                    |   | P.L.102-573 |
| > ~~(5) Treatment and control of alcoholism among    |   |             |
| > Indians: \$1,000,000 for fiscal year 1978,         |   | P.L.102-573 |
| > \$9,000,000 for fiscal year 1979, and \$9,200,000  |   |             |
| > for fiscal year 1980.~~                            |   | **[NOTE:    |
| >                                                    |   | ]{.underlin |
| > ~~(5) There are authorized to be appropriated      |   | e}Reference |
| > \$16,500,000 for the fiscal year ending September  |   | to          |
| > 30, 1981, \$19,000,000 for the fiscal year ending  |   | subsection  |
| > September 30, 1982,\$22,000,000 for the fiscal     |   | (f) should  |
| > year ending September 30, 1983, and \$25,100,000   |   | be to (e)** |
| > for the fiscal year ending September 30, 1984.~~   |   |             |
| >                                                    |   | P.L.102-573 |
| > ~~(6) Maintenance and repair (direct and           |   |             |
| > indirect): sums and positions as provided in       |   | P.L.102-573 |
| > subsection (e) for fiscal year 1978 \$3,000,000    |   |             |
| > and twenty positions for fiscal year 1979, and     |   | P.L.102-573 |
| > \$4,000,000 and thirty positions for fiscal year   |   |             |
| > 1980.~~                                            |   | P.L.102-573 |
| >                                                    |   |             |
| > ~~(6) There are authorized to be appropriated      |   | P.L.102-573 |
| > \$5,000,000 for the fiscal year ending September   |   |             |
| > 30, 1981, \$5,750,000 for the fiscal year ending   |   | P.L.102-573 |
| > September 30, 1982, \$6,600,000 for the fiscal     |   |             |
| > year ending September 30, 1983, and \$7,600,000    |   | P.L.102-573 |
| > for the fiscal year ending September 30, 1984, and |   |             |
| > such further additional positions are authorized   |   | P.L.102-573 |
| > as may be necessary for each such fiscal year.~~   |   |             |
| >                                                    |   | P.L.102-573 |
| > ~~(7) For fiscal years 1981, 1982, 1983, and 1984  |   |             |
| > there are authorized to be appropriated for the    |   | P.L.102-573 |
| > items referred to in the preceding paragraph such  |   |             |
| > sums as may be specifically authorized by an Act   |   | P.L.102-573 |
| > enacted after this Act. For such fiscal years,     |   |             |
| > positions are authorized for such items (other     |   | P.L.102-573 |
| > than the items referred to in paragraphs (1)(E)    |   |             |
| > and (5)) as may be specified in an Act enacted     |   | P.L.102-573 |
| > after the date of the enactment of this Act.~~     |   |             |
|                                                      |   | P.L.102-573 |
| ~~(d) The Secretary, acting through the Service,     |   |             |
| shall expend directly or by contract not less than 1 |   | P.L.102-573 |
| per centum of the funds appropriated under the       |   |             |
| authorizations in each of the clauses (1) through    |   | P.L.102-573 |
| (5) of subsection (c) for research in each of the    |   |             |
| areas of Indian health care for which such funds are |   | P.L.102-573 |
| authorized to be appropriated.~~                     |   |             |
|                                                      |   | P.L.102-573 |
| ~~(e) for fiscal year 1978, the Secretary is         |   |             |
| authorized to apportion not to exceed a total of     |   | P.L.102-573 |
| \$10,025,000 and 425 positions for the programs      |   |             |
| enumerated in clauses (c)(1) through (4) and (c)(6)  |   | P.L.102-573 |
| of this section.~~                                   |   |             |
|                                                      |   | P.L.102-573 |
| ~~IMPROVEMENT OF HEALTH STATUS~~                     |   |             |
|                                                      |   | P.L.102-573 |
| INDIAN HEALTH CARE IMPROVEMENT FUND                  |   |             |
|                                                      |   | P.L.102-573 |
| SEC. 201. (a) The Secretary is authorized to expend  |   |             |
| funds which are appropriated under the authority     |   | P.L.102-573 |
| ~~of subsection (h)~~ this section, through the      |   |             |
| Service, for the purpose of\--                       |   | P.L.102-573 |
|                                                      |   |             |
| > ~~(1) raising the health status of Indians to zero |   | P.L.102-573 |
| > deficiency,~~                                      |   |             |
| >                                                    |   | P.L.102-573 |
| > \(1\) eliminating the deficiencies in health       |   |             |
| > status and resources of all Indian tribes,         |   | **[NOTE:    |
| >                                                    |   | ]{.underlin |
| > \(2\) Eliminating backlogs in the provision of     |   | e}Reference |
| > health care services to Indians,                   |   | to section  |
| >                                                    |   | 214(        |
| > \(3\) meeting the health needs of Indians in an    |   | b)(5)should |
| > efficient and equitable manner, and                |   | be to       |
| >                                                    |   | section     |
| > \(4\) augmenting the ability of the Service to     |   | (b)(6)**    |
| > meet the following health service                  |   |             |
| > responsibilities**,** either through direct or     |   |             |
| > contract care or through contracts entered into    |   |             |
| > pursuant to the Indian Self-Determination Act,     |   |             |
| > with respect to those Indian tribes with the       |   |             |
| > highest levels of health ~~resources deficiency~~  |   |             |
| > status and resource deficiencies;                  |   |             |
| >                                                    |   |             |
| > \(A\) clinical care (direct and indirect)          |   |             |
| > including clinical eye and vision care;            |   |             |
| >                                                    |   |             |
| > \(B\) preventive health~~;~~**,** including        |   |             |
| > screening mammography in accordance with section   |   |             |
| > 212;                                               |   |             |
| >                                                    |   |             |
| > \(C\) dental care (direct and indirect);           |   |             |
| >                                                    |   |             |
| > \(D\) mental health, including community mental    |   |             |
| > health services, inpatient mental health services, |   |             |
| > dormitory mental health services, therapeutic and  |   |             |
| > residential treatment centers, and training of     |   |             |
| > traditional Indian practitioners;                  |   |             |
| >                                                    |   |             |
| > \(E\) emergency medical services;                  |   |             |
| >                                                    |   |             |
| > \(F\) treatment and control of, and rehabilitative |   |             |
| > care related to, alcoholism and drug abuse         |   |             |
| > (including fetal alcohol syndrome) among Indians;  |   |             |
| >                                                    |   |             |
| > \(G\) accident prevention programs;                |   |             |
| >                                                    |   |             |
| > \(H\) home health care;                            |   |             |
| >                                                    |   |             |
| > \(I\) community health representatives; and        |   |             |
| >                                                    |   |             |
| > \(J\) maintenance and repair.                      |   |             |
|                                                      |   |             |
| (b)(1) Any funds appropriated under the authority of |   |             |
| ~~subsection (h)~~ this section shall not be used to |   |             |
| offset or limit any appropriations made to the       |   |             |
| Service under the Act of November 2, 1921 (25 U.S.C. |   |             |
| 13), popularly known as the Snyder Act, or any other |   |             |
| provision of law.                                    |   |             |
|                                                      |   |             |
| ~~(2) Funds which are appropriated under the         |   |             |
| authority of subsection (h) may be allocated to, or  |   |             |
| used for the benefit of, any Indian tribe which has  |   |             |
| a health resources deficiency level at level I or II |   |             |
| only if a sufficient amount of funds have been       |   |             |
| appropriated under the authority of subsection (h)   |   |             |
| to raise all Indian tribes to health resources       |   |             |
| deficiency level II.~~                               |   |             |
|                                                      |   |             |
| ~~(3)~~(2)(A) Funds appropriated under the authority |   |             |
| of ~~subsection (h)~~ this section may be allocated  |   |             |
| on a service unit basis ~~but such allocation shall  |   |             |
| be made in a manner which ensures that the           |   |             |
| requirement of paragraph (2) is met.~~ The funds     |   |             |
| allocated to each service unit under this            |   |             |
| subparagraph shall be used by the service unit ~~(in |   |             |
| accordance with paragraph (2))~~ to ~~raise the      |   |             |
| deficiency~~ reduce the health status and resource   |   |             |
| deficiency ~~level~~ of each tribe served by such    |   |             |
| service unit.                                        |   |             |
|                                                      |   |             |
| \(B\) The apportionment of funds allocated to a      |   |             |
| service unit under subparagraph (A) among the health |   |             |
| service responsibilities described in subsection     |   |             |
| (a)(4) shall be determined by the Service in         |   |             |
| consultation with**,** and with the active           |   |             |
| participation of, the affected Indian tribes.        |   |             |
|                                                      |   |             |
| \(c\) For purposes of this section\--                |   |             |
|                                                      |   |             |
| > ~~(1) The health resources deficiency levels of an |   |             |
| > Indian tribe are as follows:~~                     |   |             |
| >                                                    |   |             |
| > ~~(A) level I\--0 to 20 percent health resources   |   |             |
| > deficiency;~~                                      |   |             |
| >                                                    |   |             |
| > ~~(B) level II\--21 to 40 percent health resources |   |             |
| > deficiency;~~                                      |   |             |
| >                                                    |   |             |
| > ~~(C) level III\--41 to 60 percent health          |   |             |
| > resources deficiency;~~                            |   |             |
| >                                                    |   |             |
| > ~~(D) level IV\--61 to 80 percent health resources |   |             |
| > deficiency; and~~                                  |   |             |
| >                                                    |   |             |
| > ~~(E) level V\--81 to 100 percent health resources |   |             |
| > deficiency.~~                                      |   |             |
| >                                                    |   |             |
| > ~~(2) The term \"health resources deficiency\"     |   |             |
| > means a percentage determined by dividing\--~~     |   |             |
| >                                                    |   |             |
| > ~~(A) the excess, if any, of\--~~                  |   |             |
| >                                                    |   |             |
| > ~~(i) the value of the health resources that the   |   |             |
| > Indian tribe needs, over~~                         |   |             |
| >                                                    |   |             |
| > ~~(ii) the value of the health resources available |   |             |
| > to the Indian tribe, by~~                          |   |             |
| >                                                    |   |             |
| > ~~(B) the value of the health resources that the   |   |             |
| > Indian tribe needs.~~                              |   |             |
| >                                                    |   |             |
| > \(1\) The term \"health status and resource        |   |             |
| > deficiency\" means the extent to which‑‑           |   |             |
| >                                                    |   |             |
| > \(A\) the health status objectives set forth in    |   |             |
| > section 3(b) are not being achieved; and           |   |             |
| >                                                    |   |             |
| > \(B\) the Indian tribe does not have available to  |   |             |
| > it the health resources it needs, taking into      |   |             |
| > account the actual cost of providing health care   |   |             |
| > services given local geographic, climatic, rural,  |   |             |
| > or other circumstances.                            |   |             |
| >                                                    |   |             |
| > ~~(3)~~(2)The health resources available to an     |   |             |
| > Indian tribe include health resources provided by  |   |             |
| > the Service as well as health resources used by    |   |             |
| > the Indian tribe, including services and financing |   |             |
| > systems provided by any Federal programs, private  |   |             |
| > insurance, and programs of State or local          |   |             |
| > governments.                                       |   |             |
| >                                                    |   |             |
| > ~~(4)~~(3) ~~Under regulations, the~~ The          |   |             |
| > Secretary shall establish procedures which allow   |   |             |
| > any Indian tribe to petition the Secretary for a   |   |             |
| > review of any determination of the ~~health        |   |             |
| > resources deficiency level~~ extent of the health  |   |             |
| > status and resource deficiency of such tribe.      |   |             |
|                                                      |   |             |
| (d)(1) Programs administered by any Indian tribe or  |   |             |
| tribal organization under the authority of the       |   |             |
| Indian Self-Determination Act shall be eligible for  |   |             |
| funds appropriated under the authority of            |   |             |
| ~~subsection (h)~~ this section on an equal basis    |   |             |
| with programs that are administered directly by the  |   |             |
| Service.                                             |   |             |
|                                                      |   |             |
| \(2\) If any funds allocated to a tribe or service   |   |             |
| unit under the authority of this section are used    |   |             |
| for a contract entered into under the Indian         |   |             |
| Self-Determination Act, a reasonable portion of such |   |             |
| funds may be used for health planning, training,     |   |             |
| technical assistance and other administrative        |   |             |
| support functions.                                   |   |             |
|                                                      |   |             |
| \(e\) By no later than the date that is ~~60 days~~  |   |             |
| 3 years after the date of enactment of the ~~Indian  |   |             |
| Health Care Amendments of 1988~~ Indian Health       |   |             |
| Amendments of 1992, the Secretary shall submit to    |   |             |
| the Congress the current ~~health services priority  |   |             |
| system~~ health status and resource deficiency       |   |             |
| report of the Service for each Indian tribe or       |   |             |
| service unit, including newly recognized or          |   |             |
| acknowledged tribes. Such report shall set out\--    |   |             |
|                                                      |   |             |
| > \(1\) the methodology then in use by the Service   |   |             |
| > for determining tribal ~~health resources          |   |             |
| > deficiencies~~ health status and resource          |   |             |
| > deficiencies, as well as the most recent           |   |             |
| > application of that methodology;                   |   |             |
| >                                                    |   |             |
| > \(2\) ~~the level of health resources deficiency   |   |             |
| > for~~ the extent of the health status and resource |   |             |
| > deficiency of each Indian tribe served by the      |   |             |
| > Service;                                           |   |             |
| >                                                    |   |             |
| > \(3\) the amount of funds necessary to ~~raise all |   |             |
| > Indian tribes served by the Service below health   |   |             |
| > resources deficiency level II to health resources  |   |             |
| > deficiency level II~~ eliminate the health status  |   |             |
| > and resource deficiencies of all Indian tribes     |   |             |
| > served by the Service; and                         |   |             |
| >                                                    |   |             |
| > ~~(4) the amount of funds necessary to raise all   |   |             |
| > tribes served by the Service below health          |   |             |
| > resources deficiency level I to health resources   |   |             |
| > deficiency level I;~~                              |   |             |
| >                                                    |   |             |
| > ~~(5) the amount of funds necessary to raise all   |   |             |
| > tribes served by the Service to zero health        |   |             |
| > resources deficiency; and~~                        |   |             |
| >                                                    |   |             |
| > ~~(6)~~ (4) an estimate of\--                      |   |             |
| >                                                    |   |             |
| > \(A\) the amount of health service funds           |   |             |
| > appropriated under the authority of this Act, or   |   |             |
| > any other Act, including the amount of any funds   |   |             |
| > transferred to the Service, for the preceding      |   |             |
| > fiscal year which is allocated to each service     |   |             |
| > unit, Indian tribe, or comparable entity.          |   |             |
| >                                                    |   |             |
| > \(B\) the number of Indians eligible for health    |   |             |
| > services in each service unit or Indian tribe; and |   |             |
| >                                                    |   |             |
| > \(C\) the number of Indians using the Service      |   |             |
| > resources made available to each service unit or   |   |             |
| > Indian tribe.                                      |   |             |
|                                                      |   |             |
| ~~(f)(1) The President shall include with the budget |   |             |
| submitted to the Congress under section 1105 of      |   |             |
| title 31, United States Code, for each fiscal year a |   |             |
| separate statement which specifies the amount of     |   |             |
| funds requested to carry out the provisions of this  |   |             |
| section for such fiscal year.~~                      |   |             |
|                                                      |   |             |
| ~~(2)~~(f) Funds appropriated under authority of     |   |             |
| this section for any fiscal year shall be included   |   |             |
| in the base budget of the Service for the purpose of |   |             |
| determining appropriations under this section in     |   |             |
| subsequent fiscal years.                             |   |             |
|                                                      |   |             |
| \(g\) Nothing in this section is intended to         |   |             |
| diminish the primary responsibility of the Service   |   |             |
| to eliminate existing backlogs in unmet health care  |   |             |
| needs, nor are the provisions of this section        |   |             |
| intended to discourage the Service from undertaking  |   |             |
| additional efforts to achieve parity among Indian    |   |             |
| tribes.                                              |   |             |
|                                                      |   |             |
| \(h\) ~~There are authorized to be appropriated for  |   |             |
| the purpose of carrying out the provisions of this   |   |             |
| section\--~~                                         |   |             |
|                                                      |   |             |
| > ~~(1) \$19,000,000 for fiscal year 1990,~~         |   |             |
| >                                                    |   |             |
| > ~~(2) \$19,000,000 for fiscal year 1991, and~~     |   |             |
| >                                                    |   |             |
| > ~~(3) \$20,000,000 for fiscal year 1992.~~         |   |             |
|                                                      |   |             |
| Any funds appropriated under the authority of this   |   |             |
| ~~subsection~~ section shall be designated as the    |   |             |
| \"Indian Health Care Improvement Fund\".             |   |             |
|                                                      |   |             |
| > **\[NOTE: Section 201(b) of P.L. 102-573 provides  |   |             |
| > that the amendments made to subsection 201(a)      |   |             |
| > through (d) of the Indian Health Care Improvement  |   |             |
| > Act shall take efffect 3 years after date of       |   |             |
| > enactment (October 29, 1995). Amendments to        |   |             |
| > subsection (e) take effect on the date of          |   |             |
| > enactment (October 29, 1992).**                    |   |             |
|                                                      |   |             |
| CATASTROPHIC HEALTH EMERGENCY FUNDS                  |   |             |
|                                                      |   |             |
| SEC. 202. (a)(1) There is hereby established an      |   |             |
| Indian Catastrophic Health Emergency Fund (hereafter |   |             |
| in this section referred to as the \"Fund\")         |   |             |
| consisting of\--                                     |   |             |
|                                                      |   |             |
| > \(A\) the amounts deposited under subsection (d),  |   |             |
| > and                                                |   |             |
| >                                                    |   |             |
| > \(B\) the amounts appropriated under subsection    |   |             |
| > ~~(e)~~ to the Fund under this section.            |   |             |
|                                                      |   |             |
| \(2\) The fund shall be administered by the          |   |             |
| Secretary, acting through the central office of the  |   |             |
| Service, solely for the purpose of meeting the       |   |             |
| extraordinary medical costs associated with the      |   |             |
| treatment of victims of disasters or catastrophic    |   |             |
| illnesses who are within the responsibility of the   |   |             |
| Service.                                             |   |             |
|                                                      |   |             |
| \(3\) The Fund shall not be allocated, apportioned,  |   |             |
| or delegated on a service unit, area office, or any  |   |             |
| other basis.                                         |   |             |
|                                                      |   |             |
| \(4\) No part of the Fund or its administration      |   |             |
| shall be subject to contract or grant under any law, |   |             |
| including the Indian Self-Determination Act.         |   |             |
|                                                      |   |             |
| \(b\) The Secretary shall, through the promulgation  |   |             |
| of regulations consistent with the provisions of     |   |             |
| this section\--                                      |   |             |
|                                                      |   |             |
| > \(1\) establish a definition of disasters and      |   |             |
| > catastrophic illnesses for which the cost of the   |   |             |
| > treatment provided under contract would qualify    |   |             |
| > for payment from the Fund;                         |   |             |
| >                                                    |   |             |
| > \(2\) provide that a service unit shall not be     |   |             |
| > eligible for reimbursement for the cost of         |   |             |
| > treatment from the Fund until its cost of treating |   |             |
| > any victim of such catastrophic illness or         |   |             |
| > disaster has reached a certain threshold cost      |   |             |
| > which the Secretary ~~shall establish at not less  |   |             |
| > than \$10,000 or not more than \$20,000;~~ shall   |   |             |
| > establish at\--                                    |   |             |
| >                                                    |   |             |
| > \(A\) for 1993, not less than \$15,000 or not more |   |             |
| > than \$25,000; and                                 |   |             |
| >                                                    |   |             |
| > \(B\) for any subsequent year, not less than the   |   |             |
| > threshold cost of the previous year increased by   |   |             |
| > the percentage increase in the medical care        |   |             |
| > expenditure category of the consumer price index   |   |             |
| > for all urban consumers (United States city        |   |             |
| > average) for the 12‑month period ending with       |   |             |
| > December of the previous year;\"; and              |   |             |
| >                                                    |   |             |
| > \[NOTE: Section 202(b) of P.L. 102-573 provides    |   |             |
| > that the amendments made to section 202(b)(2) of   |   |             |
| > the Indian Health Care Improvement Act shall take  |   |             |
| > effect on January 1, 1993.\]                       |   |             |
| >                                                    |   |             |
| > \(3\) establish a procedure for the reimbursement  |   |             |
| > of the portion of the costs incurred by\--         |   |             |
| >                                                    |   |             |
| > \(A\) service units or facilities of the Service,  |   |             |
| > or                                                 |   |             |
| >                                                    |   |             |
| > \(B\) whenever otherwise authorized by the         |   |             |
| > Service, non-Service facilities or providers,      |   |             |
| >                                                    |   |             |
| > in rendering treatment that exceeds such threshold |   |             |
| > cost;                                              |   |             |
| >                                                    |   |             |
| > \(4\) establish a procedure for payment from the   |   |             |
| > Fund in cases in which the exigencies of the       |   |             |
| > medial circumstances warrant treatment prior to    |   |             |
| > the authorization of such treatment by the         |   |             |
| > Service; and                                       |   |             |
| >                                                    |   |             |
| > \(5\) establish a procedure that will ensure that  |   |             |
| > no payment shall be made from the Fund to any      |   |             |
| > provider of treatment to the extent that such      |   |             |
| > provider is eligible to receive payment for the    |   |             |
| > treatment from any other Federal, State, local, or |   |             |
| > private source of reimbursement for which the      |   |             |
| > patient is eligible.                               |   |             |
|                                                      |   |             |
| \(c\) ~~Funds appropriated under subsection (e)~~    |   |             |
| Amounts appropriated to the Fund under this section  |   |             |
| shall not be used to offset or limit appropriations  |   |             |
| made to the Service under the authority of the Act   |   |             |
| of November 2, 1921 (25 U.S.C. 13), popularly known  |   |             |
| as the Snyder Act, or any other law.                 |   |             |
|                                                      |   |             |
| \(d\) There shall be deposited into the Fund all     |   |             |
| reimbursements to which the Service is entitled from |   |             |
| any Federal, State, local, or private source         |   |             |
| (including third party insurance) by reason of       |   |             |
| treatment rendered to any victim of a disaster or    |   |             |
| catastrophic illness the cost of which was paid from |   |             |
| the Fund.                                            |   |             |
|                                                      |   |             |
| ~~(e) There are authorized to be appropriated for    |   |             |
| the purpose of carrying out the provisions of this   |   |             |
| section\--~~                                         |   |             |
|                                                      |   |             |
| > ~~(1) \$12,000,000 for fiscal year 1989, and~~     |   |             |
| >                                                    |   |             |
| > ~~(2) for each of the fiscal years 1990, 1991, and |   |             |
| > 1992, such sums as may be necessary to restore the |   |             |
| > Fund to a level of \$12,000,000 for such fiscal    |   |             |
| > year.~~                                            |   |             |
|                                                      |   |             |
| ~~Funds appropriated under the authority of this     |   |             |
| subsection shall remain available until expended.~~  |   |             |
|                                                      |   |             |
| HEALTH PROMOTION AND DISEASE PREVENTION SERVICES     |   |             |
|                                                      |   |             |
| > **\[NOTE: P.L. 100-713 contained a free-standing   |   |             |
| > provision affecting section 203. This language is  |   |             |
| > provided below for easy reference.\]**             |   |             |
| >                                                    |   |             |
| > **{Sec. 203. (a) The Congress finds that health    |   |             |
| > promotion and disease prevention activites         |   |             |
| > will\--**                                          |   |             |
| >                                                    |   |             |
| > **(1) improve the health and well-being of         |   |             |
| > Indians, and**                                     |   |             |
| >                                                    |   |             |
| > **(2) reduce the expenses for medical care of      |   |             |
| > Indians.}**                                        |   |             |
|                                                      |   |             |
| SEC. 203. (a) The Secretary, acting through the      |   |             |
| Service, shall provide health promotion and disease  |   |             |
| prevention services to Indians so as to achieve the  |   |             |
| health status objectives set forth in section 3(b).  |   |             |
|                                                      |   |             |
| \(b\) The Secretary shall submit to the President    |   |             |
| for inclusion in each statement which is required to |   |             |
| be submitted to the Congress under ~~section         |   |             |
| 201(f)~~ section 801 an evaluation of\--             |   |             |
|                                                      |   |             |
| > \(1\) the health promotion and disease prevention  |   |             |
| > needs of Indians,                                  |   |             |
| >                                                    |   |             |
| > \(2\) the health promotion and disease prevention  |   |             |
| > activities which would best meet such needs,       |   |             |
| >                                                    |   |             |
| > \(3\) the internal capacity of the Service to meet |   |             |
| > such needs, and                                    |   |             |
| >                                                    |   |             |
| > \(4\) the resources which would be required to     |   |             |
| > enable the Service to undertake the health         |   |             |
| > promotion anD disease prevention activities        |   |             |
| > necessary to meet such needs.                      |   |             |
|                                                      |   |             |
| ~~(c)(1) The Secretary shall establish at least 1    |   |             |
| demonstration project (but no more than 4            |   |             |
| demonstration projects) to determine the most        |   |             |
| effective and cost-efficient means of\--~~           |   |             |
|                                                      |   |             |
| > ~~(A) providing health promotion and disease       |   |             |
| > prevention services,~~                             |   |             |
| >                                                    |   |             |
| > ~~(B) encouraging Indians to adopt good health     |   |             |
| > habits,~~                                          |   |             |
| >                                                    |   |             |
| > ~~(C) reducing health risks to Indians,            |   |             |
| > particularly the risks of heart disease, cancer,   |   |             |
| > stroke, diabetes, anxiety, depression, and         |   |             |
| > lifestyle-related accidents,~~                     |   |             |
| >                                                    |   |             |
| > ~~(D) reducing medical expenses of Indians through |   |             |
| > health promotion and disease prevention            |   |             |
| > activities,~~                                      |   |             |
| >                                                    |   |             |
| > ~~(E) establishing a program\--~~                  |   |             |
| >                                                    |   |             |
| > ~~(i) which trains Indians in the provision of     |   |             |
| > health promotion and disease prevention services   |   |             |
| > to members of their tribe, and~~                   |   |             |
| >                                                    |   |             |
| > ~~(ii) under which such Indians are available on a |   |             |
| > contract basis to provide such services to other   |   |             |
| > tribes; and~~                                      |   |             |
| >                                                    |   |             |
| > ~~(F) providing training and continuing education  |   |             |
| > to employees of the Service and to                 |   |             |
| > paraprofessionals participating in the Community   |   |             |
| > Health Representative Program, in the delivery of  |   |             |
| > health promotion and disease prevention            |   |             |
| > services.~~                                        |   |             |
|                                                      |   |             |
| ~~(2) The demonstration project described in         |   |             |
| paragraph (1) shall include an analysis of the cost  |   |             |
| effectiveness of organizational structures and of    |   |             |
| social and educational programs that may be useful   |   |             |
| in achieving the objectives described in paragraph   |   |             |
| (1).~~                                               |   |             |
|                                                      |   |             |
| ~~(3)(A) The demonstration project described in      |   |             |
| paragraph (1) shall be conducted in association with |   |             |
| at least one\--~~                                    |   |             |
|                                                      |   |             |
| > ~~(i) health profession school,~~                  |   |             |
| >                                                    |   |             |
| > ~~(ii) allied health profession or nurse training  |   |             |
| > institution, or~~                                  |   |             |
| >                                                    |   |             |
| > ~~(iii) public or private entity that provides     |   |             |
| > health care.~~                                     |   |             |
|                                                      |   |             |
| ~~(B) The Secretary is authorized to enter into      |   |             |
| contracts with, or make grants to, any school of     |   |             |
| medicine or school of osteopathy for the purpose of  |   |             |
| carrying out the demonstration project described in  |   |             |
| paragraph (1).~~                                     |   |             |
|                                                      |   |             |
| ~~(C) For purposes of this paragraph, the term       |   |             |
| \"school of medicine\" and \"school of osteopathy\"  |   |             |
| have the respective meaning given to such terms by   |   |             |
| section 701(4) of the Public Health Service Act (42  |   |             |
| U.S.C. 292a(4)).~~                                   |   |             |
|                                                      |   |             |
| ~~(4) the Secretary shall submit to Congress a final |   |             |
| report on the demonstration project described in     |   |             |
| paragraph (1) within 60 days after the termination   |   |             |
| of such project.~~                                   |   |             |
|                                                      |   |             |
| ~~(5) The demonstration project described in         |   |             |
| paragraph (1) shall be established by no later than  |   |             |
| the date that is 12 months after the date of         |   |             |
| enactment of the Indian Health Care Amendments of    |   |             |
| 1988 and shall terminate on the date that is 30      |   |             |
| months after the date of enactment of such           |   |             |
| amendments.~~                                        |   |             |
|                                                      |   |             |
| ~~(6) There are authorized to be appropriated        |   |             |
| \$500,000 for the purpose of carrying out the        |   |             |
| provisions of this subsection, such sum to remain    |   |             |
| available without fiscal year limitation.~~          |   |             |
|                                                      |   |             |
| DIABETES PREVENTION, TREATMENT, AND CONTROL          |   |             |
|                                                      |   |             |
| SEC. 204. ~~(a)(1)~~ (a) The Secretary, in           |   |             |
| consultation with the tribes, shall determine\--     |   |             |
|                                                      |   |             |
| > ~~(A)~~ (1) by tribe and by service unit of the    |   |             |
| > Service, the incidence of, and the types of        |   |             |
| > complications resulting from, diabetes among       |   |             |
| > Indians; and                                       |   |             |
| >                                                    |   |             |
| > ~~(B)~~ (2) based on ~~subparagraph (A)~~          |   |             |
| > paragraph (1), the measures (including patient     |   |             |
| > education) each Service unit should take to reduce |   |             |
| > the incidence of, and prevent, treat, and control  |   |             |
| > the complications resulting from, diabetes among   |   |             |
| > tribes within that service unit.                   |   |             |
|                                                      |   |             |
| ~~(2) Within 18 months after the date of enactment   |   |             |
| of the Indian Health Care Amendments of 1988, the    |   |             |
| Secretary shall prepare and transmit to the          |   |             |
| President and the Congress a report describing the   |   |             |
| determinations made and measures taken under         |   |             |
| paragraph (1) and making recommendations for         |   |             |
| additional funding to prevent, treat, and control    |   |             |
| diabetes among Indians.~~                            |   |             |
|                                                      |   |             |
| \(b\) The Secretary shall screen each Indian who     |   |             |
| receives services from the Service for diabetes and  |   |             |
| for conditions which indicate a high risk that the   |   |             |
| individual will become diabetic. Such screening may  |   |             |
| be done by a tribe or tribal organization operating  |   |             |
| health care programs or facilities with funds from   |   |             |
| the Service under the Indian Self-Determination Act. |   |             |
|                                                      |   |             |
| ~~(c)(1) The Secretary shall continue to maintain    |   |             |
| during fiscal years 1988 through 1991 each of the    |   |             |
| following model diabetes projects which are in       |   |             |
| existence on the date of enactment of the Indian     |   |             |
| Health Care Amendments of 1988:~~                    |   |             |
|                                                      |   |             |
| (c)(1) The Secretary shall continue to maintain      |   |             |
| through fiscal year 2000 each model diabetes project |   |             |
| in existence on the date of enactment of the Indian  |   |             |
| Health Amendments of 1992 and located\--             |   |             |
|                                                      |   |             |
| > \(A\) at the Claremore Indian Hospital in          |   |             |
| > Oklahoma;                                          |   |             |
| >                                                    |   |             |
| > \(B\) at the Fort Totten Health Center in North    |   |             |
| > Dakota;                                            |   |             |
| >                                                    |   |             |
| > \(C\) at the Sacaton Indian Hospital in Arizona;   |   |             |
| >                                                    |   |             |
| > \(D\) at the Winnebago Indian Hospital in          |   |             |
| > Nebraska;                                          |   |             |
| >                                                    |   |             |
| > \(E\) at the Albuquerque Indian Hospital in New    |   |             |
| > Mexico;                                            |   |             |
| >                                                    |   |             |
| > \(F\) at the Perry, Princeton, and Old Town Health |   |             |
| > Centers in Maine; and                              |   |             |
| >                                                    |   |             |
| > \(G\) at the Bellingham Health Center in           |   |             |
| > Washington~~.~~ ;                                  |   |             |
|                                                      |   |             |
| ~~(2) The Secretary shall establish in fiscal year   |   |             |
| 1989, and maintain during fiscal years 1989 through  |   |             |
| 1991, a model diabetes project in each of the        |   |             |
| following locations:~~                               |   |             |
|                                                      |   |             |
| > ~~(A) Fort Berthold Reservation;~~                 |   |             |
| >                                                    |   |             |
| > ~~(B) the Navajo Reservation;~~                    |   |             |
| >                                                    |   |             |
| > ~~(C) the Papago Reservation;~~                    |   |             |
| >                                                    |   |             |
| > ~~(D) the Zuni Reservation; and~~                  |   |             |
| >                                                    |   |             |
| > ~~(E) the States of Alaska, California, Minnesota, |   |             |
| > Montana, Oregon, and Utah.~~                       |   |             |
| >                                                    |   |             |
| > \(H\) at the Fort Berthold Reservation;            |   |             |
| >                                                    |   |             |
| > \(I\) at the Navajo Reservation;                   |   |             |
| >                                                    |   |             |
| > \(J\) at the Papago Reservation;                   |   |             |
| >                                                    |   |             |
| > \(K\) at the Zuni Reservation; or                  |   |             |
| >                                                    |   |             |
| > \(L\) in the States of Alaska, California,         |   |             |
| > Minnesota, Montana, Oregon, or Utah.               |   |             |
| >                                                    |   |             |
| > \(2\) The Secretary may establish new model        |   |             |
| > diabetes projects under this section taking into   |   |             |
| > consideration applications received under this     |   |             |
| > section from all service areas, except that the    |   |             |
| > Secretary may not establish a greater number of    |   |             |
| > such projects in one service area than in any      |   |             |
| > other service area until there is an equal number  |   |             |
| > of such projects established with respect to all   |   |             |
| > service areas from which the Secretary receives    |   |             |
| > qualified applications during the application      |   |             |
| > period (as determined by the Secretary).           |   |             |
|                                                      |   |             |
| \(d\) The Secretary shall\--                         |   |             |
|                                                      |   |             |
| > \(1\) employ in each area office of the Service at |   |             |
| > least one diabetes control officer who shall       |   |             |
| > coordinate and manage on a full-time basis         |   |             |
| > activities within that area office for the         |   |             |
| > prevention, treatment, and control of diabetes.    |   |             |
| >                                                    |   |             |
| > \(2\) establish in each area office of the Service |   |             |
| > a registry of patients with diabetes to track the  |   |             |
| > incidence of diabetes and the complications from   |   |             |
| > diabetes in that area; ~~and~~                     |   |             |
| >                                                    |   |             |
| > \(3\) ensure that data collected in each area      |   |             |
| > office regarding diabetes and related              |   |             |
| > complications among Indians is disseminated to all |   |             |
| > other area offices~~.~~; and                       |   |             |
| >                                                    |   |             |
| > \(4\) evaluate the effectiveness of services       |   |             |
| > provided through model diabetes projects           |   |             |
| > established under this section.                    |   |             |
|                                                      |   |             |
| ~~(e) There are authorized to be appropriated such   |   |             |
| sums as may be necessary to carry out the provisions |   |             |
| of this section.~~ Funds appropriated under          |   |             |
| ~~subsection (c)~~ this section in any fiscal year   |   |             |
| shall be in addition to base resources appropriated  |   |             |
| to the Service for that year.                        |   |             |
|                                                      |   |             |
| ~~NATIVE HAWAIIAN HEALTH PROMOTION AND DISEASE       |   |             |
| PREVENTION~~                                         |   |             |
|                                                      |   |             |
| ~~Sec. 205. (a)(1) The Secretary shall, acting       |   |             |
| through the Public Health Service, establish in the  |   |             |
| State of Hawaii, as a demonstration project, a       |   |             |
| Native Hawaiian Program for Health Promotion and     |   |             |
| Disease Prevention for the purpose of exploring ways |   |             |
| to meet the unique health care needs of Native       |   |             |
| Hawaiians.~~                                         |   |             |
|                                                      |   |             |
| ~~(2) The demonstration program that is to be        |   |             |
| established under paragraph (1) shall\--~~           |   |             |
|                                                      |   |             |
| > ~~(A) provide necessary preventive oriented health |   |             |
| > services, including health education and mental    |   |             |
| > health care,~~                                     |   |             |
| >                                                    |   |             |
| > ~~(B) develop innovative training and research     |   |             |
| > projects,~~                                        |   |             |
| >                                                    |   |             |
| > ~~(C) establish cooperative relationships with the |   |             |
| > leaderships of the Native Hawaiian community;~~    |   |             |
| >                                                    |   |             |
| > ~~(D) ensure that a continuous effort is made to   |   |             |
| > establish programs which can be of direct benefit  |   |             |
| > to other Native American people, and~~             |   |             |
| >                                                    |   |             |
| > ~~(E) assure a comprehensive effort to reduce the  |   |             |
| > incidence of diabetes among Native Hawaiians.~~    |   |             |
|                                                      |   |             |
| ~~(3) The Secretary is authorized to enter into      |   |             |
| contracts with Native Hawaiian organizations for the |   |             |
| purpose of assisting the Secretary in meeting the    |   |             |
| objectives of the demonstration program that is to   |   |             |
| be established under paragraph (1).~~                |   |             |
|                                                      |   |             |
| ~~(b)(1) In fulfillment of the objective set forth   |   |             |
| in subsection (a)(2)(E), the Secretary shall enter   |   |             |
| into a contract with a Native Hawaiian organization  |   |             |
| to conduct a study to determine\--~~                 |   |             |
|                                                      |   |             |
| > ~~(A) the incidence of diabetes among Native       |   |             |
| > Hawaiians;~~                                       |   |             |
| >                                                    |   |             |
| > ~~(B) activities which should be undertaken\--~~   |   |             |
| >                                                    |   |             |
| > ~~(i) to reduce the incidence of diabetes among    |   |             |
| > Native Hawaiians,~~                                |   |             |
| >                                                    |   |             |
| > ~~(ii) to provide Native Hawaiians with guidance   |   |             |
| > in the prevention, treatment, and control of       |   |             |
| > diabetes,~~                                        |   |             |
| >                                                    |   |             |
| > ~~(iii) to provide early diagnosis of diabetes     |   |             |
| > among Native Hawaiians, and~~                      |   |             |
| >                                                    |   |             |
| > ~~(iv) to ensure that proper continuing health     |   |             |
| > care is provided to Native Hawaiians who are       |   |             |
| > diagnosed as diabetic;~~                           |   |             |
|                                                      |   |             |
| ~~(2) The Secretary shall enter into a contract with |   |             |
| a Native Hawaiian organization for the purpose of    |   |             |
| preparing an inventory of all health care programs   |   |             |
| (public and private) within the State of Hawaii that |   |             |
| are available for the treatment, prevention, or      |   |             |
| control of diabetes among Native Hawaiians.~~        |   |             |
|                                                      |   |             |
| ~~(3) By no later than the date that is two years    |   |             |
| after the date of enactment of this section, the     |   |             |
| Native Hawaiian organization with whom the Secretary |   |             |
| has entered into a contract, shall prepare and       |   |             |
| transmit to the Secretary a report describing the    |   |             |
| determinations made under paragraph (1), containing  |   |             |
| the inventory prepared under paragraph (2), and      |   |             |
| describing the research activities conducted under   |   |             |
| this subsection. The Secretary shall submit the      |   |             |
| report to the Congress and the President.~~          |   |             |
|                                                      |   |             |
| ~~(c)(1) By no later than the date that is three     |   |             |
| years after the date of enactment of this section,   |   |             |
| the Secretary shall enter into a contract with a     |   |             |
| Native Hawaiian organization for the purpose of      |   |             |
| implementing a program designed\--~~                 |   |             |
|                                                      |   |             |
| > ~~(A) to establish a diabetes control program;~~   |   |             |
| >                                                    |   |             |
| > ~~(B) to screen those Native Hawaiian individuals  |   |             |
| > that have been identified as having a high risk of |   |             |
| > becoming diabetic;~~                               |   |             |
| >                                                    |   |             |
| > ~~(C) to effectively treat\--~~                    |   |             |
| >                                                    |   |             |
| > ~~(i) individuals diagnosed as diabetics in order  |   |             |
| > to reduce further complications from diabetes,~~   |   |             |
| >                                                    |   |             |
| > ~~(ii) individuals who have a high risk of         |   |             |
| > becoming diabetic in order to reduce the incidence |   |             |
| > of diabetes, and~~                                 |   |             |
| >                                                    |   |             |
| > ~~(iii) short-term and long-term complications of  |   |             |
| > diabetes;~~                                        |   |             |
| >                                                    |   |             |
| > ~~(D) to conduct for Federal, State, and other     |   |             |
| > Native Hawaiian health care providers (including   |   |             |
| > Native Hawaiian community health outreach          |   |             |
| > workers), training programs concerning current     |   |             |
| > methods of prevention, diagnosis, and treatment of |   |             |
| > diabetes and related complications among Native    |   |             |
| > Hawaiians;~~                                       |   |             |
| >                                                    |   |             |
| > ~~(E) to determine the appropriate delivery to     |   |             |
| > Native Hawaiians of health care services relating  |   |             |
| > to diabetes;~~                                     |   |             |
| >                                                    |   |             |
| > ~~(F) to develop and present health education      |   |             |
| > information to Native Hawaiian communities and     |   |             |
| > schools concerning the prevention, treatment, and  |   |             |
| > control of diabetes; and~~                         |   |             |
| >                                                    |   |             |
| > ~~(G) to ensure that proper continuing health care |   |             |
| > is provided to Native Hawaiians who are diagnosed  |   |             |
| > as being diabetic.~~                               |   |             |
|                                                      |   |             |
| ~~(2) The Secretary shall enter into a contract with |   |             |
| a Native Hawaiian organization for the purpose       |   |             |
| of\--~~                                              |   |             |
|                                                      |   |             |
| > ~~(A) promoting coordination and cooperation       |   |             |
| > between all health care providers in the delivery  |   |             |
| > of diabetes related services to Native Hawaiians;  |   |             |
| > and~~                                              |   |             |
| >                                                    |   |             |
| > ~~(B) encouraging and funding joint projects       |   |             |
| > between Federal programs, State health care        |   |             |
| > facilities, community health centers, and Native   |   |             |
| > Hawaiian communities for the prevention and        |   |             |
| > treatment of diabetes.~~                           |   |             |
|                                                      |   |             |
| ~~(3)(A) the Secretary shall enter into a contract   |   |             |
| with a Native Hawaiian organization for the purpose  |   |             |
| of establishing a model diabetes program to serve    |   |             |
| Native Hawaiians in the State of Hawaii.~~           |   |             |
|                                                      |   |             |
| ~~(B) The Secretary shall enter into a contract with |   |             |
| a Native Hawaiian organization for the purpose of    |   |             |
| developing and implementing an outreach program to   |   |             |
| ensure that the achievements and benefits derived    |   |             |
| from the activities of the model diabetes program    |   |             |
| established under subparagraph (A) are applied in    |   |             |
| Native Hawaiian communities to assure the diagnosis, |   |             |
| prevention,and treatment of diabetes among Native    |   |             |
| Hawaiians.~~                                         |   |             |
|                                                      |   |             |
| ~~(4) The Secretary shall submit to the Congress an  |   |             |
| annual report outlining the activities,              |   |             |
| achievements, needs, and goals of the Native         |   |             |
| Hawaiian diabetes care program established under     |   |             |
| this paragraph.~~                                    |   |             |
|                                                      |   |             |
| ~~(d) the Secretary shall enter into a contract with |   |             |
| a Native Hawaiian organization, for the purpose of   |   |             |
| developing a standardized system to collect,         |   |             |
| analyze, and report data regarding diabetes and      |   |             |
| related complications among Native Hawaiians. Such   |   |             |
| system shall be designed to facilitate dissemination |   |             |
| of the best available information on diabetes to     |   |             |
| Native Hawaiian communities and health care          |   |             |
| professionals.~~                                     |   |             |
|                                                      |   |             |
| ~~(e) The Secretary shall enter into a contract with |   |             |
| a Native Hawaiian organization for the purpose       |   |             |
| of\--~~                                              |   |             |
|                                                      |   |             |
| > ~~(1) conducting research concerning the causes,   |   |             |
| > diagnosis, treatment, and prevention of diabetes   |   |             |
| > and related complications among Native Hawaiians,  |   |             |
| > and~~                                              |   |             |
| >                                                    |   |             |
| > ~~(2) coordinating such research with all other    |   |             |
| > relevant agencies and units of the government of   |   |             |
| > the State of Hawaii and the Department of Health   |   |             |
| > and Human Services which conduct research relating |   |             |
| > to diabetes and related complications.~~           |   |             |
|                                                      |   |             |
| ~~(f) The Secretary shall submit to the Congress an  |   |             |
| annual report on the status nd accomplishments of    |   |             |
| the progress established under this section during   |   |             |
| each of the fiscal years 1990, 1991, and 1992.~~     |   |             |
|                                                      |   |             |
| ~~(g)(1) The Secretary shall include in any contract |   |             |
| which the Secretary enters into with any Native      |   |             |
| Hawaiian organization under this subsection such     |   |             |
| conditions as the Secretary considers necessary to   |   |             |
| ensure that the objectives of such contract are      |   |             |
| achieved.~~                                          |   |             |
|                                                      |   |             |
| ~~(2) The Secretary shall develop procedures to      |   |             |
| evaluate compliance with, and performance of,        |   |             |
| contracts entered into by Native Hawaiian            |   |             |
| organizations under this subsection.~~               |   |             |
|                                                      |   |             |
| ~~(3) The Secretary shall conduct an evaluation of   |   |             |
| each Native Hawaiian organization which has entered  |   |             |
| into a contract under this subsection for purposes   |   |             |
| of determining the compliance of such organization   |   |             |
| with, and evaluating the performance of such         |   |             |
| organization under, such contract.~~                 |   |             |
|                                                      |   |             |
| ~~(4) If, as a result of the evaluations conducted   |   |             |
| under paragraph (3), the Secretary determines that a |   |             |
| Native Hawaiian organization has not complied with   |   |             |
| or satisfactorily performed a contract entered into  |   |             |
| under this subsection, the Secretary shall, prior to |   |             |
| renewing such contract, attempt to resolve the areas |   |             |
| of noncompliance or unsatisfactory performance and   |   |             |
| modify such contract to prevent future occurrences   |   |             |
| of such noncompliance or unsatisfactory performance. |   |             |
| If the Secretary determines that such noncompliance  |   |             |
| or unsatisfactory performance cannot be resolved and |   |             |
| prevented in the future, the Secretary shall not     |   |             |
| renew such contract with such organization and is    |   |             |
| authorized to enter into a contract under this       |   |             |
| subsection with another Native Hawaiian organization |   |             |
| that serves the same population of Native Hawaiians  |   |             |
| which is served by the Native Hawaiian organization  |   |             |
| whose contract is not renewed by reason of this      |   |             |
| subparagraph.~~                                      |   |             |
|                                                      |   |             |
| ~~(5) In determining whether to renew a contract     |   |             |
| entered into with a Native Hawaiian organization     |   |             |
| under this subsection, the Secretary shall\--~~      |   |             |
|                                                      |   |             |
| > ~~(A) review the records of the Native Hawaiian    |   |             |
| > organization and~~                                 |   |             |
| >                                                    |   |             |
| > ~~(B) shall consider the results of the onsite     |   |             |
| > evaluations conducted under paragraph (3).~~       |   |             |
|                                                      |   |             |
| ~~(6) All contracts entered into by the Secretary    |   |             |
| under this subsection shall be in accordance with    |   |             |
| all Federal contracting laws and regulations except  |   |             |
| that, in the discretion of the Secretary, such       |   |             |
| contracts may be negotiated without advertising and  |   |             |
| need not conform to the provision of the Act of      |   |             |
| August 24, 1935 (40 U.S.C. 270a, et seqq.).~~        |   |             |
|                                                      |   |             |
| ~~(7) Payments made under any contract entered into  |   |             |
| under this subsection may be made in advance, by     |   |             |
| means of reimbursement, or in installments and shall |   |             |
| be made on such conditions as the Secretary deems    |   |             |
| necessary to carry out the purposes of this          |   |             |
| subsection.~~                                        |   |             |
|                                                      |   |             |
| ~~(8) Notwithstanding any other provision of law,    |   |             |
| the Secretary may, at the request or consent of a    |   |             |
| Native Hawaiian organization, revise or amend any    |   |             |
| contract entered into by the Secretary with such     |   |             |
| organization under this subsection as necessary to   |   |             |
| carry out the purposes of this subsection.~~         |   |             |
|                                                      |   |             |
| ~~(9)(A) For each fiscal year during which a Native  |   |             |
| Hawaiian organization receives or expends funds      |   |             |
| pursuant to a contract entered into under this       |   |             |
| subsection, such organization shall submit to the    |   |             |
| Secretary a quarterly report on\--~~                 |   |             |
|                                                      |   |             |
| > ~~(i) activities conducted by the organization     |   |             |
| > under the contract,~~                              |   |             |
| >                                                    |   |             |
| > ~~(ii) the amounts and purposes for which Federal  |   |             |
| > funds were expended, and~~                         |   |             |
| >                                                    |   |             |
| > ~~(iii) such other information as the Secretary    |   |             |
| > may request.~~                                     |   |             |
|                                                      |   |             |
| ~~(B) The reports and records of any Native Hawaiian |   |             |
| organization which concern any contract entered into |   |             |
| under this subsection shall be subject to audit by   |   |             |
| the Secretary and the Comptroller General of the     |   |             |
| United States.~~                                     |   |             |
|                                                      |   |             |
| ~~(10) The Secretary shall allow as a cost of any    |   |             |
| contract entered into under this subsection the cost |   |             |
| of an annual private audit conducted by a certified  |   |             |
| public accountant.~~                                 |   |             |
|                                                      |   |             |
| > ~~(11) The authority of the Secretary to enter     |   |             |
| > into contracts under this subsection shall be to   |   |             |
| > the extent, and in amounts, provided for in        |   |             |
| > appropriation Acts.~~                              |   |             |
|                                                      |   |             |
| ~~(h) For purposes of this subsection\--~~           |   |             |
|                                                      |   |             |
| > ~~(1) The term \"Native Hawaiian\" means any       |   |             |
| > individual who\--~~                                |   |             |
| >                                                    |   |             |
| > ~~(A) is a citizen of the United States,~~         |   |             |
| >                                                    |   |             |
| > ~~(B) is a resident of the State of Hawaii, and~~  |   |             |
| >                                                    |   |             |
| > ~~(C) is a descendant of the aboriginal people     |   |             |
| > who, prior to 1778, occupied and exercised         |   |             |
| > sovereignty in the are that now constitutes the    |   |             |
| > State of Hawaii, as evidenced by\--~~              |   |             |
| >                                                    |   |             |
| > ~~(i) genealogical records,~~                      |   |             |
| >                                                    |   |             |
| > ~~(ii) Kupuna (elders) or Kama\'aina (long-term    |   |             |
| > community residents) verification, or~~            |   |             |
| >                                                    |   |             |
| > ~~(iii) birth records of the State of Hawaii.~~    |   |             |
| >                                                    |   |             |
| > ~~(2) The term \"Native Hawaiian organization\"    |   |             |
| > means any organization\--~~                        |   |             |
| >                                                    |   |             |
| > ~~(A) which serves and represents the interests of |   |             |
| > Native Hawaiians,~~                                |   |             |
| >                                                    |   |             |
| > ~~(B) which is recognized by the Department of     |   |             |
| > Health of the State of Hawaii, the Office of       |   |             |
| > Hawaiian Affairs of the State of Hawaii, and E Ola |   |             |
| > Mau for the purpose of planning, conducting, or    |   |             |
| > administering programs (or portion of programs)    |   |             |
| > authorized under this Act for Native Hawaiians,    |   |             |
| > and~~                                              |   |             |
| >                                                    |   |             |
| > ~~(C) in which Native Hawaiian health              |   |             |
| > professionals significantly participate in the     |   |             |
| > planning, management, monitoring, and evaluation   |   |             |
| > of health services.~~                              |   |             |
| >                                                    |   |             |
| > ~~(i) There ar authorized to be appropriated       |   |             |
| > \$750,000 for each of the fiscal years 1990, 1991, |   |             |
| > 1992, and 1993, for the purpose of carrying out    |   |             |
| > the provisions of this subsection.~~               |   |             |
| >                                                    |   |             |
| > ~~(j) The programs and services established by     |   |             |
| > this section shall not be administered by or       |   |             |
| > through the Indian Health Service nor shall any    |   |             |
| > funds appropriated to the Indian Health Service be |   |             |
| > used to supplement funding of such programs and    |   |             |
| > services.~~                                        |   |             |
|                                                      |   |             |
| 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 such individuals;          |   |             |
| >                                                    |   |             |
| > \(3\) determine the most appropriate means to      |   |             |
| > facilitate the participation of Indian tribes and  |   |             |
| > tribal organizations in providing hospice care;    |   |             |
| >                                                    |   |             |
| > \(4\) 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        |   |             |
| > 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)).             |   |             |
|                                                      |   |             |
| REIMBURSEMENT FROM CERTAIN THIRD PARTIES OF COSTS OF |   |             |
| HEALTH SERVICES                                      |   |             |
|                                                      |   |             |
| SEC. 206. ~~(a) The~~ (a) Except as provided in      |   |             |
| subsection (f), the United States, an indian tribe   |   |             |
| or tribal organization shall have the right to       |   |             |
| recover the reasonable expenses incurred by the      |   |             |
| Secretary, an Indian tribe or tribal organization in |   |             |
| providing health services, through the Service, an   |   |             |
| Indian tribe, or tribal organization to any          |   |             |
| individual to the same extent that such individual,  |   |             |
| or any nongovernmental provider of such services,    |   |             |
| would be eligible to receive reimbursement or        |   |             |
| indemnification for such expenses if\--              |   |             |
|                                                      |   |             |
| > \(1\) such services had been provided by a         |   |             |
| > nongovernmental provider, and                      |   |             |
| >                                                    |   |             |
| > \(2\) such individual had been required to pay     |   |             |
| > such expenses and did pay such expenses.           |   |             |
|                                                      |   |             |
| \(b\) Subsection (a) shall provide a right of        |   |             |
| recovery against any State, ~~or any political       |   |             |
| subdivision of a State,~~ only if the injury,        |   |             |
| illness, or disability for which health services     |   |             |
| were provided is covered under\--                    |   |             |
|                                                      |   |             |
| > \(1\) workers\' compensation laws, or              |   |             |
| >                                                    |   |             |
| > \(2\) a no-fault automobile accident insurance     |   |             |
| > plan or program.                                   |   |             |
|                                                      |   |             |
| \(c\) No law of any State, or of any political       |   |             |
| subdivision of a State and no provision of any       |   |             |
| contract entered into or renewed after the date of   |   |             |
| enactment of the Indian Health Care Amendments of    |   |             |
| 1988, shall prevent or hinder the right of recovery  |   |             |
| of the United States, an Indian tribe, or tribal     |   |             |
| organization under subsection (a).                   |   |             |
|                                                      |   |             |
| \(d\) No action taken by the United States, an       |   |             |
| Indian tribe, or tribal organization to enforce the  |   |             |
| right of recovery provided under subsection (a)      |   |             |
| shall affect the right of any person to any damages  |   |             |
| (other than damages for the cost of health services  |   |             |
| provided by the Secretary through the Service).      |   |             |
|                                                      |   |             |
| \(e\) The United States, an Indian tribe, or tribal  |   |             |
| organization, may enforce the right of recovery      |   |             |
| provided under subsection (a) by\--                  |   |             |
|                                                      |   |             |
| > \(1\) intervening or joining in any civil action   |   |             |
| > or proceeding brought\--                           |   |             |
| >                                                    |   |             |
| > \(A\) by the individual for whom health services   |   |             |
| > were provided by the Secretary, an Indian tribe or |   |             |
| > tribal organization or                             |   |             |
| >                                                    |   |             |
| > \(B\) by any representative or heirs of such       |   |             |
| > individual, or                                     |   |             |
| >                                                    |   |             |
| > \(2\) instituting a separate civil action, after   |   |             |
| > providing such individual, or to the               |   |             |
| > representative or heirs of such individual, notice |   |             |
| > of the intention of the United States, an Indian   |   |             |
| > tribe, or tribal organization to institute a       |   |             |
| > separate civil action.                             |   |             |
|                                                      |   |             |
| \(f\) The United States shall not have a right of    |   |             |
| recovery under this section if the injury, illness,  |   |             |
| or disability for which health services were         |   |             |
| provided is covered under a self‑insurance plan      |   |             |
| funded by an Indian tribe or tribal organization.    |   |             |
|                                                      |   |             |
| CREDITING OF REIMBURSEMENTS                          |   |             |
|                                                      |   |             |
| SEC. 207. (a)Except as provided in section 202(d),   |   |             |
| title IV, and section ~~713~~ 813 of this Act, all   |   |             |
| reimbursements received or recovered, under          |   |             |
| authority of this Act, Public law 87-693 (42 U.S.C.  |   |             |
| 2651, et seq.), or any other provision of law, by    |   |             |
| reason of the provision of health services by the    |   |             |
| Service or by a tribe or tribal organization under a |   |             |
| contract pursuant to the Indian Self-Determination   |   |             |
| Act shall be retained by the Service or that tribe   |   |             |
| or tribal organization and shall be available for    |   |             |
| the facilities, and to carry out the programs, of    |   |             |
| the Service or that tribe or tribal organization to  |   |             |
| provide health care services to Indians.             |   |             |
|                                                      |   |             |
| (b)The Service may not offset or limit the amount of |   |             |
| funds obligated to any service unit or entity under  |   |             |
| contract with the Service because of the receipt of  |   |             |
| reimbursements under subsection (a).                 |   |             |
|                                                      |   |             |
| HEALTH SERVICES RESEARCH                             |   |             |
|                                                      |   |             |
| SEC. 208. Of the amounts appropriated for the        |   |             |
| Service in any fiscal year, other than amounts made  |   |             |
| available for the Indian Health Care Improvement     |   |             |
| Fund, not less than \$200,000 shall be available     |   |             |
| only for research to further the performance of the  |   |             |
| health service responsibilities of the Service.      |   |             |
| Indian tribes and tribal organizations contracting   |   |             |
| with the Service under the authority of the Indian   |   |             |
| Self-Determination Act shall be given under an equal |   |             |
| opportunity to compete for, and receive, research    |   |             |
| funds under this section.                            |   |             |
|                                                      |   |             |
| > **\[NOTE: P.L. 101-630 included a free-standing    |   |             |
| > provision affecting section 209, Indian Mental     |   |             |
| > Health provisions. This language has been provided |   |             |
| > below for easy reference\]**                       |   |             |
|                                                      |   |             |
| **{MENTAL HEALTH PREVENTION AND TREATMENT SERVICES** |   |             |
|                                                      |   |             |
| > **(a) PURPOSES.\--The purposes of this section are |   |             |
| > to\--**                                            |   |             |
| >                                                    |   |             |
| > **(1) authorize and direct the Indian Health       |   |             |
| > Service to develop a comprehensive mental health   |   |             |
| > prevention and treatment program;**                |   |             |
| >                                                    |   |             |
| > **(2) provide direction and guidance relating to   |   |             |
| > mental illness and dysfunction and                 |   |             |
| > self-destructive behavior, including child abuse   |   |             |
| > and family violence, to those Federal, tribal,     |   |             |
| > State, and local agencies responsible for programs |   |             |
| > in Indian communities in areas of health car,      |   |             |
| > education, social services, child and family       |   |             |
| > welfare, alcohol and substance abuse, law          |   |             |
| > enforcement and judicial services;**               |   |             |
| >                                                    |   |             |
| > **(3) assist Indian tribes to identify services    |   |             |
| > and resources available to address mental illness  |   |             |
| > and dysfunctional and self-destructive behavior;** |   |             |
| >                                                    |   |             |
| > **(4) provide authority and opportunities for      |   |             |
| > Indian tribes to develop and implement, and        |   |             |
| > coordinate with, community-based mental health     |   |             |
| > programs which include identification, prevention, |   |             |
| > education, referral, and treatment services,       |   |             |
| > including through multi-disciplinary resource      |   |             |
| > teams;**                                           |   |             |
| >                                                    |   |             |
| > **(5) ensure that Indians, as citizens of the      |   |             |
| > United States and of the States in which they      |   |             |
| > reside, have the same access to mental health      |   |             |
| > services to which all citizens have access; and**  |   |             |
| >                                                    |   |             |
| > **(6) modify or supplement existing programs and   |   |             |
| > authorities in the areas identified in paragraph   |   |             |
| > (2).}**                                            |   |             |
|                                                      |   |             |
| ~~Sec. 209. MENTAL HEALTH PREVENTION AND TREATMENT   |   |             |
| SERVICES.~~                                          |   |             |
|                                                      |   |             |
| MENTAL HEALTH PREVENTION AND TREATMENT SERVICES      |   |             |
|                                                      |   |             |
| Sec. 209. (a) National Plan for Indian Mental Health |   |             |
| Services.\--                                         |   |             |
|                                                      |   |             |
| > \(1\) Not later than 120 days after the date of    |   |             |
| > enactment of this section, the Secretary, acting   |   |             |
| > through the Service, shall develop and publish in  |   |             |
| > the Federal Register, a final national plan for    |   |             |
| > Indian Mental Health Services. The plan shall      |   |             |
| > include\--                                         |   |             |
| >                                                    |   |             |
| > \(A\) an assessment of the scope of the problem of |   |             |
| > mental illness and dysfunctional and               |   |             |
| > self-destructive behavior, including child abuse   |   |             |
| > and family violence, among Indians, including\--   |   |             |
| >                                                    |   |             |
| > \(i\) the number of Indians served by the Service  |   |             |
| > who are directly or indirectly affected by such    |   |             |
| > illness or behavior, and                           |   |             |
| >                                                    |   |             |
| > \(ii\) an estimate of the financial and human cost |   |             |
| > attributable to such illness or behavior;          |   |             |
| >                                                    |   |             |
| > \(B\) an assessment of the existing and additional |   |             |
| > resources necessary for the prevention and         |   |             |
| > treatment of such illness and behavior; and        |   |             |
| >                                                    |   |             |
| > \(C\) an estimate of the additional funding needed |   |             |
| > by the Service to meet its responsibilities under  |   |             |
| > the plan.                                          |   |             |
| >                                                    |   |             |
| > \(2\) The Secretary shall submit a copy of the     |   |             |
| > national plan to the Congress.                     |   |             |
|                                                      |   |             |
| ~~(c)~~(b) MEMORANDUM OF AGREEMENT.\-- Not later     |   |             |
| than 180 days after the date of enactment of this    |   |             |
| section, the Secretary and the Secretary of the      |   |             |
| Interior shall develop and enter into a memorandum   |   |             |
| of agreement under which the Secretaries shall,      |   |             |
| among other things\--                                |   |             |
|                                                      |   |             |
| > \(1\) determine and define the scope and nature of |   |             |
| > mental illness and dysfunctional and               |   |             |
| > self-destructive behavior, including child abuse   |   |             |
| > and family violence, among Indians;                |   |             |
| >                                                    |   |             |
| > \(2\) make an assessment of the existing Federal,  |   |             |
| > tribal, State, local, and private services,        |   |             |
| > resources, and programs available to provide       |   |             |
| > mental health services for Indians;                |   |             |
| >                                                    |   |             |
| > \(3\) make an initial determination of the unmet   |   |             |
| > need for additional services, resources, programs  |   |             |
| > necessary to meet the needs identified pursuant to |   |             |
| > paragraph (1);                                     |   |             |
| >                                                    |   |             |
| > (4)(A) ensure that Indians, as citizens of the     |   |             |
| > United States and of the States in which they      |   |             |
| > reside, have access to mental health services to   |   |             |
| > which all citizens have access;                    |   |             |
| >                                                    |   |             |
| > \(B\) determine the right of Indians to            |   |             |
| > participate in, and receive the benefit of, such   |   |             |
| > services; and                                      |   |             |
| >                                                    |   |             |
| > \(C\) take actions necessary to protect the        |   |             |
| > exercise of such right;                            |   |             |
| >                                                    |   |             |
| > \(5\) delineate the responsibilities of the Bureau |   |             |
| > of Indian Affairs and the Service, including       |   |             |
| > mental health identification, prevention,          |   |             |
| > education, referral, and treatment services        |   |             |
| > (including services through multidisciplinary      |   |             |
| > resource teams), at the central, area, and agency  |   |             |
| > and service unit levels to address the problems    |   |             |
| > identified in paragraph (1);                       |   |             |
| >                                                    |   |             |
| > \(6\) provide a strategy for the comprehensive     |   |             |
| > coordination of the mental health services         |   |             |
| > provided by the Bureau of Indian Affairs and the   |   |             |
| > Service to meet the needs identified pursuant to   |   |             |
| > paragraph (1), including\--                        |   |             |
| >                                                    |   |             |
| > \(A\) the coordination of alcohol and substance    |   |             |
| > abuse programs of the Service, the Bureau of       |   |             |
| > Indian Affairs, and the various tribes (developed  |   |             |
| > under the Indian Alcohol and Substance Abuse       |   |             |
| > Prevention and Treatment Act of 1986) with the     |   |             |
| > mental health initiatives pursuant to this Act,    |   |             |
| > particularly with respect to the referral and      |   |             |
| > treatment of dually-diagnosed individuals          |   |             |
| > requiring mental health and substance abuse        |   |             |
| > treatment; and                                     |   |             |
| >                                                    |   |             |
| > \(B\) ensuring that the Bureau of Indian Affairs   |   |             |
| > and Service programs and services (including       |   |             |
| > multi-disciplinary resource teams) addressing      |   |             |
| > child abuse and family violence are coordinated    |   |             |
| > with such non-Federal programs and services;       |   |             |
| >                                                    |   |             |
| > \(7\) direct appropriate officials of the Bureau   |   |             |
| > of Indian Affairs and the Service, particularly at |   |             |
| > the agency and service unit levels to cooperate    |   |             |
| > fully with tribal requests made pursuant to        |   |             |
| > subsection (d); and                                |   |             |
| >                                                    |   |             |
| > \(8\) provide for an annual review of such         |   |             |
| > agreement by the two Secretaries.                  |   |             |
|                                                      |   |             |
| ~~(d)~~(c) COMMUNITY MENTAL HEALTH PLAN.\-- (1) The  |   |             |
| governing body of any Indian tribe may, at its       |   |             |
| discretion, adopt a resolution for the establishment |   |             |
| of a community mental health plan providing for the  |   |             |
| identification and coordination of available         |   |             |
| resources and programs to identify, prevent, or      |   |             |
| treat mental illness or dysfunctional and            |   |             |
| self-destructive behavior, including child abuse and |   |             |
| family violence, among its members.                  |   |             |
|                                                      |   |             |
| \(2\) In furtherance of a plan established pursuant  |   |             |
| to paragraph (1) and at the request of a tribe, the  |   |             |
| appropriate agency, service unit, or other officials |   |             |
| of the Bureau of Indian Affairs and the Service      |   |             |
| shall cooperate with, and provide technical          |   |             |
| assistance to, the tribe in the development of such  |   |             |
| plan. Upon the establishment of such a plan and at   |   |             |
| the request of the tribe, such officials, as         |   |             |
| directed by the memorandum of agreement developed    |   |             |
| pursuant to subsection (c), shall cooperate with the |   |             |
| tribe in the implementation of such plan.            |   |             |
|                                                      |   |             |
| \(3\) Two or more Indian tribes may form a coalition |   |             |
| for the adoption of resolutions and the              |   |             |
| establishment and development of a joint community   |   |             |
| mental health plan under this subsection.            |   |             |
|                                                      |   |             |
| \(4\) The Secretary, acting through the Service, may |   |             |
| make grants to Indian tribes adopting a resolution   |   |             |
| pursuant to paragraph (1) to obtain technical        |   |             |
| assistance for the development of a community mental |   |             |
| health plan and to provide administrative support in |   |             |
| the implementation of such plan.                     |   |             |
|                                                      |   |             |
| ~~(5) There is hereby authorized to be appropriated  |   |             |
| \$500,000 for fiscal year 1991 and \$1,000,000 for   |   |             |
| fiscal year 1992 to carry out this subsection.~~     |   |             |
|                                                      |   |             |
| ~~(e)~~(d) MENTAL HEALTH TRAINING AND COMMUNITY      |   |             |
| EDUCATION PROGRAMS.\--(1) The Secretary and the      |   |             |
| Secretary of the Interior, in consultation with      |   |             |
| representatives of Indian tribes, shall conduct a    |   |             |
| study and compile a list of the types of staff       |   |             |
| positions specified in paragraph (2) whose           |   |             |
| qualifications include, or should include, training  |   |             |
| in the identification, prevention, education,        |   |             |
| referral, or treatment of mental illness or          |   |             |
| dysfunctional and self-destructive behavior.         |   |             |
|                                                      |   |             |
| \(2\) The positions referred to in paragraph (1)     |   |             |
| are\--                                               |   |             |
|                                                      |   |             |
| > \(A\) staff positions within the Bureau of Indian  |   |             |
| > Affairs, including existing positions, in the      |   |             |
| > fields of\--                                       |   |             |
| >                                                    |   |             |
| > \(i\) elementary and secondary education;          |   |             |
| >                                                    |   |             |
| > \(ii\) social services and family and child        |   |             |
| > welfare;                                           |   |             |
| >                                                    |   |             |
| > \(iii\) law enforcement and judicial services; and |   |             |
| >                                                    |   |             |
| > \(iv\) alcohol and substance abuse;                |   |             |
| >                                                    |   |             |
| > \(B\) staff positions with the Service; and        |   |             |
| >                                                    |   |             |
| > \(C\) staff positions similar to those identified  |   |             |
| > in subparagraphs (A) and (B) established and       |   |             |
| > maintained by Indian tribes, including positions   |   |             |
| > established in contracts entered into under the    |   |             |
| > Indian Self-Determination Act.                     |   |             |
|                                                      |   |             |
| (3)(A) The appropriate Secretary shall provide       |   |             |
| training criteria appropriate to each type of        |   |             |
| position identified in paragraph (2)(A) and ensure   |   |             |
| that appropriate training has been, or will be,      |   |             |
| provided to any individual in any such position.     |   |             |
| With respect to any such individual in a position    |   |             |
| identified pursuant to paragraph (2)(C), the         |   |             |
| respective Secretaries shall provide appropriate     |   |             |
| training to, or provide funds to an Indian tribe for |   |             |
| the training of, such individual. In the case of     |   |             |
| positions funded under a contract entered into under |   |             |
| the Indian Self-Determination Act, the appropriate   |   |             |
| Secretary shall ensure that such training costs are  |   |             |
| included in the contract, if necessary.              |   |             |
|                                                      |   |             |
| \(B\) Funds authorized to be appropriated pursuant   |   |             |
| to ~~this subsection~~ this section may be used to   |   |             |
| provide training authorized by this paragraph for    |   |             |
| community education programs described in paragraph  |   |             |
| (5) if a plan adopted pursuant to subsection (d)     |   |             |
| identifies individuals or employment categories,     |   |             |
| other than those identified pursuant to paragraph    |   |             |
| (1), for which such training or community education  |   |             |
| is deemed necessary or desirable.                    |   |             |
|                                                      |   |             |
| \(4\) Position-specific training criteria described  |   |             |
| in paragraph (3) shall be culturally relevant to     |   |             |
| Indians and Indian tribes and shall ensure that      |   |             |
| appropriate information regarding traditional Indian |   |             |
| healing and treatment practices is provided.         |   |             |
|                                                      |   |             |
| \(5\) The Service shall develop and implement or,    |   |             |
| upon the request of the Indian tribe, assist such    |   |             |
| tribe to develop and implement, a program of         |   |             |
| community education on mental illness and            |   |             |
| dysfunctional and self-destructive behavior for      |   |             |
| individuals, as determined in a plan adopted         |   |             |
| pursuant to subsection (d). In carrying out this     |   |             |
| paragraph, the Service shall provide, upon the       |   |             |
| request of an Indian tribe, technical assistance to  |   |             |
| the Indian tribe to obtain or develop community      |   |             |
| education and training materials on the              |   |             |
| identification, prevention, referral, and treatment  |   |             |
| of mental illness and dysfunctional and              |   |             |
| self-destructive behavior.                           |   |             |
|                                                      |   |             |
| ~~(6) There is hereby authorized to be               |   |             |
| appropriated\--~~                                    |   |             |
|                                                      |   |             |
| > ~~(A) \$500,000 for fiscal year 1991 to carry out  |   |             |
| > this subsection, of which \$100,000 shall be       |   |             |
| > allocated for community education under paragraph  |   |             |
| > (5); and~~                                         |   |             |
| >                                                    |   |             |
| > ~~(B) \$5,000,000 for fiscal year 1992 to carry    |   |             |
| > out this subsection, of which \$1,200,000 shall be |   |             |
| > allocated for community education under paragraph  |   |             |
| > (5).~~                                             |   |             |
|                                                      |   |             |
| ~~(f)~~(e) STAFFING.\--(1) Within 90 days after the  |   |             |
| date of enactment of this section, the Secretary     |   |             |
| shall develop a plan under which the Service will    |   |             |
| increase the health care staff providing mental      |   |             |
| health services by at least 500 positions within     |   |             |
| five years after the date of enactment of this       |   |             |
| section, with at least 200 of such positions devoted |   |             |
| to child, adolescent, and family services. Such      |   |             |
| additional staff shall be primarily assigned to the  |   |             |
| service unit level for services which shall include  |   |             |
| outpatient, emergency, aftercare and follow-up, and  |   |             |
| prevention and education services.                   |   |             |
|                                                      |   |             |
| \(2\) The plan developed under paragraph (1) shall   |   |             |
| be implemented under the Act of November 2, 1921 (25 |   |             |
| U.S.C. 13) popularly known as the \"Snyder Act\".    |   |             |
|                                                      |   |             |
| ~~(g)~~(f) STAFF RECRUITMENT AND RETENTION.\--(1)    |   |             |
| The Secretary shall provide for the recruitment of   |   |             |
| the additional personnel required by subsection (f)  |   |             |
| and the retention of all Service personnel providing |   |             |
| mental health services. In carrying out this         |   |             |
| subsection, the Secretary shall give priority to     |   |             |
| practitioners providing mental health services to    |   |             |
| children and adolescents with mental health          |   |             |
| problems.                                            |   |             |
|                                                      |   |             |
| \(2\) In carrying out paragraph (1), the Secretary   |   |             |
| shall develop a program providing for\-\--           |   |             |
|                                                      |   |             |
| > \(A\) the payment of bonuses (which shall not be   |   |             |
| > more favorable than those provided for under       |   |             |
| > sections 116 and 117) for service in hardship      |   |             |
| > posts;                                             |   |             |
| >                                                    |   |             |
| > \(B\) the repayment of loans (for which the        |   |             |
| > provisions of repayment contracts shall not be     |   |             |
| > more favorable than the repayment contracts under  |   |             |
| > section 108) for health professions education as a |   |             |
| > recruitment incentive; and                         |   |             |
| >                                                    |   |             |
| > \(C\) a system of postgraduate rotations as a      |   |             |
| > retention incentive.                               |   |             |
|                                                      |   |             |
| \(3\) This subsection shall be carried out in        |   |             |
| coordination with the recruitment and retention      |   |             |
| programs under title I.                              |   |             |
|                                                      |   |             |
| ~~(4) There are authorized to be appropriated        |   |             |
| \$1,200,000 for the fiscal year 1992 to carrying out |   |             |
| this subsection.~~                                   |   |             |
|                                                      |   |             |
| ~~(h)~~(g) MENTAL HEALTH TECHNICIAN PROGRAM.\-- (1)  |   |             |
| Under the authority of the Snyder Act of November 2, |   |             |
| 1921 (25 U.S.C. 13), the Secretary shall establish   |   |             |
| and maintain a Mental Health Technician program      |   |             |
| within the Service which\--                          |   |             |
|                                                      |   |             |
| > \(A\) provides for the training of Indians as      |   |             |
| > mental health technicians; and                     |   |             |
| >                                                    |   |             |
| > \(B\) employs such technicians in the provision of |   |             |
| > community-based mental health care that includes   |   |             |
| > identification, prevention, education, referral,   |   |             |
| > and treatment services.                            |   |             |
|                                                      |   |             |
| \(2\) In carrying out paragraph (1)(A), the          |   |             |
| Secretary shall provide high standard                |   |             |
| paraprofessional training in mental health care      |   |             |
| necessary to provide quality care to the Indian      |   |             |
| communities to be served. Such training shall be     |   |             |
| based upon a curriculum developed or approved by the |   |             |
| Secretary which combines education in the theory of  |   |             |
| mental health care with supervised practical         |   |             |
| experience in the provision of such care.            |   |             |
|                                                      |   |             |
| \(3\) The Secretary shall supervise and evaluate the |   |             |
| mental health technicians in the training program.   |   |             |
|                                                      |   |             |
| \(4\) The Secretary shall ensure that the program    |   |             |
| established pursuant to this subsection involves the |   |             |
| utilization and promotion of the traditional Indian  |   |             |
| health care and treatment practices of the Indian    |   |             |
| tribes to be served.                                 |   |             |
|                                                      |   |             |
| ~~(5) For purposes of providing the training         |   |             |
| required under this subsection, there are authorized |   |             |
| to be appropriated \$1,000,000 for the fiscal year   |   |             |
| 1992, which shall remain available until expended.~~ |   |             |
|                                                      |   |             |
| ~~(i)~~(h) MENTAL HEALTH RESEARCH.\--~~(1)~~ The     |   |             |
| Secretary, acting through the Service and in         |   |             |
| consultation with the National Institute of Mental   |   |             |
| Health, shall enter into contracts with, or make     |   |             |
| grants to, appropriate institutions for the conduct  |   |             |
| of research on the incidence and prevalence of       |   |             |
| mental disorders among Indians on Indian             |   |             |
| reservations and in urban areas. Research priorities |   |             |
| under this subsection shall include\--               |   |             |
|                                                      |   |             |
| > ~~(A)~~(1) the inter-relationship and              |   |             |
| > inter-dependence of mental disorders with          |   |             |
| > alcoholism, suicide, homicides, accidents, and the |   |             |
| > incidence of family violence, and                  |   |             |
| >                                                    |   |             |
| > ~~(B)~~(2) the development of models of prevention |   |             |
| > techniques.                                        |   |             |
|                                                      |   |             |
| The effect of the inter-relationships and            |   |             |
| interdependencies referred to in ~~subparagraph      |   |             |
| (A)~~ paragraph (1) on children, and the development |   |             |
| of prevention techniques under ~~subparagraph (B)~~  |   |             |
| paragraph (2) applicable to children, shall be       |   |             |
| emphasized.                                          |   |             |
|                                                      |   |             |
| ~~(2) For purposes of carrying out this subsection,  |   |             |
| there are authorized to be appropriated \$2,000,000  |   |             |
| for fiscal year 1992, which shall remain available   |   |             |
| until expended~~.                                    |   |             |
|                                                      |   |             |
| ~~(j)~~(i) FACILITIES ASSESSMENT.\--~~(1)~~ Within   |   |             |
| one year after the date of enactment of this         |   |             |
| section, the Secretary, acting through the Service,  |   |             |
| shall make an assessment of the need for inpatient   |   |             |
| mental health care among Indians and the             |   |             |
| availability and cost of inpatient mental health     |   |             |
| facilities which can meet such need. In making such  |   |             |
| assessment, the Secretary shall consider the         |   |             |
| possible conversion of existing, under-utilized      |   |             |
| service hospital beds into psychiatric units to meet |   |             |
| such need.                                           |   |             |
|                                                      |   |             |
| ~~(2) There are authorized to be appropriated        |   |             |
| \$500,000 for the fiscal year 1992 to make the       |   |             |
| assessment required by this subsection.~~            |   |             |
|                                                      |   |             |
| ~~(k)(j)~~ ANNUAL REPORT.\-- The Service shall       |   |             |
| develop methods for analyzing and evaluating the     |   |             |
| overall status of mental health programs and         |   |             |
| services for Indians and shall ~~submit to the       |   |             |
| Congress an annual report~~ submit to the President, |   |             |
| for inclusion in each report required to be          |   |             |
| transmitted to the Congress under section 801, a     |   |             |
| report on the mental health status of Indians which  |   |             |
| shall describe the progress being made to address    |   |             |
| mental health problems of Indian communities.        |   |             |
|                                                      |   |             |
| ~~(l)~~(k) MENTAL HEALTH DEMONSTRATION GRANT         |   |             |
| PROGRAM.\-- (1) The Secretary, acting through the    |   |             |
| Service, is authorized to make grants to Indian      |   |             |
| tribes and inter-tribal consortia to pay 75 percent  |   |             |
| of the cost of planning, developing, and             |   |             |
| implementing programs to deliver innovative          |   |             |
| community-based mental health services to Indians.   |   |             |
| The 25 percent tribal share of such cost may be      |   |             |
| provided in cash or through the provision of         |   |             |
| property or services.                                |   |             |
|                                                      |   |             |
| \(2\) The Secretary may award a grant for a project  |   |             |
| under paragraph (1) to an Indian tribe or            |   |             |
| inter-tribal consortium which meets the following    |   |             |
| criteria:                                            |   |             |
|                                                      |   |             |
| > \(A\) The project will address significant unmet   |   |             |
| > mental health needs among Indians.                 |   |             |
| >                                                    |   |             |
| > \(B\) The project will serve a significant number  |   |             |
| > of Indians.                                        |   |             |
| >                                                    |   |             |
| > \(C\) The project has the potential to deliver     |   |             |
| > services in an efficient and effective manner.     |   |             |
| >                                                    |   |             |
| > \(D\) The tribe or consortium has the              |   |             |
| > administrative and financial capability to         |   |             |
| > administer the project.                            |   |             |
| >                                                    |   |             |
| > \(E\) The project will deliver services in a       |   |             |
| > manner consistent with traditional Indian healing  |   |             |
| > and treatment practices.                           |   |             |
| >                                                    |   |             |
| > \(F\) The project is coordinated with, and avoids  |   |             |
| > duplication of, existing services.                 |   |             |
|                                                      |   |             |
| \(3\) For purposes of this subsection, the Secretary |   |             |
| shall, in evaluating applications for grants for     |   |             |
| projects to be operated under any contract entered   |   |             |
| into with the Service under the Indian               |   |             |
| Self-Determination Act, use the same criteria that   |   |             |
| the Secretary uses in evaluating any other           |   |             |
| application for such a grant.                        |   |             |
|                                                      |   |             |
| \(4\) The Secretary may only award one grant under   |   |             |
| this subsection with respect to a service area until |   |             |
| the Secretary has awarded grants for all service     |   |             |
| areas with respect to which the Secretary receives   |   |             |
| applications during the application period, as       |   |             |
| determined by the Secretary, which meet the criteria |   |             |
| specified in paragraph (2).                          |   |             |
|                                                      |   |             |
| \(5\) Not later than 180 days after the close of the |   |             |
| term of the last grant awarded pursuant to this      |   |             |
| subsection, the Secretary shall submit to the        |   |             |
| Congress a report evaluating the effectiveness of    |   |             |
| the innovative community-based projects demonstrated |   |             |
| pursuant to this subsection. Such report shall       |   |             |
| include findings and recommendations, if any,        |   |             |
| relating to the reorganization of the programs of    |   |             |
| the Service for delivery of mental health service to |   |             |
| Indians.                                             |   |             |
|                                                      |   |             |
| \(6\) ~~There is authorized to be appropriated       |   |             |
| \$2,000,000 for fiscal year 1991 and \$3,000,000 for |   |             |
| fiscal year 1992 to carry out the purposes of this   |   |             |
| subsection~~. Grants made pursuant to this           |   |             |
| ~~subsection~~ section may be expended over a period |   |             |
| of three years and no grant may exceed \$1,000,000   |   |             |
| for the fiscal years involved.                       |   |             |
|                                                      |   |             |
| \(l\) LICENSING REQUIREMENT FOR MENTAL HEALTH CARE   |   |             |
| WORKERS.‑‑Any person employed as a psychologist,     |   |             |
| social worker, or marriage and family therapist for  |   |             |
| the purpose of providing mental health care services |   |             |
| to Indians in a clinical setting under the authority |   |             |
| of this Act or through a contract pursuant to the    |   |             |
| Indian Self-Determination Act shall‑‑                |   |             |
|                                                      |   |             |
| > \(1\) in the case of a person employed as a        |   |             |
| > psychologist, be licensed as a clinical            |   |             |
| > psychologist or working under the direct           |   |             |
| > supervision of a licensed clinical psychologist;   |   |             |
| >                                                    |   |             |
| > \(2\) in the case of a person employed as a social |   |             |
| > worker, be licensed as a social worker or working  |   |             |
| > under the direct supervision of a licensed social  |   |             |
| > worker; or                                         |   |             |
| >                                                    |   |             |
| > \(3\) in the case of a person employed as a        |   |             |
| > marriage and family therapist, be licensed as a    |   |             |
| > marriage and family therapist or working under the |   |             |
| > direct supervision of a licensed marriage and      |   |             |
| > family therapist.                                  |   |             |
|                                                      |   |             |
| \(m\) INTERMEDIATE ADOLESCENT MENTAL HEALTH          |   |             |
| SERVICES.‑‑(1) The Secretary, acting through the     |   |             |
| Service, may make grants to Indian tribes and tribal |   |             |
| organizations to provide intermediate mental health  |   |             |
| services to Indian children and adolescents,         |   |             |
| including‑‑                                          |   |             |
|                                                      |   |             |
| > \(A\) inpatient and outpatient services;           |   |             |
| >                                                    |   |             |
| > \(B\) emergency care;                              |   |             |
| >                                                    |   |             |
| > \(C\) suicide prevention and crisis intervention;  |   |             |
| > and                                                |   |             |
| >                                                    |   |             |
| > \(D\) prevention and treatment of mental illness,  |   |             |
| > and dysfunctional and self‑destructive behavior,   |   |             |
| > including child abuse and family violence.         |   |             |
| >                                                    |   |             |
| > \(2\) Funds provided under this subsection may be  |   |             |
| > used‑‑                                             |   |             |
| >                                                    |   |             |
| > \(A\) to construct or renovate an existing health  |   |             |
| > facility to provide intermediate mental health     |   |             |
| > services;                                          |   |             |
| >                                                    |   |             |
| > \(B\) to hire mental health professionals;         |   |             |
| >                                                    |   |             |
| > \(C\) to staff, operate, and maintain an           |   |             |
| > intermediate mental health facility, group home,   |   |             |
| > or youth shelter where intermediate mental health  |   |             |
| > services are being provided; and                   |   |             |
| >                                                    |   |             |
| > \(D\) to make renovations and hire appropriate     |   |             |
| > staff to convert existing hospital beds into       |   |             |
| > adolescent psychiatric units.                      |   |             |
| >                                                    |   |             |
| > \(3\) Funds provided under this subsection may not |   |             |
| > be used for the purposes described in section      |   |             |
| > 216(b)(1).                                         |   |             |
| >                                                    |   |             |
| > \(4\) An Indian tribe or tribal organization       |   |             |
| > receiving a grant under this subsection shall      |   |             |
| > ensure that intermediate adolescent mental health  |   |             |
| > services are coordinated with other tribal,        |   |             |
| > Service, and Bureau of Indian Affairs mental       |   |             |
| > health, alcohol and substance abuse, and social    |   |             |
| > services programs on the reservation of such tribe |   |             |
| > or tribal organization.                            |   |             |
| >                                                    |   |             |
| > \(5\) The Secretary shall establish criteria for   |   |             |
| > the review and approval of applications for grants |   |             |
| > made pursuant to this subsection.                  |   |             |
| >                                                    |   |             |
| > \(6\) There are authorized to be appropriated to   |   |             |
| > carry out this section \$10,000,000 for fiscal     |   |             |
| > year 1993 and such sums as may be necessary for    |   |             |
| > each of the fiscal years 1994, 1995, 1996, 1997,   |   |             |
| > 1998, 1999, and 2000.                              |   |             |
|                                                      |   |             |
| 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.                                     |   |             |
|                                                      |   |             |
| 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     |   |             |
| program, 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~~ **[1996 through 2000]{.underline}** such  |   |             |
| sums as may be necessary to carry out the purposes   |   |             |
| of this section.                                     |   |             |
|                                                      |   |             |
| COVERAGE OF SCREENING MAMMOGRAPHY                    |   |             |
|                                                      |   |             |
| SEC. 212. The Secretary, through the Service, shall  |   |             |
| provide for screening mammography (as defined in     |   |             |
| section 1861(jj) of the Social Security Act) for     |   |             |
| Indian and urban Indian women 35 years of age or     |   |             |
| older at a frequency, determined by the Secretary    |   |             |
| (in consultation with the Director of the National   |   |             |
| Cancer Institute), appropriate to such women, and    |   |             |
| under such terms and conditions as are consistent    |   |             |
| with standards established by the Secretary to       |   |             |
| assure the safety and accuracy of screening          |   |             |
| mammography under part B of title XVIII of the       |   |             |
| Social Security Act.                                 |   |             |
|                                                      |   |             |
| PATIENT TRAVEL COSTS                                 |   |             |
|                                                      |   |             |
| SEC. 213. (a) The Secretary, acting through the      |   |             |
| Service, shall provide funds for the following       |   |             |
| patient travel costs associated with receiving       |   |             |
| health care services provided (either through direct |   |             |
| or contract care or through contracts entered into   |   |             |
| pursuant to the Indian Self‑Determination Act) under |   |             |
| this Act‑‑                                           |   |             |
|                                                      |   |             |
| > \(1\) emergency air transportation; and            |   |             |
| >                                                    |   |             |
| > \(2\) nonemergency air transportation where ground |   |             |
| > transportation is infeasible.                      |   |             |
|                                                      |   |             |
| \(b\) There are authorized to be appropriated to     |   |             |
| carry out this section \$15,000,000 for fiscal year  |   |             |
| 1993 and such sums as may be necessary for each of   |   |             |
| the fiscal years 1994, 1995, 1996, 1997, 1998, 1999, |   |             |
| and 2000.                                            |   |             |
|                                                      |   |             |
| EPIDEMIOLOGY CENTERS                                 |   |             |
|                                                      |   |             |
| SEC. 214. (a)(1) The Secretary shall establish an    |   |             |
| epidemiology center in each Service area to carry    |   |             |
| out the functions described in paragraph (3).        |   |             |
|                                                      |   |             |
| \(2\) To assist such centers in carrying out such    |   |             |
| functions, the Secretary shall perform the           |   |             |
| following:                                           |   |             |
|                                                      |   |             |
| > \(A\) In consultation with the Centers for Disease |   |             |
| > and Indian tribes, develop sets of data (which to  |   |             |
| > the extent practicable, shall be consistent with   |   |             |
| > the uniform data sets used by the States with      |   |             |
| > respect to the year 2000 health objectives) for    |   |             |
| > uniformly defining health status for purposes of   |   |             |
| > the objectives specified in section 3(b). Such     |   |             |
| > sets shall consist of one or more categories of    |   |             |
| > information. The Secretary shall develop formats   |   |             |
| > for the uniform collecting and reporting of        |   |             |
| > information on such categories.                    |   |             |
| >                                                    |   |             |
| > \(B\) Establish and maintain a system for          |   |             |
| > monitoring the progress made toward meeting each   |   |             |
| > of the health status objectives described in       |   |             |
| > section 3(b).                                      |   |             |
|                                                      |   |             |
| \(3\) In consultation with Indian tribes and urban   |   |             |
| Indian communities, each area epidemiology center    |   |             |
| established under this subsection shall, with        |   |             |
| respect to such area‑‑                               |   |             |
|                                                      |   |             |
| > \(A\) collect data relating to, and monitor        |   |             |
| > progress made toward meeting, each of the health   |   |             |
| > status objectives described in section 3(b) using  |   |             |
| > the data sets and monitoring system developed by   |   |             |
| > the Secretary pursuant to paragraph (2);           |   |             |
| >                                                    |   |             |
| > \(B\) evaluate existing delivery systems, data     |   |             |
| > systems, and other systems that impact the         |   |             |
| > improvement of Indian health;                      |   |             |
| >                                                    |   |             |
| > \(C\) assist tribes and urban Indian communities   |   |             |
| > in identifying their highest priority health       |   |             |
| > status objectives and the services needed to       |   |             |
| > achieve such objectives, based on epidemiological  |   |             |
| > data;                                              |   |             |
| >                                                    |   |             |
| > \(D\) make recommendations for the targeting of    |   |             |
| > services needed by tribal, urban, and other Indian |   |             |
| > communities;                                       |   |             |
| >                                                    |   |             |
| > \(E\) make recommendations to improve health care  |   |             |
| > delivery systems for Indians and urban Indians;    |   |             |
| >                                                    |   |             |
| > \(F\) work cooperatively with tribal providers of  |   |             |
| > health and social services in order to avoid       |   |             |
| > duplication of existing services; and              |   |             |
| >                                                    |   |             |
| > \(G\) provide technical assistance to Indian       |   |             |
| > tribes and urban Indian organizations in the       |   |             |
| > development of local health service priorities and |   |             |
| > incidence and prevalence rates of disease and      |   |             |
| > other illness in the community.                    |   |             |
|                                                      |   |             |
| \(4\) Epidemiology centers established under this    |   |             |
| subsection shall be subject to the provisions of the |   |             |
| Indian Self‑Determination Act (25 U.S.C. 450f et     |   |             |
| seq.).                                               |   |             |
|                                                      |   |             |
| \(5\) The director of the Centers for Disease        |   |             |
| Control shall provide technical assistance to the    |   |             |
| centers in carrying out the requirements of this     |   |             |
| subsection.                                          |   |             |
|                                                      |   |             |
| \(6\) The Service shall assign one epidemiologist    |   |             |
| from each of its area offices to each area           |   |             |
| epidemiology center to provide such center with      |   |             |
| technical assistance necessary to carry out this     |   |             |
| subsection.                                          |   |             |
|                                                      |   |             |
| (b)(1) The Secretary may make grants to Indian       |   |             |
| tribes, tribal organizations, and eligible           |   |             |
| intertribal consortia or Indian organizations to     |   |             |
| conduct epidemiological studies of Indian            |   |             |
| communities.                                         |   |             |
|                                                      |   |             |
| \(2\) An intertribal consortia or Indian             |   |             |
| organization is eligible to receive a grant under    |   |             |
| this subsection if‑‑                                 |   |             |
|                                                      |   |             |
| > \(A\) it is incorporated for the primary purpose   |   |             |
| > of improving Indian health; and                    |   |             |
| >                                                    |   |             |
| > \(B\) it is representative of the tribes or urban  |   |             |
| > Indian communities in which it is located.         |   |             |
|                                                      |   |             |
| \(3\) An application for a grant under this          |   |             |
| subsection shall be submitted in such manner and at  |   |             |
| such time as the Secretary shall prescribe.          |   |             |
|                                                      |   |             |
| \(4\) Applicants for grants under this subsection    |   |             |
| shall‑‑                                              |   |             |
|                                                      |   |             |
| > \(A\) demonstrate the technical, administrative,   |   |             |
| > and financial expertise necessary to carry out the |   |             |
| > functions described in paragraph (5);              |   |             |
| >                                                    |   |             |
| > \(B\) consult and cooperate with providers of      |   |             |
| > related health and social services in order to     |   |             |
| > avoid duplication of existing services; and        |   |             |
| >                                                    |   |             |
| > \(C\) demonstrate cooperation from Indian tribes   |   |             |
| > or urban Indian organizations in the area to be    |   |             |
| > served.                                            |   |             |
|                                                      |   |             |
| \(5\) A grant awarded under paragraph (1) may be     |   |             |
| used to‑‑                                            |   |             |
|                                                      |   |             |
| > \(A\) carry out the functions described in         |   |             |
| > subsection (a)(3);                                 |   |             |
| >                                                    |   |             |
| > \(B\) provide information to and consult with      |   |             |
| > tribal leaders, urban Indian community leaders,    |   |             |
| > and related health staff, on health care and       |   |             |
| > health services management issues; and             |   |             |
| >                                                    |   |             |
| > \(C\) provide, in collaboration with tribes and    |   |             |
| > urban Indian communities, the Service with         |   |             |
| > information regarding ways to improve the health   |   |             |
| > status of Indian people.                           |   |             |
|                                                      |   |             |
| \(6\) There are authorized to be appropriated to     |   |             |
| carry out the purposes of this subsection not more   |   |             |
| than \$12,000,000 for fiscal year 1993 and such sums |   |             |
| as may be necessary for each of the fiscal years     |   |             |
| 1994, 1995, 1996, 1997, 1998, 1999, and 2000.\".     |   |             |
|                                                      |   |             |
| COMPREHENSIVE SCHOOL HEALTH EDUCATION PROGRAMS       |   |             |
|                                                      |   |             |
| SEC. 215. (a) The Secretary, acting through the      |   |             |
| Service and in consultation with the Secretary of    |   |             |
| the Interior, may award grants to Indian tribes to   |   |             |
| develop comprehensive school health education        |   |             |
| programs for children from preschool through grade   |   |             |
| 12 in schools located on Indian reservations.        |   |             |
|                                                      |   |             |
| \(b\) Grants awarded under this section may be used  |   |             |
| to‑‑                                                 |   |             |
|                                                      |   |             |
| > \(1\) develop health education curricula;          |   |             |
| >                                                    |   |             |
| > \(2\) train teachers in comprehensive school       |   |             |
| > health education curricula;                        |   |             |
| >                                                    |   |             |
| > \(3\) integrate school‑based, community‑based, and |   |             |
| > other public and private health promotion efforts; |   |             |
| >                                                    |   |             |
| > \(4\) encourage healthy, tobacco‑free school       |   |             |
| > environments;                                      |   |             |
| >                                                    |   |             |
| > \(5\) coordinate school‑based health programs with |   |             |
| > existing services and programs available in the    |   |             |
| > community;                                         |   |             |
| >                                                    |   |             |
| > \(6\) develop school programs on nutrition         |   |             |
| > education, personal health, and fitness;           |   |             |
| >                                                    |   |             |
| > \(7\) develop mental health wellness programs;     |   |             |
| >                                                    |   |             |
| > \(8\) develop chronic disease prevention programs; |   |             |
| >                                                    |   |             |
| > \(9\) develop substance abuse prevention programs; |   |             |
| >                                                    |   |             |
| > \(10\) develop accident prevention and safety      |   |             |
| > education programs;                                |   |             |
| >                                                    |   |             |
| > \(11\) develop activities for the prevention and   |   |             |
| > control of communicable diseases; and              |   |             |
| >                                                    |   |             |
| > \(12\) develop community and environmental health  |   |             |
| > education programs.                                |   |             |
|                                                      |   |             |
| \(c\) The Secretary shall provide technical          |   |             |
| assistance to Indian tribes in the development of    |   |             |
| health education plans, and the dissemination of     |   |             |
| health education materials and information on        |   |             |
| existing health programs and resources.              |   |             |
|                                                      |   |             |
| \(d\) The Secretary shall establish criteria for the |   |             |
| review and approval of applications for grants made  |   |             |
| pursuant to this section.                            |   |             |
|                                                      |   |             |
| \(e\) Recipients of grants under this section shall  |   |             |
| submit to the Secretary an annual report on          |   |             |
| activities undertaken with funds provided under this |   |             |
| section. Such reports shall include a statement of‑‑ |   |             |
|                                                      |   |             |
| > \(1\) the number of preschools, elementary         |   |             |
| > schools, and secondary schools served;             |   |             |
| >                                                    |   |             |
| > \(2\) the number of students served;               |   |             |
| >                                                    |   |             |
| > \(3\) any new curricula established with funds     |   |             |
| > provided under this section;                       |   |             |
| >                                                    |   |             |
| > \(4\) the number of teachers trained in the health |   |             |
| > curricula; and                                     |   |             |
| >                                                    |   |             |
| > \(5\) the involvement of parents, members of the   |   |             |
| > community, and community health workers in         |   |             |
| > programs established with funds provided under     |   |             |
| > this section.                                      |   |             |
|                                                      |   |             |
| (f)(1) The Secretary of the Interior, acting through |   |             |
| the Bureau of Indian Affairs and in cooperation with |   |             |
| the Secretary, shall develop a comprehensive school  |   |             |
| health education program for children from preschool |   |             |
| through grade 12 in schools operated by the Bureau   |   |             |
| of Indian Affairs.                                   |   |             |
|                                                      |   |             |
| \(2\) Such program shall include‑‑                   |   |             |
|                                                      |   |             |
| > \(A\) school programs on nutrition education,      |   |             |
| > personal health, and fitness;                      |   |             |
| >                                                    |   |             |
| > \(B\) mental health wellness programs;             |   |             |
| >                                                    |   |             |
| > \(C\) chronic disease prevention programs;         |   |             |
| >                                                    |   |             |
| > \(D\) substance abuse prevention programs;         |   |             |
| >                                                    |   |             |
| > \(E\) accident prevention and safety education     |   |             |
| > programs; and                                      |   |             |
| >                                                    |   |             |
| > \(F\) activities for the prevention and control    |   |             |
| > communicable diseases.                             |   |             |
|                                                      |   |             |
| \(3\) The Secretary of the Interior shall‑‑          |   |             |
|                                                      |   |             |
| > \(A\) provide training to teachers in              |   |             |
| > comprehensive school health education curricula;   |   |             |
| >                                                    |   |             |
| > \(B\) ensure the integration and coordination of   |   |             |
| > school‑ based programs with existing services and  |   |             |
| > health programs available in the community; and    |   |             |
| >                                                    |   |             |
| > \(C\) encourage healthy, tobacco‑free school       |   |             |
| > environments.                                      |   |             |
|                                                      |   |             |
| \(g\) There are authorized to be appropriated to     |   |             |
| carry out this section \$15,000,000 for fiscal year  |   |             |
| 1993 and such sums as may be necessary for each of   |   |             |
| the fiscal years 1994, 1995, 1996, 1997, 1998, 1999, |   |             |
| and 2000.                                            |   |             |
|                                                      |   |             |
| INDIAN YOUTH GRANT PROGRAM                           |   |             |
|                                                      |   |             |
| SEC. 216. (a) The Secretary, acting through the      |   |             |
| Service, is authorized to make grants to Indian      |   |             |
| tribes, tribal organizations, and urban Indian       |   |             |
| organizations for innovative mental and physical     |   |             |
| disease prevention and health promotion and          |   |             |
| treatment programs for Indian preadolescent and      |   |             |
| adolescent youths.                                   |   |             |
|                                                      |   |             |
| (b)(1) Funds made available under this section may   |   |             |
| be used to‑‑                                         |   |             |
|                                                      |   |             |
| > \(A\) develop prevention and treatment programs    |   |             |
| > for Indian youth which promote mental and physical |   |             |
| > health and incorporate cultural values, community  |   |             |
| > and family involvement, and traditional healers;   |   |             |
| > and                                                |   |             |
| >                                                    |   |             |
| > \(B\) develop and provide community training and   |   |             |
| > education.                                         |   |             |
| >                                                    |   |             |
| > \(2\) Funds made available under this section may  |   |             |
| > not be used to provide services described in       |   |             |
| > section 209(m).                                    |   |             |
|                                                      |   |             |
| \(c\) The Secretary shall‑‑                          |   |             |
|                                                      |   |             |
| > \(1\) disseminate to Indian tribes information     |   |             |
| > regarding models for the delivery of comprehensive |   |             |
| > health care services to Indian and urban Indian    |   |             |
| > adolescents;                                       |   |             |
| >                                                    |   |             |
| > \(2\) encourage the implementation of such models; |   |             |
| > and                                                |   |             |
| >                                                    |   |             |
| > \(3\) at the request of an Indian tribe, provide   |   |             |
| > technical assistance in the implementation of such |   |             |
| > models.                                            |   |             |
|                                                      |   |             |
| \(d\) The Secretary shall establish criteria for the |   |             |
| review and approval of applications under this       |   |             |
| section.                                             |   |             |
|                                                      |   |             |
| \(e\) There are authorized to be appropriated to     |   |             |
| carry out this section \$5,000,000 for fiscal year   |   |             |
| 1993 and such sums as may be necessary for each of   |   |             |
| the fiscal years 1994, 1995, 1996, 1997, 1998, 1999, |   |             |
| and 2000.                                            |   |             |
|                                                      |   |             |
| AMERICAN INDIANS INTO PSYCHOLOGY PROGRAM             |   |             |
|                                                      |   |             |
| SEC. 217. (a) The Secretary may provide grants to at |   |             |
| least 3 colleges and universities for the purpose of |   |             |
| developing and maintaining American Indian           |   |             |
| psychology career recruitment programs as a means of |   |             |
| encouraging Indians to enter the mental health       |   |             |
| field.                                               |   |             |
|                                                      |   |             |
| \(b\) The Secretary shall provide one of the grants  |   |             |
| authorized under subsection (a) to develop and       |   |             |
| maintain a program at the University of North Dakota |   |             |
| to be known as the \"Quentin N. Burdick American     |   |             |
| Indians Into Psychology Program\". Such program      |   |             |
| shall, to the maximum extent feasible, coordinate    |   |             |
| with the Quentin N. Burdick Indian Health Programs   |   |             |
| authorized under section 114(b), the Quentin N.      |   |             |
| Burdick American Indians Into Nursing Program        |   |             |
| authorized under section 112(e), and existing        |   |             |
| university research and communications networks.     |   |             |
|                                                      |   |             |
| (c)(1) The Secretary shall issue regulations for the |   |             |
| competitive awarding of the grants provided under    |   |             |
| this section.                                        |   |             |
|                                                      |   |             |
| \(2\) Applicants for grants under this section shall |   |             |
| agree to provide a program which, at a minimum‑‑     |   |             |
|                                                      |   |             |
| > \(A\) provides outreach and recruitment for health |   |             |
| > professions to Indian communities including        |   |             |
| > elementary, secondary and community colleges       |   |             |
| > located on Indian reservations that will be served |   |             |
| > by the program;                                    |   |             |
| >                                                    |   |             |
| > \(B\) incorporates a program advisory board        |   |             |
| > comprised of representatives from the tribes and   |   |             |
| > communities that will be served by the program;    |   |             |
| >                                                    |   |             |
| > \(C\) provides summer enrichment programs to       |   |             |
| > expose Indian students to the varied fields of     |   |             |
| > psychology through research, clinical, and         |   |             |
| > experiential activities;                           |   |             |
| >                                                    |   |             |
| > \(D\) provides stipends to undergraduate and       |   |             |
| > graduate students to pursue a career in            |   |             |
| > psychology;                                        |   |             |
| >                                                    |   |             |
| > \(E\) develops affiliation agreements with tribal  |   |             |
| > community colleges, the Service, university        |   |             |
| > affiliated programs, and other appropriate         |   |             |
| > entities to enhance the education of Indian        |   |             |
| > students;                                          |   |             |
| >                                                    |   |             |
| > \(F\) to the maximum extent feasible, utilizes     |   |             |
| > existing university tutoring, counseling and       |   |             |
| > student support services; and                      |   |             |
| >                                                    |   |             |
| > \(G\) to the maximum extent feasible, employs      |   |             |
| > qualified Indians in the program.                  |   |             |
|                                                      |   |             |
| \(d\) The active duty service obligation prescribed  |   |             |
| under section 338C of the Public Health Service Act  |   |             |
| (42 U.S.C. 254m) shall be met by each graduate       |   |             |
| student who receives a stipend described in          |   |             |
| subsection (c)(2)(D) that is funded by a grant       |   |             |
| provided under this section. Such obligation shall   |   |             |
| be met by service‑‑                                  |   |             |
|                                                      |   |             |
| > \(1\) in the Indian Health Service;                |   |             |
| >                                                    |   |             |
| > \(2\) in a program conducted under a contract      |   |             |
| > entered into under the Indian Self‑Determination   |   |             |
| > Act;                                               |   |             |
| >                                                    |   |             |
| > \(3\) in a program assisted under title V of this  |   |             |
| > Act; or                                            |   |             |
| >                                                    |   |             |
| > \(4\) in the private practice of psychology if, as |   |             |
| > determined by the Secretary, in accordance with    |   |             |
| > guidelines promulgated by the Secretary, such      |   |             |
| > practice is situated in a physician or other       |   |             |
| > health professional shortage area and addresses    |   |             |
| > the health care needs of a substantial number of   |   |             |
| > Indians.                                           |   |             |
|                                                      |   |             |
| PREVENTION, CONTROL, AND ELIMINATION OF TUBERCULOSIS |   |             |
|                                                      |   |             |
| SEC. 218. (a) The Secretary, acting through the      |   |             |
| Service after consultation with the Centers for      |   |             |
| Disease Control, may make grants to Indian tribes    |   |             |
| and tribal organizations for‑‑                       |   |             |
|                                                      |   |             |
| > \(1\) projects for the prevention, control, and    |   |             |
| > elimination of tuberculosis;                       |   |             |
| >                                                    |   |             |
| > \(2\) public information and education programs    |   |             |
| > for the prevention, control, and elimination of    |   |             |
| > tuberculosis; and                                  |   |             |
| >                                                    |   |             |
| > \(3\) education, training, and clinical skills     |   |             |
| > improvement activities in the prevention, control, |   |             |
| > and elimination of tuberculosis for health         |   |             |
| > professionals, including allied health             |   |             |
| > professionals.                                     |   |             |
|                                                      |   |             |
| \(b\) The Secretary may make a grant under           |   |             |
| subsection (a) only if an application for the grant  |   |             |
| is submitted to the Secretary and the application is |   |             |
| in such form, is made in such manner, and contains   |   |             |
| the assurances required by subsection (c) and such   |   |             |
| other agreements, assurances, and information as the |   |             |
| Secretary may require.                               |   |             |
|                                                      |   |             |
| \(c\) To be eligible for a grant under subsection    |   |             |
| (a), an applicant must provide assurances            |   |             |
| satisfactory to the Secretary that‑                  |   |             |
|                                                      |   |             |
| > \(1\) the applicant will coordinate its activities |   |             |
| > for prevention, control, and elimination of        |   |             |
| > tuberculosis with activities of the Centers for    |   |             |
| > Disease Control, and State and local health        |   |             |
| > agencies; and                                      |   |             |
| >                                                    |   |             |
| > \(2\) the applicant will submit to the Secretary   |   |             |
| > an annual report on its activities for the         |   |             |
| > prevention, control, and elimination of            |   |             |
| > tuberculosis.                                      |   |             |
|                                                      |   |             |
| \(d\) In carrying out this section, the Secretary‑‑  |   |             |
|                                                      |   |             |
| > \(1\) shall establish criteria for the review and  |   |             |
| > approval of applications for grants under          |   |             |
| > subsection (a), including requirement of public    |   |             |
| > health qualifications of applicants;               |   |             |
| >                                                    |   |             |
| > \(2\) shall, subject to available appropriations,  |   |             |
| > make at least one grant under subsection (a)       |   |             |
| > within each area office;                           |   |             |
| >                                                    |   |             |
| > \(3\) may, at the request of an Indian tribe or    |   |             |
| > tribal organization, provide technical assistance; |   |             |
| > and                                                |   |             |
| >                                                    |   |             |
| > \(4\) shall prepare and submit a report to the     |   |             |
| > Committee on Energy and Commerce and the Committee |   |             |
| > on Interior and Insular Affairs of the House and   |   |             |
| > the Select Committee on Indian Affairs of the      |   |             |
| > Senate not later than February 1, 1994, and        |   |             |
| > biennially thereafter, on the use of funds under   |   |             |
| > this section and on the progress made toward the   |   |             |
| > prevention, control, and elimination of            |   |             |
| > tuberculosis among Indian tribes and tribal        |   |             |
| > organizations.                                     |   |             |
|                                                      |   |             |
| \(e\) The Secretary may, at the request of a         |   |             |
| recipient of a grant under subsection (a), reduce    |   |             |
| the amount of such grant by‑‑                        |   |             |
|                                                      |   |             |
| > \(1\) the fair market value of any supplies or     |   |             |
| > equipment furnished the grant recipient; and       |   |             |
| >                                                    |   |             |
| > \(2\) the amount of the pay, allowances, and       |   |             |
| > travel expenses of any officer or employee of the  |   |             |
| > Government when detailed to the grant recipient    |   |             |
| > and the amount of any other costs incurred in      |   |             |
| > connection with the detail of such officer or      |   |             |
| > employee,                                          |   |             |
|                                                      |   |             |
| when the furnishing of such supplies or equipment or |   |             |
| the detail of such an officer or employee is for the |   |             |
| convenience of and at the request of such grant      |   |             |
| recipient and for the purpose of carrying out a      |   |             |
| program with respect to which the grant under        |   |             |
| subsection (a) is made. The amount by which any such |   |             |
| grant is so reduced shall be available for payment   |   |             |
| by the Secretary of the costs incurred in furnishing |   |             |
| the supplies or equipment, or in detailing the       |   |             |
| personnel, on which the reduction of such grant is   |   |             |
| based, and such amount shall be deemed as part of    |   |             |
| the grant and shall be deemed to have been paid to   |   |             |
| the grant recipient.                                 |   |             |
|                                                      |   |             |
| CONTRACT HEALTH SERVICES PAYMENT STUDY               |   |             |
|                                                      |   |             |
| SEC. 219. (a) The Secretary, acting through the      |   |             |
| Service and in consultation with representatives of  |   |             |
| Indian tribes and tribal organizations operating     |   |             |
| contract health care programs under the Indian       |   |             |
| Self‑Determination Act (25 U.S.C. 450f et seq.) or   |   |             |
| under self‑governance compacts, Service personnel,   |   |             |
| private contract health services providers, the      |   |             |
| Indian Health Service Fiscal Intermediary, and other |   |             |
| appropriate experts, shall conduct a study‑‑         |   |             |
|                                                      |   |             |
| > \(1\) to assess and identify administrative        |   |             |
| > barriers that hinder the timely payment for        |   |             |
| > services delivered by private contract health      |   |             |
| > services providers to individual Indians by the    |   |             |
| > Service and the Indian Health Service Fiscal       |   |             |
| > Intermediary;                                      |   |             |
|                                                      |   |             |
| \(2\) to assess and identify the impact of such      |   |             |
| delayed payments upon the personal credit histories  |   |             |
| of individual Indians who have been treated by such  |   |             |
| providers; and                                       |   |             |
|                                                      |   |             |
| > \(3\) to determine the most efficient and          |   |             |
| > effective means of improving the Service\'s        |   |             |
| > contract health services payment system and        |   |             |
| > ensuring the development of appropriate consumer   |   |             |
| > protection policies to protect individual Indians  |   |             |
| > who receive authorized services from private       |   |             |
| > contract health services providers from billing    |   |             |
| > and collection practices, including the            |   |             |
| > development of materials and programs explaining   |   |             |
| > patients\' rights and responsibilities.            |   |             |
|                                                      |   |             |
| \(b\) The study required by subsection (a) shall‑‑   |   |             |
|                                                      |   |             |
| > \(1\) assess the impact of the existing contract   |   |             |
| > health services regulations and policies upon the  |   |             |
| > ability of the Service and the Indian Health       |   |             |
| > Service Fiscal Intermediary to process, on a       |   |             |
| > timely and efficient basis, the payment of bills   |   |             |
| > submitted by private contract health services      |   |             |
| > providers;                                         |   |             |
| >                                                    |   |             |
| > \(2\) assess the financial and any other burdens   |   |             |
| > imposed upon individual Indians and private        |   |             |
| > contract health services providers by delayed      |   |             |
| > payments;                                          |   |             |
| >                                                    |   |             |
| > \(3\) survey the policies and practices of         |   |             |
| > collection agencies used by contract health        |   |             |
| > services providers to collect payments for         |   |             |
| > services rendered to individual Indians;           |   |             |
| >                                                    |   |             |
| > \(4\) identify appropriate changes in Federal      |   |             |
| > policies, administrative procedures, and           |   |             |
| > regulations, to eliminate the problems experienced |   |             |
| > by private contract health services providers and  |   |             |
| > individual Indians as a result of delayed          |   |             |
| > payments; and                                      |   |             |
| >                                                    |   |             |
| > \(5\) compare the Service\'s payment processing    |   |             |
| > requirements with private insurance claims         |   |             |
| > processing requirements to evaluate the systemic   |   |             |
| > differences or similarities employed by the        |   |             |
| > Service and private insurers.                      |   |             |
|                                                      |   |             |
| \(c\) Not later than 12 months after the date of the |   |             |
| enactment of this section, the Secretary shall       |   |             |
| transmit to the Congress a report that includes‑‑    |   |             |
|                                                      |   |             |
| > \(1\) a detailed description of the study          |   |             |
| > conducted pursuant to this section; and            |   |             |
| >                                                    |   |             |
| > \(2\) a discussion of the findings and conclusions |   |             |
| > of such study.                                     |   |             |
|                                                      |   |             |
| PROMPT ACTION ON PAYMENT OF CLAIMS                   |   |             |
|                                                      |   |             |
| SEC. 220. (a) The Service shall respond to a         |   |             |
| notification of a claim by a provider of a contract  |   |             |
| care service with either an individual purchase      |   |             |
| order or a denial of the claim within 5 working days |   |             |
| after the receipt of such notification.              |   |             |
|                                                      |   |             |
| \(b\) If the Service fails to respond to a           |   |             |
| notification of a claim in accordance with           |   |             |
| subsection (a), the Service shall accept as valid    |   |             |
| the claim submitted by the provider of a contract    |   |             |
| care service.                                        |   |             |
|                                                      |   |             |
| \(c\) The Service shall pay a completed contract     |   |             |
| care service claim within 30 days after completion   |   |             |
| of the claim.                                        |   |             |
|                                                      |   |             |
| DEMONSTRATION OF ELECTRONIC CLAIMS PROCESSING        |   |             |
|                                                      |   |             |
| SEC. 221. (a) Not later than June 15, 1993, the      |   |             |
| Secretary shall develop and implement, directly or   |   |             |
| by contract, 2 projects to demonstrate in a pilot    |   |             |
| setting the use of claims processing technology to   |   |             |
| improve the accuracy and timeliness of the billing   |   |             |
| for, and payment of, contract health services.       |   |             |
|                                                      |   |             |
| \(b\) The Secretary shall conduct one of the         |   |             |
| projects authorized in subsection (a) in the Service |   |             |
| area served by the area office located in Phoenix,   |   |             |
| Arizona.                                             |   |             |
|                                                      |   |             |
| LIABILITY FOR PAYMENT                                |   |             |
|                                                      |   |             |
| SEC. 222. (a) A patient who receives contract health |   |             |
| care services that are authorized by the Service     |   |             |
| shall not be liable for the payment of any charges   |   |             |
| or costs associated with the provision of such       |   |             |
| services.                                            |   |             |
|                                                      |   |             |
| \(b\) The Secretary shall notify a contract care     |   |             |
| provider and any patient who receives contract       |   |             |
| health care services authorized by the Service that  |   |             |
| such patient is not liable for the payment of any    |   |             |
| charges or costs associated with the provision of    |   |             |
| such services.                                       |   |             |
|                                                      |   |             |
| OFFICE OF INDIAN WOMEN\'S HEALTH CARE                |   |             |
|                                                      |   |             |
| SEC. 223. There is established within the Service an |   |             |
| Office of Indian Women\'s Health Care to oversee     |   |             |
| efforts of the Service to monitor and improve the    |   |             |
| quality of health care for Indian women of all ages  |   |             |
| through the planning and delivery of programs        |   |             |
| administered by the Service, in order to improve and |   |             |
| enhance the treatment models of care for Indian      |   |             |
| women.                                               |   |             |
|                                                      |   |             |
| AUTHORIZATION OF APPROPRIATIONS                      |   |             |
|                                                      |   |             |
| SEC. 224. Except as provided in sections 209(m),     |   |             |
| 211, 213, 214(b)(5), 215, and 216, there are         |   |             |
| authorized to be appropriated such sums as may be    |   |             |
| necessary for each fiscal year through fiscal year   |   |             |
| 2000 to carry out this title.                        |   |             |
|                                                      |   |             |
| XXXXXXXXXXXXXXXXXXXXXXXXXXXXXX                       |   |             |
| XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX |   |             |
| XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX |   |             |
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