**National Steering Committee for the **

**Reauthorization of the**

**Indian Health Care Improvement Act, P.L. 94-437**

**TITLE V \-- HEALTH SERVICES FOR URBAN INDIANS**

**DRAFT 1 --- July 16, 1999**

**For Review and Comment Only**

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| | **Indian Health Care Improvement Act (with DRAFT proposed | | |   |
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| | amendments, if any)**                                     | | |   |
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| **TITLE V -- HEALTH SERVICES FOR URBAN INDIANS**                |   |
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**PURPOSE**

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  ** Sec. 501. **The purpose of this title is to establish programs in urban centers to make health services more accessible to urban Indians.   
                                                                                                                                                 
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**CONTRACTS WITH, AND GRANTS TO, URBAN INDIAN ORGANIZATIONS**

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|   **Sec. 502.                                                        |
| **Under authority of the Act of November 2, 1921 (25 U.S.C. 13), pop |
| ularly known as the Snyder Act, the Secretary, through the Service,  |
| shall enter into contracts with, or make grants to,** **urban Indian |
|  organizations to assist such organizations in the establishment and |
|  administration, within the urban centers in which such organization |
| s are situated, of programs which meet the requirements set forth in |
|  this title. The Secretary, through the Service, [subject to subsect |
| ion 506,]{.underline} shall include such conditions as the Secretary |
|  considers necessary to effect the purpose of this title in any cont |
| ract which the Secretary enters into with, or in any grant the Secre |
| tary makes to, any urban Indian organization pursuant to this title. |
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|                                                                      |
| *Conforming amendment to section 506 change.*                        |
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**CONTRACTS AND GRANTS FOR THE PROVISION OF**

**HEALTH CARE AND REFERRAL SERVICES**

**Sec. 503. **(a) Under authority of the Act of November 2, 1921 (25
U.S.C. 13), popularly known as the Snyder Act, the Secretary, through
the Service, shall enter into contracts with~~,~~ [and]{.underline} make
grants to, urban Indian organizations for the provision of health care
and referral services for urban Indians residing in the urban centers in
which such organizations are situated. Any such contract or grant shall
include requirements that the urban Indian organization successfully
undertake to\--

\(1\) estimate the population of urban Indians residing in the urban
center in which such organization is situated who are or could be
recipients of health care or referral services;

\(2\) estimate the current health status of urban Indians residing in
such urban center;

\(3\) estimate the current health care needs of urban Indians residing
in such urban center;

\(4\) ~~identify all public and private health services resources within
such urban center which are or may be available to urban Indians;~~

~~(5) determine the use of public and private health services resources
by the urban Indians residing in such urban center;~~

~~(6) assist such health services resources in providing services to
urban Indians;~~

~~(7) assist urban Indians in becoming familiar with and utilizing such
health services resources;~~

~~(8)~~ provide basic health education, including health promotion and
disease prevention education, to urban Indians;

~~(9) establish and implement training programs to accomplish the
referral and education tasks set forth in paragraphs (6) through (8) of
this subsection;~~

~~(10)identify gaps between unmet health needs of urban Indians and the
resources available to meet such needs;~~

[(5)]{.underline} ~~(11)~~ make recommendations to the Secretary and
Federal, State, local, and other resource agencies on methods of
improving health service programs to meet the needs of urban Indians;
and

[(6)]{.underline} ~~(12) ~~where necessary, provide, or enter into
contracts for the provision of, health care services for urban Indians.

\(b\) The Secretary, through the Service, shall by regulation prescribe
the criteria for selecting urban Indian organizations to enter into
contracts or receive grants** **under this section. Such criteria shall,
among other factors, include\--

\(1\) the extent of unmet health care needs of urban Indians in the
urban center involved;

\(2\) the size of the urban Indian population in the urban center [or
centers]{.underline} involved;

\(3\) ~~the accessibility to, and utilization of, health care services
(other than services provided under this title) by urban Indians in the
urban center involved;~~

~~(4)~~ the extent, if any, to which the activities set forth in
subsection (a) would duplicate~~\--~~

~~(A) any previous or current public or private health services project
in an urban center that was or is funded in a manner other than pursuant
to this title; or~~

~~(B)~~ any project funded under this title;

[(4)]{.underline} ~~(5)~~ the capability of an urban Indian organization
to perform the activities set forth in subsection (a) and to enter into
a contract with the Secretary or to meet the requirements for receiving
a grant under this section;

[(5)]{.underline} ~~(6)~~ the satisfactory performance and successful
completion by an urban Indian organization of other contracts with the
Secretary under this title;

[(6)]{.underline} ~~(7)~~ the appropriateness and likely effectiveness
of conducting the activities set forth in subsection (a) in an urban
center [or centers]{.underline}; and

[(7)]{.underline} ~~(8)~~ the extent of existing or likely future
participation in the activities set forth in subsection (a) by
appropriate health and health-related Federal, State, local, and other
agencies.

\(c\) The Secretary, acting through the Service, shall facilitate access
to, or provide, health promotion and disease prevention services for
urban Indians through grants made to urban Indian organizations
administering contracts entered into pursuant to this section** **or
receiving grants under subsection (a).

(d)(1) The Secretary, acting through the Service, shall facilitate
access to, or provide, immunization services for urban Indians through
grants made to urban Indian organizations administering contracts
entered[,]{.underline} ~~into pursuant to this section~~ or receiving
grants[,]{.underline} under [this section]{.underline} ~~subsection
(a)~~.

\(2\) ~~In making any grant to carry out this subsection, the Secretary
shall take into consideration\--~~

~~(A) the size of the urban Indian population to be served;~~

~~(B) the immunization levels of the urban Indian population,
particularly the immunization levels of infants, children, and the
elderly;~~

~~(C) the utilization by the urban Indians of alternative resources from
State and local governments for no-cost or low-cost immunization
services to the general population; and~~

~~(D) the capability of the urban Indian organization to carry out
services pursuant to this subsection.~~

~~(3)~~ For purposes of this subsection, the term \"immunization
services\" means services to provide without charge immunizations
against vaccine-preventable diseases.

(e)(1) The Secretary, acting through the Service, shall facilitate
access to, or provide, mental health services for urban Indians through
grants made to urban Indian organizations administering contracts
entered into pursuant to this section or receiving grants under
subsection (a).

\(2\) A grant may not be made under this subsection to an urban Indian
organization until that organization has prepared, and the Service has
approved, an assessment of the mental health needs of the urban Indian
population concerned, the mental health services and other related
resources available to that population, the barriers to obtaining those
services and resources, and the needs that are unmet by such services
and resources.

\(3\) Grants may be made under this subsection\--

\(A\) to prepare assessments required under paragraph (2);

\(B\) to provide outreach, educational, and referral services to urban
Indians regarding the availability of direct mental health services, to
educate urban Indians about mental health issues and services, and
effect coordination with existing mental health providers in order to
improve services to urban Indians;

\(C\) to provide outpatient mental health services to urban Indians,
including the identification and assessment of illness, therapeutic
treatments, case management, support groups, family treatment, and other
treatment; and

\(D\) to develop innovative mental health service delivery models which
incorporate Indian cultural support systems and resources.

(f)(1) The Secretary acting through the Service, shall facilitate access
to, or provide, services for urban Indians through grants to urban
Indian organizations administering contracts entered into pursuant to
this section or receiving grants under subsection (a) to prevent and
treat child abuse (including sexual abuse) among urban Indians.

\(2\) A grant may not be made under this subsection to an urban Indian
organization until that organization has prepared, and the Service has
approved, an assessment that documents the prevalence of child abuse in
the urban Indian population concerned and specifies the services and
programs (which may not duplicate existing services and programs) for
which the grant is requested.

\(3\) Grants may be made under this subsection\--

\(A\) to prepare assessments required under paragraph (2);

\(B\) for the development of prevention, training, and education
programs for urban Indian populations, including child education, parent
education, provider training on identification and intervention,
education on reporting requirements, prevention campaigns, and
establishing service networks of all those involved in Indian child
protection; and

\(C\) to provide direct outpatient treatment services (including
individual treatment, family treatment, group therapy, and support
groups) to urban Indians who are child victims of abuse (including
sexual abuse) or adult survivors of child sexual abuse, to the families
of such child victims, and to urban Indian perpetrators of child abuse
(including sexual abuse).

\(4\) In making grants to carry out this subsection, the Secretary shall
take into consideration\--

\(A\) the support for the urban Indian organization demonstrated by the
child protection authorities in the area, including committees or other
services funded under the Indian Child Welfare Act of 1978 (25 U.S.C.
1901 et seq.), if any;

\(B\) the capability and expertise demonstrated by the urban Indian
organization to address the complex problem of child sexual abuse in the
community; and

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|   \(C\) the assessment required under paragraph (2).                 |
|   ----------------------------------------------------               |
|                                                                      |
| *Revise performance standards and selection criteria to delete       |
| references relating to accessibility to, and utilization of, health  |
| care services other than those provided by urban Indian              |
| organizations. *                                                     |
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|                                                                      |
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**CONTRACTS AND GRANTS FOR THE DETERMINATION**

**OF UNMET HEALTH CARE NEEDS**

**Sec. 504. **(a) Under authority of the Act of November 2, 1921 (25
U.S.C. 13), popularly known as the Snyder Act, the Secretary, through
the Service, may enter into contracts with, or make grants to, urban
Indian organizations situated in urban centers for which contracts have
not been entered into, or grants have not been made, under section 503.
The purpose of a contract or grant made under this section shall be the
determination of the matters described in subsection (b)(1) in order to
assist the Secretary in assessing the health status and health care
needs of urban Indians in the urban center involved and determining
whether the Secretary should enter into a contract or make a grant under
section 503 with respect to the urban Indian organization which the
Secretary has entered into a contract with, or made a grant to, under
this section.

\(b\) Any contract entered into, or grant made, by the Secretary under
this section shall include requirements that\--

\(1\) the urban Indian organization successfully undertake to\--

\(A\) document the health care status and unmet health care needs of
urban Indians in the urban center involved; and

\(B\) with respect to urban Indians in the urban center involved,
determine the matters described in clauses (2), (3), (4), and (8) of
section 503(b); and

\(2\) the urban Indian organization complete performance of the
contract, or carry out the requirements of the grant, within one year
after the date on which the Secretary and such organization enter into
such contract, or within one year after such organization receives such
grant, whichever is applicable.

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  \(c\) The Secretary may not renew any contract entered into, or grant made, under this section.   
                                                                                                    
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**EVALUATIONS; RENEWALS**

**Sec. 505. **(a) The Secretary, through the Service, shall develop
procedures to evaluate compliance with grant requirements under this
title and compliance with, and performance of contracts entered into by
urban Indian organizations under this title. Such procedures shall
include provisions for carrying out the requirements of this section.

\(b\) The Secretary, through the Service, shall [evaluate the
compliance]{.underline} ~~conduct an annual onsite evaluation~~ of each
urban Indian organization which has entered into a contract or received
a grant** **under section 503 [with the]{.underline} ~~for purposes of
determining the compliance of such organization with, and evaluating the
performance of such organization under, such~~ contract or the terms of
such grant. [For purposes of this evaluation, the Secretary, in
determining the capacity of an urban Indian organization to deliver
quality patient carea shall, at the option of the
organization---]{.underline}

[(1) through the Service conduct an annual onsite evaluation of the
organization; or]{.underline}

[(2) accept in lieu of such onsite evaluation evidence of the
organization's provisional or full accreditation by a private
independent entity recognized by the Secretary for purposes of
conducting quality reviews or providers participating in the Medicare
program under Title XVIII of the Social Security Act.]{.underline}

~~(c) If, as a result of the evaluations conducted under this section,
the Secretary determines that an urban Indian organization has not
complied with the requirements of a grant or complied with or
satisfactorily performed a contract under section 503, the Secretary
shall, prior to renewing such contract or grant, attempt to resolve with
such organization the areas of noncompliance or unsatisfactory
performance and modify such contract or grant~~**~~ ~~**~~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 or grant~~**~~ ~~**~~with such
organization and is authorized to enter into a contract or make a grant
under section 503 with another urban Indian organization which is
situated in the same urban center as the urban Indian organization whose
contract or grant~~**~~ ~~**~~is not renewed under this section.~~

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  ~~ (d) In determining whether to renew a contract or grant~~**~~ ~~**~~with an urban Indian organization under section 503 which has completed performance of a contract or grant~~**~~ ~~**~~under section 504, the Secretary shall review the records of the urban Indian organization, the reports submitted under section 507, and, in the case of a renewal of a contract or grant~~**~~ ~~**~~under section 503, shall consider the results of the onsite evaluations conducted under subsection (b).~~
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***Accreditation: ****Allow urban Indian organizations, at their option,
to substitute accreditation for the annual *

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  *IHS onsite evaluations if the accrediting entity is recognized by the Secretary for Medicare purposes.*
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**OTHER CONTRACT AND GRANT REQUIREMENTS**

**Sec. 506. **(a) Contracts with urban Indian organizations entered into
pursuant to this title 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 provisions of the Act of August 24, 1935 (40 U.S.C.
270a, et seq.).

\(b\) Payments under any contracts or grants** **pursuant to this title
[shall, notwithstanding any term or condition of such contract or
grant---]{.underline}

[(1) be made in their entirety by the Secretary to the urban Indian
organization by no later than the end of the first 30 days of the
funding period with respect to which the payments apply;
and]{.underline}

[(2) if unexpended by the urban Indian organization during the funding
period with respect to which the payments initially apply, shall be
carried forward for expenditure with respect to allowable or
reimbursable costs incurred by the organization during one or more
subsequent funding periods without additional justification or
documentation by the organization as a condition of carrying forward the
expenditure of such funds.]{.underline}

~~may be made in advance or by way of reimbursement and in such
installments and on such conditions as the Secretary deems necessary to
carry out the purposes of this title.~~

~~(c) Notwithstanding any provision of law to the contrary, the
Secretary may, at the request or consent of an urban Indian
organization, revise or amend any contract entered into by the Secretary
with such organization under this title as necessary to carry out the
purposes of this title.~~

~~ (d) In connection with any contract or grant~~**~~ ~~**~~entered into
pursuant to this title, the Secretary may permit an urban Indian
organization to utilize, in carrying out such contract or grant,
existing facilities owned by the Federal Government within the
Secretary\'s jurisdiction under such terms and conditions as may be
agreed upon for the use and maintenance of such facilities.~~

~~(e) Contracts with or grants to~~**~~ ~~**~~urban Indian organizations
and regulations adopted pursuant to this title shall include provisions
to assure the fair and uniform provision to urban Indians of services
and assistance under such contracts or grants by such organizations.~~

~~ (f) Urban Indians, as defined under section 4(f) of this Act, shall
be eligible for health care or referral services provided pursuant to
this title.~~

  --
  --

***Advance Payments: ****Require the Secretary to make payments under a
grant or contract with respect to a funding period in the first month of
the funding period.*

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  *** **Carry-forward of funding****: Allow urban Indian organizations to carry forward unexpended funds under a grant or contract from one funding period to subsequent funding periods without additional justification or documentation.*
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**REPORTS AND RECORDS**

**Sec. 507. **(a) For each fiscal year during which an urban Indian
organization receives or expends funds pursuant to a contract entered
into, or a grant received,** **pursuant to this title, such organization
shall submit to the Secretary [on a basis no more frequent than every
six months,]{.underline} ~~a quarterly report~~ including\--

\(1\) in the case of a contract or grant under section 503, information
gathered pursuant to clauses (10) and (11) of subsection (a) of such
section;

\(2\) information on activities conducted by the organization pursuant
to the contract** **or grant;

\(3\) an accounting of the amounts and purpose for which Federal funds
were expended; and

\(4\) [a minimum set of data, using uniformly defined elements, that is
specified by the Secretary in consultation consistent with section
]{.underline}**[5\_\_]{.underline}**[, with urban Indian
organizations]{.underline} ~~such other information as the Secretary may
request~~.

\(b\) The reports and records of the urban Indian organization with
respect to a contract or grant under this title shall be subject to
audit by the Secretary and the Comptroller General of the United States.

\(c\) The Secretary shall [require]{.underline} ~~allow~~ as a cost of
any contract or grant entered into [or awarded]{.underline} under
section [502 or]{.underline} 503 the cost of an annual [independent
financial]{.underline} ~~private~~ audit conducted by[--- ]{.underline}

[(1)]{.underline} a certified public accountant[; or]{.underline}.

\(2\) a certified public accounting firm qualified to conduct Federal
compliance audits.

~~(d)(1) The Secretary, acting through the Service, shall submit a
report to the Congress not later than March 31, 1992, evaluating\--~~

~~(A) the health status of urban Indians;~~

~~(B) the services provided to Indians through this title;~~

~~(C) areas of unmet needs in urban areas served under this title; and~~

~~(D) areas of unmet needs in urban areas not served under this title.~~

~~(2) In preparing the report under paragraph (1), the Secretary shall
consult with urban Indian health providers and may contract with a
national organization representing urban Indian health concerns to
conduct any aspect of the report.~~

~~(3) The Secretary and the Secretary of the Interior shall\--~~

~~(A) assess the status of the welfare of urban Indian children,
including the volume of child protection cases, the prevalence of child
sexual abuse, and the extent of urban Indian coordination with tribal
authorities with respect to child sexual abuse; and~~

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  ~~(B) submit a report on the assessment required under subparagraph (A), together with recommended legislation to improve Indian child protection in urban Indian populations, to the Congress no later than March 31, 1992.~~
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***Reporting.**** Require the submission, on a semi-annual basis, of
reports that contain a minimum data set developed the Secretary in
consultation with urban Indian organizations.*

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  ***Audits****: Clarify that the cost of an independent financial audit conducted annually by a CPA firm qualified to conduct federal compliance audits or by a CPA is required as a cost under Title V contracts or grants. *
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**LIMITATION ON CONTRACT AUTHORITY**

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|   **Sec. 508. **The authority of the Secretary to enter into c       |
| ontracts [or to award grants]{.underline} under this title shall be  |
| to the extent, and in an amount, provided for in appropriation Acts. |
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|                                                                      |
| ***Limitations****. Extend the current appropriation limitations to  |
| grants under Title V. *                                              |
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|                                                                      |
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**FACILITIES ~~RENOVATION~~**

**Sec. 509. **[(a)]{.underline} The Secretary may make funds available
to contractors or grant recipients under this title for [the purposes
described in subsection (b) in order]{.underline} ~~minor renovations to
facilities, including leased facilities,~~ to assist such contractors or
grant recipients** **in [complying with applicable licensure or
certification requirements under state law]{.underline} ~~meeting or
maintaining the Joint Commission for Accreditation of Health Care
Organizations (JCAHO) standards~~.

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|   [(b) The purposes described in                                     |
| this subsection include lease, purchase, renovation, construction, a |
| nd expansion of facilities including leased facilities.]{.underline} |
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| -------------------------------------------------------------------- |
|                                                                      |
| ***Facilities:**** Authorize the Secretary to fund the lease,        |
| purchase, construction, expansion, or renovation of facilities by    |
| urban Indian organizations in order to assist the organizations in   |
| complying with state licensure or certification requirements. *      |
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|                                                                      |
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**[OFFICE OF]{.underline} URBAN [INDIAN]{.underline} HEALTH ~~PROGRAMS
BRANCH~~**

**Sec. 510. [(a) ESTABLISHMENT.\--]{.underline}**There is hereby
established within the Service [an Office]{.underline} ~~a Branch~~ of
Urban [Indian]{.underline} Health ~~Programs~~[,]{.underline} which
shall be responsible for[:]{.underline}

[(1)]{.underline} carrying out the provisions of this
title[;]{.underline} ~~and~~

[(2)]{.underline} ~~for~~ providing central oversight of the programs
and services authorized under this title[; and]{.underline}

[(3) providing technical assistance to urbaqn Indian
organizations]{.underline}.

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|   ~~(b) Staff, Services, an                                          |
| d Equipment.\--The Secretary shall appoint such employees to work in |
|  the branch, including a program director, and shall provide such se |
| rvices and equipment, as may be necessary for it to carry out its re |
| sponsibilities. The Secretary shall also analyze the need to provide |
|  at least one urban health program analyst for each area office of t |
| he Indian Health Service and shall submit his findings to the Congre |
| ss as a part of the Department\'s fiscal year 1993 budget request.~~ |
|   ---------------------------                                        |
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|                                                                      |
| *Redesignate the Branch of Urban Indian Health Programs as the       |
| Office of Urban Indian Health, and add to its responsibilities the   |
| provision of technical assistance to urban Indian health programs. * |
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|                                                                      |
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**GRANTS FOR ALCOHOL AND SUBSTANCE ABUSE RELATED SERVICES **

** Sec. 511. **(**a) GRANTS.\--**The Secretary may make grants for the
provision of health-related services in prevention of, treatment of,
rehabilitation of, or school and community-based education in, alcohol
and substance abuse in urban centers to those urban Indian organizations
with whom the Secretary has entered into a contract under this title or
under section 201.

**(b) GOALS OF GRANT.\--**Each grant made pursuant to subsection (a)
shall set forth the goals to be accomplished pursuant to the grant. The
goals shall be specific to each grant as agreed to between the Secretary
and the grantee.

**(c) CRITERIA.\--**The Secretary shall establish criteria for the
grants made under subsection (a), including criteria relating to the-

\(1\) size of the urban Indian population;

\(2\) accessibility to, and utilization of, other health resources
available to such population;

\(3\) duplication of existing Service or other Federal grants or
contracts;

\(4\) capability of the organization to adequately perform the
activities required under the grant;

\(5\) satisfactory performance standards for the organization in meeting
the goals set forth in such grant, which standards shall be negotiated
and agreed to between the Secretary and the grantee on a grant-by-grant
basis; and

\(6\) identification of need for services.

The Secretary shall develop a methodology for allocating grants made
pursuant to this section based on such criteria.

**(d) TREATMENT OF FUNDS RECEIVED BY URBAN INDIAN ORGANIZATIONS.\--**
Any funds received by an urban Indian organization under this Act for
substance abuse prevention, treatment, and rehabilitation shall be
subject to the criteria set forth in subsection (c).

  -- --
     
     
  -- --

**TREATMENT OF CERTAIN DEMONSTRATION PROJECTS **

** Sec. 512. **(a) Notwithstanding any other provision of law, the
Oklahoma City Clinic ~~demonstration project~~ and ~~the~~ Tulsa Clinic
demonstration project[s]{.underline} shall [become permanent programs
within the Service's direct car program and continue to]{.underline} be
treated as service units in the allocation of resources and coordination
of care[,]{.underline} and shall [continue to meet the requirements and
definitions of an urban Indian organization in Title V of this Act, and
as such will]{.underline} not be subject to the provisions of the Indian
Self-Determination Act ~~for the term of such projects. The Secretary
shall provide assistance to such projects in the development of
resources and equipment and facility needs. ~~

  --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
  \(b\) The Secretary shall submit to the President~~, for inclusion in the~~ [a]{.underline} report [on the progress of these two programs to be treated like service units and the improvements in health status achieved by the two urban Indian populations]{.underline} ~~required to be submitted to the Congress under section 801 for fiscal year 1999, a report on the findings and conclusions derived from the demonstration projects specified in subsection (a). ~~
  --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

***THERE IS NO CONSENSUS **ABOUT THE PROPOSED **AMENDMENTS TO THIS
**SECTION AS OF THE 7/14/99 **NATIONAL STEERING **COMMITTEE MEETING.***

***drafter**'**s note: language **supplied by Oklahoma projects;
**consideration should be given to **addressing technical drafting
**issues\]***

  --------------------------------------------------------------------------------------------------
  *Establish Oklahoma City Clinic and Tulsa Clinic demonstration projects as permanent programs. *
  --------------------------------------------------------------------------------------------------

**URBAN NIAAA TRANSFERRED PROGRAMS **

** Sec. 513.** (a) The Secretary shall, [through]{.underline} ~~within~~
the [Office]{.underline} ~~Branch~~ of Urban [Indian]{.underline} Health
~~Programs~~ of the Service, make grants or enter into contracts
[effective no later than September 30, 2001, with urban Indian
organizations]{.underline} for the administration of urban Indian
alcohol programs that were originally established under the National
Institute on Alcoholism and Alcohol Abuse (hereafter in this section
referred to as \"NIAAA\") and transferred to the Service.

\(b\) Grants provided or contracts entered into under this section shall
be used to provide support for the continuation of alcohol prevention
and treatment services for urban Indian populations and such other
objectives as are agreed upon between the Service and a recipient of a
grant or contract under this section.

\(c\) Urban Indian organizations that operate Indian alcohol programs
originally funded under NIAAA and subsequently transferred to the
Service are eligible for grants or contracts under this section.

\(d\) For the purpose of carrying out this section, the Secretary may
combine NIAAA alcohol funds with other substance abuse funds currently
administered through the Branch of Urban Health Programs of the Service.

+----------------------------------------------------------------------+
|   ---------                                                          |
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| -------------------------------------------------------------------- |
|   \(e\) T                                                            |
| he Secretary shall evaluate and report to the Congress on the activi |
| ties of programs funded under this section at least every two years. |
|   ---------                                                          |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
|                                                                      |
| *Direct the Service, through the Office of Urban Health, to complete |
| the transfer of the NIAAA programs to urban Indian organizations by  |
| September 30, 2001. *                                                |
+----------------------------------------------------------------------+
|                                                                      |
+----------------------------------------------------------------------+

**[CONSULTATION WITH URBAN INDIANS]{.underline}**

**[Sec. 514.]{.underline}**[ (a) The Secretary shall ensure that the
Service, the Health Care Financing Administration, and other Operating
Divisions and Staff Divisions of the Department of Health and Human
Services consult, to the greatest extent practicable, with urban Indians
(as defined in section 4(f) prior to taking any action, or approving
federal financial assistance for any action of a state, that may affect
urban Indians or urban Indian organizations.]{.underline}

+----------------------------------------------------------------------+
|   -------------------------------------------                        |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
|   [(b) For purposes of subsection (a), cons                          |
| ultation is the open and free exchange of information and opinion am |
| ong urban Indians and the Operating and Staff Divisions of the Depar |
| tment which leads to mutual understanding and comprehension and whic |
| h emphasizes trust, respect, and shared responsibility.]{.underline} |
|   -------------------------------------------                        |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
| -------------------------------------------------------------------- |
|                                                                      |
| *Clarify that the responsibility of the Secretary of HHS and the     |
| Operating Divisions of the Department to consult with Indian people  |
| extends to urban Indians.*                                           |
+----------------------------------------------------------------------+
|                                                                      |
+----------------------------------------------------------------------+

**[FEDERAL TORT CLAIMS ACT COVERAGE]{.underline}**

** [Sec. 515. ]{.underline}**

**\[DRAFTING OPTION #1:\]** [For purposes of section 224 of the Public
Health Service Act of July 1, 1944 (42 U.S.C. 233(a)), as amended by
Section 4 of the Act of December 31, 1970, (84 Stat. 1870), with respect
to claims by any person, initially filed on or after
]{.underline}**[\[INSERT EFFECTIVE DATE\]]{.underline}**[, whether or
not such person is an Indian or Alaska Native or is served on a fee
basis or under other circumstances as permitted by Federal law or
regulations, for personal injury, including death, resulting from the
performance prior to, including, or after \[]{.underline}**[INSERT
EFFECTIVE DATE\] ]{.underline}**[of medical, surgical, dental, or
related functions, including the conduct of clinical studies or
investigations, or for purposes of section 2679, title 28, United States
Code, with respect to claims by any such person, on or after
\[]{.underline}**[INSERT EFFECTIVE DATE\]]{.underline}**[, for personal
injury, including death, resulting from the operation of an emergency
motor vehicle, an urban Indian organization that has entered into a
contract or received a grant pursuant to this title is deemed to be part
of the Public Health Service in the Department of Health and Human
Services while carrying out any such contract or grant and its employees
(including those acting on behalf of the organization as provided in
section 2671 of title 28, United States Code, and including an
individual who provides health care services pursuant to a personal
services contract with an urban Indian organization for the provision of
services in any facility owned, operated, or constructed under the
jurisdiction of the Indian Health Service) are deemed employees of the
Service while acting within the scope of their employment in carrying
out the contract or grant; Provided, that such employees shall be deemed
to be acting within the scope of their employment in carrying out the
contract or grant when they are required, by reason of their employment,
to perform medical, surgical, dental or related functions at a facility
other than a facility operated by the urban Indian organization pursuant
to such contract or grant, but only if such employees are not
compensated for the performance of such functions by a person or entity
other than the urban Indian organization.]{.underline}

  -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
  **\[DRAFTING OPTION #2:\]** [The provisions of section 102(d) of the Indian Self-Determination Act (relating to the application of the Federal Tort Claims Act) shall apply to an urban Indian organization which has entered into a contract or received a grant under this title and its employees to the same extent as the provisions apply to a tribal organization or Indian contractor carrying out a contract, grant agreement, or cooperative agreement under section 102 or 103 of the Indian Self-Determination Act and its employees with respect to claims relating to items or services provided on or after ]{.underline}**[\[INSERT EFFECTIVE DATE\].]{.underline}**[ ]{.underline}
  -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

*Apply the FTCA to urban Indian organizations that have entered into
contracts or are receiving grants under Title V.*

  ------------------------------------------------------
  ***Two options are presented for **consideration.***
  ------------------------------------------------------

**[URBAN YOUTH TREATMENT CENTER DEMONSTRATION]{.underline}**

** [Sec. 516.]{.underline}**[ (a) The Secretary, acting through the
Service, shall, through grant or contract, make payment for the
construction and operation of at least 2 residential treatment centers
in each state described in subsection (b) to demonstrate the provision
of alcohol and substance abuse treatment services to urban Indian youth
in a culturally competent residential setting.]{.underline}

[(b) A state described in this subsection is a state in
which:]{.underline}

[(1) there reside a large number of urban Indian youth with need for
alcohol and substance abuse treatment services in a residential setting;
and]{.underline}

+----------------------------------------------------------------------+
|   ---------------------------------------------------------------    |
| -------------------------------------------------------------------- |
|   [(2) there is a significant shortage of culturally competent       |
| residential treatment services for urban Indian youth. ]{.underline} |
|   ---------------------------------------------------------------    |
| -------------------------------------------------------------------- |
|                                                                      |
| *Authorize the funding of culturally competent residential programs  |
| to demonstrate the treatment of alcohol and substance abuse among    |
| urban Indian youth in states with high need. *                       |
+----------------------------------------------------------------------+
|                                                                      |
+----------------------------------------------------------------------+

**[USE OF FEDERAL GOVERNMENT FACILITIES AND SOURCES OF
]{.underline}[SUPPLY]{.underline}**

** [Sec 517.]{.underline}**[ ]{.underline}

***\[DRAFTING OPTION #1:\]**** *[(a) The Secretary shall permit an urban
Indian organization that has entered into a contract or received a grant
pursuant to this title, in carrying out such contract or grant, to use
existing facilities and all equipment therein or appertaining thereto
and other personal property owned by the Federal Government within the
Secretary's jurisdiction under such terms and conditions as may be
agreed upon for their use and maintenance.]{.underline}

[(b) The Secretary shall donate to an urban Indian organization that has
entered into a contract or received a grant pursuant to this title any
personal or real property to be excess to the needs of the Indian Health
Service or the General Services Administration for purposes of carrying
out the contract or grant.]{.underline}

[(c)For purposes of section 201(a) of the Federal Property and
Administrative Services Act of 1949 (40 U.S.C. 481(a))(relating to
Federal sources of supply, including lodging providers, airlines, and
other transportation providers), an urban Indian organization that has
entered into a contract or received a grant pursuant to this title shall
be deemed an executive agency when carrying out such contract or grant,
and the employees of the urban Indian organization shall be eligible to
have access to such sources of supply on the same basis as employees of
an executive agency have such access. ]{.underline}

  ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
  ***\[DRAFTING OPTION #2:\] ***[The provisions of section 105(f) and 105(k) of the Indian Self-Determination Act shall apply to an urban Indian organization that has entered into a contract or received a grant pursuant to this title to the same extent that such provisions apply to an Indian tribe or tribal organization in connection with any self-determination contract or grant. ]{.underline}
  ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

*Extend to urban Indian organizations the same access to Federal
facilities and sources of supply as is currently available to tribes and
tribal organizations.*

  ----------------------------------------------------
  ***Two options are presented for consideration.***
  ----------------------------------------------------

**[DIABETES PREVENTION, TREATMENT AND CONTROL]{.underline}**

+----------------------------------------------------------------------+
| +----------------------------------------------------------------+   |
| |   ------------------------------                               |   |
| |   ** [Sec. 518.]{.underline}**                                 |   |
| |   ------------------------------                               |   |
| |                                                                |   |
| | *This is a placeholder for adding a provision parallel to the  |   |
| | Title II provision regarding Diabetes Prevention.*             |   |
| +----------------------------------------------------------------+   |
| |                                                                |   |
| +----------------------------------------------------------------+   |
|                                                                      |
| *The urban Indian organizations are continuing to work on amendments |
| and will have additional substantive proposals that could not be     |
| developed in time for National Steering Committee review.*           |
+----------------------------------------------------------------------+
|                                                                      |
+----------------------------------------------------------------------+

**AUTHORIZATION OF APPROPRIATIONS **

**Sec. [519]{.underline} ~~514~~. **There are authorized to be
appropriated such sums as may be necessary for each fiscal year through
fiscal year [2012]{.underline} ~~2000~~ to carry out this title.

**\[NOTE: Subsections 506(a) and (b) of P.L. 101-630, did not amend
Title V but did establish certain one time requirements for the Title V
program and are presented here for your convenience.**

**{Sec. 506. FACILITIES ASSESSMENT}**

**{(a) Survey.\--The Secretary shall conduct a survey of all facilities
used by contractors under title V of the Indian Health Care Improvement
Act and shall submit a report to the Congress on such survey not later
than one year after the date of enactment of this Act. The report shall,
at a minimum, contain the following information for each location:**

** (1) the extent to which the facility meet the safety and building
codes and, if direct care is provided, the extent of compliance with
Joint Commission Accreditation of Health Care Organizations (JCAHO)
standards.**

**(2) The extent to which improvements, expansions, or relocation is
necessary to meet program requirements, provide adequate services, or
achieve building code compliance.**

**(3) Any lease restriction that would hamper accomplishment of needed
improvement, expansion, or relocation.**

**(4) The term of the lease, if appropriate, the age of the structure,
and the structure\'s life expectancy with and without improvement.**

**(5) An assessment of the deficiencies of the facility.**

**{(b) Report.\--The report shall contain general recommendations for
addressing the deficiencies of facilities in which programs funded under
title V of the Indian Health Care Improvement Act are located and shall
propose specific policies for accomplishing those recommendations.**

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