# H.R. 3962/Division D/Title I
## TITLE I — AMENDMENTS TO INDIAN LAWS
### Sec. 3101. Indian Health Care Improvement amended.

    (a) In General.—
       The Indian Health Care Improvement Act (25 U.S.C. 1601 et seq.) is amended to read as follows:
“Section 1. Short Title; Table of Contents.
“(a) Short Title.—This Act may be cited as the “Indian Health Care Improvement Act”.
“(b) Table of Contents.—The table of contents for this Act is as follows:
“Sec. 1. Short title; table of contents. “Sec. 2. Findings. “Sec. 3. Declaration of national Indian health policy. “Sec. 4. Definitions.
“TITLE I—INDIAN HEALTH, HUMAN RESOURCES, AND DEVELOPMENT
“Sec. 101. Purpose. “Sec. 102. Health professions recruitment program for Indians. “Sec. 103. Health professions preparatory scholarship program for Indians. “Sec. 104. Indian health professions scholarships. “Sec. 105. American Indians Into Psychology Program. “Sec. 106. Scholarship programs for Indian Tribes. “Sec. 107. Indian Health Service extern programs. “Sec. 108. Continuing education allowances. “Sec. 109. Community Health Representative Program. “Sec. 110. Indian Health Service Loan Repayment Program. “Sec. 111. Scholarship and Loan Repayment Recovery Fund. “Sec. 112. Recruitment activities. “Sec. 113. Indian recruitment and retention program. “Sec. 114. Advanced training and research. “Sec. 115. Quentin N. Burdick American Indians Into Nursing Program. “Sec. 116. Tribal cultural orientation. “Sec. 117. INMED Program. “Sec. 118. Health training programs of community colleges. “Sec. 119. Retention bonus. “Sec. 120. Nursing residency program. “Sec. 121. Community Health Aide Program. “Sec. 122. Tribal Health Program administration. “Sec. 123. Health professional chronic shortage demonstration programs. “Sec. 124. National Health Service Corps. “Sec. 125. Substance abuse counselor educational curricula demonstration programs. “Sec. 126. Behavioral health training and community education programs. “Sec. 127. Exemption from payment of certain fees. “Sec. 128. Authorization of appropriations.
“TITLE II—HEALTH SERVICES
“Sec. 201. Indian Health Care Improvement Fund. “Sec. 202. Health promotion and disease prevention services. “Sec. 203. Diabetes prevention, treatment, and control. “Sec. 204. Shared services for long-term care. “Sec. 205. Health services research. “Sec. 206. Mammography and other cancer screening. “Sec. 207. Patient travel costs. “Sec. 208. Epidemiology centers. “Sec. 209. Comprehensive school health education programs. “Sec. 210. Indian youth program. “Sec. 211. Prevention, control, and elimination of communicable and infectious diseases. “Sec. 212. Other authority for provision of services. “Sec. 213. Indian women’s health care. “Sec. 214. Environmental and nuclear health hazards. “Sec. 215. Arizona as a contract health service delivery area. “Sec. 216. North Dakota and South Dakota as contract health service delivery area. “Sec. 217. California contract health services program. “Sec. 218. California as a contract health service delivery area. “Sec. 219. Contract health services for the Trenton Service Area. “Sec. 220. Programs operated by Indian Tribes and tribal organizations. “Sec. 221. Licensing. “Sec. 222. Notification of provision of emergency contract health services. “Sec. 223. Prompt action on payment of claims. “Sec. 224. Liability for payment. “Sec. 225. Office of Indian Men's Health. “Sec. 226. Catastrophic health emergency fund. “Sec. 227. Authorization of appropriations.
“TITLE III—FACILITIES
“Sec. 301. Consultation; construction and renovation of facilities; reports. “Sec. 302. Sanitation facilities. “Sec. 303. Preference to Indians and Indian firms. “Sec. 304. Expenditure of non-Service funds for renovation. “Sec. 305. Funding for the construction, expansion, and modernization of small ambulatory care facilities. “Sec. 306. Indian health care delivery demonstration project. “Sec. 307. Land transfer. “Sec. 308. Leases, contracts, and other agreements. “Sec. 309. Study on loans, loan guarantees, and loan repayment. “Sec. 310. Tribal leasing. “Sec. 311. Indian Health Service/tribal facilities joint venture program. “Sec. 312. Location of facilities. “Sec. 313. Maintenance and improvement of health care facilities. “Sec. 314. Tribal management of federally owned quarters. “Sec. 315. Applicability of Buy American Act requirement. “Sec. 316. Other funding for facilities. “Sec. 317. Authorization of appropriations.
“TITLE IV—ACCESS TO HEALTH SERVICES
“Sec. 401. Treatment of payments under Social Security Act health benefits programs. “Sec. 402. Grants to and contracts with the Service, Indian Tribes, Tribal Organizations, and urban Indian organizations to facilitate outreach, enrollment, and coverage of Indians under Social Security Act health benefit programs. “Sec. 403. Reimbursement from certain third parties of costs of health services. “Sec. 404. Crediting of reimbursements. “Sec. 405. Purchasing health care coverage. “Sec. 406. Sharing arrangements with Federal agencies. “Sec. 407. Eligible indian veteran services. “Sec. 408. Payor of last resort. “Sec. 409. Consultation. “Sec. 410. State Children's Health Insurance Program (SCHIP). “Sec. 411. Premium and cost sharing protections and eligibility determinations under Medicaid and SCHIP and protection of certain Indian property from Medicaid estate recovery. “Sec. 412. Treatment under Medicaid and SCHIP managed care. “Sec. 413. Navajo Nation Medicaid Agency feasibility study. “Sec. 414. Exception for excepted benefits. “Sec. 415. Authorization of appropriations.
“TITLE V—HEALTH SERVICES FOR URBAN INDIANS
“Sec. 501. Purpose. “Sec. 502. Contracts with, and grants to, urban Indian organizations. “Sec. 503. Contracts and grants for the provision of health care and referral services. “Sec. 504. Use of Federal Government Facilities and Sources of Supply. “Sec. 505. Contracts and grants for the determination of unmet health care needs. “Sec. 506. Evaluations; renewals. “Sec. 507. Other contract and grant requirements. “Sec. 508. Reports and records. “Sec. 509. Limitation on contract authority. “Sec. 510. Facilities. “Sec. 511. Division of Urban Indian Health. “Sec. 512. Grants for alcohol and substance abuse-related services. “Sec. 513. Treatment of certain demonstration projects. “Sec. 514. Urban NIAAA transferred programs. “Sec. 515. Conferring with urban Indian organizations. “Sec. 516. Urban youth treatment center demonstration. “Sec. 517. Grants for diabetes prevention, treatment, and control. “Sec. 518. Community health representatives. “Sec. 519. Effective date. “Sec. 520. Eligibility for services. “Sec. 521. Authorization of appropriations. “Sec. 522. Health information technology.
“TITLE VI—ORGANIZATIONAL IMPROVEMENTS
“Sec. 601. Establishment of the Indian Health Service as an agency of the Public Health Service. “Sec. 602. Automated management information system. “Sec. 603. Authorization of appropriations.
“TITLE VII—BEHAVIORAL HEALTH PROGRAMS
“Sec. 701. Behavioral health prevention and treatment services. “Sec. 702. Memoranda of agreement with the Department of the Interior. “Sec. 703. Comprehensive behavioral health prevention and treatment program. “Sec. 704. Mental health technician program. “Sec. 705. Licensing requirement for mental health care workers. “Sec. 706. Indian women treatment programs. “Sec. 707. Indian youth program. “Sec. 708. Indian youth telemental health demonstration project. “Sec. 709. Inpatient and community-based mental health facilities design, construction, and staffing. “Sec. 710. Training and community education. “Sec. 711. Behavioral health program. “Sec. 712. Fetal alcohol disorder programs. “Sec. 713. Child sexual abuse and prevention treatment programs. “Sec. 714. Domestic and sexual violence prevention and treatment. “Sec. 715. Behavioral health research. “Sec. 716. Definitions. “Sec. 717. Authorization of appropriations.
“TITLE VIII—MISCELLANEOUS
“Sec. 801. Reports. “Sec. 802. Regulations. “Sec. 803. Plan of implementation. “Sec. 804. Limitation on use of funds appropriated to Indian Health Service. “Sec. 805. Eligibility of California Indians. “Sec. 806. Health services for ineligible persons. “Sec. 807. Reallocation of base resources. “Sec. 808. Results of demonstration projects. “Sec. 809. Provision of services in Montana. “Sec. 810. Moratorium. “Sec. 811. Severability provisions. “Sec. 812. Use of patient safety organizations. “Sec. 813. Confidentiality of medical quality assurance records; qualified immunity for participants. “Sec. 814. Claremore Indian Hospital. “Sec. 815. Sense of Congress regarding law enforcement and methamphetamine issues in Indian country. “Sec. 816. Permitting implementation through contracts with Tribal Health Programs. “Sec. 817. Authorization of appropriations; availability.
“SEC. 2. Findings.
“Congress makes the following findings:
“(1) Federal health services to maintain and improve the health of the Indians are consonant with and required by the Federal Government’s historical and unique legal relationship with, and resulting responsibility to, the American Indian people.
“(2) A major national goal of the United States is to provide the resources, processes, and structure that will enable Indian tribes and tribal members to obtain the quantity and quality of health care services and opportunities that will eradicate the health disparities between Indians the general population.
“(3) A major national goal of the United States is to provide the quantity and quality of health services which will permit the health status of Indians to be raised to the highest possible level and to encourage the maximum participation of Indians in the planning and management of those services.
“(4) Federal health services to Indians have resulted in a reduction in the prevalence and incidence of preventable illnesses among, and unnecessary and premature deaths of, Indians.
“(5) Despite such services, the unmet health needs of the American Indian people are severe and the health status of the Indians is far below that of the general population of the United States.
“SEC. 3. Declaration of national Indian health policy.
“Congress declares that it is the policy of this Nation, in fulfillment of its special trust responsibilities and legal obligations to Indians—
“(1) to assure the highest possible health status for Indians and Urban Indians and to provide all resources necessary to effect that policy;
“(2) to raise the health status of Indians and Urban Indians to at least the levels set forth in the goals contained within the Health People 2010 or successor objectives;
“(3) to the greatest extent possible, to allow Indians to set their own health care priorities and establish goals that reflect their unmet needs;
“(4) to increase the proportion of all degrees in the health professions and allied and associated health professions awarded to Indians so that the proportion of Indian health professionals in each Service Area is raised to at least the level of that of the general population;
“(5) to require meaningful consultation with Indian Tribes, Tribal Organizations, and urban Indian organizations to implement this Act and the national policy of Indian self-determination; and
“(6) to provide funding for programs and facilities operated by Indian Tribes, Tribal Organizations, and Urban Indian Organizations in amounts that are not less than the amounts provided to programs and facilities operated directly by the Service.
“SEC. 4. Definitions.
“For purposes of this Act:
“(1) The term ‘accredited and accessible’ means on or near a reservation and accredited by a national or regional organization with accrediting authority.
“(2) The term ‘Area Office’ means an administrative entity, including a program office, within the Service through which services and funds are provided to the Service Units within a defined geographic area.
“(3) The term ‘Assistant Secretary’ means the Assistant Secretary of Indian Health.
“(4)(A) The term ‘behavioral health’ means the blending of substance (including alcohol, drugs, inhalants, and tobacco) abuse and mental health prevention and treatment, for the purpose of providing comprehensive services.
“(B) The term ‘behavioral health’ includes the joint development of substance abuse and mental health treatment planning and coordinated case management using a multidisciplinary approach.
“(5) The term ‘California Indians’ means those Indians who are eligible for health services of the Service pursuant to section 805.
“(6) The term ‘community college’ means—
“(A) a tribal college or university, or
“(B) a junior or community college.
“(7) The term ‘contract health service’ means health services provided at the expense of the Service or a Tribal Health Program by public or private medical providers or hospitals, other than the Service Unit or the Tribal Health Program at whose expense the services are provided.
“(8) The term ‘Department’ means, unless otherwise designated, the Department of Health and Human Services.
“(9) The term ‘disease prevention’ means the reduction, limitation, and prevention of disease and its complications and reduction in the consequences of disease, including—
“(A) controlling—
“(i) the development of diabetes;
“(ii) high blood pressure;
“(iii) infectious agents;
“(iv) injuries;
“(v) occupational hazards and disabilities;
“(vi) sexually transmittable diseases; and
“(vii) toxic agents; and
“(B) providing—
“(i) fluoridation of water; and
“(ii) immunizations.
“(10) The term ‘health profession’ means allopathic medicine, family medicine, internal medicine, pediatrics, geriatric medicine, obstetrics and gynecology, podiatric medicine, nursing, public health nursing, dentistry, psychiatry, osteopathy, optometry, pharmacy, psychology, public health, social work, marriage and family therapy, chiropractic medicine, environmental health and engineering, allied health professions, naturopathic medicine, and any other health profession.
“(11) The term ‘health promotion’ means—
“(A) fostering social, economic, environmental, and personal factors conducive to health, including raising public awareness about health matters and enabling the people to cope with health problems by increasing their knowledge and providing them with valid information;
“(B) encouraging adequate and appropriate diet, exercise, and sleep;
“(C) promoting education and work in conformity with physical and mental capacity;
“(D) making available safe water and sanitary facilities;
“(E) improving the physical, economic, cultural, psychological, and social environment;
“(F) promoting culturally competent care; and
“(G) providing adequate and appropriate programs, which may include—
“(i) abuse prevention (mental and physical);
“(ii) community health;
“(iii) community safety;
“(iv) consumer health education;
“(v) diet and nutrition;
“(vi) immunization and other prevention of communicable diseases, including HIV/AIDS;
“(vii) environmental health;
“(viii) exercise and physical fitness;
“(ix) avoidance of fetal alcohol disorders;
“(x) first aid and CPR education;
“(xi) human growth and development;
“(xii) injury prevention and personal safety;
“(xiii) behavioral health;
“(xiv) monitoring of disease indicators between health care provider visits, through appropriate means, including Internet-based health care management systems;
“(xv) personal health and wellness practices;
“(xvi) personal capacity building;
“(xvii) prenatal, pregnancy, and infant care;
“(xviii) psychological well-being;
“(xix) reproductive health and family planning;
“(xx) safe and adequate water;
“(xxi) healthy work environments;
“(xxii) elimination, reduction, and prevention of contaminants that create unhealthy household conditions (including mold and other allergens);
“(xxiii) stress control;
“(xxiv) substance abuse;
“(xxv) sanitary facilities;
“(xxvi) sudden infant death syndrome prevention;
“(xxvii) tobacco use cessation and reduction;
“(xxviii) violence prevention; and
“(xxix) activities to promote achievement of any of the objectives described in section 3(2).
“(12) The term ‘Indian’, unless otherwise designated, means any person who is a member of an Indian Tribe or is eligible for health services under section 805, except that, for the purpose of sections 102 and 103, the term also means any individual who—
“(A)(i) irrespective of whether the individual lives on or near a reservation, is a member of a tribe, band, or other organized group of Indians, including those tribes, bands, or groups terminated since 1940 and those recognized now or in the future by the State in which they reside; or
“(ii) is a descendant, in the first or second degree, of any such member;
“(B) is an Eskimo or Aleut or other Alaska Native;
“(C) is considered by the Secretary of the Interior to be an Indian for any purpose; or
“(D) is determined to be an Indian under regulations promulgated by the Secretary.
“(13) The term ‘Indian Health Program’ means—
“(A) any health program administered directly by the Service;
“(B) any Tribal Health Program; or
“(C) any Indian Tribe or Tribal Organization to which the Secretary provides funding pursuant to section 23 of the Act of June 25, 1910 (25 U.S.C. 47) (commonly known as the ‘Buy Indian Act’).
“(14) The term ‘Indian Tribe’ has the meaning given the term in the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.).
“(15) The term ‘junior or community college’ has the meaning given the term by section 312(f) of the Higher Education Act of 1965 (20 U.S.C. 1058(f)).
“(16) The term ‘reservation’ means any federally recognized Indian Tribe’s reservation, Pueblo, or colony, including former reservations in Oklahoma, Indian allotments, and Alaska Native Regions established pursuant to the Alaska Native Claims Settlement Act (43 U.S.C. 1601 et seq.).
“(17) The term ‘Secretary’, unless otherwise designated, means the Secretary of Health and Human Services.
“(18) The term ‘Service’ means the Indian Health Service.
“(19) The term ‘Service Area’ means the geographical area served by each Area Office.
“(20) The term ‘Service Unit’ means an administrative entity of the Service, or a Tribal Health Program through which services are provided, directly or by contract, to eligible Indians within a defined geographic area.
“(21) The term ‘telehealth’ has the meaning given the term in section 330K(a) of the Public Health Service Act (42 U.S.C. 254c–16(a)).
“(22) The term ‘telemedicine’ means a telecommunications link to an end user through the use of eligible equipment that electronically links health professionals or patients and health professionals at separate sites in order to exchange health care information in audio, video, graphic, or other format for the purpose of providing improved health care services.
“(23) The term ‘tribal college or university’ has the meaning given the term in section 316(b)(3) of the Higher Education Act (20 U.S.C. 1059c(b)(3)).
“(24) The term ‘Tribal Health Program’ means an Indian Tribe or Tribal Organization that operates any health program, service, function, activity, or facility funded, in whole or part, by the Service through, or provided for in, a contract or compact with the Service under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.).
“(25) The term ‘Tribal Organization’ has the meaning given the term in the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.).
“(26) The term ‘Urban Center’ means any community which has a sufficient Urban Indian population with unmet health needs to warrant assistance under title V of this Act, as determined by the Secretary.
“(27) The term ‘Urban Indian’ means any individual who resides in an Urban Center and who meets 1 or more of the following criteria:
“(A) Irrespective of whether the individual lives on or near a reservation, the individual is a member of a tribe, band, or other organized group of Indians, including those tribes, bands, or groups terminated since 1940 and those tribes, bands, or groups that are recognized by the States in which they reside, or who is a descendant in the first or second degree of any such member.
“(B) The individual is an Eskimo, Aleut, or other Alaska Native.
“(C) The individual is considered by the Secretary of the Interior to be an Indian for any purpose.
“(D) The individual is determined to be an Indian under regulations promulgated by the Secretary.
“(28) The term ‘urban Indian organization’ means a nonprofit corporate body that (A) is situated in an Urban Center; (B) is governed by an Urban Indian-controlled board of directors; (C) provides for the participation of all interested Indian groups and individuals; and (D) is capable of legally cooperating with other public and private entities for the purpose of performing the activities described in section 503(a).
(b) Rate of pay.—
(1) POSITIONS AT LEVEL IV.—Section 5315 of title 5, United States Code, is amended by striking “Assistant Secretaries of Health and Human Services (6).” and inserting “Assistant Secretaries of Health and Human Services (7)”.
(2) POSITIONS AT LEVEL V.—Section 5316 of title 5, United States Code, is amended by striking “Director, Indian Health Service, Department of Health and Human Services”.
(c) Amendments to other provisions of law.—
(1) Section 3307(b)(1)(C) of the Children’s Health Act of 2000 (25 U.S.C. 1671 note; Public Law 106–310) is amended by striking “Director of the Indian Health Service” and inserting “Assistant Secretary for Indian Health”.
(2) The Indian Lands Open Dump Cleanup Act of 1994 is amended—
(A) in section 3 (25 U.S.C. 3902)—
(i) by striking paragraph (2);
(ii) by redesignating paragraphs (1), (3), (4), (5), and (6) as paragraphs (4), (5), (2), (6), and (1), respectively, and moving those paragraphs so as to appear in numerical order; and
(iii) by inserting before paragraph (4) (as redesignated by subclause (II)) the following:
“(3) ASSISTANT SECRETARY.—The term ‘Assistant Secretary’ means the Assistant Secretary for Indian Health.”;
(B) in section 5 (25 U.S.C. 3904), by striking the section designation and heading and inserting the following:
“SEC. 5. Authority of Assistant Secretary for Indian Health”;
(C) in section 6(a) (25 U.S.C. 3905(a)), in the subsection heading, by striking “Director” and inserting “Assistant Secretary”;
(D) in section 9(a) (25 U.S.C. 3908(a)), in the subsection heading, by striking “Director” and inserting “Assistant Secretary”; and
(E) by striking “Director” each place it appears and inserting “Assistant Secretary”.
(3) Section 5504(d)(2) of the Augustus F. Hawkins-Robert T. Stafford Elementary and Secondary School Improvement Amendments of 1988 (25 U.S.C. 2001 note; Public Law 100–297) is amended by striking “Director of the Indian Health Service” and inserting “Assistant Secretary for Indian Health”.
(4) Section 203(a)(1) of the Rehabilitation Act of 1973 (29 U.S.C. 763(a)(1)) is amended by striking “Director of the Indian Health Service” and inserting “Assistant Secretary for Indian Health”.
(5) Subsections (b) and (e) of section 518 of the Federal Water Pollution Control Act (33 U.S.C. 1377) are amended by striking “Director of the Indian Health Service” each place it appears and inserting “Assistant Secretary for Indian Health”.
(6) Section 317M(b) of the Public Health Service Act (42 U.S.C. 247b–14(b)) is amended—
(A) by striking “Director of the Indian Health Service” each place it appears and inserting “Assistant Secretary for Indian Health”; and
(B) in paragraph (2)(A), by striking “the Directors referred to in such paragraph” and inserting “the Director of the Centers for Disease Control and Prevention and the Assistant Secretary for Indian Health”.
(7) Section 417C(b) of the Public Health Service Act (42 U.S.C. 285–9(b)) is amended by striking “Director of the Indian Health Service” and inserting “Assistant Secretary for Indian Health”.
(8) Section 1452(i) of the Safe Drinking Water Act (42 U.S.C. 300j–12(i)) is amended by striking “Director of the Indian Health Service” each place it appears and inserting “Assistant Secretary for Indian Health”.
(9) Section 803B(d)(1) of the Native American Programs Act of 1974 (42 U.S.C. 2991b–2(d)(1)) is amended in the last sentence by striking “Director of the Indian Health Service” and inserting “Assistant Secretary for Indian Health”.
(10) Section 203(b) of the Michigan Indian Land Claims Settlement Act (Public Law 105–143; 111 Stat. 2666) is amended by striking “Director of the Indian Health Service” and inserting “Assistant Secretary for Indian Health”.

### Sec. 3102. Soboba Sanitation Facilities.

The Act of December 17, 1970 (84 Stat. 1465), is amended by adding at the end the following:
“Sec. 9. Nothing in this Act shall preclude the Soboba Band of Mission Indians and the Soboba Indian Reservation from being provided with sanitation facilities and services under the authority of section 7 of the Act of August 5, 1954 (68 Stat. 674), as amended by the Act of July 31, 1959 (73 Stat. 267).”.

### Sec. 3103. Native American Health and Wellness Foundation.

(a) In general.—The Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.) is amended by adding at the end the following:
“TITLE VIII—Native American Health and Wellness Foundation
“SEC. 801. Definitions.
“In this title:
“(1) BOARD.—The term ‘Board’ means the Board of Directors of the Foundation.
“(2) COMMITTEE.—The term ‘Committee’ means the Committee for the Establishment of Native American Health and Wellness Foundation established under section 802(f).
“(3) FOUNDATION.—The term ‘Foundation’ means the Native American Health and Wellness Foundation established under section 802.
“(4) SECRETARY.—The term ‘Secretary’ means the Secretary of Health and Human Services.
“(5) SERVICE.—The term ‘Service’ means the Indian Health Service of the Department of Health and Human Services.
“SEC. 802. Native American Health and Wellness Foundation.
“(a) Establishment.—
“(1) IN GENERAL.—As soon as practicable after the date of enactment of this title, the Secretary shall establish, under the laws of the District of Columbia and in accordance with this title, the Native American Health and Wellness Foundation.
“(2) FUNDING DETERMINATIONS.—No funds, gift, property, or other item of value (including any interest accrued on such an item) acquired by the Foundation shall—
“(A) be taken into consideration for purposes of determining Federal appropriations relating to the provision of health care and services to Indians; or
“(B) otherwise limit, diminish, or affect the Federal responsibility for the provision of health care and services to Indians.
“(b) Perpetual existence.—The Foundation shall have perpetual existence.
“(c) Nature of corporation.—The Foundation—
“(1) shall be a charitable and nonprofit federally chartered corporation; and
“(2) shall not be an agency or instrumentality of the United States.
“(d) Place of incorporation and domicile.—The Foundation shall be incorporated and domiciled in the District of Columbia.
“(e) Duties.—The Foundation shall—
“(1) encourage, accept, and administer private gifts of real and personal property, and any income from or interest in such gifts, for the benefit of, or in support of, the mission of the Service;
“(2) undertake and conduct such other activities as will further the health and wellness activities and opportunities of Native Americans; and
“(3) participate with and assist Federal, State, and tribal governments, agencies, entities, and individuals in undertaking and conducting activities that will further the health and wellness activities and opportunities of Native Americans.
“(f) Committee for the Establishment of Native American Health and Wellness Foundation.—
“(1) IN GENERAL.—The Secretary shall establish the Committee for the Establishment of Native American Health and Wellness Foundation to assist the Secretary in establishing the Foundation.
“(2) DUTIES.—Not later than 180 days after the date of enactment of this section, the Committee shall—
“(A) carry out such activities as are necessary to incorporate the Foundation under the laws of the District of Columbia, including acting as incorporators of the Foundation;
“(B) ensure that the Foundation qualifies for and maintains the status required to carry out this section, until the Board is established;
“(C) establish the constitution and initial bylaws of the Foundation;
“(D) provide for the initial operation of the Foundation, including providing for temporary or interim quarters, equipment, and staff; and
“(E) appoint the initial members of the Board in accordance with the constitution and initial bylaws of the Foundation.
“(g) Board of Directors.—
“(1) IN GENERAL.—The Board of Directors shall be the governing body of the Foundation.
“(2) POWERS.—The Board may exercise, or provide for the exercise of, the powers of the Foundation.
“(3) SELECTION.—
“(A) IN GENERAL.—Subject to subparagraph (B), the number of members of the Board, the manner of selection of the members (including the filling of vacancies), and the terms of office of the members shall be as provided in the constitution and bylaws of the Foundation.
“(B) REQUIREMENTS.—
“(i) NUMBER OF MEMBERS.—The Board shall have at least 11 members, who shall have staggered terms.
“(ii) INITIAL VOTING MEMBERS.—The initial voting members of the Board—
“(I) shall be appointed by the Committee not later than 180 days after the date on which the Foundation is established; and
“(II) shall have staggered terms.
“(iii) QUALIFICATION.—The members of the Board shall be United States citizens who are knowledgeable or experienced in Native American health care and related matters.
“(C) COMPENSATION.—A member of the Board shall not receive compensation for service as a member, but shall be reimbursed for actual and necessary travel and subsistence expenses incurred in the performance of the duties of the Foundation.
“(h) Officers.—
“(1) IN GENERAL.—The officers of the Foundation shall be—
“(A) a secretary, elected from among the members of the Board; and
“(B) any other officers provided for in the constitution and bylaws of the Foundation.
“(2) CHIEF OPERATING OFFICER.—The secretary of the Foundation may serve, at the direction of the Board, as the chief operating officer of the Foundation, or the Board may appoint a chief operating officer, who shall serve at the direction of the Board.
“(3) ELECTION.—The manner of election, term of office, and duties of the officers of the Foundation shall be as provided in the constitution and bylaws of the Foundation.
“(i) Powers.—The Foundation—
“(1) shall adopt a constitution and bylaws for the management of the property of the Foundation and the regulation of the affairs of the Foundation;
“(2) may adopt and alter a corporate seal;
“(3) may enter into contracts;
“(4) may acquire (through a gift or otherwise), own, lease, encumber, and transfer real or personal property as necessary or convenient to carry out the purposes of the Foundation;
“(5) may sue and be sued; and
“(6) may perform any other act necessary and proper to carry out the purposes of the Foundation.
“(j) Principal office.—
“(1) IN GENERAL.—The principal office of the Foundation shall be in the District of Columbia.
“(2) ACTIVITIES; OFFICES.—The activities of the Foundation may be conducted, and offices may be maintained, throughout the United States in accordance with the constitution and bylaws of the Foundation.
“(k) Service of process.—The Foundation shall comply with the law on service of process of each State in which the Foundation is incorporated and of each State in which the Foundation carries on activities.
“(l) Liability of officers, employees, and agents.—
“(1) IN GENERAL.—The Foundation shall be liable for the acts of the officers, employees, and agents of the Foundation acting within the scope of their authority.
“(2) PERSONAL LIABILITY.—A member of the Board shall be personally liable only for gross negligence in the performance of the duties of the member.
“(m) Restrictions.—
“(1) LIMITATION ON SPENDING.—Beginning with the fiscal year following the first full fiscal year during which the Foundation is in operation, the administrative costs of the Foundation shall not exceed the percentage described in paragraph (2) of the sum of—
“(A) the amounts transferred to the Foundation under subsection (o) during the preceding fiscal year; and
“(B) donations received from private sources during the preceding fiscal year.
“(2) PERCENTAGES.—The percentages referred to in paragraph (1) are—
“(A) for the first fiscal year described in that paragraph, 20 percent;
“(B) for the following fiscal year, 15 percent; and
“(C) for each fiscal year thereafter, 10 percent.
“(3) APPOINTMENT AND HIRING.—The appointment of officers and employees of the Foundation shall be subject to the availability of funds.
“(4) STATUS.—A member of the Board or officer, employee, or agent of the Foundation shall not by reason of association with the Foundation be considered to be an officer, employee, or agent of the United States.
“(n) Audits.—The Foundation shall comply with section 10101 of title 36, United States Code, as if the Foundation were a corporation under part B of subtitle II of that title.
“(o) Funding.—
“(1) AUTHORIZATION OF APPROPRIATIONS.—There is authorized to be appropriated to carry out subsection (e)(1) $500,000 for each fiscal year, as adjusted to reflect changes in the Consumer Price Index for all-urban consumers published by the Department of Labor.
“(2) TRANSFER OF DONATED FUNDS.—The Secretary shall transfer to the Foundation funds held by the Department of Health and Human Services under the Act of August 5, 1954 (42 U.S.C. 2001 et seq.), if the transfer or use of the funds is not prohibited by any term under which the funds were donated.
“SEC. 803. Administrative services and support.
“(a) Provision of support by Secretary.—Subject to subsection (b), during the 5-year period beginning on the date on which the Foundation is established, the Secretary—
“(1) may provide personnel, facilities, and other administrative support services to the Foundation;
“(2) may provide funds for initial operating costs and to reimburse the travel expenses of the members of the Board; and
“(3) shall require and accept reimbursements from the Foundation for—
“(A) services provided under paragraph (1); and
“(B) funds provided under paragraph (2).
“(b) Reimbursement.—Reimbursements accepted under subsection (a)(3)—
“(1) shall be deposited in the Treasury of the United States to the credit of the applicable appropriations account; and
“(2) shall be chargeable for the cost of providing services described in subsection (a)(1) and travel expenses described in subsection (a)(2).
“(c) Continuation of certain services.—The Secretary may continue to provide facilities and necessary support services to the Foundation after the termination of the 5-year period specified in subsection (a) if the facilities and services—
“(1) are available; and
“(2) are provided on reimbursable cost basis.”.
(b) Technical amendments.—The Indian Self-Determination and Education Assistance Act is amended—
(1) by redesignating title V (25 U.S.C. 458bbb et seq.) as title VII;
(2) by redesignating sections 501, 502, and 503 (25 U.S.C. 458bbb, 458bbb–1, 458bbb–2) as sections 701, 702, and 703, respectively; and
(3) in subsection (a)(2) of section 702 and paragraph (2) of section 703 (as redesignated by paragraph (2)), by striking “section 501” and inserting “section 701”.

### Sec. 3104. GAO Study and Report on Payments for Contract Health Services.

(a) Study.—
(1) IN GENERAL.—The Comptroller General of the United States (in this section referred to as the “Comptroller General”) shall conduct a study on the utilization of health care furnished by health care providers under the contract health services program funded by the Indian Health Service and operated by the Indian Health Service, an Indian Tribe, or a Tribal Organization (as those terms are defined in section 4 of the Indian Health Care Improvement Act).
(2) ANALYSIS.—The study conducted under paragraph (1) shall include an analysis of—
(A) the amounts reimbursed under the contract health services program described in paragraph (1) for health care furnished by entities, individual providers, and suppliers, including a comparison of reimbursement for such health care through other public programs and in the private sector;
(B) barriers to accessing care under such contract health services program, including, but not limited to, barriers relating to travel distances, cultural differences, and public and private sector reluctance to furnish care to patients under such program;
(C) the adequacy of existing Federal funding for health care under such contract health services program; and
(D) any other items determined appropriate by the Comptroller General.
(b) Report.—Not later than 18 months after the date of enactment of this Act, the Comptroller General shall submit to Congress a report on the study conducted under subsection (a), together with recommendations regarding—
(1) the appropriate level of Federal funding that should be established for health care under the contract health services program described in subsection (a)(1); and
(2) how to most efficiently utilize such funding.
(c) Consultation.—In conducting the study under subsection (a) and preparing the report under subsection (b), the Comptroller General shall consult with the Indian Health Service, Indian Tribes, and Tribal Organizations.