19–010

Calendar No. 144

108TH CONGRESS REPORT " SENATE ! 1st Session 108–76

ELEVATING THE POSITION OF DIRECTOR OF THE INDIAN HEALTH SERVICE WITHIN THE DEPARTMENT OF HEALTH AND HUMAN SERVICES TO 

ASSISTANT SECRETARY FOR INDIAN HEALTH, AND FOR OTHER PURPOSES

JUNE 18, 2003.—Ordered to be printed 

Mr. CAMPBELL, from the Committee on Indian Affairs, 

submitted the following 

R E P O R T 

[To accompany S. 558]

The Committee on Indian Affairs, to which was referred the bill 

(S. 558) to elevate the position of Director of the Indian Health 

Service within the Department of Health and Human Services to 

Assistant Secretary for Indian Health, and for other purposes, having considered the same, reports favorably thereon without amendment and recommends that the bill do pass. 

PURPOSE

The purpose of S. 558 is to elevate the position of the Director 

of the Indian Health Service to the status of an Assistant Secretary 

within the Department of Health and Human Services. The bill establishes the Office of Assistant Secretary for Indian Health in 

order to further the unique government-to-government relationship 

between Indian tribes and the United States, facilitate advocacy for 

the development of Indian health policy, and promote consultation 

on matters related to Indian health. 

BACKGROUND

In exchange for ceding millions of acres of land to which Indian 

tribes held aboriginal title, the United States entered into treties 

with the Indian tribes. Many of the treaties provided that health 

care services would be provided to the citizens of Indian tribes. 

Some have asserted that these contracts between the United States 

and Indian governments represent the ‘‘first pre-paid health care 

plan’’ in America.

2

The Federal obligation to provide health care services to Indians 

also arises out of the special trust relationship between the United 

States and Indian tribes, which reflects the authority found in Article I, Section 8, clause 3 of the U.S. Constitution, and which has 

been given form and substance by numerous treaties, laws, Supreme Court decisions, and Executive Orders. 

The first Federal statute authorizing the appropriation of funds 

to carry out the United States’ responsibilities was the Snyder Act 

of 1921 (25 U.S.C. 13). In 1976, the Indian Health Care Improvement Act (25 U.S.C. 1601 et seq.) (IHCIA) became law. The IHCIA 

was the first comprehensive statute specifically addressing the provision of health care to Indians and the Federal administration of 

health care. 

A. EVOLUTION OF THE INDIAN HEALTH SERVICE

The Bureau of Indian Affairs within the U.S. Department of the 

Interior was initially charged with carrying out the United States 

responsibility for the provision of health care to Federally-recognized tribes and their members. 

In 1954, in response to a growing concern by the public health 

community that the Indian health care responsibility should be 

transferred to his authority, the Surgeon General, acting through 

the Public Health Service (PHS), established the Division of Indian 

Health (DIH) to administer the Indian health program. 

In 1968, the Division became the Indian Health Service (IHS) 

and operated as a sub-agency of other agencies within the Public 

Health Service including the Health Resources and Services Administration. 

In 1988, the Indian Health Service was established as a separate 

agency within the Public Health Service. 

On October 1, 1995, the Department of Health and Human Services (DHHS) reorganized its internal administrative structure and 

the Indian Health Service, along with the other agencies of the 

Public Health Service, became a separate operating division of the 

Department. 

Presently, the Director of the Indian Health Service is appointed 

by the President and is subject to Senate confirmation pursuant to 

25 U.S.C. 1661(a). Under current law, the IHS Director reports to 

the DHHS Secretary through the Assistant Secretary for Health. 

Since the 1995 reorganization of the DHHS, all agencies, operating divisions, and programs within the Department, including 

those previously part of the Public Health Service and under the 

direction of the Assistant Secretary for Health, have been required 

to report directly to the Secretary. Under the DHHS restructuring, 

the position of Assistant Secretary for Health was combined with 

the position of Surgeon General and the Office of Public Health and 

Science (OPHS) was established. The Assistant Secretary for 

Health directs the OPHS, serves as the Secretary’s senior advisor 

for public health and science, and provides leadership and coordination across the Department on public health and science issues. 

A key component to the IHS health care system is the Public 

Health Service’s Commissioned Corps. The Corps was established 

by the Congress in 1889 as part of the Marine Hospital Service, 

which later became the Public Health Service. The original mission 

of the Corps was to provide medical care to sick and disabled navy 

3

and merchant seamen. While the Corps’ duties were expanded during World Wars I and II, its original mission now serves as the 

basis for its9 continuing status as a uniformed service. The Surgeon General is statutorily responsible for supervising the activities 

of the Commissioned Corps. The Corps is also charged with providing technical and financial assistance to a variety of other federal agencies, state, and local public health departments. 

At the request of this Committee, the General Accounting Office 

(GAO) conducted a study of the role of the Corps in the Indian 

Health Service system. Corps officers have been assigned to Indian 

health agencies since 1926 and the Corps continues to provide 

many of the physicians, registered nurses, dentists, pharmacists, 

engineers, and sanitarians in Indian health facilities.

As of August 1999, the Public Health Service employed 5,936 

Corps officers of which 2,204 or about 37 percent, are assigned to 

the Indian Health Service. 

S. 558, as introduced, closely resembles previous versions of legislation introduced in the last several Congresses, which resulted 

from discussions with tribal leaders and representatives of the 

DHHS. 

Like its legislative predecessors in previous sessions of the Congress, S. 558 seeks to honor the government-to-government relationship between the United States and Indian tribes, to provide 

the necessary leadership within the Administration on Indian 

health issues, and to bring focus and national attention to the 

health care status of American Indians and Alaska Natives. The 

bill is intended to enhance the Federal capacity to respond to the 

ongoing health crisis in Indian country and the continuing frustrations of Indian patients that their needs and concerns are not adequately addressed under the current administrative policy and 

budgetary processes. 

B. INDIAN HEALTH CARE AND STATUS OF THE IHS

The IHS employs approximately 15,000 employees or about onequarter of all DHHS personnel. The IHS is a comprehensive health 

care delivery system operating nationwide through a variety of 

health care facilities. The IHS provides health care services directly 

and through tribally contracted and operated health care programs 

operated pursuant to the Indian Self Determination and Education 

Assistance Act, 25 U.S.C. 450 et seq. 

Health services are also purchased from more than two thousand 

private providers. As of 2002, the IHS system consisted of 594 direct health care delivery facilities funded through the IHS: 146 of 

these were directly operated by the IHS and 448 were operated by 

tribes. 

These facilities include, among others, 49 hospitals, 231 health 

care centers, 309 health stations, five school centers, and 34 urban 

Indian programs. Each year the IHS provides health care services 

to 559 Indian tribes in 35 states and in 2002 provided services to 

1.6 million American Indians and Alaska Natives. In 1998, IHS 

and tribal hospitals registered some 68,000 admissions and IHS 

and tribal direct health clinics provided 7 million outpatient visits. 

Previous efforts to address Indian health care needs and concerns have not greatly affected the steady decline in purchasing 

power of the IHS budget. The disparity between Indian and nonVerDate Jan 31 2003 05:15 Jun 21, 2003 Jkt 019010 PO 00000 Frm 00003 Fmt 6659 Sfmt 6602 E:\HR\OC\SR076.XXX SR076
4

Indian communities in Federal health care expenditures continues 

to grow. IHS Health Expenditures for Fiscal Year 1998 reflect a 

$1,507 per capita expenditure for Indians, compared with a $3,383 

per capita outlay for non-Indians. 

The Committee strongly believes that the institutionalization of 

a senior policy official responsible for Indian health within the 

DHHS is necessary to bring parity to Indian health care needs. 

S. 558 is intended to strengthen the Executive Order issued on 

April 29, 1994, 59 F.R. 22951, which recognizes the government-togovernment relationship between the United States and the tribes 

and the November 6, 2000, Executive Order No. 13175 directing executive agencies to consult with Indian tribes prior to any Federal 

action that would affect the tribes. 

C. THE ROLE OF THE ASSISTANT SECRETARY FOR INDIAN HEALTH

On April 9, 2003, the Committee held a hearing to receive testimony to discuss S. 558, among other legislation. At that hearing, 

the National Indian Health Board, a national Indian health policy 

advocacy organization, indicated its strong support for the elevation of the Director of IHS to Assistant Secretary for Indian 

Health. Additionally, the Committee has received a significant volume of correspondence, uniformly supporting the elevation of the 

Director of IHS to Assistant Secretary for Indian Health. 

The Administration has indicated its concerns with the elevation 

of the IHS Director. Testifying before the Committee, the DHHS 

witness noted that significant policymaking role given to the IHS 

Director by the DHHS Secretary, and the revitalization of the 

Intra-departmental Council for Native American Affairs, on which 

the IHS Director serves as Vice-Chair. 

The Committee is appreciative of the strong support for, and emphasis placed on Native health issues by the current Secretary. 

However, the Committee remains concerned that future Secretaries 

may not place a similarly high priority on Native health issues 

and, for that reason, elevation of the Director to Assistant Secretary is important. 

The Committee also recognizes the role of the Assistant Secretary for Health (Surgeon General) in addressing the health needs 

of all citizens of this country, including the American Indian and 

Native Alaska populations. S. 558 does not alter the important role 

the Assistant Secretary for Health (Surgeon General) serves, particularly as principal adviser to the Secretary of DHHS for public 

health matters affecting the general population. 

It is the Committee’s hope that a close collaboration between the 

Assistant Secretary for Health and the Assistant Secretary for Indian Health can serve as a model of interagency cooperation and 

partnership and raise the health status of American Indians and 

Alaska Natives. 

S. 558 elevates the position of the IHS Director, but more importantly, recognizes the unique government-to-government relationship between Federally recognized Indian tribes and the United 

States. The Assistant Secretary for Indian Health will provide the 

necessary leadership and consultation to the Secretary, the Assistant Secretary for Health, and others, on the important health 

issues facing Indian people. S. 558 serves to support the Federal 

policy of tribal self-determination and ensures that Indian people 

5

are heard and their concerns are brought to the table when important policy and budget decisions are made on their behalf. 

The establishment of an Assistant Secretary for Indian Health 

will ensure that there is a senior official in current and future administrations who is knowledgeable about the United States’ legal 

and moral obligations to Indian people, the mission of the IHS, and 

who has the status to advocate within the DHHS and the Office 

of Management and Budget for the funding resources and policies 

that are necessary to effectively and efficiently address the health 

care needs and concerns of the Indian people. 

S. 558 places this important and special leadership role with the 

Assistant Secretary for Indian Health. 

LEGISLATIVE HISTORY

S. 558 was introduced on March 6, 2003, by Senator McCain for 

himself, and for Senators Campbell, Domenici, Johnson, Bingaman 

and Murray. The bill was referred to the Committee on Indian Affairs. Senator Inouye was added as a cosponsor on March 10, 2003, 

and Senator Conrad was added on April 1, 2003. 

The bill was the subject of a hearing held by the Senate Indian 

Affairs Committee on April 9, 2003, during which the Committee 

received testimony from the DHHS, the NIHB, and tribal leaders. 

SECTION-BY-SECTION ANALYSIS

Section 1. Office of Assistant Secretary for Indian Health 

Subsection (a) provides definitions for the terms ‘‘Assistant Secretary’’, ‘‘Department’’, ‘‘Office’’, and ‘‘Secretary’’. 

Subsection (b) provides that the Office of Assistant Secretary for 

Indian Health is established within the Department and will be 

headed by the Assistant Secretary, who is appointed by the President and confirmed by the United States Senate. This subsection 

further provides for the current incumbent Director of the IHS to 

serve as the Assistant Secretary, at the pleasure of the President, 

after enactment. The duties of the Assistant Secretary are to, consistent with the unique government-to-government relationship between Indian tribes and the United States, facilitate advocacy for 

the development of Indian health policy, and promote consultation 

on matters related to Indian health. 

Subsection (c) provides that the Assistant Secretary for Indian 

Health shall report directly to the Secretary on all policy and budget related matters affecting Indian health, collaborate with the Assistant Secretary for Health on Indian health matters, advise other 

Assistant Secretaries and others within DHHS concerning matters 

of Indian health, perform the functions of the Director of the Indian Health Service, and other functions as designed by the Secretary of Health and Human Services. 

Subsection (d) provides technical changes to conform with the 

Act. The elevation of the Director of Indian Health Service to Assistant Secretary would increase the number of assistant secretaries to seven. This subsection also abolishes the position of the 

Director of Indian Health Service. 

Subsection (e) amends section 601 of the Indian Health Care Improvement Act, 25 U.S.C. 1661, by establishing the Indian Health 

6

Service within the Public Health Service and further outlines and 

clarifies the duties of the Assistant Secretary for Indian Health. 

Subsection (f) further amends the Indian Health Care Improvement Act by deleting all provisions referring to ‘‘the Director’’ or 

‘‘Director of Indian Health Service’’ and inserting in lieu thereof 

‘‘the Assistant Secretary for Indian Health.’’ This subsection also 

provides for conforming amendments to other statutes to conform 

with this Act. 

Subsection (g) provides that any references to the Director of Indian Health Service in any other Federal laws, Executive order, 

rule, regulation, or delegation of authority, or any document will be 

deemed to refer to the Assistant Secretary for Indian Health. 

COMMITTEE RECOMMENDATION AND TABULATION OF VOTE

On May 14, 2003, the Committee on Indian Affairs, in an open 

business session, considered S. 558. The bill, without amendment, 

was ordered favorably reported with a recommendation that the 

bill do pass.

COST AND BUDGETARY CONSIDERATION

The cost estimate for S. 558 as calculated by the Congressional 

Budget Office, is set forth below:

U.S. CONGRESS, 

CONGRESSIONAL BUDGET OFFICE, 

Washington, DC, May 22, 2003. 

Hon. BEN NIGHTHORSE CAMPBELL, Chairman, Committee on Indian Affairs, 

U.S. Senate, Washington, DC. 

DEAR MR. CHAIRMAN: The Congressional Budget Office has prepared the enclosed cost estimate for S. 558, a bill to elevate the position of Director of the Indian Health Service within the Department of Health and Human Services to Assistant Secretary for Indian Health, and for other purposes. 

If you wish further details on this estimate, we will be pleased 

to provide them. The CBO staff contact is Eric Rollins. 

Sincerely, 

DOUGLAS HOLTZ-EAKIN, 

Director. 

Enclosure. 

CONGRESSIONAL BUDGET OFFICE COST ESTIMATE

S. 558—A bill to elevate the position of Director of the Indian 

Health Service within the Department of Health and Human 

Services to Assistant Secretary for Indian Health, and for other 

purposes 

CBO estimates that enacting this bill would have no significant 

effect on the federal budget. S. 558 contains no intergovernmental 

or private-sector mandates as defined in the Unfunded Mandates 

Reform Act and would not affect the budgets of state, local, or tribal governments. 

S. 558 would establish the position of Assistant Secretary for Indian Health in lieu of the current position of Director of the Indian 

7

Health Service. The duties and responsibilities of the office would 

not be changed significantly. The rate of pay would increase from 

level V to level IV of the Executive Schedule, an increase of $8,600. 

This change would not affect the salary of the current Director of 

the Indian Health Service, because his pay is governed by the pay 

structure of the Public Health Service Commissioned Corps. 

The CBO staff contact for this estimate is Eric Rollins. This estimate was approved by Peter H. Fontaine, Deputy Assistant Director for Budget Analysis.

REGULATORY IMPACT STATEMENT

Paragraph 11(b) of rule XXVI of the Standing Rules of the Senate requires that each report accompanying a bill to evaluate the 

regulatory paperwork impact that would be incurred in carrying 

out the bill. The Committee believes that S. 558 will have minimal 

regulatory or paperwork impact. 

EXECUTIVE COMMUNICATIONS

There have been no executive communications received regarding 

this legislation. 

CHANGES IN EXISTING LAW

In compliance with subsection 12 of rule XXVI of the Standing 

Rules of the Senate, the Committee states that enactment of S. 558 

will result in the following changes in the following statutes as 

noted below, with existing language which is to be deleted in brackets and the new language which is to be added in italic: 

UNITED STATES CODE 

TITLE 5.—GOVERNMENT 

ORGANIZATION AND EMPLOYEES 

* * * * * * *

SEC. 5315. POSITIONS AT LEVEL IV. 

Level IV of the Executive Schedule applies to the following positions, for which the annual rate of basic pay shall be the rate determined with respect to such level under chapter 11 of title 2, as 

adjusted by section 5318 of this title: * * *

Assistant Secretaries of Health and Human Services ø(6)¿ (7). ***

* * * * * * *

SEC. 5316. POSITIONS AT LEVEL V. 

Level V of the Executive Schedule applies to the following positions, for which the annual rate of basic pay shall be the rate determined with respect to such level under 11 of title 2, as adjusted 

by section 5318 of this title: * * * 

øDirector, Indian Health Service, Department of Health and 

Human Services.¿ ***

* * * * * * *

8

UNITED STATES CODE 

TITLE 29.—LABOR 

* * * * * * *

SEC. 5315. INTERAGENCY COMMITTEE. 

(a) —

(1) In order to promote coordination and cooperation among Federal departments and agencies conducting rehabilitation research 

programs, including programs relating to assistive technology research and research that incorporates the principles of universal 

design, there is established within the Federal Government an 

Interagency Committee on Disability Research (hereinafter in this 

section referred to as the ‘‘Committee’’), chaired by the Director and 

comprised of such members as the President may designate, including the following (or their designees): the Director, the Commissioner of the Rehabilitation Services Administration, the Assistant 

Secretary for Special Education and Rehabilitative Services, the 

Secretary of Education, the Secretary of Veterans Affairs, the Director of the National Institutes of Health, the Director of the National Institute of Mental Health, the Administrator of the National Aeronautics and Space Administration, the Secretary of 

Transportation, the Assistant Secretary of the Interior for Indian 

Affairs, the Assistant Secretary for Indian Health, and the Director 

of the National Science Foundation. * * *

* * * * * * *

UNITED STATES CODE 

TITLE 33.—NAVIGATION AND 

NAVIGABLE WATERS 

* * * * * * *

SEC. 1377. INDIAN TRIBES. * * *

* * * * * * *

(B) ASSESSMENT OF SEWAGE TREATMENT NEEDS; REPORT.—The 

Administrator in cooperation with the øDirector of the Indian 

Health Service¿ Assistant Secretary for Indian Health, shall assess 

the need for sewage treatment works to serve Indian tribes, the degree to which such needs will be met through funds allotted to 

States under section 205 of this Act and priority lists under section 

216 of this Act, and any obstacles which prevent such needs from 

being met. Not later than one year after the date of the enactment 

of this section, the Administrator shall submit a report to Congress 

on the assessment under this subsection, along with recommendations specifying (1) how the Administrator intends to provide assistance to Indian tribes to develop waste treatment management 

plans and to construct treatment works under this Act, and (2) 

9

methods by which the participation in and administration of programs under this Act by Indian tribes can be maximized. * * *

* * * * * * *

(e) TREATMENT AS STATES.—The Administrator is authorized to 

treat an Indian tribe as a State for purposes of title II and sections 

104, 106, 303, 305, 308, 309, 314, 319, 401, 402, 404, and 406 of 

this Act to the degree necessary to carry out the objectives of this 

section, but only if— ***

(3) the Indian tribe is reasonably expected to be capable, in 

the Administrator’s judgment, of carrying out the functions to 

be exercised in a manner consistent with the terms and purposes of this Act and of all applicable regulations. 

Such treatment as a State may include the direct provision of 

funds reserved under subsection (c) to the governing bodies of Indian tribes, and the determination of priorities by Indian tribes, 

where not determined by the Administrator in cooperation with the 

øDirector of the Indian Health Service¿ Assistant Secretary for Indian Health. The Administrator, in cooperation with the øDirector 

of the Indian Health Service¿ Assistant Secretary for Indian 

Health, is authorized to make grants under title II of this Act in 

an amount not to exceed 100 percent of the cost of a project. Not 

later than 18 months after the date of the enactment of this section, the Administrator shall, in consultation with Indian tribes, 

promulgate final regulations which specify how Indian tribes shall 

be treated as States for purposes of this Act. The Administrator 

shall, in promulgating such regulations, consult affected States 

sharing common water bodies and provide a mechanism for the resolution of any unreasonable consequences that may arise as a result of differing water quality standards that may be set by States 

and Indian tribes located on common bodies of water. Such mechanism shall provide for explicit consideration of relevant factors including, but not limited to, the effects of differing water quality 

permit requirements on upstream and downstream dischargers,

economic impacts, and present and historical uses and quality of 

the waters subject to such standards. Such mechanism should provide for the avoidance of such unreasonable consequences in a 

manner consistent with the objective of this Act. * * *

* * * * * * *

UNITED STATES CODE 

TITLE 42.—PUBLIC HEALTH AND 

WELFARE 

* * * * * * *

SEC. 247b–14. ORAL HEALTH PROMOTION AND DISEASE PREVENTION. 

***

* * * * * * *

(b) COMMUNITY WATER FLUORIDATION. (1) IN GENERAL.—The Secretary, acting through the Director 

of the Centers for Disease Control and Prevention and in collaboration with the øDirector of the Indian Health Service¿ AsVerDate Jan 31 2003 05:15 Jun 21, 2003 Jkt 019010 PO 00000 Frm 00009 Fmt 6659 Sfmt 6602 E:\HR\OC\SR076.XXX SR076
10

sistant Secretary for Indian Health, shall establish a demonstration project that is designed to assist rural water systems in successfully implementing the water fluoridation 

guidelines of the Centers for Disease Control and Prevention 

that are entitled ‘‘Engineering and Administrative Recommendations for Water Fluoridation, 1995’’ (referred to in 

this subsection as the ‘‘EARWF’’). 

(2) REQUIREMENTS. (A) COLLABORATION.—In collaborating under paragraph 

(1), øthe Directors¿ the Director of the Centers for Disease 

Control and Prevention and the Assistant Secretary for Indian Health referred to in such paragraph shall ensure 

that technical assistance and training are provided to tribal programs located in each of the 12 areas of the Indian 

Health Service. The øDirector of the Indian Health Service¿ Assistant Secretary for Indian Health shall provide coordination and administrative support to tribes under this 

section. * * *

* * * * * * *

SEC. 285a–9. GRANTS FOR EDUCATION, PREVENTION, AND EARLY DETECTION OF RADIOGENIC CANCERS AND DISEASES. * * *

* * * * * * *

(b) IN GENERAL.—The Secretary, acting through the Administrator of the Health Resources and Services Administration in consultation with the Director of the National Institutes of Health and 

the øDirector of the Indian Health Service¿ Assistant Secretary for 

Indian Health, may make competitive grants to any entity for the 

purpose of carrying out programs to— ***

* * * * * * *

SEC. 300j–12. STATE REVOLVING LOAN FUNDS. * * *

* * * * * * *

(i) INDIAN TRIBES. * * *

* * * * * * *

(2) USE OF FUNDS.—Funds reserved pursuant to paragraph 

(1) shall be used to address the most significant threats to public health associated with public water systems that serve Indian Tribes, as determined by the Administrator in consultation with the øDirector of the Indian Health Service¿ Assistant 

Secretary for Indian Health and Indian Tribes. * * *

* * * * * * *

(4) NEEDS ASSESSMENT.—The Administrator, in consultation 

with the øDirector of the Indian Health Service¿ Assistant Secretary for Indian Health and Indian Tribes, shall, in accordance with a schedule that is consistent with the needs surveys 

conducted pursuant to subsection (h), prepare surveys and assess the needs of drinking water treatment facilities to serve 

Indian Tribes, including an evaluation of the public water systems that pose the most significant threats to public health. 

***

* * * * * * *

11

SEC. 2991b–2. ESTABLISHMENT OF ADMINISTRATION FOR NATIVE 

AMERICANS. * * *

* * * * * * *

(d) INTRA-DEPARTMENTAL COUNCIL ON NATIVE AMERICAN AFFAIRS. 

(1) There is established in the Office of the Secretary the 

Intra-Departmental Council on Native American Affairs. The 

Commissioner shall be the chairperson of such Council and 

shall advise the Secretary on all matters affecting Native 

Americans that involve the Department. The øDirector of the 

Indian Health Service¿ Assistant Secretary for Indian Health

shall serve as vice chairperson of the Council. * * *

* * * * * * *

INDIAN HEALTH CARE IMPROVEMENT 

ACT 

PUBLIC LAW 94–437

AN ACT To implement the Federal responsibility for the care and education of the 

Indian people by improving the services and facilities of Federal Indian health 

programs and encouraging maximum participation of Indians in such programs, 

and for other purposes 

Be it enacted by the Senate and House of Representatives of the 

United States of America in Congress assembled,

* * * * * * *

øSEC. 601. ESTABLISHMENT OF INDIAN HEALTH SERVICE AS AN AGENCY OF PUBLIC HEALTH SERVICE. 

ø(a) ESTABLISHMENT.—In order to more effectively and efficiently 

carry out the responsibilities, authorities, and functions of the 

United States to provide health care services to Indians and Indian 

tribes, as are or may be on and after November 23, 1988, provided 

by Federal statute or treaties, there is established within the Public Health Service of the Department of Health and Human Services the Indian Health Service. The Indian Health Service shall be 

administered by a Director, who shall be appointed by the President, by and with the advice and consent of the Senate. The Director of the Indian Health Service shall report to the Secretary 

through the Assistant Secretary for Health of the Department of 

Health and Human Services. Effective with respect to an individual 

appointed by the President, by and with the advice and consent of 

the Senate, after January 1, 1993, the term of service of the Director shall be 4 years. A Director may serve more than 1 term.¿

SEC. 601. ESTABLISHMENT OF THE INDIAN HEALTH SERVICE AS AN 

AGENCY OF THE PUBLIC HEALTH SERVICE. 

(a) ESTABLISHMENT.—

(1) IN GENERAL.—In order to more effectively and efficiently 

carry out the responsibilities, authorities, and functions of the 

United States to provide health care services to Indians and Indian tribes, there is established within the Public Health Service of the Department of Health and Human Services the Indian Health Service. 

12

(2) ADMINISTRATION.—The Indian Health Service shall be administered by the Assistant Secretary for Indian Health. 

(3) DUTIES.—In carrying out paragraph (2), the Assistant 

Secretary for Indian Health shall—

(A) report directly to the Secretary concerning all policyand budget-related matters affecting Indian health; 

(B) collaborate with the Assistant Secretary for Health 

concerning appropriate matters of Indian health that affect 

the agencies of the Public Health Service; 

(C) advise each Assistant Secretary of the Department of 

Health and Human Services concerning matters of Indian 

health with respect to which that Assistant Secretary has 

authority and responsibility; 

(D) advise the heads of other agencies and programs of 

the Department of Health and Human Services concerning 

matters of Indian health with respect to which those heads 

have authority and responsibility; 

(E) coordinate the activities of the Department of Health 

and Human Services concerning matters of Indian health; 

and 

(F) perform such other function as the Secretary may designate. * * *

* * * * * * *

(c) The Secretary shall carry out through the øDirector of the Indian Health Service¿ Assistant Secretary for Indian Health—

(1) all functions which were, on the day before November 23, 

1988, carried out by or under the direction of the individual 

serving as øDirector of the Indian Health Service¿ Assistant 

Secretary for Indian Health. ***

* * * * * * *

(d) AUTHORITY OF SECRETARY.—

(1) The Secretary, acting through the øDirector of the Indian 

Health Service¿ Assistant Secretary for Indian Health, shall 

have the authority—***

* * * * * * *

SEC. 816. INDIAN HEALTH SERVICE AND DEPARTMENT OF VETERANS 

AFFAIRS HEALTH FACILITIES AND SERVICES SHARING. 

***

* * * * * * *

(c) CROSS UTILIZATION OF SERVICES.—

(1) Not later than December 23, 1988, the øDirector of the 

Indian Health Service¿ Assistant Secretary for Indian Health

and the Secretary of Veterans Affairs shall implement an 

agreement under which— ***

* * * * * * *

13

CHILDREN’S HEALTH ACT OF 2000

PUBLIC LAW 106–310

AN ACT To amend the Public Health Service Act with respect to children’s health 

Be it enacted by the Senate and House of Representatives of the 

United States of America in Congress assembled, 

* * * * * * *

SEC. 3307. ESTABLISHMENT OF COMMISSION. * * *

* * * * * * *

(b) MEMBERSHIP.—

(1) IN GENERAL.—The Commission established under subsection (a) shall consist of—

(A) the Secretary; 

(B) 15 members who are experts in the health care field 

and issues that the Commission is established to examine; 

and 

(C) the øDirector of the Indian Health Service¿ Assistant 

Secretary for Indian Health and the Commissioner of Indian Affairs, who shall be nonvoting members. * * *

* * * * * * *

INDIAN LANDS OPEN DUMP CLEANUP 

ACT OF 1994

PUBLIC LAW 103–399

AN ACT To clean up open dumps on Indian lands, and for other purposes 

Be it enacted by the Senate and House of Representatives of the 

United States of America in Congress assembled, 

* * * * * * *

SEC. 3. DEFINITIONS. 

For the purposes of this Act, the following definitions shall apply: 

ø(6)¿ (1) ALASKA NATIVE ENTITY.—The term ‘‘Alaska Native 

entity’’ includes native corporations established pursuant to 

the Alaska Native Claims Settlement Act (43 U.S.C. 1600 et 

seq.) and any Alaska Native village or municipal entity which 

owns Alaska Native land. 

ø(2) DIRECTOR.—The term ‘‘Director’’ means the Director of 

the Indian Health Service.¿

ø(4)¿ (2) ALASKA NATIVE LAND.—The term ‘‘Alaska Native 

land’’ means (A) land conveyed or to be conveyed pursuant to 

the Alaska Native Claims Settlement Act (43 U.S.C. 1600 et 

seq.), including any land reconveyed under section 14(c)(3) of 

that Act (43 U.S.C. 1613(c)(3)), and (B) land conveyed pursuant 

to the Act of November 2, 1966 (16 U.S.C. 1151 et seq.; commonly known as the ‘‘Fur Seal Act of 1966’’).

(3) ASSISTANT SECRETARY.—The term ‘‘Assistant Secretary’’

means the Assistant Secretary for Indian Health.

14

ø(1)¿ (4) CLOSURE OR CLOSE.—The term ‘‘closure or close’’ means the termination of operations at open dumps on Indian 

land or Alaska Native land and bringing such dumps into compliance with applicable Federal standards and regulations, or 

standards promulgated by an Indian tribal government or 

Alaska Native entity, if such standards are more stringent 

than the Federal standards and regulations. 

ø(3)¿ (5) INDIAN LAND.—The term ‘‘Indian land’’ means— (A) land within the limits of any Indian reservation 

under the jurisdiction of the United States Government, 

notwithstanding the issuance of any patent, and including 

rights-of-way running through the reservation; 

(B) dependent Indian communities within the borders of 

the United States whether within the original or subsequently acquired territory thereof, and whether within or 

without the limits of a State; and 

(C) Indian allotments, the Indian titles to which have 

not been extinguished, including rights-of-way running 

through such allotments. 

ø(5)¿ (6) INDIAN TRIBAL GOVERNMENT.—The term ‘‘Indian 

tribal government’’ means the governing body of any Indian 

tribe, band, nation, pueblo, or other organized group or community which is recognized as eligible for the special programs 

and services provided by the United States to Indians because 

of their status as Indians. * * *

* * * * * * *

SEC. 4. INVENTORY OF OPEN DUMPS. 

(a) STUDY AND INVENTORY.—Not later than 12 months after the 

date of enactment of this Act, the øDirector¿ Assistant Secretary

shall conduct a study and inventory of open dumps on Indian lands 

and Alaska Native lands. The inventory shall list the geographic location of all open dumps, an evaluation of the contents of each 

dump, and an assessment of the relative severity of the threat to 

public health and the environment posed by each dump. Such assessment shall be carried out cooperatively with the Administrator 

of the Environmental Protection Agency. The øDirector¿ Assistant 

Secretary shall obtain the concurrence of the Administrator in the 

determination of relative severity made by any such assessment. 

(b) ANNUAL REPORTS.—Upon completion of the study and inventory under subsection (a), the øDirector¿ Assistant Secretary shall 

report to the Congress, and update such report annually—*** (c) 10-YEAR PLAN.—The øDirector¿ Assistant Secretary shall develop and begin implementation of a 10-year plan to address solid 

waste disposal needs on Indian lands and Alaska Native lands. 

This 10-year plan shall identify— ***

* * * * * * *

øSEC. 5. AUTHORITY OF THE DIRECTOR OF THE INDIAN HEALTH 

SERVICE.¿ SEC. 5. AUTHORITY OF ASSISTANT SECRETARY 

FOR INDIAN HEALTH.

(a) RESERVATION INVENTORY.—(1) Upon request by an Indian 

tribal government or Alaska Native entity, the øDirector¿ Assistant 

Secretary shall— ***

(B) determine the relative severity of the threat to public 

health and the environment posed by each dump based on 

15

information available to the Director and the Indian tribal 

government or Alaska Native entity unless the øDirector¿

Assistant Secretary, in consultation with the Indian tribal 

government or Alaska Native entity, determines that additional actions such as soil testing or water monitoring 

would be appropriate in the circumstances; * * *

(2) The inventory and evaluation authorized under paragraph (1)(A) shall be carried out cooperatively with the Administrator of the Environmental Protection Agency. The øDirector¿ Assistant Secretary shall obtain the concurrence of the Administrator in the determination of relative severity made 

under paragraph (1)(B). 

(b) ASSISTANCE.—Upon completion of the activities required to be 

performed pursuant to subsection (a), the øDirector¿ Assistant Secretary shall, subject to subsection (c), provide financial and technical assistance to the Indian tribal government or Alaska Native 

entity to carry out the activities necessary to—

(1) close such dumps; and 

(2) provide for postclosure maintenance of such dumps. 

(c) CONDITIONS.—All assistance provided pursuant to subsection 

(b) shall be made available on a site-specific basis in accordance 

with priorities developed by the øDirector¿ Assistant Secretary. Priorities shall take into account the relative severity of the threat to 

public health and the environment posed by each open dump and 

the availability of funds necessary for closure and postclosure 

maintenance. 

SEC. 6. CONTRACT AUTHORITY. 

(a) AUTHORITY OF øDIRECTOR¿ ASSISTANT SECRETARY.—To the 

maximum extent feasible, the øDirector¿ Assistant Secretary shall 

carry out duties under this Act through contracts, compacts, or 

memoranda of agreement with Indian tribal governments or Alaska 

Native entities pursuant to the Indian Self-Determination and 

Education Assistance Act (25 U.S.C. 450 et seq.), section 7 of the 

Act of August 5, 1954 (42 U.S.C. 2004a), or section 302 of the Indian Health Care Improvement Act (25 U.S.C. 1632).

(b) COOPERATIVE AGREEMENTS.—The øDirector¿ Assistant Secretary is authorized, for purposes of carrying out the duties of the 

øDirector¿ Assistant Secretary under this Act, to contract with or 

enter into such cooperative agreements with such other Federal 

agencies as is considered necessary to provide cost-sharing for closure and postclosure activities, to obtain necessary technical and financial assistance and expertise, and for such other purposes as 

the øDirector¿ Assistant Secretary considers necessary. 

SEC. 7. TRIBAL DEMONSTRATIONS PROJECT. 

(a) IN GENERAL.—The øDirector¿ Assistant Secretary may establish and carry out a program providing for demonstration projects 

involving open dumps on Indian land or Alaska Native land. It 

shall be the purpose of such projects to determine if there are 

unique cost factors involved in the cleanup and maintenance of 

open dumps on such land, and the extent to which advanced closure planning is necessary. Under the program, the øDirector¿ Assistant Secretary is authorized to select no less than three Indian 

tribal governments or Alaska Native entities to a participate in 

such demonstration projects. 

16

(b) CRITERIA.—Criteria established by the øDirector¿ Assistant 

Secretary for the selection and participation of an Indian tribal government or Alaska Native entity in the demonstration project shall 

provide that in order to be eligible to participate, an Indian tribal 

government or Alaska Native entity must— ***

* * * * * * *

SEC. 8. AUTHORIZATION OF APPROPRIATIONS. 

* * * * * * *

(b) COORDINATION.—The activities required to be performed by 

the øDirector¿ Assistant Secretary under this Act shall be coordinated with activities related to solid waste and sanitation facilities 

funded pursuant to other authorizations. 

SEC. 9. DISCLAIMERS. 

(a) AUTHORITY OF øDIRECTOR¿ ASSISTANT SECRETARY.—Nothing 

in this Act shall be construed to alter, diminish, repeal, or supersede any authority conferred on the [Director] Assistant Secretary

pursuant to section 302 of the Indian Health Care Improvement 

Act (25 U.S.C. 1632), and section 7 of the Act of August 5, 1954 

(42 U.S.C. 2004a). 

AUGUSTUS F. HAWKINS-ROBERT T. 

STAFFORD ELEMENTARY AND SECONDARY SCHOOL IMPROVEMENT 

AMENDMENTS OF 1988 

PUBLIC LAW 100–297

AN ACT To improve elementary and secondary education, and for other purposes 

Be it enacted by the Senate and House of Representatives of the 

United States of America in Congress assembled, 

* * * * * * *

SEC. 5504. ADMINISTRATIVE PROVISIONS. * * *

* * * * * * *

(d) FEDERAL AGENCY COOPERATION AND ASSISTANCE.—***

(2) The Commissioner of the Administration for Native 

Americans of the Department of Health and Human Services 

and the øDirector of the Indian Health Service¿ Assistant Secretary for Indian Health of the Department of Health and 

Human Services are authorized to detail personnel to the Task 

Force, upon request, to enable the Task Force to carry out its 

functions under this part. * * *

* * * * * * *

17

MICHIGAN INDIAN LAND CLAIMS 

SETTLEMENT ACT 

PUBLIC LAW 105–143

AN ACT To provide for the division, use, and distribution of judgment funds of the 

Ottawa and Chippewa Indians of Michigan pursuant to dockets numbered 18–E, 

58, 364, and 18–R before the Indian Claims Commission 

Be it enacted by the Senate and House of Representatives of the 

United States of American in Congress assembled, 

* * * * * * *

SEC. 203. LIMITATION. * * *

* * * * * * *

(b) CONSIDERATION.—In any case in which the Secretary, acting 

through the øDirector of the Indian Health Service¿ Assistant Secretary for Indian Health, is required to select from more than 1 application for a contract or compact described in subsection (a), in 

awarding the contract or compact, the Secretary shall take into 

consideration— ***

* * * * * * *

Æ