I 

113TH CONGRESS 

1ST SESSION H. R. 2037 

To establish a demonstration grant program to recruit, train, deploy, and 

professionally support psychiatric physicians in Indian health programs. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 16, 2013 

Mr. SCHRADER introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on 

Natural Resources, for a period to be subsequently determined by the 

Speaker, in each case for consideration of such provisions as fall within 

the jurisdiction of the committee concerned 

A BILL 

To establish a demonstration grant program to recruit, train, 

deploy, and professionally support psychiatric physicians 

in Indian health programs. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Native American Psy5 chiatric and Mental Health Care Improvement Act’’. 

6 SEC. 2. FINDINGS. 

7 Congress makes the following findings: 


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1 (1) The Substance Abuse and Mental Health 

2 Services Administration concludes the rate of serious 

3 mental illness in American Indians and Alaska Na4 tives is twice that of any other race or ethnicity. 

5 (2) The Centers for Disease Control and Pre6 vention concludes the suicide rate among American 

7 Indian and Alaska Native youth is more than twice 

8 that of any other race or ethnicity. 

9 (3) The United States Surgeon General at10 tributes high rates of homelessness, incarceration, 

11 alcohol and drug abuse, stress, and trauma as prin12 cipal causes of mental illness in American Indians 

13 and Alaska Natives. 

14 (4) The Agency for Healthcare Research and 

15 Quality concludes in The National Health Disparity 

16 Report, 2011, that American Indians and Alaska 

17 Natives had worse care than Whites in 28 measures 

18 of health care quality and access. 

19 (5) The Indian Health Service reports that per 

20 capita spending on personal health care of American 

21 Indians and Alaska Natives was $2,741 in 2012— 

22 nearly two-thirds below the national average of 

23 $7,239. 

24 (6) The Department of Health and Human 

25 Services, Office of Inspector General, reports that a 


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1 shortage of psychiatrists at the Indian Health Serv2 ice and other tribal health facilities significantly lim3 its mental health access to American Indians and 

4 Alaska Natives. 

5 (7) The One Sky Center, the American Indian/ 

6 Alaska Native National Resource Center for Sub7 stance Abuse and Mental Health Services, identifies 

8 20 psychiatrists currently practicing in Indian coun9 try (out of approximately 60,000 psychiatrists prac10 ticing nationwide), and 2 Native American psychia11 trists currently practicing in Indian country (out of 

12 13 practicing nationwide). 

13 (8) According to the American Psychiatric As14 sociation, psychiatric physicians practicing in Amer15 ican Indian and Alaska Native population groups 

16 often face cultural competency challenges, profes17 sional isolation, high demand for medical and mental 

18 health services, relatively low compensation, and 

19 high burnout rates. 

20 (9) A legislative initiative is warranted to create 

21 a nationally-replicable workforce model that identi22 fies and incorporates best practices for recruiting, 

23 training, deploying, and professionally supporting 

24 Native American psychiatric physicians or non-Na25 tive American psychiatric physicians (or both), who 


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1 are fully integrated into existing medical, mental, 

2 and behavioral health systems in Indian health pro3 grams. 

4 SEC. 3. DEMONSTRATION GRANT PROGRAM TO RECRUIT, 

5 TRAIN, DEPLOY, AND PROFESSIONALLY SUP6 PORT PSYCHIATRIC PHYSICIANS IN INDIAN 

7 HEALTH PROGRAMS. 

8 (a) ESTABLISHMENT.—The Secretary of Health and 

9 Human Services (in this section referred to as the ‘‘Sec10 retary’’), in consultation with the Director of the Indian 

11 Health Service and demonstration programs established 

12 under section 123 of the Indian Health Care Improvement 

13 Act (25 U.S.C. 1616p), shall award one 5-year grant to 

14 one eligible entity to carry out a demonstration program 

15 (in this Act referred to as the ‘‘Program’’) under which 

16 the eligible entity shall carry out the activities described 

17 in subsection (b). 

18 (b) ACTIVITIES TO BE CARRIED OUT BY RECIPIENT

19 OF GRANT UNDER PROGRAM.—Under the Program, the 

20 grant recipient shall— 

21 (1) create a nationally-replicable workforce 

22 model that identifies and incorporates best practices 

23 for recruiting, training, deploying, and professionally 

24 supporting Native American and non-Native Amer25 ican psychiatric physicians to be fully integrated into 


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1 medical, mental, and behavioral health systems in 

2 Indian health programs; 

3 (2) recruit to participate in the Program Native 

4 American and non-Native American psychiatric phy5 sicians who demonstrate interest in providing spe6 cialty health care services (as defined in section 

7 313(a)(3) of the Indian Health Care Improvement 

8 Act (25 U.S.C. 1638g(a)(3))) and primary care serv9 ices to American Indians and Alaska Natives; 

10 (3) provide such psychiatric physicians partici11 pating in the Program with not more than 1 year of 

12 supplemental clinical and cultural competency train13 ing to enable such physicians to provide such spe14 cialty health care services and primary care services 

15 in Indian health programs; 

16 (4) with respect to such psychiatric physicians 

17 who are participating in the Program and trained 

18 under paragraph (3), deploy such physicians to prac19 tice specialty care or primary care in Indian health 

20 programs for a period of not less than 2 years and 

21 professionally support such physicians for such pe22 riod with respect to practicing such care in such pro23 grams; and 

24 (5) not later than 1 year after the last day of 

25 the 5-year period for which the grant is awarded 


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1 under subsection (a), submit to the Secretary and to 

2 the appropriate committees of Congress a report 

3 that shall include— 

4 (A) the workforce model created under 

5 paragraph (1); 

6 (B) strategies for disseminating the work7 force model to other entities with the capability 

8 of adopting it; and 

9 (C) recommendations for the Secretary and 

10 Congress with respect to supporting an effective 

11 and stable psychiatric and mental health work12 force that serves American Indians and Alaska 

13 Natives. 

14 (c) ELIGIBLE ENTITIES.— 

15 (1) REQUIREMENTS.—To be eligible to receive 

16 the grant under this section, an entity shall— 

17 (A) submit to the Secretary an application 

18 at such time, in such manner, and containing 

19 such information as the Secretary may require; 

20 (B) be a department of psychiatry within 

21 a medical school in the United States that is 

22 accredited by the Liaison Committee on Medical 

23 Education or a public or private non-profit enti24 ty affiliated with a medical school in the United 


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1 States that is accredited by the Liaison Com2 mittee on Medical Education; and 

3 (C) have in existence, as of the time of 

4 submission of the application under subpara5 graph (A), a relationship with Indian health 

6 programs in at least two States with a dem7 onstrated need for psychiatric physicians and 

8 provide assurances that the grant will be used 

9 to serve rural and non-rural American Indian 

10 and Alaska Native populations in at least two 

11 States. 

12 (2) PRIORITY IN SELECTING GRANT RECIPI13 ENT.—In awarding the grant under this section, the 

14 Secretary shall give priority to an eligible entity that 

15 satisfies each of the following: 

16 (A) Demonstrates sufficient infrastructure 

17 in size, scope, and capacity to undertake the 

18 supplemental clinical and cultural competency 

19 training of a minimum of 5 psychiatric physi20 cians, and to provide ongoing professional sup21 port to psychiatric physicians during the de22 ployment period to an Indian health program. 

23 (B) Demonstrates a record in successfully 

24 recruiting, training, and deploying physicians 

25 who are American Indians and Alaska Natives. 


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1 (C) Demonstrates the ability to establish a 

2 program advisory board, which may be pri3 marily composed of representatives of federally4 recognized tribes, Alaska Natives, and Indian 

5 health programs to be served by the Program. 

6 (d) ELIGIBILITY OF PSYCHIATRIC PHYSICIANS TO

7 PARTICIPATE IN THE PROGRAM.— 

8 (1) IN GENERAL.—To be eligible to participate 

9 in the Program, as described in subsection (b), a 

10 psychiatric physician shall— 

11 (A) be licensed or eligible for licensure to 

12 practice in the State to which the physician is 

13 to be deployed under subsection (b)(4); and 

14 (B) demonstrate a commitment beyond the 

15 one year of training described in subsection 

16 (b)(3) and two years of deployment described in 

17 subsection (b)(4) to a career as a specialty care 

18 physician or primary care physician providing 

19 mental health services in Indian health pro20 grams. 

21 (2) PREFERENCE.—In selecting physicians to 

22 participate under the Program, as described in sub23 section (b)(2), the grant recipient shall give pref24 erence to physicians who are American Indians and 

25 Alaska Natives. 


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1 (e) LOAN FORGIVENESS.—Under the Program, any 

2 psychiatric physician accepted to participate in the Pro3 gram shall, notwithstanding the provisions of subsection 

4 (b) of section 108 of the Indian Health Care Improvement 

5 Act (25 U.S.C. 1616a) and upon acceptance into the Pro6 gram, be deemed eligible and enrolled to participate in the 

7 Indian Health Service Loan Repayment Program under 

8 such section 108. Under such Loan Repayment Program, 

9 the Secretary shall pay on behalf of the physician for each 

10 year of deployment under the Program under this section 

11 up to $35,000 for loans described in subsection (g)(1) of 

12 such section 108. 

13 (f) DEFERRAL OF CERTAIN SERVICE.—The starting 

14 date of required service of individuals in the National 

15 Health Service Corps Service Program under title II of 

16 the Public Health Service Act (42 U.S.C. 202 et seq.) who 

17 are psychiatric physicians participating under the Pro18 gram under this section shall be deferred until the date 

19 that is 30 days after the date of completion of the partici20 pation of such a physician in the Program under this sec21 tion. 

22 (g) DEFINITIONS.—For purposes of this Act: 

23 (1) AMERICAN INDIANS AND ALASKA NA24 TIVES.—The term ‘‘American Indians and Alaska 

25 Natives’’ has the meaning given the term ‘‘Indian’’ 


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1 in section 447.50(b)(1) of title 42, Code of Federal 

2 Regulations, as in existence as of the date of the en3 actment of this Act. 

4 (2) INDIAN HEALTH PROGRAM.—The term ‘‘In5 dian health program’’ has the meaning given such 

6 term in section 104(12) of the Indian Health Care 

7 Improvement Act (25 U.S.C. 1603(12)). 

8 (3) PROFESSIONALLY SUPPORT.—The term 

9 ‘‘professionally support’’ means, with respect to psy10 chiatric physicians participating in the Program and 

11 deployed to practice specialty care or primary care 

12 in Indian health programs, the provision of com13 pensation to such physicians for the provision of 

14 such care during such deployment and may include 

15 the provision, dissemination, or sharing of best prac16 tices, field training, and other activities deemed ap17 propriate by the recipient of the grant under this 

18 section. 

19 (4) PSYCHIATRIC PHYSICIAN.—The term ‘‘psy20 chiatric physician’’ means a medical doctor or doctor 

21 of osteopathy in good standing who has successfully 

22 completed four-year psychiatric residency training or 

23 who is enrolled in four-year psychiatric residency 

24 training in a residency program accredited by the 


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1 Accreditation Council for Graduate Medical Edu2 cation. 

3 (h) AUTHORIZATION OF APPROPRIATIONS.—There is 

4 authorized to be appropriated to carry out this section 

5 $1,000,000 for each of the fiscal years 2014 through 

6 2018. 

Æ 


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