II 

Calendar No. 375 

109TH CONGRESS 

2D SESSION S. 1057 

[Report No. 109–222] 

To amend the Indian Health Care Improvement Act to revise and extend 

that Act. 

IN THE SENATE OF THE UNITED STATES 

MAY 17, 2005 

Mr. MCCAIN (for himself, Mr. DORGAN, Mr. JOHNSON, Mr. KENNEDY, Mr. 

BINGAMAN, Ms. CANTWELL, and Mrs. MURRAY) introduced the following 

bill; which was read twice and referred to the Committee on Indian Affairs 

MARCH 16 (legislative day, MARCH 15), 2006 

Reported by Mr. MCCAIN, with an amendment 

[Strike out all after the enacting clause and insert the part printed in italic] 

A BILL 

To amend the Indian Health Care Improvement Act to revise 

and extend that Act. 

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 ‘‘Indian Health Care 

5 Improvement Act Amendments of 2005’’. 


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1 SEC. 2. INDIAN HEALTH CARE IMPROVEMENT ACT AMEND2 ED. 

3 (a) IN GENERAL.—The Indian Health Care Improve4 ment Act (25 U.S.C. 1601 et seq.) is amended to read 

5 as follows: 

6 ‘‘SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

7 ‘‘(a) SHORT TITLE.—This Act may be cited as the 

8 ‘Indian Health Care Improvement Act’. 

9 ‘‘(b) TABLE OF CONTENTS.—The table of contents 

10 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. Funding for tribes for scholarship programs 

‘‘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 for Alaska 

‘‘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 


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‘‘Sec. 126. Behavioral health training and community education programs 

‘‘Sec. 127. Authorization of appropriations 

‘‘TITLE II—HEALTH SERVICES 

‘‘Sec. 201. Indian Health Care Improvement Fund 

‘‘Sec. 202. Catastrophic Health Emergency Fund 

‘‘Sec. 203. Health promotion and disease prevention services 

‘‘Sec. 204. Diabetes prevention, treatment, and control 

‘‘Sec. 205. Shared services for long-term care 

‘‘Sec. 206. Health services research 

‘‘Sec. 207. Mammography and other cancer screening 

‘‘Sec. 208. Patient travel costs 

‘‘Sec. 209. Epidemiology centers 

‘‘Sec. 210. Comprehensive school health education programs 

‘‘Sec. 211. Indian youth program 

‘‘Sec. 212. Prevention, control, and elimination of communicable and infectious 

diseases 

‘‘Sec. 213. Authority for provision of other services 

‘‘Sec. 214. Indian women’s health care 

‘‘Sec. 215. Environmental and nuclear health hazards 

‘‘Sec. 216. Arizona as a contract health service delivery area 

‘‘Sec. 216A. North Dakota and South Dakota as a 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. 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 nonservice 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. 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 


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‘‘Sec. 401. Treatment of payments under Social Security Act health care programs 

‘‘Sec. 402. Grants to and contracts with the Service, Indian tribes, Tribal Organizations, and Urban Indian Organizations 

‘‘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. Payor of last resort 

‘‘Sec. 408. Nondiscrimination in qualifications for reimbursement for services 

‘‘Sec. 409. Consultation 

‘‘Sec. 410. State Children’s Health Insurance Program (SCHIP) 

‘‘Sec. 411. Social Security Act sanctions 

‘‘Sec. 412. Cost sharing 

‘‘Sec. 413. Treatment under Medicaid managed care 

‘‘Sec. 414. Navajo Nation Medicaid Agency feasibility study 

‘‘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. Contracts and grants for the determination of unmet health care 

needs 

‘‘Sec. 505. Evaluations; renewals 

‘‘Sec. 506. Other contract and grant requirements 

‘‘Sec. 507. Reports and records 

‘‘Sec. 508. Limitation on contract authority 

‘‘Sec. 509. Facilities 

‘‘Sec. 510. Office of Urban Indian Health 

‘‘Sec. 511. Grants for alcohol and substance abuse-related services 

‘‘Sec. 512. Treatment of certain demonstration projects 

‘‘Sec. 513. Urban NIAAA transferred programs 

‘‘Sec. 514. Consultation with Urban Indian Organizations 

‘‘Sec. 515. Federal Tort Claim Act coverage 

‘‘Sec. 516. Urban youth treatment center demonstration 

‘‘Sec. 517. Use of Federal Government facilities and sources of supply 

‘‘Sec. 518. Grants for diabetes prevention, treatment, and control 

‘‘Sec. 519. Community health representatives 

‘‘Sec. 520. Regulations 

‘‘Sec. 521. Eligibility for services 

‘‘Sec. 522. Authorization of appropriations 

‘‘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 


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‘‘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. Inpatient and community-based mental health facilities design, construction, and staffing 

‘‘Sec. 709. Training and community education 

‘‘Sec. 710. Behavioral health program 

‘‘Sec. 711. Fetal alcohol disorder funding 

‘‘Sec. 712. Child sexual abuse and prevention treatment programs 

‘‘Sec. 713. Behavioral health research 

‘‘Sec. 714. Definitions 

‘‘Sec. 715. Authorization of appropriations 

‘‘TITLE VIII—MISCELLANEOUS 

‘‘Sec. 801. Reports 

‘‘Sec. 802. Regulations 

‘‘Sec. 803. Plan of implementation 

‘‘Sec. 804. Availability of funds 

‘‘Sec. 805. Limitation on use of funds appropriated to the Indian Health Service 

‘‘Sec. 806. Eligibility of California Indians 

‘‘Sec. 807. Health services for ineligible persons 

‘‘Sec. 808. Reallocation of base resources 

‘‘Sec. 809. Results of demonstration projects 

‘‘Sec. 810. Provision of services in Montana 

‘‘Sec. 811. Moratorium 

‘‘Sec. 812. Tribal employment 

‘‘Sec. 813. Severability provisions 

‘‘Sec. 814. Establishment of National Bipartisan Commission on Indian Health 

Care 

‘‘Sec. 815. Appropriations; availability 

‘‘Sec. 816. Authorization of appropriations 

1 ‘‘SEC. 2. FINDINGS. 

2 ‘‘Congress makes the following findings: 

3 ‘‘(1) Federal health services to maintain and 

4 improve the health of the Indians are consonant 

5 with and required by the Federal Government’s his6 torical and unique legal relationship with, and re7 sulting responsibility to, the American Indian people. 

8 ‘‘(2) A major national goal of the United States 

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1 ices which will permit the health status of Indians 

2 to be raised to the highest possible level and to en3 courage the maximum participation of Indians in the 

4 planning and management of those services. 

5 ‘‘(3) Federal health services to Indians have re6 sulted in a reduction in the prevalence and incidence 

7 of preventable illnesses among, and unnecessary and 

8 premature deaths of, Indians. 

9 ‘‘(4) Despite such services, the unmet health 

10 needs of the American Indian people are severe and 

11 the health status of the Indians is far below that of 

12 the general population of the United States. 

13 ‘‘SEC. 3. DECLARATION OF NATIONAL INDIAN HEALTH POL14 ICY. 

15 ‘‘Congress declares that it is the policy of this Nation, 

16 in fulfillment of its special trust responsibilities and legal 

17 obligations to Indians— 

18 ‘‘(1) to assure the highest possible health status 

19 for Indians and to provide all resources necessary to 

20 effect that policy; 

21 ‘‘(2) to raise the health status of Indians by the 

22 year 2010 to at least the levels set forth in the goals 

23 contained within the Healthy People 2010 or suc24 cessor objectives; 


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1 ‘‘(3) to the greatest extent possible, to allow In2 dians to set their own health care priorities and es3 tablish goals that reflect their unmet needs; 

4 ‘‘(4) to increase the proportion of all degrees in 

5 the health professions and allied and associated 

6 health professions awarded to Indians so that the 

7 proportion of Indian health professionals in each 

8 Service Area is raised to at least the level of that of 

9 the general population; 

10 ‘‘(5) to require meaningful consultation with In11 dian Tribes, Tribal Organizations, and Urban Indian 

12 Organizations to implement this Act and the na13 tional policy of Indian self-determination; and 

14 ‘‘(6) to provide funding for programs and facili15 ties operated by Indian Tribes and Tribal Organiza16 tions in amounts that are not less than the amounts 

17 provided to programs and facilities operated directly 

18 by the Service. 

19 ‘‘SEC. 4. DEFINITIONS. 

20 ‘‘For purposes of this Act: 

21 ‘‘(1) The term ‘accredited and accessible’ means 

22 on or near a reservation and accredited by a na23 tional or regional organization with accrediting au24 thority. 


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1 ‘‘(2) The term ‘Area Office’ means an adminis2 trative entity, including a program office, within the 

3 Service through which services and funds are pro4 vided to the Service Units within a defined geo5 graphic area. 

6 ‘‘(3) The term ‘Assistant Secretary’ means the 

7 Assistant Secretary of Indian Health. 

8 ‘‘(4)(A) The term ‘behavioral health’ means the 

9 blending of substance (alcohol, drugs, inhalants, and 

10 tobacco) abuse and mental health prevention and 

11 treatment, for the purpose of providing comprehen12 sive services. 

13 ‘‘(B) The term ‘behavioral health’ includes the 

14 joint development of substance abuse and mental 

15 health treatment planning and coordinated case 

16 management using a multidisciplinary approach. 

17 ‘‘(5) The term ‘California Indians’ means those 

18 Indians who are eligible for health services of the 

19 Service pursuant to section 806. 

20 ‘‘(6) The term ‘community college’ means— 

21 ‘‘(A) a tribal college or university, or 

22 ‘‘(B) a junior or community college. 

23 ‘‘(7) The term ‘contract health service’ means 

24 health services provided at the expense of the Serv25 ice or a Tribal Health Program by public or private 


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1 medical providers or hospitals, other than the Serv2 ice Unit or the Tribal Health Program at whose ex3 pense the services are provided. 

4 ‘‘(8) The term ‘Department’ means, unless oth5 erwise designated, the Department of Health and 

6 Human Services. 

7 ‘‘(9) The term ‘disease prevention’ means the 

8 reduction, limitation, and prevention of disease and 

9 its complications and reduction in the consequences 

10 of disease, including— 

11 ‘‘(A) controlling— 

12 ‘‘(i) development of diabetes; 

13 ‘‘(ii) high blood pressure; 

14 ‘‘(iii) infectious agents; 

15 ‘‘(iv) injuries; 

16 ‘‘(v) occupational hazards and disabil17 ities; 

18 ‘‘(vi) sexually transmittable diseases; 

19 and 

20 ‘‘(vii) toxic agents; and 

21 ‘‘(B) providing— 

22 ‘‘(i) fluoridation of water; and 

23 ‘‘(ii) immunizations. 

24 ‘‘(10) The term ‘health profession’ means 

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1 cine, pediatrics, geriatric medicine, obstetrics and 

2 gynecology, podiatric medicine, nursing, public 

3 health nursing, dentistry, psychiatry, osteopathy, op4 tometry, pharmacy, psychology, public health, social 

5 work, marriage and family therapy, chiropractic 

6 medicine, environmental health and engineering, al7 lied health professions, and any other health profes8 sion. 

9 ‘‘(11) The term ‘health promotion’ means— 

10 ‘‘(A) fostering social, economic, environ11 mental, and personal factors conducive to 

12 health, including raising public awareness about 

13 health matters and enabling the people to cope 

14 with health problems by increasing their knowl15 edge and providing them with valid information; 

16 ‘‘(B) encouraging adequate and appro17 priate diet, exercise, and sleep; 

18 ‘‘(C) promoting education and work in con19 formity with physical and mental capacity; 

20 ‘‘(D) making available suitable housing, 

21 safe water, and sanitary facilities; 

22 ‘‘(E) improving the physical, economic, cul23 tural, psychological, and social environment; 


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1 ‘‘(F) promoting adequate opportunity for 

2 spiritual, religious, and Traditional Health Care 

3 Practices; and 

4 ‘‘(G) providing adequate and appropriate 

5 programs, including— 

6 ‘‘(i) abuse prevention (mental and 

7 physical); 

8 ‘‘(ii) community health; 

9 ‘‘(iii) community safety; 

10 ‘‘(iv) consumer health education; 

11 ‘‘(v) diet and nutrition; 

12 ‘‘(vi) immunization and other preven13 tion of communicable diseases, including 

14 HIV/AIDS; 

15 ‘‘(vii) environmental health; 

16 ‘‘(viii) exercise and physical fitness; 

17 ‘‘(ix) avoidance of fetal alcohol dis18 orders; 

19 ‘‘(x) first aid and CPR education; 

20 ‘‘(xi) human growth and development; 

21 ‘‘(xii) injury prevention and personal 

22 safety; 

23 ‘‘(xiii) behavioral health; 

24 ‘‘(xiv) monitoring of disease indicators 

25 between health care provider visits, 


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1 through appropriate means, including 

2 Internet-based health care management 

3 systems; 

4 ‘‘(xv) personal health and wellness 

5 practices; 

6 ‘‘(xvi) personal capacity building; 

7 ‘‘(xvii) prenatal, pregnancy, and in8 fant care; 

9 ‘‘(xviii) psychological well-being; 

10 ‘‘(xix) reproductive health and family 

11 planning; 

12 ‘‘(xx) safe and adequate water; 

13 ‘‘(xxi) safe housing, relating to elimi14 nation, reduction, and prevention of con15 taminants that create unhealthy housing 

16 conditions; 

17 ‘‘(xxii) safe work environments; 

18 ‘‘(xxiii) stress control; 

19 ‘‘(xxiv) substance abuse; 

20 ‘‘(xxv) sanitary facilities; 

21 ‘‘(xxvi) sudden infant death syndrome 

22 prevention; 

23 ‘‘(xxvii) tobacco use cessation and re24 duction; 

25 ‘‘(xxviii) violence prevention; and 


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1 ‘‘(xxix) such other activities identified 

2 by the Service, a Tribal Health Program, 

3 or an Urban Indian Organization, to pro4 mote achievement of any of the objectives 

5 described in section 3(2). 

6 ‘‘(12) The term ‘Indian’, unless otherwise des7 ignated, means any person who is a member of an 

8 Indian tribe or is eligible for health services under 

9 section 806, except that, for the purpose of sections 

10 102 and 103, the term also means any individual 

11 who— 

12 ‘‘(A)(i) irrespective of whether the indi13 vidual lives on or near a reservation, is a mem14 ber of a tribe, band, or other organized group 

15 of Indians, including those tribes, bands, or 

16 groups terminated since 1940 and those recog17 nized now or in the future by the State in 

18 which they reside; or 

19 ‘‘(ii) is a descendant, in the first or second 

20 degree, of any such member; 

21 ‘‘(B) is an Eskimo or Aleut or other Alas22 ka Native; 

23 ‘‘(C) is considered by the Secretary of the 

24 Interior to be an Indian for any purpose; or 


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1 ‘‘(D) is determined be an Indian under 

2 regulations promulgated by the Secretary. 

3 ‘‘(13) The term ‘Indian Health Program’ 

4 means— 

5 ‘‘(A) any health program administered di6 rectly by the Service; 

7 ‘‘(B) any Tribal Health Program; or 

8 ‘‘(C) any Indian Tribe or Tribal Organiza9 tion to which the Secretary provides funding 

10 pursuant to section 23 of the Act of April 30, 

11 1908 (25 U.S.C. 47), commonly known as the 

12 ‘Buy Indian Act’. 

13 ‘‘(14) The term ‘Indian Tribe’ has the meaning 

14 given the term in the Indian Self-Determination and 

15 Education Assistance Act (25 U.S.C. 450 et seq.). 

16 ‘‘(15) The term ‘junior or community college’ 

17 has the meaning given the term by section 312(e) of 

18 the Higher Education Act of 1965 (20 U.S.C. 

19 1058(e)). 

20 ‘‘(16) The term ‘reservation’ means any feder21 ally recognized Indian Tribe’s reservation, Pueblo, or 

22 colony, including former reservations in Oklahoma, 

23 Indian allotments, and Alaska Native Regions estab24 lished pursuant to the Alaska Native Claims Settle25 ment Act (25 U.S.C. 1601 et seq.). 


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1 ‘‘(17) The term ‘Secretary’, unless otherwise 

2 designated, means the Secretary of Health and 

3 Human Services. 

4 ‘‘(18) The term ‘Service’ means the Indian 

5 Health Service. 

6 ‘‘(19) The term ‘Service Area’ means the geo7 graphical area served by each Area Office. 

8 ‘‘(20) The term ‘Service Unit’ means an admin9 istrative entity of the Service, or a Tribal Health 

10 Program through which services are provided, di11 rectly or by contract, to eligible Indians within a de12 fined geographic area. 

13 ‘‘(21) The term ‘telehealth’ has the meaning 

14 given the term in section 330K(a) of the Public 

15 Health Service Act (42 U.S.C. 254c–16(a)). 

16 ‘‘(22) The term ‘telemedicine’ means a tele17 communications link to an end user through the use 

18 of eligible equipment that electronically links health 

19 professionals or patients and health professionals at 

20 separate sites in order to exchange health care infor21 mation in audio, video, graphic, or other format for 

22 the purpose of providing improved health care serv23 ices. 

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1 titioners of the Native healing sciences (as opposed 

2 or in contradistinction to Western healing sciences) 

3 which embody the influences or forces of innate 

4 Tribal discovery, history, description, explanation 

5 and knowledge of the states of wellness and illness 

6 and which call upon these influences or forces, in7 cluding physical, mental, and spiritual forces in the 

8 promotion, restoration, preservation, and mainte9 nance of health, well-being, and life’s harmony. 

10 ‘‘(24) The term ‘tribal college or university’ has 

11 the meaning given the term in section 316(b)(3) of 

12 the Higher Education Act (20 U.S.C. 1059c(b)(3)). 

13 ‘‘(25) The term ‘Tribal Health Program’ means 

14 an Indian Tribe or Tribal Organization that oper15 ates any health program, service, function, activity, 

16 or facility funded, in whole or part, by the Service 

17 through, or provided for in, a contract or compact 

18 with the Service under the Indian Self-Determina19 tion and Education Assistance Act (25 U.S.C. 450 

20 et seq.). 

21 ‘‘(26) The term ‘Tribal Organization’ has the 

22 meaning given the term in the Indian Self-Deter23 mination and Education Assistance Act (25 U.S.C. 

24 450 et seq.). 


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1 ‘‘(27) The term ‘Urban Center’ means any com2 munity which has a sufficient Urban Indian popu3 lation with unmet health needs to warrant assistance 

4 under title V of this Act, as determined by the Sec5 retary. 

6 ‘‘(28) The term ‘Urban Indian’ means any indi7 vidual who resides in an Urban Center and who 

8 meets 1 or more of the following criteria: 

9 ‘‘(A) Irrespective of whether the individual 

10 lives on or near a reservation, the individual is 

11 a member of a tribe, band, or other organized 

12 group of Indians, including those tribes, bands, 

13 or groups terminated since 1940 and those 

14 tribes, bands, or groups that are recognized by 

15 the States in which they reside, or who is a de16 scendant in the first or second degree of any 

17 such member. 

18 ‘‘(B) The individual is an Eskimo, Aleut, 

19 or other Alaskan Native. 

20 ‘‘(C) The individual is considered by the 

21 Secretary of the Interior to be an Indian for 

22 any purpose. 

23 ‘‘(D) The individual is determined to be an 

24 Indian under regulations promulgated by the 

25 Secretary. 


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1 ‘‘(29) The term ‘Urban Indian Organization’ 

2 means a nonprofit corporate body that (A) is situ3 ated in an Urban Center; (B) is governed by an 

4 Urban Indian-controlled board of directors; (C) pro5 vides for the participation of all interested Indian 

6 groups and individuals; and (D) is capable of legally 

7 cooperating with other public and private entities for 

8 the purpose of performing the activities described in 

9 section 503(a). 

10 ‘‘TITLE I—INDIAN HEALTH, 

11 HUMAN RESOURCES, AND DE12 VELOPMENT 

13 ‘‘SEC. 101. PURPOSE. 

14 ‘‘The purpose of this title is to increase, to the max15 imum extent feasible, the number of Indians entering the 

16 health professions and providing health services, and to 

17 assure an optimum supply of health professionals to the 

18 Indian Health Programs and Urban Indian Organizations 

19 involved in the provision of health services to Indians. 

20 ‘‘SEC. 102. HEALTH PROFESSIONS RECRUITMENT PROGRAM 

21 FOR INDIANS. 

22 ‘‘(a) IN GENERAL.—The Secretary, acting through 

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1 grams, or Urban Indian Organizations to assist such enti2 ties in meeting the costs of— 

3 ‘‘(1) identifying Indians with a potential for 

4 education or training in the health professions and 

5 encouraging and assisting them— 

6 ‘‘(A) to enroll in courses of study in such 

7 health professions; or 

8 ‘‘(B) if they are not qualified to enroll in 

9 any such courses of study, to undertake such 

10 postsecondary education or training as may be 

11 required to qualify them for enrollment; 

12 ‘‘(2) publicizing existing sources of financial aid 

13 available to Indians enrolled in any course of study 

14 referred to in paragraph (1) or who are undertaking 

15 training necessary to qualify them to enroll in any 

16 such course of study; or 

17 ‘‘(3) establishing other programs which the Sec18 retary determines will enhance and facilitate the en19 rollment of Indians in, and the subsequent pursuit 

20 and completion by them of, courses of study referred 

21 to in paragraph (1). 

22 ‘‘(b) FUNDING.— 

23 ‘‘(1) APPLICATION.—The Secretary shall not 

24 make a grant under this section unless an applica25 tion has been submitted to, and approved by, the 


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1 Secretary. Such application shall be in such form, 

2 submitted in such manner, and contain such infor3 mation, as the Secretary shall by regulation pre4 scribe pursuant to this Act. The Secretary shall give 

5 a preference to applications submitted by Tribal 

6 Health Programs or Urban Indian Organizations. 

7 ‘‘(2) AMOUNT OF FUNDS; PAYMENT.—The 

8 amount of a grant under this section shall be deter9 mined by the Secretary. Payments pursuant to this 

10 section may be made in advance or by way of reim11 bursement, and at such intervals and on such condi12 tions as provided for in regulations issued pursuant 

13 to this Act. To the extent not otherwise prohibited 

14 by law, funding commitments shall be for 3 years, 

15 as provided in regulations issued pursuant to this 

16 Act. 

17 ‘‘SEC. 103. HEALTH PROFESSIONS PREPARATORY SCHOL18 ARSHIP PROGRAM FOR INDIANS. 

19 ‘‘(a) SCHOLARSHIPS AUTHORIZED.—The Secretary, 

20 acting through the Service, shall provide scholarship 

21 grants to Indians who— 

22 ‘‘(1) have successfully completed their high 

23 school education or high school equivalency; and 


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1 ‘‘(2) have demonstrated the potential to suc2 cessfully complete courses of study in the health pro3 fessions. 

4 ‘‘(b) PURPOSES.—Scholarships provided pursuant to 

5 this section shall be for the following purposes: 

6 ‘‘(1) Compensatory preprofessional education of 

7 any recipient, such scholarship not to exceed 2 years 

8 on a full-time basis (or the part-time equivalent 

9 thereof, as determined by the Secretary pursuant to 

10 regulations issued under this Act). 

11 ‘‘(2) Pregraduate education of any recipient 

12 leading to a baccalaureate degree in an approved 

13 course of study preparatory to a field of study in a 

14 health profession, such scholarship not to exceed 4 

15 years. An extension of up to 2 years (or the part16 time equivalent thereof, as determined by the Sec17 retary pursuant to regulations issued pursuant to 

18 this Act) may be approved. 

19 ‘‘(c) OTHER CONDITIONS.—Scholarships under this 

20 section— 

21 ‘‘(1) may cover costs of tuition, books, trans22 portation, board, and other necessary related ex23 penses of a recipient while attending school; 

24 ‘‘(2) shall not be denied solely on the basis of 

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1 cant has been admitted to, or maintained good 

2 standing at, an accredited institution; and 

3 ‘‘(3) shall not be denied solely by reason of such 

4 applicant’s eligibility for assistance or benefits under 

5 any other Federal program. 

6 ‘‘SEC. 104. INDIAN HEALTH PROFESSIONS SCHOLARSHIPS. 

7 ‘‘(a) IN GENERAL.— 

8 ‘‘(1) AUTHORITY.—The Secretary, acting 

9 through the Service, shall make scholarship grants 

10 to Indians who are enrolled full or part time in ac11 credited schools pursuing courses of study in the 

12 health professions. Such scholarships shall be des13 ignated Indian Health Scholarships and shall be 

14 made in accordance with section 338A of the Public 

15 Health Services Act (42 U.S.C. 2541), except as 

16 provided in subsection (b) of this section. 

17 ‘‘(2) ALLOCATION BY FORMULA.—Except as 

18 provided in paragraph (3), the funding authorized 

19 by this section shall be allocated by Service Area by 

20 a formula developed in consultation with Indian 

21 Tribes, Tribal Organizations, and Urban Indian Or22 ganizations. Such formula shall consider the human 

23 resource development needs in each Service Area. 

24 ‘‘(3) CONTINUITY OF PRIOR SCHOLARSHIPS.— 

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1 vidual recipients of scholarships provided under this 

2 section (as in effect 1 day prior to the date of enact3 ment of the Indian Health Care Improvement Act 

4 Amendments of 2005) until such time as the indi5 vidual completes the course of study that is sup6 ported through such scholarship. 

7 ‘‘(4) CERTAIN DELEGATION NOT ALLOWED.— 

8 The administration of this section shall be a respon9 sibility of the Assistant Secretary and shall not be 

10 delegated in a contract or compact under the Indian 

11 Self-Determination and Education Assistance Act 

12 (25 U.S.C. 450 et seq.). 

13 ‘‘(b) ACTIVE DUTY SERVICE OBLIGATION.— 

14 ‘‘(1) OBLIGATION MET.—The active duty serv15 ice obligation under a written contract with the Sec16 retary under section 338A of the Public Health 

17 Service Act (42 U.S.C. 254l) that an Indian has en18 tered into under that section shall, if that individual 

19 is a recipient of an Indian Health Scholarship, be 

20 met in full-time practice on an equivalent year-for21 year obligation, by service in one or more of the fol22 lowing: 

23 ‘‘(A) In an Indian Health Program. 

24 ‘‘(B) In a program assisted under title V 

25 of this Act. 


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1 ‘‘(C) In the private practice of the applica2 ble profession if, as determined by the Sec3 retary, in accordance with guidelines promul4 gated by the Secretary, such practice is situated 

5 in a physician or other health professional 

6 shortage area and addresses the health care 

7 needs of a substantial number of Indians. 

8 ‘‘(2) OBLIGATION DEFERRED.—At the request 

9 of any individual who has entered into a contract re10 ferred to in paragraph (1) and who receives a degree 

11 in medicine (including osteopathic or allopathic med12 icine), dentistry, optometry, podiatry, or pharmacy, 

13 the Secretary shall defer the active duty service obli14 gation of that individual under that contract, in 

15 order that such individual may complete any intern16 ship, residency, or other advanced clinical training 

17 that is required for the practice of that health pro18 fession, for an appropriate period (in years, as deter19 mined by the Secretary), subject to the following 

20 conditions: 

21 ‘‘(A) No period of internship, residency, or 

22 other advanced clinical training shall be counted 

23 as satisfying any period of obligated service 

24 under this subsection. 


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1 ‘‘(B) The active duty service obligation of 

2 that individual shall commence not later than 

3 90 days after the completion of that advanced 

4 clinical training (or by a date specified by the 

5 Secretary). 

6 ‘‘(C) The active duty service obligation will 

7 be served in the health profession of that indi8 vidual in a manner consistent with paragraph 

9 (1). 

10 ‘‘(D) A recipient of a scholarship under 

11 this section may, at the election of the recipient, 

12 meet the active duty service obligation described 

13 in paragraph (1) by service in a program speci14 fied under that paragraph that— 

15 ‘‘(i) is located on the reservation of 

16 the Indian Tribe in which the recipient is 

17 enrolled; or 

18 ‘‘(ii) serves the Indian Tribe in which 

19 the recipient is enrolled. 

20 ‘‘(3) PRIORITY WHEN MAKING ASSIGNMENTS.— 

21 Subject to paragraph (2), the Secretary, in making 

22 assignments of Indian Health Scholarship recipients 

23 required to meet the active duty service obligation 

24 described in paragraph (1), shall give priority to as25 signing individuals to service in those programs 


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1 specified in paragraph (1) that have a need for 

2 health professionals to provide health care services 

3 as a result of individuals having breached contracts 

4 entered into under this section. 

5 ‘‘(c) PART-TIME STUDENTS.—In the case of an indi6 vidual receiving a scholarship under this section who is 

7 enrolled part time in an approved course of study— 

8 ‘‘(1) such scholarship shall be for a period of 

9 years not to exceed the part-time equivalent of 4 

10 years, as determined by the Area Office; 

11 ‘‘(2) the period of obligated service described in 

12 subsection (b)(1) shall be equal to the greater of— 

13 ‘‘(A) the part-time equivalent of 1 year for 

14 each year for which the individual was provided 

15 a scholarship (as determined by the Area Of16 fice); or 

17 ‘‘(B) 2 years; and 

18 ‘‘(3) the amount of the monthly stipend speci19 fied in section 338A(g)(1)(B) of the Public Health 

20 Service Act (42 U.S.C. 254l(g)(1)(B)) shall be re21 duced pro rata (as determined by the Secretary) 

22 based on the number of hours such student is en23 rolled. 

24 ‘‘(d) BREACH OF CONTRACT.— 


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1 ‘‘(1) SPECIFIED BREACHES.—An individual 

2 shall be liable to the United States for the amount 

3 which has been paid to the individual, or on behalf 

4 of the individual, under a contract entered into with 

5 the Secretary under this section on or after the date 

6 of enactment of the Indian Health Care Improve7 ment Act Amendments of 2005 if that individual— 

8 ‘‘(A) fails to maintain an acceptable level 

9 of academic standing in the educational institu10 tion in which he or she is enrolled (such level 

11 determined by the educational institution under 

12 regulations of the Secretary); 

13 ‘‘(B) is dismissed from such educational 

14 institution for disciplinary reasons; 

15 ‘‘(C) voluntarily terminates the training in 

16 such an educational institution for which he or 

17 she is provided a scholarship under such con18 tract before the completion of such training; or 

19 ‘‘(D) fails to accept payment, or instructs 

20 the educational institution in which he or she is 

21 enrolled not to accept payment, in whole or in 

22 part, of a scholarship under such contract, in 

23 lieu of any service obligation arising under such 

24 contract. 


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1 ‘‘(2) OTHER BREACHES.—If for any reason not 

2 specified in paragraph (1) an individual breaches a 

3 written contract by failing either to begin such indi4 vidual’s service obligation required under such con5 tract or to complete such service obligation, the 

6 United States shall be entitled to recover from the 

7 individual an amount determined in accordance with 

8 the formula specified in subsection (l) of section 110 

9 in the manner provided for in such subsection. 

10 ‘‘(3) CANCELLATION UPON DEATH OF RECIPI11 ENT.—Upon the death of an individual who receives 

12 an Indian Health Scholarship, any outstanding obli13 gation of that individual for service or payment that 

14 relates to that scholarship shall be canceled. 

15 ‘‘(4) WAIVERS AND SUSPENSIONS.—The Sec16 retary shall provide for the partial or total waiver or 

17 suspension of any obligation of service or payment of 

18 a recipient of an Indian Health Scholarship if the 

19 Secretary, in consultation with the affected Area Of20 fice, Indian Tribes, Tribal Organizations, and Urban 

21 Indian Organizations, determines that— 

22 ‘‘(A) it is not possible for the recipient to 

23 meet that obligation or make that payment; 


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1 ‘‘(B) requiring that recipient to meet that 

2 obligation or make that payment would result 

3 in extreme hardship to the recipient; or 

4 ‘‘(C) the enforcement of the requirement to 

5 meet the obligation or make the payment would 

6 be unconscionable. 

7 ‘‘(5) EXTREME HARDSHIP.—Notwithstanding 

8 any other provision of law, in any case of extreme 

9 hardship or for other good cause shown, the Sec10 retary may waive, in whole or in part, the right of 

11 the United States to recover funds made available 

12 under this section. 

13 ‘‘(6) BANKRUPTCY.—Notwithstanding any 

14 other provision of law, with respect to a recipient of 

15 an Indian Health Scholarship, no obligation for pay16 ment may be released by a discharge in bankruptcy 

17 under title 11, United States Code, unless that dis18 charge is granted after the expiration of the 5-year 

19 period beginning on the initial date on which that 

20 payment is due, and only if the bankruptcy court 

21 finds that the nondischarge of the obligation would 

22 be unconscionable. 


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1 ‘‘SEC. 105. AMERICAN INDIANS INTO PSYCHOLOGY PRO2 GRAM. 

3 ‘‘(a) GRANTS AUTHORIZED.—The Secretary, acting 

4 through the Service, shall make grants to at least 3 col5 leges and universities for the purpose of developing and 

6 maintaining Indian psychology career recruitment pro7 grams as a means of encouraging Indians to enter the 

8 mental health field. These programs shall be located at 

9 various locations throughout the country to maximize their 

10 availability to Indian students and new programs shall be 

11 established in different locations from time to time. 

12 ‘‘(b) QUENTIN N. BURDICK PROGRAM GRANT.—The 

13 Secretary shall provide a grant authorized under sub14 section (a) to develop and maintain a program at the Uni15 versity of North Dakota to be known as the ‘Quentin N. 

16 Burdick American Indians Into Psychology Program’. 

17 Such program shall, to the maximum extent feasible, co18 ordinate with the Quentin N. Burdick Indian Health Pro19 grams authorized under section 117(b), the Quentin N. 

20 Burdick American Indians Into Nursing Program author21 ized under section 115(e), and existing university research 

22 and communications networks. 

23 ‘‘(c) REGULATIONS.—The Secretary shall issue regu24 lations pursuant to this Act for the competitive awarding 

25 of grants provided under this section. 


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1 ‘‘(d) CONDITIONS OF GRANT.—Applicants under this 

2 section shall agree to provide a program which, at a min3 imum— 

4 ‘‘(1) provides outreach and recruitment for 

5 health professions to Indian communities including 

6 elementary, secondary, and accredited and accessible 

7 community colleges that will be served by the pro8 gram; 

9 ‘‘(2) incorporates a program advisory board 

10 comprised of representatives from the tribes and 

11 communities that will be served by the program; 

12 ‘‘(3) provides summer enrichment programs to 

13 expose Indian students to the various fields of psy14 chology through research, clinical, and experimental 

15 activities; 

16 ‘‘(4) provides stipends to undergraduate and 

17 graduate students to pursue a career in psychology; 

18 ‘‘(5) develops affiliation agreements with tribal 

19 colleges and universities, the Service, university af20 filiated programs, and other appropriate accredited 

21 and accessible entities to enhance the education of 

22 Indian students; 

23 ‘‘(6) to the maximum extent feasible, uses exist24 ing university tutoring, counseling, and student sup25 port services; and 


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1 ‘‘(7) to the maximum extent feasible, employs 

2 qualified Indians in the program. 

3 ‘‘(e) ACTIVE DUTY SERVICE REQUIREMENT.—The 

4 active duty service obligation prescribed under section 

5 338C of the Public Health Service Act (42 U.S.C. 254m) 

6 shall be met by each graduate who receives a stipend de7 scribed in subsection (d)(4) that is funded under this sec8 tion. Such obligation shall be met by service— 

9 ‘‘(1) in an Indian Health Program; 

10 ‘‘(2) in a program assisted under title V of this 

11 Act; or 

12 ‘‘(3) in the private practice of psychology if, as 

13 determined by the Secretary, in accordance with 

14 guidelines promulgated by the Secretary, such prac15 tice is situated in a physician or other health profes16 sional shortage area and addresses the health care 

17 needs of a substantial number of Indians. 

18 ‘‘SEC. 106. FUNDING FOR TRIBES FOR SCHOLARSHIP PRO19 GRAMS. 

20 ‘‘(a) IN GENERAL.— 

21 ‘‘(1) GRANTS AUTHORIZED.—The Secretary, 

22 acting through the Service, shall make grants to 

23 Tribal Health Programs for the purpose of providing 

24 scholarships for Indians to serve as health profes25 sionals in Indian communities. 


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1 ‘‘(2) AMOUNT.—Amounts available under para2 graph (1) for any fiscal year shall not exceed 5 per3 cent of the amounts available for each fiscal year for 

4 Indian Health Scholarships under section 104. 

5 ‘‘(3) APPLICATION.—An application for a grant 

6 under paragraph (1) shall be in such form and con7 tain such agreements, assurances, and information 

8 as consistent with this section. 

9 ‘‘(b) REQUIREMENTS.— 

10 ‘‘(1) IN GENERAL.—A Tribal Health Program 

11 receiving a grant under subsection (a) shall provide 

12 scholarships to Indians in accordance with the re13 quirements of this section. 

14 ‘‘(2) COSTS.—With respect to costs of providing 

15 any scholarship pursuant to subsection (a)— 

16 ‘‘(A) 80 percent of the costs of the scholar17 ship shall be paid from the funds made avail18 able pursuant to subsection (a)(1) provided to 

19 the Tribal Health Program; and 

20 ‘‘(B) 20 percent of such costs may be paid 

21 from any other source of funds. 

22 ‘‘(c) COURSE OF STUDY.—A Tribal Health Program 

23 shall provide scholarships under this section only to Indi24 ans enrolled or accepted for enrollment in a course of 


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1 study (approved by the Secretary) in one of the health pro2 fessions contemplated by this Act. 

3 ‘‘(d) CONTRACT.—In providing scholarships under 

4 subsection (b), the Secretary and the Tribal Health Pro5 gram shall enter into a written contract with each recipi6 ent of such scholarship. Such contract shall— 

7 ‘‘(1) obligate such recipient to provide service in 

8 an Indian Health Program or Urban Indian Organi9 zation, in the same Service Area where the Tribal 

10 Health Program providing the scholarship is located, 

11 for— 

12 ‘‘(A) a number of years for which the 

13 scholarship is provided (or the part-time equiva14 lent thereof, as determined by the Secretary), 

15 or for a period of 2 years, whichever period is 

16 greater; or 

17 ‘‘(B) such greater period of time as the re18 cipient and the Tribal Health Program may 

19 agree; 

20 ‘‘(2) provide that the amount of the scholar21 ship— 

22 ‘‘(A) may only be expended for— 

23 ‘‘(i) tuition expenses, other reasonable 

24 educational expenses, and reasonable living 


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1 expenses incurred in attendance at the 

2 educational institution; and 

3 ‘‘(ii) payment to the recipient of a 

4 monthly stipend of not more than the 

5 amount authorized by section 338(g)(1)(B) 

6 of the Public Health Service Act (42 

7 U.S.C. 254m(g)(1)(B)), with such amount 

8 to be reduced pro rata (as determined by 

9 the Secretary) based on the number of 

10 hours such student is enrolled, and not to 

11 exceed, for any year of attendance for 

12 which the scholarship is provided, the total 

13 amount required for the year for the pur14 poses authorized in this clause; and 

15 ‘‘(B) may not exceed, for any year of at16 tendance for which the scholarship is provided, 

17 the total amount required for the year for the 

18 purposes authorized in subparagraph (A); 

19 ‘‘(3) require the recipient of such scholarship to 

20 maintain an acceptable level of academic standing as 

21 determined by the educational institution in accord22 ance with regulations issued pursuant to this Act; 

23 and 


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1 ‘‘(4) require the recipient of such scholarship to 

2 meet the educational and licensure requirements ap3 propriate to each health profession. 

4 ‘‘(e) BREACH OF CONTRACT.— 

5 ‘‘(1) SPECIFIC BREACHES.—An individual who 

6 has entered into a written contract with the Sec7 retary and a Tribal Health Program under sub8 section (d) shall be liable to the United States for 

9 the Federal share of the amount which has been 

10 paid to him or her, or on his or her behalf, under 

11 the contract if that individual— 

12 ‘‘(A) fails to maintain an acceptable level 

13 of academic standing in the educational institu14 tion in which he or she is enrolled (such level 

15 as determined by the educational institution 

16 under regulations of the Secretary); 

17 ‘‘(B) is dismissed from such educational 

18 institution for disciplinary reasons; 

19 ‘‘(C) voluntarily terminates the training in 

20 such an educational institution for which he or 

21 she is provided a scholarship under such con22 tract before the completion of such training; or 

23 ‘‘(D) fails to accept payment, or instructs 

24 the educational institution in which he or she is 

25 enrolled not to accept payment, in whole or in 


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1 part, of a scholarship under such contract, in 

2 lieu of any service obligation arising under such 

3 contract. 

4 ‘‘(2) OTHER BREACHES.—If for any reason not 

5 specified in paragraph (1), an individual breaches a 

6 written contract by failing to either begin such indi7 vidual’s service obligation required under such con8 tract or to complete such service obligation, the 

9 United States shall be entitled to recover from the 

10 individual an amount determined in accordance with 

11 the formula specified in subsection (l) of section 110 

12 in the manner provided for in such subsection. 

13 ‘‘(3) CANCELLATION UPON DEATH OF RECIPI14 ENT.—Upon the death of an individual who receives 

15 an Indian Health Scholarship, any outstanding obli16 gation of that individual for service or payment that 

17 relates to that scholarship shall be canceled. 

18 ‘‘(4) INFORMATION.—The Secretary may carry 

19 out this subsection on the basis of information re20 ceived from Tribal Health Programs involved or on 

21 the basis of information collected through such other 

22 means as the Secretary deems appropriate. 

23 ‘‘(f) RELATION TO SOCIAL SECURITY ACT.—The re24 cipient of a scholarship under this section shall agree, in 


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1 providing health care pursuant to the requirements here2 in— 

3 ‘‘(1) not to discriminate against an individual 

4 seeking care on the basis of the ability of the indi5 vidual to pay for such care or on the basis that pay6 ment for such care will be made pursuant to a pro7 gram established in title XVIII of the Social Secu8 rity Act or pursuant to the programs established in 

9 title XIX or title XXI of such Act; and 

10 ‘‘(2) to accept assignment under section 

11 1842(b)(3)(B)(ii) of the Social Security Act for all 

12 services for which payment may be made under part 

13 B of title XVIII of such Act, and to enter into an 

14 appropriate agreement with the State agency that 

15 administers the State plan for medical assistance 

16 under title XIX, or the State child health plan under 

17 title XXI, of such Act to provide service to individ18 uals entitled to medical assistance or child health as19 sistance, respectively, under the plan. 

20 ‘‘(g) CONTINUANCE OF FUNDING.—The Secretary 

21 shall make payments under this section to a Tribal Health 

22 Program for any fiscal year subsequent to the first fiscal 

23 year of such payments unless the Secretary determines 

24 that, for the immediately preceding fiscal year, the Tribal 


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1 Health Program has not complied with the requirements 

2 of this section. 

3 ‘‘SEC. 107. INDIAN HEALTH SERVICE EXTERN PROGRAMS. 

4 ‘‘(a) EMPLOYMENT PREFERENCE.—Any individual 

5 who receives a scholarship pursuant to section 104 or 106 

6 shall be given preference for employment in the Service, 

7 or may be employed by a Tribal Health Program or an 

8 Urban Indian Organization, or other agencies of the De9 partment as available, during any nonacademic period of 

10 the year. 

11 ‘‘(b) NOT COUNTED TOWARD ACTIVE DUTY SERVICE

12 OBLIGATION.—Periods of employment pursuant to this 

13 subsection shall not be counted in determining fulfillment 

14 of the service obligation incurred as a condition of the 

15 scholarship. 

16 ‘‘(c) TIMING; LENGTH OF EMPLOYMENT.—Any indi17 vidual enrolled in a program, including a high school pro18 gram, authorized under section 102(a) may be employed 

19 by the Service or by a Tribal Health Program or an Urban 

20 Indian Organization during any nonacademic period of the 

21 year. Any such employment shall not exceed 120 days dur22 ing any calendar year. 

23 ‘‘(d) NONAPPLICABILITY OF COMPETITIVE PER24 SONNEL SYSTEM.—Any employment pursuant to this sec25 tion shall be made without regard to any competitive perVerDate Aug 31 2005 05:25 Mar 17, 2006 Jkt 049200 PO 00000 Frm 00039 Fmt 6652 Sfmt 6401 E:\BILLS\S1057.RS S1057

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1 sonnel system or agency personnel limitation and to a po2 sition which will enable the individual so employed to re3 ceive practical experience in the health profession in which 

4 he or she is engaged in study. Any individual so employed 

5 shall receive payment for his or her services comparable 

6 to the salary he or she would receive if he or she were 

7 employed in the competitive system. Any individual so em8 ployed shall not be counted against any employment ceil9 ing affecting the Service or the Department. 

10 ‘‘SEC. 108. CONTINUING EDUCATION ALLOWANCES. 

11 ‘‘In order to encourage health professionals, including 

12 community health representatives and emergency medical 

13 technicians, to join or continue in an Indian Health Pro14 gram or an Urban Indian Organization and to provide 

15 their services in the rural and remote areas where a sig16 nificant portion of Indians reside, the Secretary, acting 

17 through the Service, may provide allowances to health pro18 fessionals employed in an Indian Health Program or an 

19 Urban Indian Organization to enable them for a period 

20 of time each year prescribed by regulation of the Secretary 

21 to take leave of their duty stations for professional con22 sultation and refresher training courses. 


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1 ‘‘SEC. 109. COMMUNITY HEALTH REPRESENTATIVE PRO2 GRAM. 

3 ‘‘(a) IN GENERAL.—Under the authority of the Act 

4 of November 2, 1921 (25 U.S.C. 13) (commonly known 

5 as the ‘Snyder Act’), the Secretary, acting through the 

6 Service, shall maintain a Community Health Representa7 tive Program under which Indian Health Programs— 

8 ‘‘(1) provide for the training of Indians as com9 munity health representatives; and 

10 ‘‘(2) use such community health representatives 

11 in the provision of health care, health promotion, 

12 and disease prevention services to Indian commu13 nities. 

14 ‘‘(b) DUTIES.—The Community Health Representa15 tive Program of the Service, shall— 

16 ‘‘(1) provide a high standard of training for 

17 community health representatives to ensure that the 

18 community health representatives provide quality 

19 health care, health promotion, and disease preven20 tion services to the Indian communities served by 

21 the Program; 

22 ‘‘(2) in order to provide such training, develop 

23 and maintain a curriculum that— 

24 ‘‘(A) combines education in the theory of 

25 health care with supervised practical experience 

26 in the provision of health care; and 


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1 ‘‘(B) provides instruction and practical ex2 perience in health promotion and disease pre3 vention activities, with appropriate consider4 ation given to lifestyle factors that have an im5 pact on Indian health status, such as alco6 holism, family dysfunction, and poverty; 

7 ‘‘(3) maintain a system which identifies the 

8 needs of community health representatives for con9 tinuing education in health care, health promotion, 

10 and disease prevention and develop programs that 

11 meet the needs for continuing education; 

12 ‘‘(4) maintain a system that provides close su13 pervision of Community Health Representatives; 

14 ‘‘(5) maintain a system under which the work 

15 of Community Health Representatives is reviewed 

16 and evaluated; and 

17 ‘‘(6) promote Traditional Health Care Practices 

18 of the Indian Tribes served consistent with the Serv19 ice standards for the provision of health care, health 

20 promotion, and disease prevention. 

21 ‘‘SEC. 110. INDIAN HEALTH SERVICE LOAN REPAYMENT 

22 PROGRAM. 

23 ‘‘(a) ESTABLISHMENT.—The Secretary, acting 

24 through the Service, shall establish and administer a pro25 gram to be known as the Service Loan Repayment ProVerDate Aug 31 2005 05:25 Mar 17, 2006 Jkt 049200 PO 00000 Frm 00042 Fmt 6652 Sfmt 6401 E:\BILLS\S1057.RS S1057

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1 gram (hereinafter referred to as the ‘Loan Repayment 

2 Program’) in order to ensure an adequate supply of 

3 trained health professionals necessary to maintain accredi4 tation of, and provide health care services to Indians 

5 through, Indian Health Programs and Urban Indian Or6 ganizations. 

7 ‘‘(b) ELIGIBLE INDIVIDUALS.—To be eligible to par8 ticipate in the Loan Repayment Program, an individual 

9 must— 

10 ‘‘(1)(A) be enrolled— 

11 ‘‘(i) in a course of study or program in an 

12 accredited educational institution (as deter13 mined by the Secretary under section 

14 338B(b)(1)(c)(i) of the Public Health Service 

15 Act (42 U.S.C. 254l–1(b)(1)(c)(i))) and be 

16 scheduled to complete such course of study in 

17 the same year such individual applies to partici18 pate in such program; or 

19 ‘‘(ii) in an approved graduate training pro20 gram in a health profession; or 

21 ‘‘(B) have— 

22 ‘‘(i) a degree in a health profession; and 

23 ‘‘(ii) a license to practice a health profes24 sion; 


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1 ‘‘(2)(A) be eligible for, or hold, an appointment 

2 as a commissioned officer in the Regular or Reserve 

3 Corps of the Public Health Service; 

4 ‘‘(B) be eligible for selection for civilian service 

5 in the Regular or Reserve Corps of the Public 

6 Health Service; 

7 ‘‘(C) meet the professional standards for civil 

8 service employment in the Service; or 

9 ‘‘(D) be employed in an Indian Health Program 

10 or Urban Indian Organization without a service obli11 gation; and 

12 ‘‘(3) submit to the Secretary an application for 

13 a contract described in subsection (e). 

14 ‘‘(c) APPLICATION.— 

15 ‘‘(1) INFORMATION TO BE INCLUDED WITH

16 FORMS.—In disseminating application forms and 

17 contract forms to individuals desiring to participate 

18 in the Loan Repayment Program, the Secretary 

19 shall include with such forms a fair summary of the 

20 rights and liabilities of an individual whose applica21 tion is approved (and whose contract is accepted) by 

22 the Secretary, including in the summary a clear ex23 planation of the damages to which the United States 

24 is entitled under subsection (l) in the case of the in25 dividual’s breach of contract. The Secretary shall 


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1 provide such individuals with sufficient information 

2 regarding the advantages and disadvantages of serv3 ice as a commissioned officer in the Regular or Re4 serve Corps of the Public Health Service or a civil5 ian employee of the Service to enable the individual 

6 to make a decision on an informed basis. 

7 ‘‘(2) CLEAR LANGUAGE.—The application form, 

8 contract form, and all other information furnished 

9 by the Secretary under this section shall be written 

10 in a manner calculated to be understood by the aver11 age individual applying to participate in the Loan 

12 Repayment Program. 

13 ‘‘(3) TIMELY AVAILABILITY OF FORMS.—The 

14 Secretary shall make such application forms, con15 tract forms, and other information available to indi16 viduals desiring to participate in the Loan Repay17 ment Program on a date sufficiently early to ensure 

18 that such individuals have adequate time to carefully 

19 review and evaluate such forms and information. 

20 ‘‘(d) PRIORITIES.— 

21 ‘‘(1) LIST.—Consistent with subsection (k), the 

22 Secretary shall annually— 

23 ‘‘(A) identify the positions in each Indian 

24 Health Program or Urban Indian Organization 

25 for which there is a need or a vacancy; and 


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1 ‘‘(B) rank those positions in order of pri2 ority. 

3 ‘‘(2) APPROVALS.—Notwithstanding the pri4 ority determined under paragraph (1), the Secretary, 

5 in determining which applications under the Loan 

6 Repayment Program to approve (and which con7 tracts to accept), shall— 

8 ‘‘(A) give first priority to applications 

9 made by individual Indians; and 

10 ‘‘(B) after making determinations on all 

11 applications submitted by individual Indians as 

12 required under subparagraph (A), give priority 

13 to— 

14 ‘‘(i) individuals recruited through the 

15 efforts of an Indian Health Program or 

16 Urban Indian Organization; and 

17 ‘‘(ii) other individuals based on the 

18 priority rankings under paragraph (1). 

19 ‘‘(e) RECIPIENT CONTRACTS.— 

20 ‘‘(1) CONTRACT REQUIRED.—An individual be21 comes a participant in the Loan Repayment Pro22 gram only upon the Secretary and the individual en23 tering into a written contract described in paragraph 

24 (2). 


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1 ‘‘(2) CONTENTS OF CONTRACT.—The written 

2 contract referred to in this section between the Sec3 retary and an individual shall contain— 

4 ‘‘(A) an agreement under which— 

5 ‘‘(i) subject to subparagraph (C), the 

6 Secretary agrees— 

7 ‘‘(I) to pay loans on behalf of the 

8 individual in accordance with the pro9 visions of this section; and 

10 ‘‘(II) to accept (subject to the 

11 availability of appropriated funds for 

12 carrying out this section) the indi13 vidual into the Service or place the in14 dividual with a Tribal Health Pro15 gram or Urban Indian Organization 

16 as provided in clause (ii)(III); and 

17 ‘‘(ii) subject to subparagraph (C), the 

18 individual agrees— 

19 ‘‘(I) to accept loan payments on 

20 behalf of the individual; 

21 ‘‘(II) in the case of an individual 

22 described in subsection (b)(1)— 

23 ‘‘(aa) to maintain enrollment 

24 in a course of study or training 

25 described in subsection (b)(1)(A) 


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1 until the individual completes the 

2 course of study or training; and 

3 ‘‘(bb) while enrolled in such 

4 course of study or training, to 

5 maintain an acceptable level of 

6 academic standing (as deter7 mined under regulations of the 

8 Secretary by the educational in9 stitution offering such course of 

10 study or training); and 

11 ‘‘(III) to serve for a time period 

12 (hereinafter in this section referred to 

13 as the ‘period of obligated service’) 

14 equal to 2 years or such longer period 

15 as the individual may agree to serve 

16 in the full-time clinical practice of 

17 such individual’s profession in an In18 dian Health Program or Urban In19 dian Organization to which the indi20 vidual may be assigned by the Sec21 retary; 

22 ‘‘(B) a provision permitting the Secretary 

23 to extend for such longer additional periods, as 

24 the individual may agree to, the period of obliVerDate Aug 31 2005 05:25 Mar 17, 2006 Jkt 049200 PO 00000 Frm 00048 Fmt 6652 Sfmt 6401 E:\BILLS\S1057.RS S1057

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1 gated service agreed to by the individual under 

2 subparagraph (A)(ii)(III); 

3 ‘‘(C) a provision that any financial obliga4 tion of the United States arising out of a con5 tract entered into under this section and any 

6 obligation of the individual which is conditioned 

7 thereon is contingent upon funds being appro8 priated for loan repayments under this section; 

9 ‘‘(D) a statement of the damages to which 

10 the United States is entitled under subsection 

11 (l) for the individual’s breach of the contract; 

12 and 

13 ‘‘(E) such other statements of the rights 

14 and liabilities of the Secretary and of the indi15 vidual, not inconsistent with this section. 

16 ‘‘(f) DEADLINE FOR DECISION ON APPLICATION.— 

17 The Secretary shall provide written notice to an individual 

18 within 21 days on— 

19 ‘‘(1) the Secretary’s approving, under sub20 section (e)(1), of the individual’s participation in the 

21 Loan Repayment Program, including extensions re22 sulting in an aggregate period of obligated service in 

23 excess of 4 years; or 

24 ‘‘(2) the Secretary’s disapproving an individ25 ual’s participation in such Program. 


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1 ‘‘(g) PAYMENTS.— 

2 ‘‘(1) IN GENERAL.—A loan repayment provided 

3 for an individual under a written contract under the 

4 Loan Repayment Program shall consist of payment, 

5 in accordance with paragraph (2), on behalf of the 

6 individual of the principal, interest, and related ex7 penses on government and commercial loans received 

8 by the individual regarding the undergraduate or 

9 graduate education of the individual (or both), which 

10 loans were made for— 

11 ‘‘(A) tuition expenses; 

12 ‘‘(B) all other reasonable educational ex13 penses, including fees, books, and laboratory ex14 penses, incurred by the individual; and 

15 ‘‘(C) reasonable living expenses as deter16 mined by the Secretary. 

17 ‘‘(2) AMOUNT.—For each year of obligated 

18 service that an individual contracts to serve under 

19 subsection (e), the Secretary may pay up to $35,000 

20 or an amount equal to the amount specified in sec21 tion 338B(g)(2)(A) of the Public Health Service 

22 Act, whichever is more, on behalf of the individual 

23 for loans described in paragraph (1). In making a 

24 determination of the amount to pay for a year of 

25 such service by an individual, the Secretary shall 


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1 consider the extent to which each such determina2 tion— 

3 ‘‘(A) affects the ability of the Secretary to 

4 maximize the number of contracts that can be 

5 provided under the Loan Repayment Program 

6 from the amounts appropriated for such con7 tracts; 

8 ‘‘(B) provides an incentive to serve in In9 dian Health Programs and Urban Indian Orga10 nizations with the greatest shortages of health 

11 professionals; and 

12 ‘‘(C) provides an incentive with respect to 

13 the health professional involved remaining in an 

14 Indian Health Program or Urban Indian Orga15 nization with such a health professional short16 age, and continuing to provide primary health 

17 services, after the completion of the period of 

18 obligated service under the Loan Repayment 

19 Program. 

20 ‘‘(3) TIMING.—Any arrangement made by the 

21 Secretary for the making of loan repayments in ac22 cordance with this subsection shall provide that any 

23 repayments for a year of obligated service shall be 

24 made no later than the end of the fiscal year in 

25 which the individual completes such year of service. 


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1 ‘‘(4) REIMBURSEMENTS FOR TAX LIABILITY.— 

2 For the purpose of providing reimbursements for tax 

3 liability resulting from a payment under paragraph 

4 (2) on behalf of an individual, the Secretary— 

5 ‘‘(A) in addition to such payments, may 

6 make payments to the individual in an amount 

7 equal to not less than 20 percent and not more 

8 than 39 percent of the total amount of loan re9 payments made for the taxable year involved; 

10 and 

11 ‘‘(B) may make such additional payments 

12 as the Secretary determines to be appropriate 

13 with respect to such purpose. 

14 ‘‘(5) PAYMENT SCHEDULE.—The Secretary 

15 may enter into an agreement with the holder of any 

16 loan for which payments are made under the Loan 

17 Repayment Program to establish a schedule for the 

18 making of such payments. 

19 ‘‘(h) EMPLOYMENT CEILING.—Notwithstanding any 

20 other provision of law, individuals who have entered into 

21 written contracts with the Secretary under this section 

22 shall not be counted against any employment ceiling af23 fecting the Department while those individuals are under24 going academic training. 


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1 ‘‘(i) RECRUITMENT.—The Secretary shall conduct re2 cruiting programs for the Loan Repayment Program and 

3 other Service manpower programs of the Service at edu4 cational institutions training health professionals or spe5 cialists identified in subsection (a). 

6 ‘‘(j) APPLICABILITY OF LAW.—Section 214 of the 

7 Public Health Service Act (42 U.S.C. 215) shall not apply 

8 to individuals during their period of obligated service 

9 under the Loan Repayment Program. 

10 ‘‘(k) ASSIGNMENT OF INDIVIDUALS.—The Secretary, 

11 in assigning individuals to serve in Indian Health Pro12 grams or Urban Indian Organizations pursuant to con13 tracts entered into under this section, shall— 

14 ‘‘(1) ensure that the staffing needs of Tribal 

15 Health Programs and Urban Indian Organizations 

16 receive consideration on an equal basis with pro17 grams that are administered directly by the Service; 

18 and 

19 ‘‘(2) give priority to assigning individuals to In20 dian Health Programs and Urban Indian Organiza21 tions that have a need for health professionals to 

22 provide health care services as a result of individuals 

23 having breached contracts entered into under this 

24 section. 

25 ‘‘(l) BREACH OF CONTRACT.— 


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1 ‘‘(1) SPECIFIC BREACHES.—An individual who 

2 has entered into a written contract with the Sec3 retary under this section and has not received a 

4 waiver under subsection (m) shall be liable, in lieu 

5 of any service obligation arising under such contract, 

6 to the United States for the amount which has been 

7 paid on such individual’s behalf under the contract 

8 if that individual— 

9 ‘‘(A) is enrolled in the final year of a 

10 course of study and— 

11 ‘‘(i) fails to maintain an acceptable 

12 level of academic standing in the edu13 cational institution in which he or she is 

14 enrolled (such level determined by the edu15 cational institution under regulations of 

16 the Secretary); 

17 ‘‘(ii) voluntarily terminates such en18 rollment; or 

19 ‘‘(iii) is dismissed from such edu20 cational institution before completion of 

21 such course of study; or 

22 ‘‘(B) is enrolled in a graduate training pro23 gram and fails to complete such training pro24 gram. 


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1 ‘‘(2) OTHER BREACHES; FORMULA FOR

2 AMOUNT OWED.—If, for any reason not specified in 

3 paragraph (1), an individual breaches his or her 

4 written contract under this section by failing either 

5 to begin, or complete, such individual’s period of ob6 ligated service in accordance with subsection (e)(2), 

7 the United States shall be entitled to recover from 

8 such individual an amount to be determined in ac9 cordance with the following formula: A=3Z(t−s/t) in 

10 which— 

11 ‘‘(A) ‘A’ is the amount the United States 

12 is entitled to recover; 

13 ‘‘(B) ‘Z’ is the sum of the amounts paid 

14 under this section to, or on behalf of, the indi15 vidual and the interest on such amounts which 

16 would be payable if, at the time the amounts 

17 were paid, they were loans bearing interest at 

18 the maximum legal prevailing rate, as deter19 mined by the Secretary of the Treasury; 

20 ‘‘(C) ‘t’ is the total number of months in 

21 the individual’s period of obligated service in 

22 accordance with subsection (f); and 

23 ‘‘(D) ‘s’ is the number of months of such 

24 period served by such individual in accordance 

25 with this section. 


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1 ‘‘(3) DEDUCTIONS IN MEDICARE PAYMENTS.— 

2 Amounts not paid within such period shall be sub3 ject to collection through deductions in medicare 

4 payments pursuant to section 1892 of the Social Se5 curity Act. 

6 ‘‘(4) TIME PERIOD FOR REPAYMENT.—Any 

7 amount of damages which the United States is enti8 tled to recover under this subsection shall be paid to 

9 the United States within the 1-year period beginning 

10 on the date of the breach or such longer period be11 ginning on such date as shall be specified by the 

12 Secretary. 

13 ‘‘(5) RECOVERY OF DELINQUENCY.— 

14 ‘‘(A) IN GENERAL.—If damages described 

15 in paragraph (4) are delinquent for 3 months, 

16 the Secretary shall, for the purpose of recov17 ering such damages— 

18 ‘‘(i) use collection agencies contracted 

19 with by the Administrator of General Serv20 ices; or 

21 ‘‘(ii) enter into contracts for the re22 covery of such damages with collection 

23 agencies selected by the Secretary. 

24 ‘‘(B) REPORT.—Each contract for recov25 ering damages pursuant to this subsection shall 


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1 provide that the contractor will, not less than 

2 once each 6 months, submit to the Secretary a 

3 status report on the success of the contractor in 

4 collecting such damages. Section 3718 of title 

5 31, United States Code, shall apply to any such 

6 contract to the extent not inconsistent with this 

7 subsection. 

8 ‘‘(m) WAIVER OR SUSPENSION OF OBLIGATION.— 

9 ‘‘(1) IN GENERAL.—The Secretary shall by reg10 ulation provide for the partial or total waiver or sus11 pension of any obligation of service or payment by 

12 an individual under the Loan Repayment Program 

13 whenever compliance by the individual is impossible 

14 or would involve extreme hardship to the individual 

15 and if enforcement of such obligation with respect to 

16 any individual would be unconscionable. 

17 ‘‘(2) CANCELED UPON DEATH.—Any obligation 

18 of an individual under the Loan Repayment Pro19 gram for service or payment of damages shall be 

20 canceled upon the death of the individual. 

21 ‘‘(3) HARDSHIP WAIVER.—The Secretary may 

22 waive, in whole or in part, the rights of the United 

23 States to recover amounts under this section in any 

24 case of extreme hardship or other good cause shown, 

25 as determined by the Secretary. 


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1 ‘‘(4) BANKRUPTCY.—Any obligation of an indi2 vidual under the Loan Repayment Program for pay3 ment of damages may be released by a discharge in 

4 bankruptcy under title 11 of the United States Code 

5 only if such discharge is granted after the expiration 

6 of the 5-year period beginning on the first date that 

7 payment of such damages is required, and only if 

8 the bankruptcy court finds that nondischarge of the 

9 obligation would be unconscionable. 

10 ‘‘(n) REPORT.—The Secretary shall submit to the 

11 President, for inclusion in each report required to be sub12 mitted to Congress under section 801, a report concerning 

13 the previous fiscal year which sets forth by Service Area 

14 the following: 

15 ‘‘(1) A list of the health professional positions 

16 maintained by Indian Health Programs and Urban 

17 Indian Organizations for which recruitment or reten18 tion is difficult. 

19 ‘‘(2) The number of Loan Repayment Program 

20 applications filed with respect to each type of health 

21 profession. 

22 ‘‘(3) The number of contracts described in sub23 section (e) that are entered into with respect to each 

24 health profession. 


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1 ‘‘(4) The amount of loan payments made under 

2 this section, in total and by health profession. 

3 ‘‘(5) The number of scholarships that are pro4 vided under sections 104 and 106 with respect to 

5 each health profession. 

6 ‘‘(6) The amount of scholarship grants provided 

7 under section 104 and 106, in total and by health 

8 profession. 

9 ‘‘(7) The number of providers of health care 

10 that will be needed by Indian Health Programs and 

11 Urban Indian Organizations, by location and profes12 sion, during the 3 fiscal years beginning after the 

13 date the report is filed. 

14 ‘‘(8) The measures the Secretary plans to take 

15 to fill the health professional positions maintained 

16 by Indian Health Programs or Urban Indian Orga17 nizations for which recruitment or retention is dif18 ficult. 

19 ‘‘SEC. 111. SCHOLARSHIP AND LOAN REPAYMENT RECOV20 ERY FUND. 

21 ‘‘(a) ESTABLISHMENT.—There is established in the 

22 Treasury of the United States a fund to be known as the 

23 Indian Health Scholarship and Loan Repayment Recovery 

24 Fund (hereafter in this section referred to as the ‘LRRF’). 

25 The LRRF shall consist of such amounts as may be colVerDate Aug 31 2005 05:25 Mar 17, 2006 Jkt 049200 PO 00000 Frm 00059 Fmt 6652 Sfmt 6401 E:\BILLS\S1057.RS S1057

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1 lected from individuals under section 104(d), section 

2 106(e), and section 110(l) for breach of contract, such 

3 funds as may be appropriated to the LRRF, and interest 

4 earned on amounts in the LRRF. All amounts collected, 

5 appropriated, or earned relative to the LRRF shall remain 

6 available until expended. 

7 ‘‘(b) USE OF FUNDS.— 

8 ‘‘(1) BY SECRETARY.—Amounts in the LRRF 

9 may be expended by the Secretary, acting through 

10 the Service, to make payments to an Indian Health 

11 Program— 

12 ‘‘(A) to which a scholarship recipient under 

13 section 104 and 106 or a loan repayment pro14 gram participant under section 110 has been 

15 assigned to meet the obligated service require16 ments pursuant to such sections; and 

17 ‘‘(B) that has a need for a health profes18 sional to provide health care services as a result 

19 of such recipient or participant having breached 

20 the contract entered into under section 104, 

21 106, or section 110. 

22 ‘‘(2) BY TRIBAL HEALTH PROGRAMS.—A Tribal 

23 Health Program receiving payments pursuant to 

24 paragraph (1) may expend the payments to provide 

25 scholarships or recruit and employ, directly or by 


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1 contract, health professionals to provide health care 

2 services. 

3 ‘‘(c) INVESTMENT OF FUNDS.—The Secretary of the 

4 Treasury shall invest such amounts of the LRRF as the 

5 Secretary of Health and Human Services determines are 

6 not required to meet current withdrawals from the LRRF. 

7 Such investments may be made only in interest bearing 

8 obligations of the United States. For such purpose, such 

9 obligations may be acquired on original issue at the issue 

10 price, or by purchase of outstanding obligations at the 

11 market price. 

12 ‘‘(d) SALE OF OBLIGATIONS.—Any obligation ac13 quired by the LRRF may be sold by the Secretary of the 

14 Treasury at the market price. 

15 ‘‘SEC. 112. RECRUITMENT ACTIVITIES. 

16 ‘‘(a) REIMBURSEMENT FOR TRAVEL.—The Sec17 retary, acting through the Service, may reimburse health 

18 professionals seeking positions with Indian Health Pro19 grams or Urban Indian Organizations, including individ20 uals considering entering into a contract under section 

21 110 and their spouses, for actual and reasonable expenses 

22 incurred in traveling to and from their places of residence 

23 to an area in which they may be assigned for the purpose 

24 of evaluating such area with respect to such assignment. 


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1 ‘‘(b) RECRUITMENT PERSONNEL.—The Secretary, 

2 acting through the Service, shall assign one individual in 

3 each Area Office to be responsible on a full-time basis for 

4 recruitment activities. 

5 ‘‘SEC. 113. INDIAN RECRUITMENT AND RETENTION PRO6 GRAM. 

7 ‘‘(a) IN GENERAL.—The Secretary, acting through 

8 the Service, shall fund, on a competitive basis, innovative 

9 demonstration projects for a period not to exceed 3 years 

10 to enable Tribal Health Programs and Urban Indian Or11 ganizations to recruit, place, and retain health profes12 sionals to meet their staffing needs. 

13 ‘‘(b) ELIGIBLE ENTITIES; APPLICATION.—Any Trib14 al Health Program or Urban Indian Organization may 

15 submit an application for funding of a project pursuant 

16 to this section. 

17 ‘‘SEC. 114. ADVANCED TRAINING AND RESEARCH. 

18 ‘‘(a) DEMONSTRATION PROGRAM.—The Secretary, 

19 acting through the Service, shall establish a demonstration 

20 project to enable health professionals who have worked in 

21 an Indian Health Program or Urban Indian Organization 

22 for a substantial period of time to pursue advanced train23 ing or research areas of study for which the Secretary de24 termines a need exists. 


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1 ‘‘(b) SERVICE OBLIGATION.—An individual who par2 ticipates in a program under subsection (a), where the 

3 educational costs are borne by the Service, shall incur an 

4 obligation to serve in an Indian Health Program or Urban 

5 Indian Organization for a period of obligated service equal 

6 to at least the period of time during which the individual 

7 participates in such program. In the event that the indi8 vidual fails to complete such obligated service, the indi9 vidual shall be liable to the United States for the period 

10 of service remaining. In such event, with respect to indi11 viduals entering the program after the date of enactment 

12 of the Indian Health Care Improvement Act Amendments 

13 of 2005, the United States shall be entitled to recover 

14 from such individual an amount to be determined in ac15 cordance with the formula specified in subsection (l) of 

16 section 110 in the manner provided for in such subsection. 

17 ‘‘(c) EQUAL OPPORTUNITY FOR PARTICIPATION.— 

18 Health professionals from Tribal Health Programs and 

19 Urban Indian Organizations shall be given an equal oppor20 tunity to participate in the program under subsection (a). 

21 ‘‘SEC. 115. QUENTIN N. BURDICK AMERICAN INDIANS INTO 

22 NURSING PROGRAM. 

23 ‘‘(a) GRANTS AUTHORIZED.—For the purpose of in24 creasing the number of nurses, nurse midwives, and nurse 

25 practitioners who deliver health care services to Indians, 


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1 the Secretary, acting through the Service, shall provide 

2 grants to the following: 

3 ‘‘(1) Public or private schools of nursing. 

4 ‘‘(2) Tribal colleges or universities. 

5 ‘‘(3) Nurse midwife programs and advanced 

6 practice nurse programs that are provided by any 

7 tribal college or university accredited nursing pro8 gram, or in the absence of such, any other public or 

9 private institutions. 

10 ‘‘(b) USE OF GRANTS.—Grants provided under sub11 section (a) may be used for one or more of the following: 

12 ‘‘(1) To recruit individuals for programs which 

13 train individuals to be nurses, nurse midwives, or 

14 advanced practice nurses. 

15 ‘‘(2) To provide scholarships to Indians enrolled 

16 in such programs that may pay the tuition charged 

17 for such program and other expenses incurred in 

18 connection with such program, including books, fees, 

19 room and board, and stipends for living expenses. 

20 ‘‘(3) To provide a program that encourages 

21 nurses, nurse midwives, and advanced practice 

22 nurses to provide, or continue to provide, health care 

23 services to Indians. 

24 ‘‘(4) To provide a program that increases the 

25 skills of, and provides continuing education to, 


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1 nurses, nurse midwives, and advanced practice 

2 nurses. 

3 ‘‘(5) To provide any program that is designed 

4 to achieve the purpose described in subsection (a). 

5 ‘‘(c) APPLICATIONS.—Each application for funding 

6 under subsection (a) shall include such information as the 

7 Secretary may require to establish the connection between 

8 the program of the applicant and a health care facility 

9 that primarily serves Indians. 

10 ‘‘(d) PREFERENCES FOR GRANT RECIPIENTS.—In 

11 providing grants under subsection (a), the Secretary shall 

12 extend a preference to the following: 

13 ‘‘(1) Programs that provide a preference to In14 dians. 

15 ‘‘(2) Programs that train nurse midwives or ad16 vanced practice nurses. 

17 ‘‘(3) Programs that are interdisciplinary. 

18 ‘‘(4) Programs that are conducted in coopera19 tion with a program for gifted and talented Indian 

20 students. 

21 ‘‘(e) QUENTIN N. BURDICK PROGRAM GRANT.—The 

22 Secretary shall provide one of the grants authorized under 

23 subsection (a) to establish and maintain a program at the 

24 University of North Dakota to be known as the ‘Quentin 

25 N. Burdick American Indians Into Nursing Program’. 


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1 Such program shall, to the maximum extent feasible, co2 ordinate with the Quentin N. Burdick Indian Health Pro3 grams established under section 117(b) and the Quentin 

4 N. Burdick American Indians Into Psychology Program 

5 established under section 105(b). 

6 ‘‘(f) ACTIVE DUTY SERVICE OBLIGATION.—The ac7 tive duty service obligation prescribed under section 338C 

8 of the Public Health Service Act (42 U.S.C. 254m) shall 

9 be met by each individual who receives training or assist10 ance described in paragraph (1) or (2) of subsection (b) 

11 that is funded by a grant provided under subsection (a). 

12 Such obligation shall be met by service— 

13 ‘‘(1) in the Service; 

14 ‘‘(2) in a program of an Indian Tribe or Tribal 

15 Organization conducted under the Indian Self-Deter16 mination and Education Assistance Act (including 

17 programs under agreements with the Bureau of In18 dian Affairs); 

19 ‘‘(3) in a program assisted under title V of this 

20 Act; or 

21 ‘‘(4) in the private practice of nursing if, as de22 termined by the Secretary, in accordance with guide23 lines promulgated by the Secretary, such practice is 

24 situated in a physician or other health shortage area 


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1 and addresses the health care needs of a substantial 

2 number of Indians. 

3 ‘‘SEC. 116. TRIBAL CULTURAL ORIENTATION. 

4 ‘‘(a) CULTURAL EDUCATION OF EMPLOYEES.—The 

5 Secretary, acting through the Service, shall require that 

6 appropriate employees of the Service who serve Indian 

7 Tribes in each Service Area receive educational instruction 

8 in the history and culture of such Indian Tribes and their 

9 relationship to the Service. 

10 ‘‘(b) PROGRAM.—In carrying out subsection (a), the 

11 Secretary shall establish a program which shall, to the ex12 tent feasible— 

13 ‘‘(1) be developed in consultation with the af14 fected Indian Tribes, Tribal Organizations, and 

15 Urban Indian Organizations; 

16 ‘‘(2) be carried out through tribal colleges or 

17 universities; 

18 ‘‘(3) include instruction in American Indian 

19 studies; and 

20 ‘‘(4) describe the use and place of Traditional 

21 Health Care Practices of the Indian Tribes in the 

22 Service Area. 

23 ‘‘SEC. 117. INMED PROGRAM. 

24 ‘‘(a) GRANTS AUTHORIZED.—The Secretary, acting 

25 through the Service, is authorized to provide grants to colVerDate Aug 31 2005 05:25 Mar 17, 2006 Jkt 049200 PO 00000 Frm 00067 Fmt 6652 Sfmt 6401 E:\BILLS\S1057.RS S1057

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1 leges and universities for the purpose of maintaining and 

2 expanding the Indian health careers recruitment program 

3 known as the ‘Indians Into Medicine Program’ (herein4 after in this section referred to as ‘INMED’) as a means 

5 of encouraging Indians to enter the health professions. 

6 ‘‘(b) QUENTIN N. BURDICK GRANT.—The Secretary 

7 shall provide one of the grants authorized under sub8 section (a) to maintain the INMED program at the Uni9 versity of North Dakota, to be known as the ‘Quentin N. 

10 Burdick Indian Health Programs’, unless the Secretary 

11 makes a determination, based upon program reviews, that 

12 the program is not meeting the purposes of this section. 

13 Such program shall, to the maximum extent feasible, co14 ordinate with the Quentin N. Burdick American Indians 

15 Into Psychology Program established under section 105(b) 

16 and the Quentin N. Burdick American Indians Into Nurs17 ing Program established under section 115. 

18 ‘‘(c) REGULATIONS.—The Secretary, pursuant to this 

19 Act, shall develop regulations to govern grants pursuant 

20 to this section. 

21 ‘‘(d) REQUIREMENTS.—Applicants for grants pro22 vided under this section shall agree to provide a program 

23 which— 

24 ‘‘(1) provides outreach and recruitment for 

25 health professions to Indian communities including 


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1 elementary and secondary schools and community 

2 colleges located on reservations which will be served 

3 by the program; 

4 ‘‘(2) incorporates a program advisory board 

5 comprised of representatives from the Indian Tribes 

6 and Indian communities which will be served by the 

7 program; 

8 ‘‘(3) provides summer preparatory programs for 

9 Indian students who need enrichment in the subjects 

10 of math and science in order to pursue training in 

11 the health professions; 

12 ‘‘(4) provides tutoring, counseling, and support 

13 to students who are enrolled in a health career pro14 gram of study at the respective college or university; 

15 and 

16 ‘‘(5) to the maximum extent feasible, employs 

17 qualified Indians in the program. 

18 ‘‘SEC. 118. HEALTH TRAINING PROGRAMS OF COMMUNITY 

19 COLLEGES. 

20 ‘‘(a) GRANTS TO ESTABLISH PROGRAMS.— 

21 ‘‘(1) IN GENERAL.—The Secretary, acting 

22 through the Service, shall award grants to accredited 

23 and accessible community colleges for the purpose of 

24 assisting such community colleges in the establish25 ment of programs which provide education in a 


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1 health profession leading to a degree or diploma in 

2 a health profession for individuals who desire to 

3 practice such profession on or near a reservation or 

4 in an Indian Health Program. 

5 ‘‘(2) AMOUNT OF GRANTS.—The amount of any 

6 grant awarded to a community college under para7 graph (1) for the first year in which such a grant 

8 is provided to the community college shall not exceed 

9 $100,000. 

10 ‘‘(b) GRANTS FOR MAINTENANCE AND RECRUIT11 ING.— 

12 ‘‘(1) IN GENERAL.—The Secretary, acting 

13 through the Service, shall award grants to accredited 

14 and accessible community colleges that have estab15 lished a program described in subsection (a)(1) for 

16 the purpose of maintaining the program and recruit17 ing students for the program. 

18 ‘‘(2) REQUIREMENTS.—Grants may only be 

19 made under this section to a community college 

20 which— 

21 ‘‘(A) is accredited; 

22 ‘‘(B) has a relationship with a hospital fa23 cility, Service facility, or hospital that could 

24 provide training of nurses or health profes25 sionals; 


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1 ‘‘(C) has entered into an agreement with 

2 an accredited college or university medical 

3 school, the terms of which— 

4 ‘‘(i) provide a program that enhances 

5 the transition and recruitment of students 

6 into advanced baccalaureate or graduate 

7 programs which train health professionals; 

8 and 

9 ‘‘(ii) stipulate certifications necessary 

10 to approve internship and field placement 

11 opportunities at Indian Health Programs; 

12 ‘‘(D) has a qualified staff which has the 

13 appropriate certifications; 

14 ‘‘(E) is capable of obtaining State or re15 gional accreditation of the program described in 

16 subsection (a)(1); and 

17 ‘‘(F) agrees to provide for Indian pref18 erence for applicants for programs under this 

19 section. 

20 ‘‘(c) TECHNICAL ASSISTANCE.—The Secretary shall 

21 encourage community colleges described in subsection 

22 (b)(2) to establish and maintain programs described in 

23 subsection (a)(1) by— 

24 ‘‘(1) entering into agreements with such col25 leges for the provision of qualified personnel of the 


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1 Service to teach courses of study in such programs; 

2 and 

3 ‘‘(2) providing technical assistance and support 

4 to such colleges. 

5 ‘‘(d) ADVANCED TRAINING.— 

6 ‘‘(1) REQUIRED.—Any program receiving as7 sistance under this section that is conducted with re8 spect to a health profession shall also offer courses 

9 of study which provide advanced training for any 

10 health professional who— 

11 ‘‘(A) has already received a degree or di12 ploma in such health profession; and 

13 ‘‘(B) provides clinical services on or near a 

14 reservation or for an Indian Health Program. 

15 ‘‘(2) MAY BE OFFERED AT ALTERNATE SITE.— 

16 Such courses of study may be offered in conjunction 

17 with the college or university with which the commu18 nity college has entered into the agreement required 

19 under subsection (b)(2)(C). 

20 ‘‘(e) FUNDING PRIORITY.—Where the requirements 

21 of subsection (b) are met, funding priority shall be pro22 vided to tribal colleges and universities in Service Areas 

23 where they exist. 


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1 ‘‘SEC. 119. RETENTION BONUS. 

2 ‘‘(a) BONUS AUTHORIZED.—The Secretary may pay 

3 a retention bonus to any health professional employed by, 

4 or assigned to, and serving in, an Indian Health Program 

5 or Urban Indian Organization either as a civilian employee 

6 or as a commissioned officer in the Regular or Reserve 

7 Corps of the Public Health Service who— 

8 ‘‘(1) is assigned to, and serving in, a position 

9 for which recruitment or retention of personnel is 

10 difficult; 

11 ‘‘(2) the Secretary determines is needed by In12 dian Health Programs and Urban Indian Organiza13 tions; 

14 ‘‘(3) has— 

15 ‘‘(A) completed 3 years of employment 

16 with an Indian Health Program or Urban In17 dian Organization; or 

18 ‘‘(B) completed any service obligations in19 curred as a requirement of— 

20 ‘‘(i) any Federal scholarship program; 

21 or 

22 ‘‘(ii) any Federal education loan re23 payment program; and 

24 ‘‘(4) enters into an agreement with an Indian 

25 Health Program or Urban Indian Organization for 


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1 continued employment for a period of not less than 

2 1 year. 

3 ‘‘(b) RATES.—The Secretary may establish rates for 

4 the retention bonus which shall provide for a higher an5 nual rate for multiyear agreements than for single year 

6 agreements referred to in subsection (a)(4), but in no 

7 event shall the annual rate be more than $25,000 per 

8 annum. 

9 ‘‘(c) DEFAULT OF RETENTION AGREEMENT.—Any 

10 health professional failing to complete the agreed upon 

11 term of service, except where such failure is through no 

12 fault of the individual, shall be obligated to refund to the 

13 Government the full amount of the retention bonus for the 

14 period covered by the agreement, plus interest as deter15 mined by the Secretary in accordance with section 

16 110(l)(2)(B). 

17 ‘‘(d) OTHER RETENTION BONUS.—The Secretary 

18 may pay a retention bonus to any health professional em19 ployed by a Tribal Health Program if such health profes20 sional is serving in a position which the Secretary deter21 mines is— 

22 ‘‘(1) a position for which recruitment or reten23 tion is difficult; and 

24 ‘‘(2) necessary for providing health care services 

25 to Indians. 


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1 ‘‘SEC. 120. NURSING RESIDENCY PROGRAM. 

2 ‘‘(a) ESTABLISHMENT OF PROGRAM.—The Sec3 retary, acting through the Service, shall establish a pro4 gram to enable Indians who are licensed practical nurses, 

5 licensed vocational nurses, and registered nurses who are 

6 working in an Indian Health Program or Urban Indian 

7 Organization, and have done so for a period of not less 

8 than 1 year, to pursue advanced training. Such program 

9 shall include a combination of education and work study 

10 in an Indian Health Program or Urban Indian Organiza11 tion leading to an associate or bachelor’s degree (in the 

12 case of a licensed practical nurse or licensed vocational 

13 nurse), a bachelor’s degree (in the case of a registered 

14 nurse), or advanced degrees or certifications in nursing 

15 and public health. 

16 ‘‘(b) SERVICE OBLIGATION.—An individual who par17 ticipates in a program under subsection (a), where the 

18 educational costs are paid by the Service, shall incur an 

19 obligation to serve in an Indian Health Program or Urban 

20 Indian Organization for a period of obligated service equal 

21 to the amount of time during which the individual partici22 pates in such program. In the event that the individual 

23 fails to complete such obligated service, the United States 

24 shall be entitled to recover from such individual an amount 

25 determined in accordance with the formula specified in 


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1 subsection (l) of section 110 in the manner provided for 

2 in such subsection. 

3 ‘‘SEC. 121. COMMUNITY HEALTH AIDE PROGRAM FOR ALAS4 KA. 

5 ‘‘(a) GENERAL PURPOSES OF PROGRAM.—Under the 

6 authority of the Act of November 2, 1921 (25 U.S.C. 13) 

7 (commonly known as the ‘Snyder Act’), the Secretary, act8 ing through the Service, shall develop and operate a Com9 munity Health Aide Program in Alaska under which the 

10 Service— 

11 ‘‘(1) provides for the training of Alaska Natives 

12 as health aides or community health practitioners; 

13 ‘‘(2) uses such aides or practitioners in the pro14 vision of health care, health promotion, and disease 

15 prevention services to Alaska Natives living in vil16 lages in rural Alaska; and 

17 ‘‘(3) provides for the establishment of tele18 conferencing capacity in health clinics located in or 

19 near such villages for use by community health aides 

20 or community health practitioners. 

21 ‘‘(b) SPECIFIC PROGRAM REQUIREMENTS.—The Sec22 retary, acting through the Community Health Aide Pro23 gram of the Service, shall— 

24 ‘‘(1) using trainers accredited by the Program, 

25 provide a high standard of training to community 


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1 health aides and community health practitioners to 

2 ensure that such aides and practitioners provide 

3 quality health care, health promotion, and disease 

4 prevention services to the villages served by the Pro5 gram; 

6 ‘‘(2) in order to provide such training, develop 

7 a curriculum that— 

8 ‘‘(A) combines education in the theory of 

9 health care with supervised practical experience 

10 in the provision of health care; 

11 ‘‘(B) provides instruction and practical ex12 perience in the provision of acute care, emer13 gency care, health promotion, disease preven14 tion, and the efficient and effective manage15 ment of clinic pharmacies, supplies, equipment, 

16 and facilities; and 

17 ‘‘(C) promotes the achievement of the 

18 health status objectives specified in section 

19 3(2); 

20 ‘‘(3) establish and maintain a Community 

21 Health Aide Certification Board to certify as com22 munity health aides or community health practi23 tioners individuals who have successfully completed 

24 the training described in paragraph (1) or can dem25 onstrate equivalent experience; 


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1 ‘‘(4) develop and maintain a system which iden2 tifies the needs of community health aides and com3 munity health practitioners for continuing education 

4 in the provision of health care, including the areas 

5 described in paragraph (2)(B), and develop pro6 grams that meet the needs for such continuing edu7 cation; 

8 ‘‘(5) develop and maintain a system that pro9 vides close supervision of community health aides 

10 and community health practitioners; and 

11 ‘‘(6) develop a system under which the work of 

12 community health aides and community health prac13 titioners is reviewed and evaluated to assure the pro14 vision of quality health care, health promotion, and 

15 disease prevention services. 

16 ‘‘(c) NATIONAL COMMUNITY HEALTH AIDE PRO17 GRAM.— 

18 ‘‘(1) IN GENERAL.—The Secretary, acting 

19 through the Service, is authorized to establish a na20 tional Community Health Aide Program in accord21 ance with subsection (a), except as provided in para22 graphs (2) and (3), without reducing funds for the 

23 Community Health Aide Program for Alaska. 

24 ‘‘(2) LIMITED CERTIFICATION.—Except for any 

25 dental health aide in the State of Alaska, the SecVerDate Aug 31 2005 05:25 Mar 17, 2006 Jkt 049200 PO 00000 Frm 00078 Fmt 6652 Sfmt 6401 E:\BILLS\S1057.RS S1057

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1 retary, acting through the Community Health Aide 

2 Program of the Service, shall ensure that, for a pe3 riod of 4 years, dental health aides are certified only 

4 to provide services relating to— 

5 ‘‘(A) early childhood dental disease preven6 tion and reversible dental procedures; and 

7 ‘‘(B) the development of local capacity to 

8 provide those dental services. 

9 ‘‘(3) REVIEW.— 

10 ‘‘(A) IN GENERAL.—During the 4-year pe11 riod described in paragraph (2), the Secretary, 

12 acting through the Community Health Aide 

13 Program of the Service, shall conduct a review 

14 of the dental health aide program in the State 

15 of Alaska to determine the ability of the pro16 gram to address the dental care needs of Native 

17 Alaskans, the quality of care provided (includ18 ing any training, improvement, or additional 

19 oversight needed), and whether the program is 

20 appropriate and necessary to carry out in any 

21 other Indian community. 

22 ‘‘(B) REPORT.—After conducting the re23 view under subparagraph (A), the Secretary 

24 shall submit to the Committee on Indian Af25 fairs of the Senate and the Committee on ReVerDate Aug 31 2005 05:25 Mar 17, 2006 Jkt 049200 PO 00000 Frm 00079 Fmt 6652 Sfmt 6401 E:\BILLS\S1057.RS S1057

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1 sources of the House of Representatives a re2 port describing any finding of the Secretary 

3 under the review. 

4 ‘‘(C) FUTURE AUTHORIZATION OF CER5 TIFICATIONS.—Before authorizing any dental 

6 procedure not described in paragraph (2)(A), 

7 the Secretary shall consult with Indian tribes, 

8 Tribal Organizations, Urban Indian Organiza9 tions, and other interested parties to ensure 

10 that the safety and quality of care of the Com11 munity Health Aide Program are adequate and 

12 appropriate. 

13 ‘‘SEC. 122. TRIBAL HEALTH PROGRAM ADMINISTRATION. 

14 ‘‘The Secretary, acting through the Service, shall, by 

15 contract or otherwise, provide training for Indians in the 

16 administration and planning of Tribal Health Programs. 

17 ‘‘SEC. 123. HEALTH PROFESSIONAL CHRONIC SHORTAGE 

18 DEMONSTRATION PROGRAMS. 

19 ‘‘(a) DEMONSTRATION PROGRAMS AUTHORIZED.— 

20 The Secretary, acting through the Service, may fund dem21 onstration programs for Tribal Health Programs to ad22 dress the chronic shortages of health professionals. 

23 ‘‘(b) PURPOSES OF PROGRAMS.—The purposes of 

24 demonstration programs funded under subsection (a) shall 

25 be— 


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1 ‘‘(1) to provide direct clinical and practical ex2 perience at a Service Unit to health profession stu3 dents and residents from medical schools; 

4 ‘‘(2) to improve the quality of health care for 

5 Indians by assuring access to qualified health care 

6 professionals; and 

7 ‘‘(3) to provide academic and scholarly opportu8 nities for health professionals serving Indians by 

9 identifying all academic and scholarly resources of 

10 the region. 

11 ‘‘(c) ADVISORY BOARD.—The demonstration pro12 grams established pursuant to subsection (a) shall incor13 porate a program advisory board composed of representa14 tives from the Indian Tribes and Indian communities in 

15 the area which will be served by the program. 

16 ‘‘SEC. 124. NATIONAL HEALTH SERVICE CORPS. 

17 ‘‘(a) NO REDUCTION IN SERVICES.—The Secretary 

18 shall not— 

19 ‘‘(1) remove a member of the National Health 

20 Service Corps from an Indian Health Program or 

21 Urban Indian Organization; or 

22 ‘‘(2) withdraw funding used to support such 

23 member, unless the Secretary, acting through the 

24 Service, Indian Tribes, or Tribal Organizations, has 

25 ensured that the Indians receiving services from 


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1 such member will experience no reduction in serv2 ices. 

3 ‘‘(b) EXEMPTION FROM LIMITATIONS.—National 

4 Health Service Corps scholars qualifying for the Commis5 sioned Corps in the United States Public Health Service 

6 shall be exempt from the full-time equivalent limitations 

7 of the National Health Service Corps and the Service 

8 when serving as a commissioned corps officer in a Tribal 

9 Health Program or an Urban Indian Organization. 

10 ‘‘SEC. 125. SUBSTANCE ABUSE COUNSELOR EDUCATIONAL 

11 CURRICULA DEMONSTRATION PROGRAMS. 

12 ‘‘(a) GRANTS AND CONTRACTS.—The Secretary, act13 ing through the Service, may enter into contracts with, 

14 or make grants to, accredited tribal colleges and univer15 sities and eligible accredited and accessible community col16 leges to establish demonstration programs to develop edu17 cational curricula for substance abuse counseling. 

18 ‘‘(b) USE OF FUNDS.—Funds provided under this 

19 section shall be used only for developing and providing 

20 educational curriculum for substance abuse counseling (in21 cluding paying salaries for instructors). Such curricula 

22 may be provided through satellite campus programs. 

23 ‘‘(c) TIME PERIOD OF ASSISTANCE; RENEWAL.—A 

24 contract entered into or a grant provided under this sec25 tion shall be for a period of 1 year. Such contract or grant 


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1 may be renewed for an additional 1-year period upon the 

2 approval of the Secretary. 

3 ‘‘(d) CRITERIA FOR REVIEW AND APPROVAL OF AP4 PLICATIONS.—Not later than 180 days after the date of 

5 enactment of the Indian Health Care Improvement Act 

6 Amendments of 2005, the Secretary, after consultation 

7 with Indian Tribes and administrators of tribal colleges 

8 and universities and eligible accredited and accessible com9 munity colleges, shall develop and issue criteria for the 

10 review and approval of applications for funding (including 

11 applications for renewals of funding) under this section. 

12 Such criteria shall ensure that demonstration programs 

13 established under this section promote the development of 

14 the capacity of such entities to educate substance abuse 

15 counselors. 

16 ‘‘(e) ASSISTANCE.—The Secretary shall provide such 

17 technical and other assistance as may be necessary to en18 able grant recipients to comply with the provisions of this 

19 section. 

20 ‘‘(f) REPORT.—Each fiscal year, the Secretary shall 

21 submit to the President, for inclusion in the report which 

22 is required to be submitted under section 801 for that fis23 cal year, a report on the findings and conclusions derived 

24 from the demonstration programs conducted under this 

25 section during that fiscal year. 


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1 ‘‘(g) DEFINITION.—For the purposes of this section, 

2 the term ‘educational curriculum’ means 1 or more of the 

3 following: 

4 ‘‘(1) Classroom education. 

5 ‘‘(2) Clinical work experience. 

6 ‘‘(3) Continuing education workshops. 

7 ‘‘SEC. 126. BEHAVIORAL HEALTH TRAINING AND COMMU8 NITY EDUCATION PROGRAMS. 

9 ‘‘(a) STUDY; LIST.—The Secretary, acting through 

10 the Service, and the Secretary of the Interior, in consulta11 tion with Indian Tribes and Tribal Organizations, shall 

12 conduct a study and compile a list of the types of staff 

13 positions specified in subsection (b) whose qualifications 

14 include, or should include, training in the identification, 

15 prevention, education, referral, or treatment of mental ill16 ness, or dysfunctional and self destructive behavior. 

17 ‘‘(b) POSITIONS.—The positions referred to in sub18 section (a) are— 

19 ‘‘(1) staff positions within the Bureau of Indian 

20 Affairs, including existing positions, in the fields 

21 of— 

22 ‘‘(A) elementary and secondary education; 

23 ‘‘(B) social services and family and child 

24 welfare; 


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1 ‘‘(C) law enforcement and judicial services; 

2 and 

3 ‘‘(D) alcohol and substance abuse; 

4 ‘‘(2) staff positions within the Service; and 

5 ‘‘(3) staff positions similar to those identified in 

6 paragraphs (1) and (2) established and maintained 

7 by Indian Tribes, Tribal Organizations (without re8 gard to the funding source), and Urban Indian Or9 ganizations. 

10 ‘‘(c) TRAINING CRITERIA.— 

11 ‘‘(1) IN GENERAL.—The appropriate Secretary 

12 shall provide training criteria appropriate to each 

13 type of position identified in subsection (b)(1) and 

14 (b)(2) and ensure that appropriate training has 

15 been, or shall be provided to any individual in any 

16 such position. With respect to any such individual in 

17 a position identified pursuant to subsection (b)(3), 

18 the respective Secretaries shall provide appropriate 

19 training to, or provide funds to, an Indian Tribe, 

20 Tribal Organization, or Urban Indian Organization 

21 for training of appropriate individuals. In the case of 

22 positions funded under a contract or compact under 

23 the Indian Self-Determination and Education Assist24 ance Act (25 U.S.C. 450 et seq.), the appropriate 

25 Secretary shall ensure that such training costs are 


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1 included in the contract or compact, as the Sec2 retary determines necessary. 

3 ‘‘(2) POSITION SPECIFIC TRAINING CRITERIA.— 

4 Position specific training criteria shall be culturally 

5 relevant to Indians and Indian Tribes and shall en6 sure that appropriate information regarding Tradi7 tional Health Care Practices is provided. 

8 ‘‘(d) COMMUNITY EDUCATION ON MENTAL ILL9 NESS.—The Service shall develop and implement, on re10 quest of an Indian Tribe, Tribal Organization, or Urban 

11 Indian Organization, or assist the Indian Tribe, Tribal Or12 ganization, or Urban Indian Organization to develop and 

13 implement, a program of community education on mental 

14 illness. In carrying out this subsection, the Service shall, 

15 upon request of an Indian Tribe, Tribal Organization, or 

16 Urban Indian Organization, provide technical assistance 

17 to the Indian Tribe, Tribal Organization, or Urban Indian 

18 Organization to obtain and develop community edu19 cational materials on the identification, prevention, refer20 ral, and treatment of mental illness and dysfunctional and 

21 self-destructive behavior. 

22 ‘‘(e) PLAN.—Not later than 90 days after the date 

23 of enactment of the Indian Health Care Improvement Act 

24 Amendments of 2005, the Secretary shall develop a plan 

25 under which the Service will increase the health care staff 


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1 providing behavioral health services by at least 500 posi2 tions within 5 years after the date of enactment of this 

3 section, with at least 200 of such positions devoted to 

4 child, adolescent, and family services. The plan developed 

5 under this subsection shall be implemented under the Act 

6 of November 2, 1921 (25 U.S.C. 13) (commonly known 

7 as the ‘Snyder Act’). 

8 ‘‘SEC. 127. AUTHORIZATION OF APPROPRIATIONS. 

9 ‘‘There are authorized to be appropriated such sums 

10 as may be necessary for each fiscal year through fiscal 

11 year 2015 to carry out this title. 

12 ‘‘TITLE II—HEALTH SERVICES 

13 ‘‘SEC. 201. INDIAN HEALTH CARE IMPROVEMENT FUND. 

14 ‘‘(a) USE OF FUNDS.—The Secretary, acting through 

15 the Service, is authorized to expend funds, directly or 

16 under the authority of the Indian Self-Determination and 

17 Education Assistance Act (25 U.S.C. 450 et seq.), which 

18 are appropriated under the authority of this section, for 

19 the purposes of— 

20 ‘‘(1) eliminating the deficiencies in health sta21 tus and health resources of all Indian Tribes; 

22 ‘‘(2) eliminating backlogs in the provision of 

23 health care services to Indians; 


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1 ‘‘(3) meeting the health needs of Indians in an 

2 efficient and equitable manner, including the use of 

3 telehealth and telemedicine when appropriate; 

4 ‘‘(4) eliminating inequities in funding for both 

5 direct care and contract health service programs; 

6 and 

7 ‘‘(5) augmenting the ability of the Service to 

8 meet the following health service responsibilities with 

9 respect to those Indian Tribes with the highest levels 

10 of health status deficiencies and resource defi11 ciencies: 

12 ‘‘(A) Clinical care, including inpatient care, 

13 outpatient care (including audiology, clinical 

14 eye, and vision care), primary care, secondary 

15 and tertiary care, and long-term care. 

16 ‘‘(B) Preventive health, including mam17 mography and other cancer screening in accord18 ance with section 207. 

19 ‘‘(C) Dental care. 

20 ‘‘(D) Mental health, including community 

21 mental health services, inpatient mental health 

22 services, dormitory mental health services, 

23 therapeutic and residential treatment centers, 

24 and training of traditional health care practi25 tioners. 


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1 ‘‘(E) Emergency medical services. 

2 ‘‘(F) Treatment and control of, and reha3 bilitative care related to, alcoholism and drug 

4 abuse (including fetal alcohol syndrome) among 

5 Indians. 

6 ‘‘(G) Accident prevention programs. 

7 ‘‘(H) Home health care. 

8 ‘‘(I) Community health representatives. 

9 ‘‘(J) Maintenance and repair. 

10 ‘‘(K) Traditional Health Care Practices. 

11 ‘‘(b) NO OFFSET OR LIMITATION.—Any funds appro12 priated under the authority of this section shall not be 

13 used to offset or limit any other appropriations made to 

14 the Service under this Act or the Act of November 2, 1921 

15 (25 U.S.C. 13) (commonly known as the ‘Snyder Act’), 

16 or any other provision of law. 

17 ‘‘(c) ALLOCATION; USE.— 

18 ‘‘(1) IN GENERAL.—Funds appropriated under 

19 the authority of this section shall be allocated to 

20 Service Units, Indian Tribes, or Tribal Organiza21 tions. The funds allocated to each Indian Tribe, 

22 Tribal Organization, or Service Unit under this 

23 paragraph shall be used by the Indian Tribe, Tribal 

24 Organization, or Service Unit under this paragraph 

25 to improve the health status and reduce the resource 


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1 deficiency of each Indian Tribe served by such Serv2 ice Unit, Indian Tribe, or Tribal Organization. 

3 ‘‘(2) APPORTIONMENT OF ALLOCATED

4 FUNDS.—The apportionment of funds allocated to a 

5 Service Unit, Indian Tribe, or Tribal Organization 

6 under paragraph (1) among the health service re7 sponsibilities described in subsection (a)(5) shall be 

8 determined by the Service in consultation with, and 

9 with the active participation of, the affected Indian 

10 Tribes and Tribal Organizations. 

11 ‘‘(d) PROVISIONS RELATING TO HEALTH STATUS

12 AND RESOURCE DEFICIENCIES.—For the purposes of this 

13 section, the following definitions apply: 

14 ‘‘(1) DEFINITION.—The term ‘health status 

15 and resource deficiency’ means the extent to 

16 which— 

17 ‘‘(A) the health status objectives set forth 

18 in section 3(2) are not being achieved; and 

19 ‘‘(B) the Indian Tribe or Tribal Organiza20 tion does not have available to it the health re21 sources it needs, taking into account the actual 

22 cost of providing health care services given local 

23 geographic, climatic, rural, or other cir24 cumstances. 


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1 ‘‘(2) AVAILABLE RESOURCES.—The health re2 sources available to an Indian Tribe or Tribal Orga3 nization include health resources provided by the 

4 Service as well as health resources used by the In5 dian Tribe or Tribal Organization, including services 

6 and financing systems provided by any Federal pro7 grams, private insurance, and programs of State or 

8 local governments. 

9 ‘‘(3) PROCESS FOR REVIEW OF DETERMINA10 TIONS.—The Secretary shall establish procedures 

11 which allow any Indian Tribe or Tribal Organization 

12 to petition the Secretary for a review of any deter13 mination of the extent of the health status and re14 source deficiency of such Indian Tribe or Tribal Or15 ganization. 

16 ‘‘(e) ELIGIBILITY FOR FUNDS.—Tribal Health Pro17 grams shall be eligible for funds appropriated under the 

18 authority of this section on an equal basis with programs 

19 that are administered directly by the Service. 

20 ‘‘(f) REPORT.—By no later than the date that is 3 

21 years after the date of enactment of the Indian Health 

22 Care Improvement Act Amendments of 2005, the Sec23 retary shall submit to Congress the current health status 

24 and resource deficiency report of the Service for each 


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1 Service Unit, including newly recognized or acknowledged 

2 Indian Tribes. Such report shall set out— 

3 ‘‘(1) the methodology then in use by the Service 

4 for determining Tribal health status and resource 

5 deficiencies, as well as the most recent application of 

6 that methodology; 

7 ‘‘(2) the extent of the health status and re8 source deficiency of each Indian Tribe served by the 

9 Service or a Tribal Health Program; 

10 ‘‘(3) the amount of funds necessary to eliminate 

11 the health status and resource deficiencies of all In12 dian Tribes served by the Service or a Tribal Health 

13 Program; and 

14 ‘‘(4) an estimate of— 

15 ‘‘(A) the amount of health service funds 

16 appropriated under the authority of this Act, or 

17 any other Act, including the amount of any 

18 funds transferred to the Service for the pre19 ceding fiscal year which is allocated to each 

20 Service Unit, Indian Tribe, or Tribal Organiza21 tion; 

22 ‘‘(B) the number of Indians eligible for 

23 health services in each Service Unit or Indian 

24 Tribe or Tribal Organization; and 


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1 ‘‘(C) the number of Indians using the 

2 Service resources made available to each Service 

3 Unit, Indian Tribe or Tribal Organization, and, 

4 to the extent available, information on the wait5 ing lists and number of Indians turned away for 

6 services due to lack of resources. 

7 ‘‘(g) INCLUSION IN BASE BUDGET.—Funds appro8 priated under this section for any fiscal year shall be in9 cluded in the base budget of the Service for the purpose 

10 of determining appropriations under this section in subse11 quent fiscal years. 

12 ‘‘(h) CLARIFICATION.—Nothing in this section is in13 tended to diminish the primary responsibility of the Serv14 ice to eliminate existing backlogs in unmet health care 

15 needs, nor are the provisions of this section intended to 

16 discourage the Service from undertaking additional efforts 

17 to achieve equity among Indian Tribes and Tribal Organi18 zations. 

19 ‘‘(i) FUNDING DESIGNATION.—Any funds appro20 priated under the authority of this section shall be des21 ignated as the ‘Indian Health Care Improvement Fund’. 

22 ‘‘SEC. 202. CATASTROPHIC HEALTH EMERGENCY FUND. 

23 ‘‘(a) ESTABLISHMENT.—There is established an In24 dian Catastrophic Health Emergency Fund (hereafter in 

25 this section referred to as the ‘CHEF’) consisting of— 


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1 ‘‘(1) the amounts deposited under subsection 

2 (f); and 

3 ‘‘(2) the amounts appropriated to CHEF under 

4 this section. 

5 ‘‘(b) ADMINISTRATION.—CHEF shall be adminis6 tered by the Secretary, acting through the central office 

7 of the Service, solely for the purpose of meeting the ex8 traordinary medical costs associated with the treatment of 

9 victims of disasters or catastrophic illnesses who are with10 in the responsibility of the Service. 

11 ‘‘(c) CONDITIONS ON USE OF FUND.—No part of 

12 CHEF or its administration shall be subject to contract 

13 or grant under any law, including the Indian Self-Deter14 mination and Education Assistance Act (25 U.S.C. 450 

15 et seq.), nor shall CHEF funds be allocated, apportioned, 

16 or delegated on an Area Office, Service Unit, or other 

17 similar basis. 

18 ‘‘(d) REGULATIONS.—The Secretary shall, through 

19 the negotiated rulemaking process under title VIII, pro20 mulgate regulations consistent with the provisions of this 

21 section to— 

22 ‘‘(1) establish a definition of disasters and cata23 strophic illnesses for which the cost of the treatment 

24 provided under contract would qualify for payment 

25 from CHEF; 


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1 ‘‘(2) provide that a Service Unit shall not be el2 igible for reimbursement for the cost of treatment 

3 from CHEF until its cost of treating any victim of 

4 such catastrophic illness or disaster has reached a 

5 certain threshold cost which the Secretary shall es6 tablish at— 

7 ‘‘(A) the 2000 level of $19,000; and 

8 ‘‘(B) for any subsequent year, not less 

9 than the threshold cost of the previous year in10 creased by the percentage increase in the med11 ical care expenditure category of the consumer 

12 price index for all urban consumers (United 

13 States city average) for the 12-month period 

14 ending with December of the previous year; 

15 ‘‘(3) establish a procedure for the reimburse16 ment of the portion of the costs that exceeds such 

17 threshold cost incurred by— 

18 ‘‘(A) Service Units; or 

19 ‘‘(B) whenever otherwise authorized by the 

20 Service, non-Service facilities or providers; 

21 ‘‘(4) establish a procedure for payment from 

22 CHEF in cases in which the exigencies of the med23 ical circumstances warrant treatment prior to the 

24 authorization of such treatment by the Service; and 


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1 ‘‘(5) establish a procedure that will ensure that 

2 no payment shall be made from CHEF to any pro3 vider of treatment to the extent that such provider 

4 is eligible to receive payment for the treatment from 

5 any other Federal, State, local, or private source of 

6 reimbursement for which the patient is eligible. 

7 ‘‘(e) NO OFFSET OR LIMITATION.—Amounts appro8 priated to CHEF under this section shall not be used to 

9 offset or limit appropriations made to the Service under 

10 the authority of the Act of November 2, 1921 (25 U.S.C. 

11 13) (commonly known as the ‘Snyder Act’), or any other 

12 law. 

13 ‘‘(f) DEPOSIT OF REIMBURSEMENT FUNDS.—There 

14 shall be deposited into CHEF all reimbursements to which 

15 the Service is entitled from any Federal, State, local, or 

16 private source (including third party insurance) by reason 

17 of treatment rendered to any victim of a disaster or cata18 strophic illness the cost of which was paid from CHEF. 

19 ‘‘SEC. 203. HEALTH PROMOTION AND DISEASE PREVENTION 

20 SERVICES. 

21 ‘‘(a) FINDINGS.—Congress finds that health pro22 motion and disease prevention activities— 

23 ‘‘(1) improve the health and well-being of Indi24 ans; and 


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1 ‘‘(2) reduce the expenses for health care of In2 dians. 

3 ‘‘(b) PROVISION OF SERVICES.—The Secretary, act4 ing through the Service and Tribal Health Programs, shall 

5 provide health promotion and disease prevention services 

6 to Indians to achieve the health status objectives set forth 

7 in section 3(2). 

8 ‘‘(c) EVALUATION.—The Secretary, after obtaining 

9 input from the affected Tribal Health Programs, shall 

10 submit to the President for inclusion in each report which 

11 is required to be submitted to Congress under section 801 

12 an evaluation of— 

13 ‘‘(1) the health promotion and disease preven14 tion needs of Indians; 

15 ‘‘(2) the health promotion and disease preven16 tion activities which would best meet such needs; 

17 ‘‘(3) the internal capacity of the Service and 

18 Tribal Health Programs to meet such needs; and 

19 ‘‘(4) the resources which would be required to 

20 enable the Service and Tribal Health Programs to 

21 undertake the health promotion and disease preven22 tion activities necessary to meet such needs. 


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1 ‘‘SEC. 204. DIABETES PREVENTION, TREATMENT, AND CON2 TROL. 

3 ‘‘(a) DETERMINATIONS REGARDING DIABETES.— 

4 The Secretary, acting through the Service, and in con5 sultation with Indian Tribes and Tribal Organizations, 

6 shall determine— 

7 ‘‘(1) by Indian Tribe and by Service Unit, the 

8 incidence of, and the types of complications resulting 

9 from, diabetes among Indians; and 

10 ‘‘(2) based on the determinations made pursu11 ant to paragraph (1), the measures (including pa12 tient education and effective ongoing monitoring of 

13 disease indicators) each Service Unit should take to 

14 reduce the incidence of, and prevent, treat, and con15 trol the complications resulting from, diabetes 

16 among Indian Tribes within that Service Unit. 

17 ‘‘(b) DIABETES SCREENING.—To the extent medi18 cally indicated and with informed consent, the Secretary 

19 shall screen each Indian who receives services from the 

20 Service for diabetes and for conditions which indicate a 

21 high risk that the individual will become diabetic and, in 

22 consultation with Indian Tribes, Urban Indian Organiza23 tions, and appropriate health care providers, establish a 

24 cost-effective approach to ensure ongoing monitoring of 

25 disease indicators. Such screening and monitoring may be 

26 conducted by a Tribal Health Program and may be conVerDate Aug 31 2005 05:25 Mar 17, 2006 Jkt 049200 PO 00000 Frm 00098 Fmt 6652 Sfmt 6401 E:\BILLS\S1057.RS S1057

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1 ducted through appropriate Internet-based health care 

2 management programs. 

3 ‘‘(c) FUNDING FOR DIABETES.—The Secretary shall 

4 continue to maintain each model diabetes project in exist5 ence on the date of enactment of the Indian Health 

6 Amendments Care Improvement Act of 2005, any such 

7 other diabetes programs operated by the Service or Tribal 

8 Health Programs, and any additional diabetes projects, 

9 such as the Medical Vanguard program provided for in 

10 title IV of Public Law 108–87, as implemented to serve 

11 Indian Tribes. Tribal Health Programs shall receive recur12 ring funding for the diabetes projects that they operate 

13 pursuant to this section, both at the date of enactment 

14 of the Indian Health Care Improvement Act Amendments 

15 of 2005 and for projects which are added and funded 

16 thereafter. 

17 ‘‘(d) FUNDING FOR DIALYSIS PROGRAMS.—The Sec18 retary is authorized to provide funding through the Serv19 ice, Indian Tribes, and Tribal Organizations to establish 

20 dialysis programs, including funding to purchase dialysis 

21 equipment and provide necessary staffing. 

22 ‘‘(e) OTHER DUTIES OF THE SECRETARY.—The Sec23 retary shall, to the extent funding is available— 

24 ‘‘(1) in each Area Office, consult with Indian 

25 Tribes and Tribal Organizations regarding programs 


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1 for the prevention, treatment, and control of diabe2 tes; 

3 ‘‘(2) establish in each Area Office a registry of 

4 patients with diabetes to track the incidence of dia5 betes and the complications from diabetes in that 

6 area; and 

7 ‘‘(3) ensure that data collected in each Area Of8 fice regarding diabetes and related complications 

9 among Indians are disseminated to all other Area 

10 Offices, subject to applicable patient privacy laws. 

11 ‘‘SEC. 205. SHARED SERVICES FOR LONG-TERM CARE. 

12 ‘‘(a) LONG-TERM CARE.—Notwithstanding any other 

13 provision of law, the Secretary, acting through the Service, 

14 is authorized to provide directly, or enter into contracts 

15 or compacts under the Indian Self-Determination and 

16 Education Assistance Act (25 U.S.C. 450 et seq.) with 

17 Indian Tribes or Tribal Organizations for, the delivery of 

18 long-term care and similar services to Indians. Such agree19 ments shall provide for the sharing of staff or other serv20 ices between the Service or a Tribal Health Program and 

21 a long-term care or other similar facility owned and oper22 ated (directly or through a contract or compact under the 

23 Indian Self-Determination and Education Assistance Act 

24 (25 U.S.C. 450 et seq.)) by such Indian Tribe or Tribal 

25 Organization. 


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1 ‘‘(b) CONTENTS OF AGREEMENTS.—An agreement 

2 entered into pursuant to subsection (a)— 

3 ‘‘(1) may, at the request of the Indian Tribe or 

4 Tribal Organization, delegate to such Indian Tribe 

5 or Tribal Organization such powers of supervision 

6 and control over Service employees as the Secretary 

7 deems necessary to carry out the purposes of this 

8 section; 

9 ‘‘(2) shall provide that expenses (including sala10 ries) relating to services that are shared between the 

11 Service and the Tribal Health Program be allocated 

12 proportionately between the Service and the Indian 

13 Tribe or Tribal Organization; and 

14 ‘‘(3) may authorize such Indian Tribe or Tribal 

15 Organization to construct, renovate, or expand a 

16 long-term care or other similar facility (including the 

17 construction of a facility attached to a Service facil18 ity). 

19 ‘‘(c) MINIMUM REQUIREMENT.—Any nursing facility 

20 provided for under this section shall meet the require21 ments for nursing facilities under section 1919 of the So22 cial Security Act. 

23 ‘‘(d) OTHER ASSISTANCE.—The Secretary shall pro24 vide such technical and other assistance as may be necVerDate Aug 31 2005 05:25 Mar 17, 2006 Jkt 049200 PO 00000 Frm 00101 Fmt 6652 Sfmt 6401 E:\BILLS\S1057.RS S1057

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1 essary to enable applicants to comply with the provisions 

2 of this section. 

3 ‘‘(e) USE OF EXISTING OR UNDERUSED FACILI4 TIES.—The Secretary shall encourage the use of existing 

5 facilities that are underused or allow the use of swing beds 

6 for long-term or similar care. 

7 ‘‘SEC. 206. HEALTH SERVICES RESEARCH. 

8 ‘‘The Secretary, acting through the Service, shall 

9 make funding available for research to further the per10 formance of the health service responsibilities of Indian 

11 Health Programs. The Secretary shall also, to the max12 imum extent practicable, coordinate departmental re13 search resources and activities to address relevant Indian 

14 Health Program research needs. Tribal Health Programs 

15 shall be given an equal opportunity to compete for, and 

16 receive, research funds under this section. This funding 

17 may be used for both clinical and nonclinical research. 

18 ‘‘SEC. 207. MAMMOGRAPHY AND OTHER CANCER SCREEN19 ING. 

20 ‘‘The Secretary, acting through the Service or Tribal 

21 Health Programs, shall provide for screening as follows: 

22 ‘‘(1) Screening mammography (as defined in 

23 section 1861(jj) of the Social Security Act) for In24 dian women at a frequency appropriate to such 

25 women under accepted and appropriate national 


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1 standards, and under such terms and conditions as 

2 are consistent with standards established by the Sec3 retary to ensure the safety and accuracy of screen4 ing mammography under part B of title XVIII of 

5 such Act. 

6 ‘‘(2) Other cancer screening meeting accepted 

7 and appropriate national standards. 

8 ‘‘SEC. 208. PATIENT TRAVEL COSTS. 

9 ‘‘The Secretary, acting through the Service and Trib10 al Health Programs, is authorized to provide funds for the 

11 following patient travel costs, including appropriate and 

12 necessary qualified escorts, associated with receiving 

13 health care services provided (either through direct or con14 tract care or through a contract or compact under the In15 dian Self-Determination and Education Assistance Act 

16 (25 U.S.C. 450 et seq.)) under this Act— 

17 ‘‘(1) emergency air transportation and non18 emergency air transportation where ground trans19 portation is infeasible; 

20 ‘‘(2) transportation by private vehicle (where no 

21 other means of transportation is available), specially 

22 equipped vehicle, and ambulance; and 

23 ‘‘(3) transportation by such other means as 

24 may be available and required when air or motor ve25 hicle transportation is not available. 


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1 ‘‘SEC. 209. EPIDEMIOLOGY CENTERS. 

2 ‘‘(a) ADDITIONAL CENTERS.—In addition to those 

3 epidemiology centers already established as of the date of 

4 enactment of this Act, and without reducing the funding 

5 levels for such centers, not later than 180 days after the 

6 date of enactment of the Indian Health Care Improvement 

7 Act Amendments of 2005, the Secretary, acting through 

8 the Service, shall establish and fund an epidemiology cen9 ter in each Service Area which does not yet have one to 

10 carry out the functions described in subsection (b). Any 

11 new centers so established may be operated by Tribal 

12 Health Programs, but such funding shall not be divisible. 

13 ‘‘(b) FUNCTIONS OF CENTERS.—In consultation with 

14 and upon the request of Indian Tribes, Tribal Organiza15 tions, and Urban Indian Organizations, each Service Area 

16 epidemiology center established under this subsection 

17 shall, with respect to such Service Area— 

18 ‘‘(1) collect data relating to, and monitor 

19 progress made toward meeting, each of the health 

20 status objectives of the Service, the Indian Tribes, 

21 Tribal Organizations, and Urban Indian Organiza22 tions in the Service Area; 

23 ‘‘(2) evaluate existing delivery systems, data 

24 systems, and other systems that impact the improve25 ment of Indian health; 


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1 ‘‘(3) assist Indian Tribes, Tribal Organizations, 

2 and Urban Indian Organizations in identifying their 

3 highest priority health status objectives and the 

4 services needed to achieve such objectives, based on 

5 epidemiological data; 

6 ‘‘(4) make recommendations for the targeting 

7 of services needed by the populations served; 

8 ‘‘(5) make recommendations to improve health 

9 care delivery systems for Indians and Urban Indi10 ans; 

11 ‘‘(6) provide requested technical assistance to 

12 Indian Tribes, Tribal Organizations, and Urban In13 dian Organizations in the development of local 

14 health service priorities and incidence and prevalence 

15 rates of disease and other illness in the community; 

16 and 

17 ‘‘(7) provide disease surveillance and assist In18 dian Tribes, Tribal Organizations, and Urban Indian 

19 Organizations to promote public health. 

20 ‘‘(c) TECHNICAL ASSISTANCE.—The Director of the 

21 Centers for Disease Control and Prevention shall provide 

22 technical assistance to the centers in carrying out the re23 quirements of this subsection. 

24 ‘‘(d) FUNDING FOR STUDIES.—The Secretary may 

25 make funding available to Indian Tribes, Tribal OrganizaVerDate Aug 31 2005 05:25 Mar 17, 2006 Jkt 049200 PO 00000 Frm 00105 Fmt 6652 Sfmt 6401 E:\BILLS\S1057.RS S1057

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1 tions, and Urban Indian Organizations to conduct epide2 miological studies of Indian communities. 

3 ‘‘SEC. 210. COMPREHENSIVE SCHOOL HEALTH EDUCATION 

4 PROGRAMS. 

5 ‘‘(a) FUNDING FOR DEVELOPMENT OF PROGRAMS.— 

6 In addition to carrying out any other program for health 

7 promotion or disease prevention, the Secretary, acting 

8 through the Service, is authorized to award grants to In9 dian Tribes, Tribal Organizations, and Urban Indian Or10 ganizations to develop comprehensive school health edu11 cation programs for children from pre-school through 

12 grade 12 in schools for the benefit of Indian and Urban 

13 Indian children. 

14 ‘‘(b) USE OF FUNDS.—Funding provided under this 

15 section may be used for purposes which may include, but 

16 are not limited to, the following: 

17 ‘‘(1) Developing and implementing health edu18 cation curricula both for regular school programs 

19 and afterschool programs. 

20 ‘‘(2) Training teachers in comprehensive school 

21 health education curricula. 

22 ‘‘(3) Integrating school-based, community23 based, and other public and private health promotion 

24 efforts. 


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1 ‘‘(4) Encouraging healthy, tobacco-free school 

2 environments. 

3 ‘‘(5) Coordinating school-based health programs 

4 with existing services and programs available in the 

5 community. 

6 ‘‘(6) Developing school programs on nutrition 

7 education, personal health, oral health, and fitness. 

8 ‘‘(7) Developing behavioral health wellness pro9 grams. 

10 ‘‘(8) Developing chronic disease prevention pro11 grams. 

12 ‘‘(9) Developing substance abuse prevention 

13 programs. 

14 ‘‘(10) Developing injury prevention and safety 

15 education programs. 

16 ‘‘(11) Developing activities for the prevention 

17 and control of communicable diseases. 

18 ‘‘(12) Developing community and environmental 

19 health education programs that include traditional 

20 health care practitioners. 

21 ‘‘(13) Violence prevention. 

22 ‘‘(14) Such other health issues as are appro23 priate. 

24 ‘‘(c) TECHNICAL ASSISTANCE.—Upon request, the 

25 Secretary, acting through the Service, shall provide techVerDate Aug 31 2005 05:25 Mar 17, 2006 Jkt 049200 PO 00000 Frm 00107 Fmt 6652 Sfmt 6401 E:\BILLS\S1057.RS S1057

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1 nical assistance to Indian Tribes, Tribal Organizations, 

2 and Urban Indian Organizations in the development of 

3 comprehensive health education plans and the dissemina4 tion of comprehensive health education materials and in5 formation on existing health programs and resources. 

6 ‘‘(d) CRITERIA FOR REVIEW AND APPROVAL OF AP7 PLICATIONS.—The Secretary, acting through the Service, 

8 and in consultation with Indian Tribes, Tribal Organiza9 tions, and Urban Indian Organizations, shall establish cri10 teria for the review and approval of applications for fund11 ing provided pursuant to this section. 

12 ‘‘(e) DEVELOPMENT OF PROGRAM FOR BIA FUNDED

13 SCHOOLS.— 

14 ‘‘(1) IN GENERAL.—The Secretary of the Inte15 rior, acting through the Bureau of Indian Affairs 

16 and in cooperation with the Secretary, acting 

17 through the Service, and affected Indian Tribes and 

18 Tribal Organizations, shall develop a comprehensive 

19 school health education program for children from 

20 preschool through grade 12 in schools for which sup21 port is provided by the Bureau of Indian Affairs. 

22 ‘‘(2) REQUIREMENTS FOR PROGRAMS.—Such 

23 programs shall include— 

24 ‘‘(A) school programs on nutrition edu25 cation, personal health, oral health, and fitness; 


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1 ‘‘(B) behavioral health wellness programs; 

2 ‘‘(C) chronic disease prevention programs; 

3 ‘‘(D) substance abuse prevention pro4 grams; 

5 ‘‘(E) injury prevention and safety edu6 cation programs; and 

7 ‘‘(F) activities for the prevention and con8 trol of communicable diseases. 

9 ‘‘(3) DUTIES OF THE SECRETARY.—The Sec10 retary of the Interior shall— 

11 ‘‘(A) provide training to teachers in com12 prehensive school health education curricula; 

13 ‘‘(B) ensure the integration and coordina14 tion of school-based programs with existing 

15 services and health programs available in the 

16 community; and 

17 ‘‘(C) encourage healthy, tobacco-free school 

18 environments. 

19 ‘‘SEC. 211. INDIAN YOUTH PROGRAM. 

20 ‘‘(a) PROGRAM AUTHORIZED.—The Secretary, acting 

21 through the Service, is authorized to establish and admin22 ister a program to provide funding to Indian Tribes, Trib23 al Organizations, and Urban Indian Organizations for in24 novative mental and physical disease prevention and 


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1 health promotion and treatment programs for Indian and 

2 Urban Indian preadolescent and adolescent youths. 

3 ‘‘(b) USE OF FUNDS.— 

4 ‘‘(1) ALLOWABLE USES.—Funds made available 

5 under this section may be used to— 

6 ‘‘(A) develop prevention and treatment 

7 programs for Indian youth which promote men8 tal and physical health and incorporate cultural 

9 values, community and family involvement, and 

10 traditional health care practitioners; and 

11 ‘‘(B) develop and provide community train12 ing and education. 

13 ‘‘(2) PROHIBITED USE.—Funds made available 

14 under this section may not be used to provide serv15 ices described in section 707(c). 

16 ‘‘(c) DUTIES OF THE SECRETARY.—The Secretary 

17 shall— 

18 ‘‘(1) disseminate to Indian Tribes, Tribal Orga19 nizations, and Urban Indian Organizations informa20 tion regarding models for the delivery of comprehen21 sive health care services to Indian and Urban Indian 

22 adolescents; 

23 ‘‘(2) encourage the implementation of such 

24 models; and 


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1 ‘‘(3) at the request of an Indian Tribe, Tribal 

2 Organization, or Urban Indian Organization, provide 

3 technical assistance in the implementation of such 

4 models. 

5 ‘‘(d) CRITERIA FOR REVIEW AND APPROVAL OF AP6 PLICATIONS.—The Secretary, in consultation with Indian 

7 Tribes, Tribal Organizations, and Urban Indian Organiza8 tions, shall establish criteria for the review and approval 

9 of applications or proposals under this section. 

10 ‘‘SEC. 212. PREVENTION, CONTROL, AND ELIMINATION OF 

11 COMMUNICABLE AND INFECTIOUS DISEASES. 

12 ‘‘(a) FUNDING AUTHORIZED.—The Secretary, acting 

13 through the Service, and after consultation with Indian 

14 Tribes, Tribal Organizations, Urban Indian Organiza15 tions, and the Centers for Disease Control and Prevention, 

16 may make funding available to Indian Tribes, Tribal Or17 ganizations, and Urban Indian Organizations for the fol18 lowing: 

19 ‘‘(1) Projects for the prevention, control, and 

20 elimination of communicable and infectious diseases, 

21 including tuberculosis, hepatitis, HIV, respiratory 

22 syncitial virus, hanta virus, sexually transmitted dis23 eases, and H. Pylori. 


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1 ‘‘(2) Public information and education pro2 grams for the prevention, control, and elimination of 

3 communicable and infectious diseases. 

4 ‘‘(3) Education, training, and clinical skills im5 provement activities in the prevention, control, and 

6 elimination of communicable and infectious diseases 

7 for health professionals, including allied health pro8 fessionals. 

9 ‘‘(4) Demonstration projects for the screening, 

10 treatment, and prevention of hepatitis C virus 

11 (HCV). 

12 ‘‘(b) APPLICATION REQUIRED.—The Secretary may 

13 provide funding under subsection (a) only if an application 

14 or proposal for funding is submitted to the Secretary. 

15 ‘‘(c) COORDINATION WITH HEALTH AGENCIES.—In16 dian Tribes, Tribal Organizations, and Urban Indian Or17 ganizations receiving funding under this section are en18 couraged to coordinate their activities with the Centers for 

19 Disease Control and Prevention and State and local health 

20 agencies. 

21 ‘‘(d) TECHNICAL ASSISTANCE; REPORT.—In carrying 

22 out this section, the Secretary— 

23 ‘‘(1) may, at the request of an Indian Tribe, 

24 Tribal Organization, or Urban Indian Organization, 

25 provide technical assistance; and 


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1 ‘‘(2) shall prepare and submit a report to Con2 gress biennially on the use of funds under this sec3 tion and on the progress made toward the preven4 tion, control, and elimination of communicable and 

5 infectious diseases among Indians and Urban Indi6 ans. 

7 ‘‘SEC. 213. AUTHORITY FOR PROVISION OF OTHER SERV8 ICES. 

9 ‘‘(a) FUNDING AUTHORIZED.—The Secretary, acting 

10 through the Service, Indian Tribes, and Tribal Organiza11 tions, may provide funding under this Act to meet the ob12 jectives set forth in section 3 through health care-related 

13 services and programs not otherwise described in this Act, 

14 including— 

15 ‘‘(1) hospice care; 

16 ‘‘(2) assisted living; 

17 ‘‘(3) long-term health care; 

18 ‘‘(4) home- and community-based services; and 

19 ‘‘(5) public health functions. 

20 ‘‘(b) SERVICES TO OTHERWISE INELIGIBLE PER21 SONS.—Subject to section 807, at the discretion of the 

22 Service, Indian Tribes, or Tribal Organizations, services 

23 provided for hospice care, home- and community-based 

24 care, assisted living, and long-term care may be provided 

25 (subject to reimbursement) to persons otherwise ineligible 


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1 for the health care benefits of the Service. Any funds re2 ceived under this subsection shall not be used to offset 

3 or limit the funding allocated to the Service or an Indian 

4 Tribe or Tribal Organization. 

5 ‘‘(c) DEFINITIONS.—For the purposes of this section, 

6 the following definitions shall apply: 

7 ‘‘(1) The term ‘home- and community-based 

8 services’ means 1 or more of the following: 

9 ‘‘(A) Homemaker/home health aide serv10 ices. 

11 ‘‘(B) Chore services. 

12 ‘‘(C) Personal care services. 

13 ‘‘(D) Nursing care services provided out14 side of a nursing facility by, or under the super15 vision of, a registered nurse. 

16 ‘‘(E) Respite care. 

17 ‘‘(F) Training for family members. 

18 ‘‘(G) Adult day care. 

19 ‘‘(H) Such other home- and community20 based services as the Secretary, an Indian tribe, 

21 or a Tribal Organization may approve. 

22 ‘‘(2) The term ‘hospice care’ means the items 

23 and services specified in subparagraphs (A) through 

24 (H) of section 1861(dd)(1) of the Social Security 

25 Act (42 U.S.C. 1395x(dd)(1)), and such other servVerDate Aug 31 2005 05:25 Mar 17, 2006 Jkt 049200 PO 00000 Frm 00114 Fmt 6652 Sfmt 6401 E:\BILLS\S1057.RS S1057

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1 ices which an Indian Tribe or Tribal Organization 

2 determines are necessary and appropriate to provide 

3 in furtherance of this care. 

4 ‘‘(3) The term ‘public health functions’ means 

5 the provision of public health-related programs, 

6 functions, and services, including assessment, assur7 ance, and policy development which Indian Tribes 

8 and Tribal Organizations are authorized and encour9 aged, in those circumstances where it meets their 

10 needs, to do by forming collaborative relationships 

11 with all levels of local, State, and Federal Govern12 ment. 

13 ‘‘SEC. 214. INDIAN WOMEN’S HEALTH CARE. 

14 ‘‘The Secretary, acting through the Service and In15 dian Tribes, Tribal Organizations, and Urban Indian Or16 ganizations, shall monitor and improve the quality of 

17 health care for Indian women of all ages through the plan18 ning and delivery of programs administered by the Service, 

19 in order to improve and enhance the treatment models of 

20 care for Indian women. 

21 ‘‘SEC. 215. ENVIRONMENTAL AND NUCLEAR HEALTH HAZ22 ARDS. 

23 ‘‘(a) STUDIES AND MONITORING.—The Secretary 

24 and the Service shall conduct, in conjunction with other 

25 appropriate Federal agencies and in consultation with conVerDate Aug 31 2005 05:25 Mar 17, 2006 Jkt 049200 PO 00000 Frm 00115 Fmt 6652 Sfmt 6401 E:\BILLS\S1057.RS S1057

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1 cerned Indian Tribes and Tribal Organizations, studies 

2 and ongoing monitoring programs to determine trends in 

3 the health hazards to Indian miners and to Indians on 

4 or near reservations and Indian communities as a result 

5 of environmental hazards which may result in chronic or 

6 life threatening health problems, such as nuclear resource 

7 development, petroleum contamination, and contamination 

8 of water source and of the food chain. Such studies shall 

9 include— 

10 ‘‘(1) an evaluation of the nature and extent of 

11 health problems caused by environmental hazards 

12 currently exhibited among Indians and the causes of 

13 such health problems; 

14 ‘‘(2) an analysis of the potential effect of ongo15 ing and future environmental resource development 

16 on or near reservations and Indian communities, in17 cluding the cumulative effect over time on health; 

18 ‘‘(3) an evaluation of the types and nature of 

19 activities, practices, and conditions causing or affect20 ing such health problems, including uranium mining 

21 and milling, uranium mine tailing deposits, nuclear 

22 power plant operation and construction, and nuclear 

23 waste disposal; oil and gas production or transpor24 tation on or near reservations or Indian commu25 nities; and other development that could affect the 


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1 health of Indians and their water supply and food 

2 chain; 

3 ‘‘(4) a summary of any findings and rec4 ommendations provided in Federal and State stud5 ies, reports, investigations, and inspections during 

6 the 5 years prior to the date of enactment of the In7 dian Health Care Improvement Act Amendments of 

8 2005 that directly or indirectly relate to the activi9 ties, practices, and conditions affecting the health or 

10 safety of such Indians; and 

11 ‘‘(5) the efforts that have been made by Federal 

12 and State agencies and resource and economic devel13 opment companies to effectively carry out an edu14 cation program for such Indians regarding the 

15 health and safety hazards of such development. 

16 ‘‘(b) HEALTH CARE PLANS.—Upon completion of 

17 such studies, the Secretary and the Service shall take into 

18 account the results of such studies and, in consultation 

19 with Indian Tribes and Tribal Organizations, develop 

20 health care plans to address the health problems studied 

21 under subsection (a). The plans shall include— 

22 ‘‘(1) methods for diagnosing and treating Indi23 ans currently exhibiting such health problems; 

24 ‘‘(2) preventive care and testing for Indians 

25 who may be exposed to such health hazards, includVerDate Aug 31 2005 05:25 Mar 17, 2006 Jkt 049200 PO 00000 Frm 00117 Fmt 6652 Sfmt 6401 E:\BILLS\S1057.RS S1057

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1 ing the monitoring of the health of individuals who 

2 have or may have been exposed to excessive amounts 

3 of radiation or affected by other activities that have 

4 had or could have a serious impact upon the health 

5 of such individuals; and 

6 ‘‘(3) a program of education for Indians who, 

7 by reason of their work or geographic proximity to 

8 such nuclear or other development activities, may ex9 perience health problems. 

10 ‘‘(c) SUBMISSION OF REPORT AND PLAN TO CON11 GRESS.—The Secretary and the Service shall submit to 

12 Congress the study prepared under subsection (a) no later 

13 than 18 months after the date of enactment of the Indian 

14 Health Care Improvement Act Amendments of 2005. The 

15 health care plan prepared under subsection (b) shall be 

16 submitted in a report no later than 1 year after the study 

17 prepared under subsection (a) is submitted to Congress. 

18 Such report shall include recommended activities for the 

19 implementation of the plan, as well as an evaluation of 

20 any activities previously undertaken by the Service to ad21 dress such health problems. 

22 ‘‘(d) INTERGOVERNMENTAL TASK FORCE.— 

23 ‘‘(1) ESTABLISHMENT; MEMBERS.—There is es24 tablished an Intergovernmental Task Force to be 


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1 composed of the following individuals (or their des2 ignees): 

3 ‘‘(A) The Secretary of Energy. 

4 ‘‘(B) The Secretary of the Environmental 

5 Protection Agency. 

6 ‘‘(C) The Director of the Bureau of Mines. 

7 ‘‘(D) The Assistant Secretary for Occupa8 tional Safety and Health. 

9 ‘‘(E) The Secretary of the Interior. 

10 ‘‘(F) The Secretary of Health and Human 

11 Services. 

12 ‘‘(G) The Director of the Indian Health 

13 Service. 

14 ‘‘(2) DUTIES.—The Task Force shall— 

15 ‘‘(A) identify existing and potential oper16 ations related to nuclear resource development 

17 or other environmental hazards that affect or 

18 may affect the health of Indians on or near a 

19 reservation or in an Indian community; and 

20 ‘‘(B) enter into activities to correct exist21 ing health hazards and ensure that current and 

22 future health problems resulting from nuclear 

23 resource or other development activities are 

24 minimized or reduced. 


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1 ‘‘(3) CHAIRMAN; MEETINGS.—The Secretary of 

2 Health and Human Services shall be the Chairman 

3 of the Task Force. The Task Force shall meet at 

4 least twice each year. 

5 ‘‘(e) HEALTH SERVICES TO CERTAIN EMPLOYEES.— 

6 In the case of any Indian who— 

7 ‘‘(1) as a result of employment in or near a 

8 uranium mine or mill or near any other environ9 mental hazard, suffers from a work-related illness or 

10 condition; 

11 ‘‘(2) is eligible to receive diagnosis and treat12 ment services from an Indian Health Program; and 

13 ‘‘(3) by reason of such Indian’s employment, is 

14 entitled to medical care at the expense of such mine 

15 or mill operator or entity responsible for the environ16 mental hazard, the Indian Health Program shall, at 

17 the request of such Indian, render appropriate med18 ical care to such Indian for such illness or condition 

19 and may be reimbursed for any medical care so ren20 dered to which such Indian is entitled at the expense 

21 of such operator or entity from such operator or en22 tity. Nothing in this subsection shall affect the 

23 rights of such Indian to recover damages other than 

24 such amounts paid to the Indian Health Program 


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1 from the employer for providing medical care for 

2 such illness or condition. 

3 ‘‘SEC. 216. ARIZONA AS A CONTRACT HEALTH SERVICE DE4 LIVERY AREA. 

5 ‘‘(a) IN GENERAL.—For fiscal years beginning with 

6 the fiscal year ending September 30, 1983, and ending 

7 with the fiscal year ending September 30, 2015, the State 

8 of Arizona shall be designated as a contract health service 

9 delivery area by the Service for the purpose of providing 

10 contract health care services to members of federally rec11 ognized Indian Tribes of Arizona. 

12 ‘‘(b) MAINTENANCE OF SERVICES.—The Service 

13 shall not curtail any health care services provided to Indi14 ans residing on reservations in the State of Arizona if such 

15 curtailment is due to the provision of contract services in 

16 such State pursuant to the designation of such State as 

17 a contract health service delivery area pursuant to sub18 section (a). 

19 ‘‘SEC. 216A. NORTH DAKOTA AND SOUTH DAKOTA AS CON20 TRACT HEALTH SERVICE DELIVERY AREA. 

21 ‘‘(a) IN GENERAL.—Beginning in fiscal year 2003, 

22 the States of North Dakota and South Dakota shall be 

23 designated as a contract health service delivery area by 

24 the Service for the purpose of providing contract health 


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1 care services to members of federally recognized Indian 

2 Tribes of North Dakota and South Dakota. 

3 ‘‘(b) LIMITATION.—The Service shall not curtail any 

4 health care services provided to Indians residing on any 

5 reservation, or in any county that has a common boundary 

6 with any reservation, in the State of North Dakota or 

7 South Dakota if such curtailment is due to the provision 

8 of contract services in such States pursuant to the des9 ignation of such States as a contract health service deliv10 ery area pursuant to subsection (a). 

11 ‘‘SEC. 217. CALIFORNIA CONTRACT HEALTH SERVICES PRO12 GRAM. 

13 ‘‘(a) FUNDING AUTHORIZED.—The Secretary is au14 thorized to fund a program using the California Rural In15 dian Health Board (hereafter in this section referred to 

16 as the ‘CRIHB’) as a contract care intermediary to im17 prove the accessibility of health services to California Indi18 ans. 

19 ‘‘(b) REIMBURSEMENT CONTRACT.—The Secretary 

20 shall enter into an agreement with the CRIHB to reim21 burse the CRIHB for costs (including reasonable adminis22 trative costs) incurred pursuant to this section, in pro23 viding medical treatment under contract to California In24 dians described in section 806(a) throughout the CaliVerDate Aug 31 2005 05:25 Mar 17, 2006 Jkt 049200 PO 00000 Frm 00122 Fmt 6652 Sfmt 6401 E:\BILLS\S1057.RS S1057

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1 fornia contract health services delivery area described in 

2 section 218 with respect to high cost contract care cases. 

3 ‘‘(c) ADMINISTRATIVE EXPENSES.—Not more than 5 

4 percent of the amounts provided to the CRIHB under this 

5 section for any fiscal year may be for reimbursement for 

6 administrative expenses incurred by the CRIHB during 

7 such fiscal year. 

8 ‘‘(d) LIMITATION ON PAYMENT.—No payment may 

9 be made for treatment provided hereunder to the extent 

10 payment may be made for such treatment under the In11 dian Catastrophic Health Emergency Fund described in 

12 section 202 or from amounts appropriated or otherwise 

13 made available to the California contract health service de14 livery area for a fiscal year. 

15 ‘‘(e) ADVISORY BOARD.—There is established an ad16 visory board which shall advise the CRIHB in carrying 

17 out this section. The advisory board shall be composed of 

18 representatives, selected by the CRIHB, from not less 

19 than 8 Tribal Health Programs serving California Indians 

20 covered under this section at least one half of whom of 

21 whom are not affiliated with the CRIHB. 

22 ‘‘SEC. 218. CALIFORNIA AS A CONTRACT HEALTH SERVICE 

23 DELIVERY AREA. 

24 ‘‘The State of California, excluding the counties of 

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1 ramento, San Francisco, San Mateo, Santa Clara, Kern, 

2 Merced, Monterey, Napa, San Benito, San Joaquin, San 

3 Luis Obispo, Santa Cruz, Solano, Stanislaus, and Ven4 tura, shall be designated as a contract health service deliv5 ery area by the Service for the purpose of providing con6 tract health services to California Indians. However, any 

7 of the counties listed herein may only be included in the 

8 contract health services delivery area if funding is specifi9 cally provided by the Service for such services in those 

10 counties. 

11 ‘‘SEC. 219. CONTRACT HEALTH SERVICES FOR THE TREN12 TON SERVICE AREA. 

13 ‘‘(a) AUTHORIZATION FOR SERVICES.—The Sec14 retary, acting through the Service, is directed to provide 

15 contract health services to members of the Turtle Moun16 tain Band of Chippewa Indians that reside in the Trenton 

17 Service Area of Divide, McKenzie, and Williams counties 

18 in the State of North Dakota and the adjoining counties 

19 of Richland, Roosevelt, and Sheridan in the State of Mon20 tana. 

21 ‘‘(b) NO EXPANSION OF ELIGIBILITY.—Nothing in 

22 this section may be construed as expanding the eligibility 

23 of members of the Turtle Mountain Band of Chippewa In24 dians for health services provided by the Service beyond 


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1 the scope of eligibility for such health services that applied 

2 on May 1, 1986. 

3 ‘‘SEC. 220. PROGRAMS OPERATED BY INDIAN TRIBES AND 

4 TRIBAL ORGANIZATIONS. 

5 ‘‘The Service shall provide funds for health care pro6 grams and facilities operated by Tribal Health Programs 

7 on the same basis as such funds are provided to programs 

8 and facilities operated directly by the Service. 

9 ‘‘SEC. 221. LICENSING. 

10 ‘‘Health care professionals employed by a Tribal 

11 Health Program shall, if licensed in any State, be exempt 

12 from the licensing requirements of the State in which the 

13 Tribal Health Program performs the services described in 

14 its contract or compact under the Indian Self-Determina15 tion and Education Assistance Act (25 U.S.C. 450 et 

16 seq.). 

17 ‘‘SEC. 222. NOTIFICATION OF PROVISION OF EMERGENCY 

18 CONTRACT HEALTH SERVICES. 

19 ‘‘With respect to an elderly Indian or an Indian with 

20 a disability receiving emergency medical care or services 

21 from a non-Service provider or in a non-Service facility 

22 under the authority of this Act, the time limitation (as 

23 a condition of payment) for notifying the Service of such 

24 treatment or admission shall be 30 days. 


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1 ‘‘SEC. 223. PROMPT ACTION ON PAYMENT OF CLAIMS. 

2 ‘‘(a) DEADLINE FOR RESPONSE.—The Service shall 

3 respond to a notification of a claim by a provider of a 

4 contract care service with either an individual purchase 

5 order or a denial of the claim within 5 working days after 

6 the receipt of such notification. 

7 ‘‘(b) EFFECT OF UNTIMELY RESPONSE.—If the 

8 Service fails to respond to a notification of a claim in ac9 cordance with subsection (a), the Service shall accept as 

10 valid the claim submitted by the provider of a contract 

11 care service. 

12 ‘‘(c) DEADLINE FOR PAYMENT OF VALID CLAIM.— 

13 The Service shall pay a valid contract care service claim 

14 within 30 days after the completion of the claim. 

15 ‘‘SEC. 224. LIABILITY FOR PAYMENT. 

16 ‘‘(a) NO PATIENT LIABILITY.—A patient who re17 ceives contract health care services that are authorized by 

18 the Service shall not be liable for the payment of any 

19 charges or costs associated with the provision of such serv20 ices. 

21 ‘‘(b) NOTIFICATION.—The Secretary shall notify a 

22 contract care provider and any patient who receives con23 tract health care services authorized by the Service that 

24 such patient is not liable for the payment of any charges 

25 or costs associated with the provision of such services not 


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1 later than 5 business days after receipt of a notification 

2 of a claim by a provider of contract care services. 

3 ‘‘(c) NO RECOURSE.—Following receipt of the notice 

4 provided under subsection (b), or, if a claim has been 

5 deemed accepted under section 223(b), the provider shall 

6 have no further recourse against the patient who received 

7 the services. 

8 ‘‘SEC. 225. AUTHORIZATION OF APPROPRIATIONS. 

9 ‘‘There are authorized to be appropriated such sums 

10 as may be necessary for each fiscal year through fiscal 

11 year 2015 to carry out this title. 

12 ‘‘TITLE III—FACILITIES 

13 ‘‘SEC. 301. CONSULTATION: CONSTRUCTION AND RENOVA14 TION OF FACILITIES; REPORTS. 

15 ‘‘(a) PREREQUISITES FOR EXPENDITURE OF

16 FUNDS.—Prior to the expenditure of, or the making of 

17 any binding commitment to expend, any funds appro18 priated for the planning, design, construction, or renova19 tion of facilities pursuant to the Act of November 2, 1921 

20 (25 U.S.C. 13) (commonly known as the ‘Snyder Act’), 

21 the Secretary, acting through the Service, shall— 

22 ‘‘(1) consult with any Indian Tribe that would 

23 be significantly affected by such expenditure for the 

24 purpose of determining and, whenever practicable, 

25 honoring tribal preferences concerning size, location, 


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1 type, and other characteristics of any facility on 

2 which such expenditure is to be made; and 

3 ‘‘(2) ensure, whenever practicable and applica4 ble, that such facility meets the construction stand5 ards of any accrediting body recognized by the Sec6 retary for the purposes of the medicare, medicaid, 

7 and SCHIP programs under titles XVIII, XIX, and 

8 XXI of the Social Security Act by not later than 1 

9 year after the date on which the construction or ren10 ovation of such facility is completed. 

11 ‘‘(b) CLOSURES.— 

12 ‘‘(1) EVALUATION REQUIRED.—Notwith13 standing any other provision of law, no facility oper14 ated by the Service may be closed if the Secretary 

15 has not submitted to Congress at least 1 year prior 

16 to the date of the proposed closure an evaluation of 

17 the impact of the proposed closure which specifies, 

18 in addition to other considerations— 

19 ‘‘(A) the accessibility of alternative health 

20 care resources for the population served by such 

21 facility; 

22 ‘‘(B) the cost-effectiveness of such closure; 

23 ‘‘(C) the quality of health care to be pro24 vided to the population served by such facility 

25 after such closure; 


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1 ‘‘(D) the availability of contract health 

2 care funds to maintain existing levels of service; 

3 ‘‘(E) the views of the Indian Tribes served 

4 by such facility concerning such closure; 

5 ‘‘(F) the level of use of such facility by all 

6 eligible Indians; and 

7 ‘‘(G) the distance between such facility and 

8 the nearest operating Service hospital. 

9 ‘‘(2) EXCEPTION FOR CERTAIN TEMPORARY

10 CLOSURES.—Paragraph (1) shall not apply to any 

11 temporary closure of a facility or any portion of a 

12 facility if such closure is necessary for medical, envi13 ronmental, or construction safety reasons. 

14 ‘‘(c) HEALTH CARE FACILITY PRIORITY SYSTEM.— 

15 ‘‘(1) IN GENERAL.— 

16 ‘‘(A) ESTABLISHMENT.—The Secretary, 

17 acting through the Service, shall establish a 

18 health care facility priority system, which 

19 shall— 

20 ‘‘(i) be developed with Indian Tribes 

21 and Tribal Organizations through nego22 tiated rulemaking under section 802; 

23 ‘‘(ii) give Indian Tribes’ needs the 

24 highest priority; and 


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1 ‘‘(iii) at a minimum, include the lists 

2 required in paragraph (2)(B) and the 

3 methodology required in paragraph (2)(E). 

4 ‘‘(B) PRIORITY OF CERTAIN PROJECTS

5 PROTECTED.—The priority of any project estab6 lished under the construction priority system in 

7 effect on the date of the Indian Health Care 

8 Improvement Act Amendments of 2005 shall 

9 not be affected by any change in the construc10 tion priority system taking place thereafter if 

11 the project was identified as 1 of the 10 top12 priority inpatient projects, 1 of the 10 top-pri13 ority outpatient projects, 1 of the 10 top-pri14 ority staff quarters developments, or 1 of the 

15 10 top-priority Youth Regional Treatment Cen16 ters in the fiscal year 2005 Indian Health Serv17 ice budget justification, or if the project had 

18 completed both Phase I and Phase II of the 

19 construction priority system in effect on the 

20 date of enactment of such Act. 

21 ‘‘(2) REPORT; CONTENTS.—The Secretary shall 

22 submit to the President, for inclusion in each report 

23 required to be transmitted to Congress under section 

24 801, a report which sets forth the following: 


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1 ‘‘(A) A description of the health care facil2 ity priority system of the Service, established 

3 under paragraph (1). 

4 ‘‘(B) Health care facilities lists, includ5 ing— 

6 ‘‘(i) the 10 top-priority inpatient 

7 health care facilities; 

8 ‘‘(ii) the 10 top-priority outpatient 

9 health care facilities; 

10 ‘‘(iii) the 10 top-priority specialized 

11 health care facilities (such as long-term 

12 care and alcohol and drug abuse treat13 ment); 

14 ‘‘(iv) the 10 top-priority staff quarters 

15 developments associated with health care 

16 facilities; and 

17 ‘‘(v) the 10 top-priority hostels associ18 ated with health care facilities. 

19 ‘‘(C) The justification for such order of 

20 priority. 

21 ‘‘(D) The projected cost of such projects. 

22 ‘‘(E) The methodology adopted by the 

23 Service in establishing priorities under its 

24 health care facility priority system. 


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1 ‘‘(3) REQUIREMENTS FOR PREPARATION OF RE2 PORTS.—In preparing each report required under 

3 paragraph (2) (other than the initial report), the 

4 Secretary shall annually— 

5 ‘‘(A) consult with and obtain information 

6 on all health care facilities needs from Indian 

7 Tribes, Tribal Organizations, and Urban Indian 

8 Organizations; and 

9 ‘‘(B) review the total unmet needs of all 

10 Indian Tribes, Tribal Organizations, and Urban 

11 Indian Organizations for health care facilities 

12 (including hostels and staff quarters), including 

13 needs for renovation and expansion of existing 

14 facilities. 

15 ‘‘(4) CRITERIA FOR EVALUATING NEEDS.—For 

16 purposes of this subsection, the Secretary shall, in 

17 evaluating the needs of facilities operated under any 

18 contract or compact under the Indian Self-Deter19 mination and Education Assistance Act (25 U.S.C. 

20 450 et seq.) use the same criteria that the Secretary 

21 uses in evaluating the needs of facilities operated di22 rectly by the Service. 

23 ‘‘(5) NEEDS OF FACILITIES UNDER ISDEAA

24 AGREEMENTS.—The Secretary shall ensure that the 

25 planning, design, construction, and renovation needs 


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1 of Service and non-Service facilities operated under 

2 contracts or compacts in accordance with the Indian 

3 Self-Determination and Education Assistance Act 

4 (25 U.S.C. 450 et seq.) are fully and equitably inte5 grated into the health care facility priority system. 

6 ‘‘(d) REVIEW OF NEED FOR FACILITIES.— 

7 ‘‘(1) INITIAL REPORT.—In the year 2006, the 

8 Government Accountability Office shall prepare and 

9 finalize a report which sets forth the needs of the 

10 Service, Indian Tribes, Tribal Organizations, and 

11 Urban Indian Organizations, for the facilities listed 

12 under subsection (c)(2)(B), including the needs for 

13 renovation and expansion of existing facilities. The 

14 Government Accountability Office shall submit the 

15 report to the appropriate authorizing and appropria16 tions committees of Congress and to the Secretary. 

17 ‘‘(2) Beginning in the year 2006, the Secretary 

18 shall update the report required under paragraph 

19 (1) every 5 years. 

20 ‘‘(3) The Comptroller General and the Sec21 retary shall consult with Indian Tribes, Tribal Orga22 nizations, and Urban Indian Organizations. The 

23 Secretary shall submit the reports required by para24 graphs (1) and (2), to the President for inclusion in 


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1 the report required to be transmitted to Congress 

2 under section 801. 

3 ‘‘(4) For purposes of this subsection, the re4 ports shall, regarding the needs of facilities operated 

5 under any contract or compact under the Indian 

6 Self-Determination and Education Assistance Act 

7 (25 U.S.C. 450 et seq.), be based on the same cri8 teria that the Secretary uses in evaluating the needs 

9 of facilities operated directly by the Service. 

10 ‘‘(5) The planning, design, construction, and 

11 renovation needs of facilities operated under con12 tracts or compacts under the Indian Self-Determina13 tion and Education Assistance Act (25 U.S.C. 450 

14 et seq.) shall be fully and equitably integrated into 

15 the development of the health facility priority sys16 tem. 

17 ‘‘(6) Beginning in 2007 and each fiscal year 

18 thereafter, the Secretary shall provide an oppor19 tunity for nomination of planning, design, and con20 struction projects by the Service, Indian Tribes, 

21 Tribal Organizations, and Urban Indian Organiza22 tions for consideration under the health care facility 

23 priority system. 

24 ‘‘(e) FUNDING CONDITION.—All funds appropriated 

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1 monly known as the ‘Snyder Act’), for the planning, de2 sign, construction, or renovation of health facilities for the 

3 benefit of 1 or more Indian Tribes shall be subject to the 

4 provisions of the Indian Self-Determination and Edu5 cation Assistance Act (25 U.S.C. 450 et seq.). 

6 ‘‘(f) DEVELOPMENT OF INNOVATIVE APPROACHES.— 

7 The Secretary shall consult and cooperate with Indian 

8 Tribes, Tribal Organizations, and Urban Indian Organiza9 tions in developing innovative approaches to address all 

10 or part of the total unmet need for construction of health 

11 facilities, including those provided for in other sections of 

12 this title and other approaches. 

13 ‘‘SEC. 302. SANITATION FACILITIES. 

14 ‘‘(a) FINDINGS.—Congress finds the following: 

15 ‘‘(1) The provision of sanitation facilities is pri16 marily a health consideration and function. 

17 ‘‘(2) Indian people suffer an inordinately high 

18 incidence of disease, injury, and illness directly at19 tributable to the absence or inadequacy of sanitation 

20 facilities. 

21 ‘‘(3) The long-term cost to the United States of 

22 treating and curing such disease, injury, and illness 

23 is substantially greater than the short-term cost of 

24 providing sanitation facilities and other preventive 

25 health measures. 


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1 ‘‘(4) Many Indian homes and Indian commu2 nities still lack sanitation facilities. 

3 ‘‘(5) It is in the interest of the United States, 

4 and it is the policy of the United States, that all In5 dian communities and Indian homes, new and exist6 ing, be provided with sanitation facilities. 

7 ‘‘(b) FACILITIES AND SERVICES.—In furtherance of 

8 the findings made in subsection (a), Congress reaffirms 

9 the primary responsibility and authority of the Service to 

10 provide the necessary sanitation facilities and services as 

11 provided in section 7 of the Act of August 5, 1954 (42 

12 U.S.C. 2004a). Under such authority, the Secretary, act13 ing through the Service, is authorized to provide the fol14 lowing: 

15 ‘‘(1) Financial and technical assistance to In16 dian Tribes, Tribal Organizations, and Indian com17 munities in the establishment, training, and equip18 ping of utility organizations to operate and maintain 

19 sanitation facilities, including the provision of exist20 ing plans, standard details, and specifications avail21 able in the Department, to be used at the option of 

22 the Indian Tribe, Tribal Organization, or Indian 

23 community. 

24 ‘‘(2) Ongoing technical assistance and training 

25 to Indian Tribes, Tribal Organizations, and Indian 


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1 communities in the management of utility organiza2 tions which operate and maintain sanitation facili3 ties. 

4 ‘‘(3) Priority funding for operation and mainte5 nance assistance for, and emergency repairs to, sani6 tation facilities operated by an Indian Tribe, Tribal 

7 Organization or Indian community when necessary 

8 to avoid an imminent health threat or to protect the 

9 investment in sanitation facilities and the investment 

10 in the health benefits gained through the provision 

11 of sanitation facilities. 

12 ‘‘(c) FUNDING.—Notwithstanding any other provi13 sion of law— 

14 ‘‘(1) the Secretary of Housing and Urban De15 velopment is authorized to transfer funds appro16 priated under the Native American Housing Assist17 ance and Self-Determination Act of 1996 to the Sec18 retary of Health and Human Services; 

19 ‘‘(2) the Secretary of Health and Human Serv20 ices is authorized to accept and use such funds for 

21 the purpose of providing sanitation facilities and 

22 services for Indians under section 7 of the Act of 

23 August 5, 1954 (42 U.S.C. 2004a); 

24 ‘‘(3) unless specifically authorized when funds 

25 are appropriated, the Secretary shall not use funds 


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1 appropriated under section 7 of the Act of August 

2 5, 1954 (42 U.S.C. 2004a), to provide sanitation fa3 cilities to new homes constructed using funds pro4 vided by the Department of Housing and Urban De5 velopment; 

6 ‘‘(4) the Secretary of Health and Human Serv7 ices is authorized to accept from any source, includ8 ing Federal and State agencies, funds for the pur9 pose of providing sanitation facilities and services 

10 and place these funds into contracts or compacts 

11 under the Indian Self-Determination and Education 

12 Assistance Act (25 U.S.C. 450 et seq.); 

13 ‘‘(5) except as otherwise prohibited by this sec14 tion, the Secretary may use funds appropriated 

15 under the authority of section 7 of the Act of Au16 gust 5, 1954 (42 U.S.C. 2004a) to fund up to 100 

17 percent of the amount of an Indian Tribe’s loan ob18 tained under any Federal program for new projects 

19 to construct eligible sanitation facilities to serve In20 dian homes; 

21 ‘‘(6) except as otherwise prohibited by this sec22 tion, the Secretary may use funds appropriated 

23 under the authority of section 7 of the Act of Au24 gust 5, 1954 (42 U.S.C. 2004a) to meet matching 

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1 eral and non-Federal programs for new projects to 

2 construct eligible sanitation facilities; 

3 ‘‘(7) all Federal agencies are authorized to 

4 transfer to the Secretary funds identified, granted, 

5 loaned, or appropriated whereby the Department’s 

6 applicable policies, rules, and regulations shall apply 

7 in the implementation of such projects; 

8 ‘‘(8) the Secretary of Health and Human Serv9 ices shall enter into interagency agreements with 

10 Federal and State agencies for the purpose of pro11 viding financial assistance for sanitation facilities 

12 and services under this Act; and 

13 ‘‘(9) the Secretary of Health and Human Serv14 ices shall, by regulation developed through rule15 making under section 802, establish standards appli16 cable to the planning, design, and construction of 

17 sanitation facilities funded under this Act. 

18 ‘‘(d) CERTAIN CAPABILITIES NOT PREREQUISITE.— 

19 The financial and technical capability of an Indian Tribe, 

20 Tribal Organization, or Indian community to safely oper21 ate, manage, and maintain a sanitation facility shall not 

22 be a prerequisite to the provision or construction of sanita23 tion facilities by the Secretary. 

24 ‘‘(e) FINANCIAL ASSISTANCE.—The Secretary is au25 thorized to provide financial assistance to Indian Tribes, 


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1 Tribal Organizations, and Indian communities for oper2 ation, management, and maintenance of their sanitation 

3 facilities. 

4 ‘‘(f) OPERATION, MANAGEMENT, AND MAINTENANCE

5 OF FACILITIES.—The Indian Tribe has the primary re6 sponsibility to establish, collect, and use reasonable user 

7 fees, or otherwise set aside funding, for the purpose of 

8 operating, managing, and maintaining sanitation facilities. 

9 If a sanitation facility serving a community that is oper10 ated by an Indian Tribe or Tribal Organization is threat11 ened with imminent failure and such operator lacks capac12 ity to maintain the integrity or the health benefits of the 

13 sanitation facility, then the Secretary is authorized to as14 sist the Indian Tribe, Tribal Organization, or Indian com15 munity in the resolution of the problem on a short-term 

16 basis through cooperation with the emergency coordinator 

17 or by providing operation, management, and maintenance 

18 service. 

19 ‘‘(g) ISDEAA PROGRAM FUNDED ON EQUAL

20 BASIS.—Tribal Health Programs shall be eligible (on an 

21 equal basis with programs that are administered directly 

22 by the Service) for— 

23 ‘‘(1) any funds appropriated pursuant to this 

24 section; and 


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1 ‘‘(2) any funds appropriated for the purpose of 

2 providing sanitation facilities. 

3 ‘‘(h) REPORT.— 

4 ‘‘(1) REQUIRED; CONTENTS.—The Secretary, in 

5 consultation with the Secretary of Housing and 

6 Urban Development, Indian Tribes, Tribal Organiza7 tions, and tribally designated housing entities (as de8 fined in section 4 of the Native American Housing 

9 Assistance and Self-Determination Act of 1996 (25 

10 U.S.C. 4103)) shall submit to the President, for in11 clusion in each report required to be transmitted to 

12 Congress under section 801, a report which sets 

13 forth— 

14 ‘‘(A) the current Indian sanitation facility 

15 priority system of the Service; 

16 ‘‘(B) the methodology for determining 

17 sanitation deficiencies and needs; 

18 ‘‘(C) the level of initial and final sanitation 

19 deficiency for each type of sanitation facility for 

20 each project of each Indian Tribe or Indian 

21 community; 

22 ‘‘(D) the amount and most effective use of 

23 funds, derived from whatever source, necessary 

24 to accommodate the sanitation facilities needs 

25 of new homes assisted with funds under the 


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1 Native American Housing Assistance and Self2 Determination Act, and to reduce the identified 

3 sanitation deficiency levels of all Indian Tribes 

4 and Indian communities to level I sanitation de5 ficiency as defined in paragraph (4)(A); and 

6 ‘‘(E) a 10-year plan to provide sanitation 

7 facilities to serve existing Indian homes and In8 dian communities and new and renovated In9 dian homes. 

10 ‘‘(2) CRITERIA.—The criteria on which the defi11 ciencies and needs will be evaluated shall be devel12 oped through negotiated rulemaking pursuant to 

13 section 802. 

14 ‘‘(3) UNIFORM METHODOLOGY.—The method15 ology used by the Secretary in determining, pre16 paring cost estimates for, and reporting sanitation 

17 deficiencies for purposes of paragraph (1) shall be 

18 applied uniformly to all Indian Tribes and Indian 

19 communities. 

20 ‘‘(4) SANITATION DEFICIENCY LEVELS.—For 

21 purposes of this subsection, the sanitation deficiency 

22 levels for an individual, Indian Tribe, or Indian com23 munity sanitation facility to serve Indian homes are 

24 determined as follows: 


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1 ‘‘(A) A level I deficiency exists if a sanita2 tion facility serving an individual, Indian Tribe, 

3 or Indian community— 

4 ‘‘(i) complies with all applicable water 

5 supply, pollution control, and solid waste 

6 disposal laws; and 

7 ‘‘(ii) deficiencies relate to routine re8 placement, repair, or maintenance needs. 

9 ‘‘(B) A level II deficiency exists if a sanita10 tion facility serving an individual, Indian Tribe, 

11 or Indian community substantially or recently 

12 complied with all applicable water supply, pollu13 tion control, and solid waste laws and any defi14 ciencies relate to— 

15 ‘‘(i) small or minor capital improve16 ments needed to bring the facility back 

17 into compliance; 

18 ‘‘(ii) capital improvements that are 

19 necessary to enlarge or improve the facili20 ties in order to meet the current needs for 

21 domestic sanitation facilities; or 

22 ‘‘(iii) the lack of equipment or train23 ing by an Indian Tribe, Tribal Organiza24 tion, or an Indian community to properly 


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1 operate and maintain the sanitation facili2 ties. 

3 ‘‘(C) A level III deficiency exists if a sani4 tation facility serving an individual, Indian 

5 Tribe or Indian community meets one or more 

6 of the following conditions— 

7 ‘‘(i) water or sewer service in the 

8 home is provided by a haul system with 

9 holding tanks and interior plumbing; 

10 ‘‘(ii) major significant interruptions to 

11 water supply or sewage disposal occur fre12 quently, requiring major capital improve13 ments to correct the deficiencies; or 

14 ‘‘(iii) there is no access to or no ap15 proved or permitted solid waste facility 

16 available. 

17 ‘‘(D) A level IV deficiency exists if— 

18 ‘‘(i) a sanitation facility of an indi19 vidual, Indian Tribe, Tribal Organization, 

20 or Indian community has no piped water 

21 or sewer facilities in the home or the facil22 ity has become inoperable due to major 

23 component failure; or 

24 ‘‘(ii) where only a washeteria or cen25 tral facility exists in the community. 


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1 ‘‘(E) A level V deficiency exists in the ab2 sence of a sanitation facility, where individual 

3 homes do not have access to safe drinking 

4 water or adequate wastewater (including sew5 age) disposal. 

6 ‘‘(i) DEFINITIONS.—For purposes of this section, the 

7 following terms apply: 

8 ‘‘(1) INDIAN COMMUNITY.—The term ‘Indian 

9 community’ means a geographic area, a significant 

10 proportion of whose inhabitants are Indians and 

11 which is served by or capable of being served by a 

12 facility described in this section. 

13 ‘‘(2) SANITATION FACILITIES.—The terms 

14 ‘sanitation facility’ and ‘sanitation facilities’ mean 

15 safe and adequate water supply systems, sanitary 

16 sewage disposal systems, and sanitary solid waste 

17 systems (and all related equipment and support in18 frastructure). 

19 ‘‘SEC. 303. PREFERENCE TO INDIANS AND INDIAN FIRMS. 

20 ‘‘(a) BUY INDIAN ACT.—The Secretary, acting 

21 through the Service, may use the negotiating authority of 

22 section 23 of the Act of June 25, 1910 (25 U.S.C. 47, 

23 commonly known as the ‘Buy Indian Act’), to give pref24 erence to any Indian or any enterprise, partnership, cor25 poration, or other type of business organization owned and 


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1 controlled by an Indian or Indians including former or 

2 currently federally recognized Indian Tribes in the State 

3 of New York (hereinafter referred to as an ‘Indian firm’) 

4 in the construction and renovation of Service facilities pur5 suant to section 301 and in the construction of sanitation 

6 facilities pursuant to section 302. Such preference may be 

7 accorded by the Secretary unless the Secretary finds, pur8 suant to regulations adopted pursuant to section 802, that 

9 the project or function to be contracted for will not be 

10 satisfactory or such project or function cannot be properly 

11 completed or maintained under the proposed contract. The 

12 Secretary, in arriving at such a finding, shall consider 

13 whether the Indian or Indian firm will be deficient with 

14 respect to— 

15 ‘‘(1) ownership and control by Indians; 

16 ‘‘(2) equipment; 

17 ‘‘(3) bookkeeping and accounting procedures; 

18 ‘‘(4) substantive knowledge of the project or 

19 function to be contracted for; 

20 ‘‘(5) adequately trained personnel; or 

21 ‘‘(6) other necessary components of contract 

22 performance. 

23 ‘‘(b) LABOR STANDARDS.— 

24 ‘‘(1) IN GENERAL.—For the purposes of imple25 menting the provisions of this title, contracts for the 


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1 construction or renovation of health care facilities, 

2 staff quarters, and sanitation facilities, and related 

3 support infrastructure, funded in whole or in part 

4 with funds made available pursuant to this title, 

5 shall contain a provision requiring compliance with 

6 subchapter IV of chapter 31 of title 40, United 

7 States Code (commonly known as the ‘Davis-Bacon 

8 Act’), unless such construction or renovation— 

9 ‘‘(A) is performed by a contractor pursu10 ant to a contract with an Indian Tribe or Trib11 al Organization with funds supplied through a 

12 contract or compact authorized by the Indian 

13 Self-Determination and Education Assistance 

14 Act, or other statutory authority; and 

15 ‘‘(B) is subject to prevailing wage rates for 

16 similar construction or renovation in the locality 

17 as determined by the Indian Tribes or Tribal 

18 Organizations to be served by the construction 

19 or renovation. 

20 ‘‘(2) EXCEPTION.—This subsection shall not 

21 apply to construction or renovation carried out by an 

22 Indian Tribe or Tribal Organization with its own 

23 employees. 


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1 ‘‘SEC. 304. EXPENDITURE OF NONSERVICE FUNDS FOR REN2 OVATION. 

3 ‘‘(a) IN GENERAL.—Notwithstanding any other pro4 vision of law, if the requirements of subsection (c) are met, 

5 the Secretary, acting through the Service, is authorized 

6 to accept any major expansion, renovation, or moderniza7 tion by any Indian Tribe or Tribal Organization of any 

8 Service facility or of any other Indian health facility oper9 ated pursuant to a contract or compact under the Indian 

10 Self-Determination and Education Assistance Act (25 

11 U.S.C. 450 et seq.), including— 

12 ‘‘(1) any plans or designs for such expansion, 

13 renovation, or modernization; and 

14 ‘‘(2) any expansion, renovation, or moderniza15 tion for which funds appropriated under any Federal 

16 law were lawfully expended. 

17 ‘‘(b) PRIORITY LIST.— 

18 ‘‘(1) IN GENERAL.—The Secretary shall main19 tain a separate priority list to address the needs for 

20 increased operating expenses, personnel, or equip21 ment for such facilities. The methodology for estab22 lishing priorities shall be developed through nego23 tiated rulemaking under section 802. The list of pri24 ority facilities will be revised annually in consulta25 tion with Indian Tribes and Tribal Organizations. 


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1 ‘‘(2) REPORT.—The Secretary shall submit to 

2 the President, for inclusion in each report required 

3 to be transmitted to Congress under section 801, the 

4 priority list maintained pursuant to paragraph (1). 

5 ‘‘(c) REQUIREMENTS.—The requirements of this sub6 section are met with respect to any expansion, renovation, 

7 or modernization if— 

8 ‘‘(1) the Indian Tribe or Tribal Organization— 

9 ‘‘(A) provides notice to the Secretary of its 

10 intent to expand, renovate, or modernize; and 

11 ‘‘(B) applies to the Secretary to be placed 

12 on a separate priority list to address the needs 

13 of such new facilities for increased operating ex14 penses, personnel, or equipment; and 

15 ‘‘(2) the expansion, renovation, or moderniza16 tion— 

17 ‘‘(A) is approved by the appropriate area 

18 director of the Service for Federal facilities; and 

19 ‘‘(B) is administered by the Indian Tribe 

20 or Tribal Organization in accordance with any 

21 applicable regulations prescribed by the Sec22 retary with respect to construction or renova23 tion of Service facilities. 

24 ‘‘(d) ADDITIONAL REQUIREMENT FOR EXPANSION.— 

25 In addition to the requirements under subsection (c), for 


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1 any expansion, the Indian Tribe or Tribal Organization 

2 shall provide to the Secretary additional information devel3 oped through negotiated rulemaking under section 802, 

4 including additional staffing, equipment, and other costs 

5 associated with the expansion. 

6 ‘‘(e) CLOSURE OR CONVERSION OF FACILITIES.—If 

7 any Service facility which has been expanded, renovated, 

8 or modernized by an Indian Tribe or Tribal Organization 

9 under this section ceases to be used as a Service facility 

10 during the 20-year period beginning on the date such ex11 pansion, renovation, or modernization is completed, such 

12 Indian Tribe or Tribal Organization shall be entitled to 

13 recover from the United States an amount which bears 

14 the same ratio to the value of such facility at the time 

15 of such cessation as the value of such expansion, renova16 tion, or modernization (less the total amount of any funds 

17 provided specifically for such facility under any Federal 

18 program that were expended for such expansion, renova19 tion, or modernization) bore to the value of such facility 

20 at the time of the completion of such expansion, renova21 tion, or modernization. 

22 ‘‘SEC. 305. FUNDING FOR THE CONSTRUCTION, EXPANSION, 

23 AND MODERNIZATION OF SMALL AMBULA24 TORY CARE FACILITIES. 

25 ‘‘(a) FUNDING.— 


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1 ‘‘(1) IN GENERAL.—The Secretary, acting 

2 through the Service, in consultation with Indian 

3 Tribes and Tribal Organizations, shall make grants 

4 to Indian Tribes and Tribal Organizations for the 

5 construction, expansion, or modernization of facili6 ties for the provision of ambulatory care services to 

7 eligible Indians (and noneligible persons pursuant to 

8 subsections (b)(2) and (c)(1)(C)). Funding made 

9 under this section may cover up to 100 percent of 

10 the costs of such construction, expansion, or mod11 ernization. For the purposes of this section, the term 

12 ‘construction’ includes the replacement of an exist13 ing facility. 

14 ‘‘(2) AGREEMENT REQUIRED.—Funding under 

15 paragraph (1) may only be made available to a Trib16 al Health Program operating an Indian health facil17 ity (other than a facility owned or constructed by 

18 the Service, including a facility originally owned or 

19 constructed by the Service and transferred to an In20 dian Tribe or Tribal Organization). 

21 ‘‘(b) USE OF FUNDS.— 

22 ‘‘(1) ALLOWABLE USES.—Funding provided 

23 under this section may be used for the construction, 

24 expansion, or modernization (including the planning 


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1 and design of such construction, expansion, or mod2 ernization) of an ambulatory care facility— 

3 ‘‘(A) located apart from a hospital; 

4 ‘‘(B) not funded under section 301 or sec5 tion 307; and 

6 ‘‘(C) which, upon completion of such con7 struction or modernization will— 

8 ‘‘(i) have a total capacity appropriate 

9 to its projected service population; 

10 ‘‘(ii) provide annually no fewer than 

11 150 patient visits by eligible Indians and 

12 other users who are eligible for services in 

13 such facility in accordance with section 

14 807(c)(2); and 

15 ‘‘(iii) provide ambulatory care in a 

16 Service Area (specified in the contract or 

17 compact under the Indian Self-Determina18 tion and Education Assistance Act (25 

19 U.S.C. 450 et seq.)) with a population of 

20 no fewer than 1,500 eligible Indians and 

21 other users who are eligible for services in 

22 such facility in accordance with section 

23 807(c)(2). 

24 ‘‘(2) ADDITIONAL ALLOWABLE USE.—The Sec25 retary may also reserve a portion of the funding proVerDate Aug 31 2005 05:25 Mar 17, 2006 Jkt 049200 PO 00000 Frm 00152 Fmt 6652 Sfmt 6401 E:\BILLS\S1057.RS S1057

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1 vided under this section and use those reserved 

2 funds to reduce an outstanding debt incurred by In3 dian Tribes or Tribal Organizations for the con4 struction, expansion, or modernization of an ambula5 tory care facility that meets the requirements under 

6 paragraph (1). The provisions of this section shall 

7 apply, except that such applications for funding 

8 under this paragraph shall be considered separately 

9 from applications for funding under paragraph (1). 

10 ‘‘(3) USE ONLY FOR CERTAIN PORTION OF

11 COSTS.—Funding provided under this section may 

12 be used only for the cost of that portion of a con13 struction, expansion, or modernization project that 

14 benefits the Service population identified above in 

15 subsection (b)(1)(C) (ii) and (iii). The requirements 

16 of clauses (ii) and (iii) of paragraph (1)(C) shall not 

17 apply to an Indian Tribe or Tribal Organization ap18 plying for funding under this section for a health 

19 care facility located or to be constructed on an is20 land or when such facility is not located on a road 

21 system providing direct access to an inpatient hos22 pital where care is available to the Service popu23 lation. 

24 ‘‘(c) FUNDING.— 


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1 ‘‘(1) APPLICATION.—No funding may be made 

2 available under this section unless an application or 

3 proposal for such funding has been approved by the 

4 Secretary in accordance with applicable regulations 

5 and has forth reasonable assurance by the applicant 

6 that, at all times after the construction, expansion, 

7 or modernization of a facility carried out pursuant 

8 to funding received under this section— 

9 ‘‘(A) adequate financial support will be 

10 available for the provision of services at such 

11 facility; 

12 ‘‘(B) such facility will be available to eligi13 ble Indians without regard to ability to pay or 

14 source of payment; and 

15 ‘‘(C) such facility will, as feasible without 

16 diminishing the quality or quantity of services 

17 provided to eligible Indians, serve noneligible 

18 persons on a cost basis. 

19 ‘‘(2) PRIORITY.—In awarding funding under 

20 this section, the Secretary shall give priority to In21 dian Tribes and Tribal Organizations that dem22 onstrate— 

23 ‘‘(A) a need for increased ambulatory care 

24 services; and 


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1 ‘‘(B) insufficient capacity to deliver such 

2 services. 

3 ‘‘(3) PEER REVIEW PANELS.—The Secretary 

4 may provide for the establishment of peer review 

5 panels, as necessary, to review and evaluate applica6 tions and proposals and to advise the Secretary re7 garding such applications using the criteria devel8 oped during consultations pursuant to subsection 

9 (a)(1). 

10 ‘‘(d) REVERSION OF FACILITIES.—If any facility (or 

11 portion thereof) with respect to which funds have been 

12 paid under this section, ceases, within 5 years after com13 pletion of the construction, expansion, or modernization 

14 carried out with such funds, to be used for the purposes 

15 of providing health care services to eligible Indians, all of 

16 the right, title, and interest in and to such facility (or por17 tion thereof) shall transfer to the United States unless 

18 otherwise negotiated by the Service and the Indian Tribe 

19 or Tribal Organization. 

20 ‘‘(e) FUNDING NONRECURRING.—Funding provided 

21 under this section shall be nonrecurring and shall not be 

22 available for inclusion in any individual Indian Tribe’s 

23 tribal share for an award under the Indian Self-Deter24 mination and Education Assistance Act or for reallocation 

25 or redesign thereunder. 


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1 ‘‘SEC. 306. INDIAN HEALTH CARE DELIVERY DEMONSTRA2 TION PROJECT. 

3 ‘‘(a) HEALTH CARE DEMONSTRATION PROJECTS.— 

4 The Secretary, acting through the Service, and in con5 sultation with Indian Tribes and Tribal Organizations, is 

6 authorized to enter into construction agreements under 

7 the Indian Self-Determination and Education Assistance 

8 Act (25 U.S.C. 450 et seq.) with Indian Tribes or Tribal 

9 Organizations for the purpose of carrying out a health 

10 care delivery demonstration project to test alternative 

11 means of delivering health care and services to Indians 

12 through facilities. 

13 ‘‘(b) USE OF FUNDS.—The Secretary, in approving 

14 projects pursuant to this section, may authorize funding 

15 for the construction and renovation of hospitals, health 

16 centers, health stations, and other facilities to deliver 

17 health care services and is authorized to— 

18 ‘‘(1) waive any leasing prohibition; 

19 ‘‘(2) permit carryover of funds appropriated for 

20 the provision of health care services; 

21 ‘‘(3) permit the use of other available funds; 

22 ‘‘(4) permit the use of funds or property do23 nated from any source for project purposes; 

24 ‘‘(5) provide for the reversion of donated real or 

25 personal property to the donor; and 


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1 ‘‘(6) permit the use of Service funds to match 

2 other funds, including Federal funds. 

3 ‘‘(c) REGULATIONS.—The Secretary shall develop 

4 and promulgate regulations not later than 1 year after the 

5 date of enactment of the Indian Health Care Improvement 

6 Act Amendments of 2005. If the Secretary has not pro7 mulgated regulations by that date, the Secretary shall de8 velop and publish regulations, through rulemaking under 

9 section 802, for the review and approval of applications 

10 submitted under this section. 

11 ‘‘(d) CRITERIA.—The Secretary may approve projects 

12 that meet the following criteria: 

13 ‘‘(1) There is a need for a new facility or pro14 gram or the reorientation of an existing facility or 

15 program. 

16 ‘‘(2) A significant number of Indians, including 

17 those with low health status, will be served by the 

18 project. 

19 ‘‘(3) The project has the potential to deliver 

20 services in an efficient and effective manner. 

21 ‘‘(4) The project is economically viable. 

22 ‘‘(5) The Indian Tribe or Tribal Organization 

23 has the administrative and financial capability to ad24 minister the project. 


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1 ‘‘(6) The project is integrated with providers of 

2 related health and social services and is coordinated 

3 with, and avoids duplication of, existing services. 

4 ‘‘(e) PEER REVIEW PANELS.—The Secretary may 

5 provide for the establishment of peer review panels, as nec6 essary, to review and evaluate applications using the cri7 teria developed pursuant to subsection (d). 

8 ‘‘(f) PRIORITY.—The Secretary shall give priority to 

9 applications for demonstration projects in each of the fol10 lowing Service Units to the extent that such applications 

11 are timely filed and meet the criteria specified in sub12 section (d): 

13 ‘‘(1) Cass Lake, Minnesota. 

14 ‘‘(2) Clinton, Oklahoma. 

15 ‘‘(3) Harlem, Montana. 

16 ‘‘(4) Mescalero, New Mexico. 

17 ‘‘(5) Owyhee, Nevada. 

18 ‘‘(6) Parker, Arizona. 

19 ‘‘(7) Schurz, Nevada. 

20 ‘‘(8) Winnebago, Nebraska. 

21 ‘‘(9) Ft. Yuma, California. 

22 ‘‘(g) TECHNICAL ASSISTANCE.—The Secretary shall 

23 provide such technical and other assistance as may be nec24 essary to enable applicants to comply with the provisions 

25 of this section. 


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1 ‘‘(h) SERVICE TO INELIGIBLE PERSONS.—Subject to 

2 section 807, the authority to provide services to persons 

3 otherwise ineligible for the health care benefits of the 

4 Service and the authority to extend hospital privileges in 

5 Service facilities to non-Service health practitioners as 

6 provided in section 807 may be included, subject to the 

7 terms of such section, in any demonstration project ap8 proved pursuant to this section. 

9 ‘‘(i) EQUITABLE TREATMENT.—For purposes of sub10 section (d)(1), the Secretary shall, in evaluating facilities 

11 operated under any contract or compact under the Indian 

12 Self-Determination and Education Assistance Act (25 

13 U.S.C. 450 et seq.), use the same criteria that the Sec14 retary uses in evaluating facilities operated directly by the 

15 Service. 

16 ‘‘(j) EQUITABLE INTEGRATION OF FACILITIES.—The 

17 Secretary shall ensure that the planning, design, construc18 tion, renovation, and expansion needs of Service and non19 Service facilities which are the subject of a contract or 

20 compact under the Indian Self-Determination and Edu21 cation Assistance Act (25 U.S.C. 450 et seq.) for health 

22 services are fully and equitably integrated into the imple23 mentation of the health care delivery demonstration 

24 projects under this section. 


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1 ‘‘SEC. 307. LAND TRANSFER. 

2 ‘‘Notwithstanding any other provision of law, the Bu3 reau of Indian Affairs and all other agencies and depart4 ments of the United States are authorized to transfer, at 

5 no cost, land and improvements to the Service for the pro6 vision of health care services. The Secretary is authorized 

7 to accept such land and improvements for such purposes. 

8 ‘‘SEC. 308. LEASES, CONTRACTS, AND OTHER AGREEMENTS. 

9 ‘‘The Secretary, acting through the Service, may 

10 enter into leases, contracts, and other agreements with In11 dian Tribes and Tribal Organizations which hold (1) title 

12 to, (2) a leasehold interest in, or (3) a beneficial interest 

13 in (when title is held by the United States in trust for 

14 the benefit of an Indian Tribe) facilities used or to be used 

15 for the administration and delivery of health services by 

16 an Indian Health Program. Such leases, contracts, or 

17 agreements may include provisions for construction or ren18 ovation and provide for compensation to the Indian Tribe 

19 or Tribal Organization of rental and other costs consistent 

20 with section 105(l) of the Indian Self-Determination and 

21 Education Assistance Act and regulations thereunder. 

22 ‘‘SEC. 309. STUDY ON LOANS, LOAN GUARANTEES, AND 

23 LOAN REPAYMENT. 

24 ‘‘(a) IN GENERAL.—The Secretary, in consultation 

25 with the Secretary of the Treasury, Indian Tribes, and 

26 Tribal Organizations, shall carry out a study to determine 


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1 the feasibility of establishing a loan fund to provide to In2 dian Tribes and Tribal Organizations direct loans or guar3 antees for loans for the construction of health care facili4 ties, including— 

5 ‘‘(1) inpatient facilities; 

6 ‘‘(2) outpatient facilities; 

7 ‘‘(3) staff quarters; 

8 ‘‘(4) hostels; and 

9 ‘‘(5) specialized care facilities, such as behav10 ioral health and elder care facilities. 

11 ‘‘(b) DETERMINATIONS.—In carrying out the study 

12 under subsection (a), the Secretary shall determine— 

13 ‘‘(1) the maximum principal amount of a loan 

14 or loan guarantee that should be offered to a recipi15 ent from the loan fund; 

16 ‘‘(2) the percentage of eligible costs, not to ex17 ceed 100 percent, that may be covered by a loan or 

18 loan guarantee from the loan fund (including costs 

19 relating to planning, design, financing, site land de20 velopment, construction, rehabilitation, renovation, 

21 conversion, improvements, medical equipment and 

22 furnishings, and other facility-related costs and cap23 ital purchase (but excluding staffing)); 


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1 ‘‘(3) the cumulative total of the principal of di2 rect loans and loan guarantees, respectively, that 

3 may be outstanding at any 1 time; 

4 ‘‘(4) the maximum term of a loan or loan guar5 antee that may be made for a facility from the loan 

6 fund; 

7 ‘‘(5) the maximum percentage of funds from 

8 the loan fund that should be allocated for payment 

9 of costs associated with planning and applying for a 

10 loan or loan guarantee; 

11 ‘‘(6) whether acceptance by the Secretary of an 

12 assignment of the revenue of an Indian Tribe or 

13 Tribal Organization as security for any direct loan 

14 or loan guarantee from the loan fund would be ap15 propriate; 

16 ‘‘(7) whether, in the planning and design of 

17 health facilities under this section, users eligible 

18 under section 807(c) may be included in any projec19 tion of patient population; 

20 ‘‘(8) whether funds of the Service provided 

21 through loans or loan guarantees from the loan fund 

22 should be eligible for use in matching other Federal 

23 funds under other programs; 


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1 ‘‘(9) the appropriateness of, and best methods 

2 for, coordinating the loan fund with the health care 

3 priority system of the Service under section 301; and 

4 ‘‘(10) any legislative or regulatory changes re5 quired to implement recommendations of the Sec6 retary based on results of the study. 

7 ‘‘(c) REPORT.—Not later than September 30, 2007, 

8 the Secretary shall submit to the Committee on Indian Af9 fairs of the Senate and the Committee on Resources and 

10 the Committee on Energy and Commerce of the House 

11 of Representatives a report that describes— 

12 ‘‘(1) the manner of consultation made as re13 quired by subsection (a); and 

14 ‘‘(2) the results of the study, including any rec15 ommendations of the Secretary based on results of 

16 the study. 

17 ‘‘SEC. 310. TRIBAL LEASING. 

18 ‘‘A Tribal Health Program may lease permanent 

19 structures for the purpose of providing health care services 

20 without obtaining advance approval in appropriation Acts. 

21 ‘‘SEC. 311. INDIAN HEALTH SERVICE/TRIBAL FACILITIES 

22 JOINT VENTURE PROGRAM. 

23 ‘‘(a) IN GENERAL.—The Secretary, acting through 

24 the Service, shall make arrangements with Indian Tribes 

25 and Tribal Organizations to establish joint venture demVerDate Aug 31 2005 05:25 Mar 17, 2006 Jkt 049200 PO 00000 Frm 00163 Fmt 6652 Sfmt 6401 E:\BILLS\S1057.RS S1057

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1 onstration projects under which an Indian Tribe or Tribal 

2 Organization shall expend tribal, private, or other avail3 able funds, for the acquisition or construction of a health 

4 facility for a minimum of 10 years, under a no-cost lease, 

5 in exchange for agreement by the Service to provide the 

6 equipment, supplies, and staffing for the operation and 

7 maintenance of such a health facility. An Indian Tribe or 

8 Tribal Organization may use tribal funds, private sector, 

9 or other available resources, including loan guarantees, to 

10 fulfill its commitment under a joint venture entered into 

11 under this subsection. An Indian Tribe or Tribal Organi12 zation shall be eligible to establish a joint venture project 

13 if, when it submits a letter of intent, it— 

14 ‘‘(1) has begun but not completed the process 

15 of acquisition or construction of a health facility to 

16 be used in the joint venture project; or 

17 ‘‘(2) has not begun the process of acquisition or 

18 construction of a health facility for use in the joint 

19 venture project. 

20 ‘‘(b) REQUIREMENTS.—The Secretary shall make 

21 such an arrangement with an Indian Tribe or Tribal Orga22 nization only if— 

23 ‘‘(1) the Secretary first determines that the In24 dian Tribe or Tribal Organization has the adminis25 trative and financial capabilities necessary to comVerDate Aug 31 2005 05:25 Mar 17, 2006 Jkt 049200 PO 00000 Frm 00164 Fmt 6652 Sfmt 6401 E:\BILLS\S1057.RS S1057

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1 plete the timely acquisition or construction of the 

2 relevant health facility; and 

3 ‘‘(2) the Indian Tribe or Tribal Organization 

4 meets the need criteria which shall be developed 

5 through the negotiated rulemaking process provided 

6 for under section 802. 

7 ‘‘(c) CONTINUED OPERATION.—The Secretary shall 

8 negotiate an agreement with the Indian Tribe or Tribal 

9 Organization regarding the continued operation of the fa10 cility at the end of the initial 10 year no-cost lease period. 

11 ‘‘(d) BREACH OF AGREEMENT.—An Indian Tribe or 

12 Tribal Organization that has entered into a written agree13 ment with the Secretary under this section, and that 

14 breaches or terminates without cause such agreement, 

15 shall be liable to the United States for the amount that 

16 has been paid to the Indian Tribe or Tribal Organization, 

17 or paid to a third party on the Indian Tribe’s or Tribal 

18 Organization’s behalf, under the agreement. The Sec19 retary has the right to recover tangible property (including 

20 supplies) and equipment, less depreciation, and any funds 

21 expended for operations and maintenance under this sec22 tion. The preceding sentence does not apply to any funds 

23 expended for the delivery of health care services, per24 sonnel, or staffing. 


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1 ‘‘(e) RECOVERY FOR NONUSE.—An Indian Tribe or 

2 Tribal Organization that has entered into a written agree3 ment with the Secretary under this subsection shall be en4 titled to recover from the United States an amount that 

5 is proportional to the value of such facility if, at any time 

6 within the 10-year term of the agreement, the Service 

7 ceases to use the facility or otherwise breaches the agree8 ment. 

9 ‘‘(f) DEFINITION.—For the purposes of this section, 

10 the term ‘health facility’ or ‘health facilities’ includes 

11 quarters needed to provide housing for staff of the rel12 evant Tribal Health Program. 

13 ‘‘SEC. 312. LOCATION OF FACILITIES. 

14 ‘‘(a) IN GENERAL.—In all matters involving the reor15 ganization or development of Service facilities or in the 

16 establishment of related employment projects to address 

17 unemployment conditions in economically depressed areas, 

18 the Bureau of Indian Affairs and the Service shall give 

19 priority to locating such facilities and projects on Indian 

20 lands, or lands in Alaska owned by any Alaska Native vil21 lage, or village or regional corporation under the Alaska 

22 Native Claims Settlement Act, or any land allotted to any 

23 Alaska Native, if requested by the Indian owner and the 

24 Indian Tribe with jurisdiction over such lands or other 

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1 nization. Top priority shall be given to Indian land owned 

2 by 1 or more Indian Tribes. 

3 ‘‘(b) DEFINITION.—For purposes of this section, the 

4 term ‘Indian lands’ means— 

5 ‘‘(1) all lands within the exterior boundaries of 

6 any reservation; and 

7 ‘‘(2) any lands title to which is held in trust by 

8 the United States for the benefit of any Indian 

9 Tribe or individual Indian or held by any Indian 

10 Tribe or individual Indian subject to restriction by 

11 the United States against alienation. 

12 ‘‘SEC. 313. MAINTENANCE AND IMPROVEMENT OF HEALTH 

13 CARE FACILITIES. 

14 ‘‘(a) REPORT.—The Secretary shall submit to the 

15 President, for inclusion in the report required to be trans16 mitted to Congress under section 801, a report which iden17 tifies the backlog of maintenance and repair work required 

18 at both Service and tribal health care facilities, including 

19 new health care facilities expected to be in operation in 

20 the next fiscal year. The report shall also identify the need 

21 for renovation and expansion of existing facilities to sup22 port the growth of health care programs. 

23 ‘‘(b) MAINTENANCE OF NEWLY CONSTRUCTED

24 SPACE.—The Secretary, acting through the Service, is au25 thorized to expend maintenance and improvement funds 


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1 to support maintenance of newly constructed space only 

2 if such space falls within the approved supportable space 

3 allocation for the Indian Tribe or Tribal Organization. 

4 Supportable space allocation shall be defined through the 

5 negotiated rulemaking process provided for under section 

6 802. 

7 ‘‘(c) REPLACEMENT FACILITIES.—In addition to 

8 using maintenance and improvement funds for renovation, 

9 modernization, and expansion of facilities, an Indian Tribe 

10 or Tribal Organization may use maintenance and improve11 ment funds for construction of a replacement facility if 

12 the costs of renovation of such facility would exceed a 

13 maximum renovation cost threshold. The maximum ren14 ovation cost threshold shall be determined through the ne15 gotiated rulemaking process provided for under section 

16 802. 

17 ‘‘SEC. 314. TRIBAL MANAGEMENT OF FEDERALLY OWNED 

18 QUARTERS. 

19 ‘‘(a) RENTAL RATES.— 

20 ‘‘(1) ESTABLISHMENT.—Notwithstanding any 

21 other provision of law, a Tribal Health Program 

22 which operates a hospital or other health facility and 

23 the federally owned quarters associated therewith 

24 pursuant to a contract or compact under the Indian 

25 Self-Determination and Education Assistance Act 


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1 (25 U.S.C. 450 et seq.) shall have the authority to 

2 establish the rental rates charged to the occupants 

3 of such quarters by providing notice to the Secretary 

4 of its election to exercise such authority. 

5 ‘‘(2) OBJECTIVES.—In establishing rental rates 

6 pursuant to authority of this subsection, a Tribal 

7 Health Program shall endeavor to achieve the fol8 lowing objectives: 

9 ‘‘(A) To base such rental rates on the rea10 sonable value of the quarters to the occupants 

11 thereof. 

12 ‘‘(B) To generate sufficient funds to pru13 dently provide for the operation and mainte14 nance of the quarters, and subject to the discre15 tion of the Tribal Health Program, to supply 

16 reserve funds for capital repairs and replace17 ment of the quarters. 

18 ‘‘(3) EQUITABLE FUNDING.—Any quarters 

19 whose rental rates are established by a Tribal 

20 Health Program pursuant to this subsection shall 

21 remain eligible for quarters improvement and repair 

22 funds to the same extent as all federally owned 

23 quarters used to house personnel in Services-sup24 ported programs. 


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1 ‘‘(4) NOTICE OF RATE CHANGE.—A Tribal 

2 Health Program which exercises the authority pro3 vided under this subsection shall provide occupants 

4 with no less than 60 days notice of any change in 

5 rental rates. 

6 ‘‘(b) DIRECT COLLECTION OF RENT.— 

7 ‘‘(1) IN GENERAL.—Notwithstanding any other 

8 provision of law, and subject to paragraph (2), a 

9 Tribal Health Program shall have the authority to 

10 collect rents directly from Federal employees who oc11 cupy such quarters in accordance with the following: 

12 ‘‘(A) The Tribal Health Program shall no13 tify the Secretary and the subject Federal em14 ployees of its election to exercise its authority 

15 to collect rents directly from such Federal em16 ployees. 

17 ‘‘(B) Upon receipt of a notice described in 

18 subparagraph (A), the Federal employees shall 

19 pay rents for occupancy of such quarters di20 rectly to the Tribal Health Program and the 

21 Secretary shall have no further authority to col22 lect rents from such employees through payroll 

23 deduction or otherwise. 

24 ‘‘(C) Such rent payments shall be retained 

25 by the Tribal Health Program and shall not be 


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1 made payable to or otherwise be deposited with 

2 the United States. 

3 ‘‘(D) Such rent payments shall be depos4 ited into a separate account which shall be used 

5 by the Tribal Health Program for the mainte6 nance (including capital repairs and replace7 ment) and operation of the quarters and facili8 ties as the Tribal Health Program shall deter9 mine. 

10 ‘‘(2) RETROCESSION OF AUTHORITY.—If a 

11 Tribal Health Program which has made an election 

12 under paragraph (1) requests retrocession of its au13 thority to directly collect rents from Federal employ14 ees occupying federally owned quarters, such ret15 rocession shall become effective on the earlier of— 

16 ‘‘(A) the first day of the month that begins 

17 no less than 180 days after the Tribal Health 

18 Program notifies the Secretary of its desire to 

19 retrocede; or 

20 ‘‘(B) such other date as may be mutually 

21 agreed by the Secretary and the Tribal Health 

22 Program. 

23 ‘‘(c) RATES IN ALASKA.—To the extent that a Tribal 

24 Health Program, pursuant to authority granted in sub25 section (a), establishes rental rates for federally owned 


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1 quarters provided to a Federal employee in Alaska, such 

2 rents may be based on the cost of comparable private rent3 al housing in the nearest established community with a 

4 year-round population of 1,500 or more individuals. 

5 ‘‘SEC. 315. APPLICABILITY OF BUY AMERICAN ACT RE6 QUIREMENT. 

7 ‘‘(a) APPLICABILITY.—The Secretary shall ensure 

8 that the requirements of the Buy American Act apply to 

9 all procurements made with funds provided pursuant to 

10 section 317. Indian Tribes and Tribal Organizations shall 

11 be exempt from these requirements. 

12 ‘‘(b) EFFECT OF VIOLATION.—If it has been finally 

13 determined by a court or Federal agency that any person 

14 intentionally affixed a label bearing a ‘Made in America’ 

15 inscription or any inscription with the same meaning, to 

16 any product sold in or shipped to the United States that 

17 is not made in the United States, such person shall be 

18 ineligible to receive any contract or subcontract made with 

19 funds provided pursuant to section 317, pursuant to the 

20 debarment, suspension, and ineligibility procedures de21 scribed in sections 9.400 through 9.409 of title 48, Code 

22 of Federal Regulations. 

23 ‘‘(c) DEFINITIONS.—For purposes of this section, the 

24 term ‘Buy American Act’ means title III of the Act enti25 tled ‘An Act making appropriations for the Treasury and 


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1 Post Office Departments for the fiscal year ending June 

2 30, 1934, and for other purposes’, approved March 3, 

3 1933 (41 U.S.C. 10a et seq.). 

4 ‘‘SEC. 316. OTHER FUNDING FOR FACILITIES. 

5 ‘‘(a) AUTHORITY TO ACCEPT FUNDS.—The Sec6 retary is authorized to accept from any source, including 

7 Federal and State agencies, funds that are available for 

8 the construction of health care facilities and use such 

9 funds to plan, design, and construct health care facilities 

10 for Indians and to place such funds into a contract or com11 pact under the Indian Self-Determination and Education 

12 Assistance Act (25 U.S.C. 450 et seq.). Receipt of such 

13 funds shall have no effect on the priorities established pur14 suant to section 301. 

15 ‘‘(b) INTERAGENCY AGREEMENTS.—The Secretary is 

16 authorized to enter into interagency agreements with 

17 other Federal agencies or State agencies and other entities 

18 and to accept funds from such Federal or State agencies 

19 or other sources to provide for the planning, design, and 

20 construction of health care facilities to be administered by 

21 Indian Health Programs in order to carry out the pur22 poses of this Act and the purposes for which the funds 

23 were appropriated or for which the funds were otherwise 

24 provided. 


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1 ‘‘(c) TRANSFERRED FUNDS.—Any Federal agency to 

2 which funds for the construction of health care facilities 

3 are appropriated is authorized to transfer such funds to 

4 the Secretary for the construction of health care facilities 

5 to carry out the purposes of this Act as well as the pur6 poses for which such funds are appropriated to such other 

7 Federal agency. 

8 ‘‘(d) ESTABLISHMENT OF STANDARDS.—The Sec9 retary, through the Service, shall establish standards by 

10 regulation, developed by rulemaking under section 802, for 

11 the planning, design, and construction of health care fa12 cilities serving Indians under this Act. 

13 ‘‘SEC. 317. AUTHORIZATION OF APPROPRIATIONS. 

14 ‘‘There are authorized to be appropriated such sums 

15 as may be necessary for each fiscal year through fiscal 

16 year 2015 to carry out this title. 

17 ‘‘TITLE IV—ACCESS TO HEALTH 

18 SERVICES 

19 ‘‘SEC. 401. TREATMENT OF PAYMENTS UNDER SOCIAL SE20 CURITY ACT HEALTH CARE PROGRAMS. 

21 ‘‘(a) DISREGARD OF MEDICARE, MEDICAID, AND

22 SCHIP PAYMENTS IN DETERMINING APPROPRIATIONS.— 

23 Any payments received by an Indian Health Program or 

24 by an Urban Indian Organization made under title XVIII, 

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1 vided to Indians eligible for benefits under such respective 

2 titles shall not be considered in determining appropria3 tions for the provision of health care and services to Indi4 ans. 

5 ‘‘(b) NONPREFERENTIAL TREATMENT.—Nothing in 

6 this Act authorizes the Secretary to provide services to an 

7 Indian with coverage under title XVIII, XIX, or XXI of 

8 the Social Security Act in preference to an Indian without 

9 such coverage. 

10 ‘‘(c) USE OF FUNDS.— 

11 ‘‘(1) SPECIAL FUND.—Notwithstanding any 

12 other provision of law, but subject to paragraph (2), 

13 payments to which a facility of the Service is enti14 tled by reason of a provision of the Social Security 

15 Act shall be placed in a special fund to be held by 

16 the Secretary and first used (to such extent or in 

17 such amounts as are provided in appropriation Acts) 

18 for the purpose of making any improvements in the 

19 programs of the Service which may be necessary to 

20 achieve or maintain compliance with the applicable 

21 conditions and requirements of titles XVIII, XIX, 

22 and XXI of the Social Security Act. Any amounts to 

23 be reimbursed that are in excess of the amount nec24 essary to achieve or maintain such conditions and 

25 requirements shall, subject to the consultation with 


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1 Indian Tribes being served by the Service Unit, be 

2 used for reducing the health resource deficiencies of 

3 the Indian Tribes. In making payments from such 

4 fund, the Secretary shall ensure that each Service 

5 Unit of the Service receives 100 percent of the 

6 amount to which the facilities of the Service, for 

7 which such Service Unit makes collections, are enti8 tled by reason of a provision of the Social Security 

9 Act. 

10 ‘‘(2) DIRECT PAYMENT OPTION.—Paragraph 

11 (1) shall not apply upon the election of a Tribal 

12 Health Program under subsection (d) to receive pay13 ments directly. No payment may be made out of the 

14 special fund described in such paragraph with re15 spect to reimbursement made for services provided 

16 during the period of such election. 

17 ‘‘(d) DIRECT BILLING.— 

18 ‘‘(1) IN GENERAL.—A Tribal Health Program 

19 may directly bill for, and receive payment for, health 

20 care items and services provided by such Indian 

21 Tribe or Tribal organization for which payment is 

22 made under title XVIII, XIX, or XXI of the Social 

23 Security Act or from any other third party payor. 

24 ‘‘(2) DIRECT REIMBURSEMENT.— 


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1 ‘‘(A) USE OF FUNDS.—Each Tribal Health 

2 Program exercising the option described in 

3 paragraph (1) with respect to a program under 

4 a title of the Social Security Act shall be reim5 bursed directly by that program for items and 

6 services furnished without regard to section 

7 401(c), but all amounts so reimbursed shall be 

8 used by the Tribal Health Program for the pur9 pose of making any improvements in Tribal fa10 cilities or Tribal Health Programs that may be 

11 necessary to achieve or maintain compliance 

12 with the conditions and requirements applicable 

13 generally to such items and services under the 

14 program under such title and to provide addi15 tional health care services, improvements in 

16 health care facilities and Tribal Health Pro17 grams, any health care-related purpose, or oth18 erwise to achieve the objectives provided in sec19 tion 3 of this Act. 

20 ‘‘(B) AUDITS.—The amounts paid to an 

21 Indian Tribe or Tribal Organization exercising 

22 the option described in paragraph (1) with re23 spect to a program under a title of the Social 

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1 quirements applicable to programs administered 

2 by an Indian Health Program. 

3 ‘‘(C) IDENTIFICATION OF SOURCE OF PAY4 MENTS.—If an Indian Tribe or Tribal Organi5 zation receives funding from the Service under 

6 the Indian Self-Determination and Education 

7 Assistance Act or an Urban Indian Organiza8 tion receives funding from the Service under 

9 title V of this Act and receives reimbursements 

10 or payments under title XVIII, XIX, or XXI of 

11 the Social Security Act, such Indian Tribe or 

12 Tribal Organization, or Urban Indian Organiza13 tion, shall provide to the Service a list of each 

14 provider enrollment number (or other identifier) 

15 under which it receives such reimbursements or 

16 payments. 

17 ‘‘(3) EXAMINATION AND IMPLEMENTATION OF

18 CHANGES.—The Secretary, acting through the Serv19 ice and with the assistance of the Administrator of 

20 the Centers for Medicare & Medicaid Services, shall 

21 examine on an ongoing basis and implement any ad22 ministrative changes that may be necessary to facili23 tate direct billing and reimbursement under the pro24 gram established under this subsection, including 

25 any agreements with States that may be necessary 


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1 to provide for direct billing under a program under 

2 a title of the Social Security Act. 

3 ‘‘(4) WITHDRAWAL FROM PROGRAM.—A Tribal 

4 Health Program that bills directly under the pro5 gram established under this subsection may with6 draw from participation in the same manner and 

7 under the same conditions that an Indian Tribe or 

8 Tribal Organization may retrocede a contracted pro9 gram to the Secretary under the authority of the In10 dian Self-Determination and Education Assistance 

11 Act (25 U.S.C. 450 et seq.). All cost accounting and 

12 billing authority under the program established 

13 under this subsection shall be returned to the Sec14 retary upon the Secretary’s acceptance of the with15 drawal of participation in this program. 

16 ‘‘SEC. 402. GRANTS TO AND CONTRACTS WITH THE SERV17 ICE, INDIAN TRIBES, TRIBAL ORGANIZA18 TIONS, AND URBAN INDIAN ORGANIZATIONS. 

19 ‘‘(a) INDIAN TRIBES AND TRIBAL ORGANIZA20 TIONS.—The Secretary, acting through the Service, shall 

21 make grants to or enter into contracts with Indian Tribes 

22 and Tribal Organizations to assist such Tribes and Tribal 

23 Organizations in establishing and administering programs 

24 on or near reservations and trust lands to assist individual 

25 Indians— 


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1 ‘‘(1) to enroll for benefits under title XVIII, 

2 XIX, or XXI of the Social Security Act and other 

3 health benefits programs; and 

4 ‘‘(2) to pay premiums for coverage for such 

5 benefits, which may be based on financial need (as 

6 determined by the Indian Tribe or Tribes being 

7 served based on a schedule of income levels devel8 oped or implemented by such Tribe or Tribes). 

9 ‘‘(b) CONDITIONS.—The Secretary, acting through 

10 the Service, shall place conditions as deemed necessary to 

11 effect the purpose of this section in any grant or contract 

12 which the Secretary makes with any Indian Tribe or Trib13 al Organization pursuant to this section. Such conditions 

14 shall include requirements that the Indian Tribe or Tribal 

15 Organization successfully undertake— 

16 ‘‘(1) to determine the population of Indians eli17 gible for the benefits described in subsection (a); 

18 ‘‘(2) to educate Indians with respect to the ben19 efits available under the respective programs; 

20 ‘‘(3) to provide transportation for such indi21 vidual Indians to the appropriate offices for enroll22 ment or applications for such benefits; and 

23 ‘‘(4) to develop and implement methods of im24 proving the participation of Indians in receiving the 


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1 benefits provided under titles XVIII, XIX, and XXI 

2 of the Social Security Act. 

3 ‘‘(c) AGREEMENTS RELATING TO IMPROVING EN4 ROLLMENT OF INDIANS UNDER SOCIAL SECURITY ACT

5 PROGRAMS.— 

6 ‘‘(1) AGREEMENTS WITH SECRETARY TO IM7 PROVE RECEIPT AND PROCESSING OF APPLICA8 TIONS.— 

9 ‘‘(A) AUTHORIZATION.—The Secretary, 

10 acting through the Service, may enter into an 

11 agreement with an Indian Tribe, Tribal Organi12 zation, or Urban Indian Organization which 

13 provides for the receipt and processing of appli14 cations by Indians for assistance under titles 

15 XIX and XXI of the Social Security Act, and 

16 benefits under title XVIII of such Act, by an 

17 Indian Health Program or Urban Indian Orga18 nization. 

19 ‘‘(B) REIMBURSEMENT OF COSTS.—Such 

20 agreements may provide for reimbursement of 

21 costs of outreach, education regarding eligibility 

22 and benefits, and translation when such services 

23 are provided. The reimbursement may, as ap24 propriate, be added to the applicable rate per 

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1 service payment to the Indian Tribe or Tribal 

2 Organization. 

3 ‘‘(C) PROCESSING CLARIFIED.—In this 

4 paragraph, the term ‘processing’ does not in5 clude a final determination of eligibility. 

6 ‘‘(2) AGREEMENTS WITH STATES FOR OUT7 REACH ON OR NEAR RESERVATION.— 

8 ‘‘(A) IN GENERAL.—In order to improve 

9 the access of Indians residing on or near a res10 ervation to obtain benefits under title XIX or 

11 XXI of the Social Security Act, the Secretary 

12 shall encourage the State to take steps to pro13 vide for enrollment on or near the reservation. 

14 Such steps may include outreach efforts such as 

15 the outstationing of eligibility workers, entering 

16 into agreements with Indian Tribes and Tribal 

17 Organizations to provide outreach, education re18 garding eligibility and benefits, enrollment, and 

19 translation services when such services are pro20 vided. 

21 ‘‘(B) CONSTRUCTION.—Nothing in sub22 paragraph (A) shall be construed as affecting 

23 arrangements entered into between States and 

24 Indian Tribes and Tribal Organizations for 

25 such Indian Tribes and Tribal Organizations to 


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1 conduct administrative activities under such ti2 tles. 

3 ‘‘(d) FACILITATING COOPERATION.—The Secretary, 

4 acting through the Centers for Medicare & Medicaid Serv5 ices, shall take such steps as are necessary to facilitate 

6 cooperation with, and agreements between, States and the 

7 Service, Indian Tribes, Tribal Organizations, or Urban In8 dian Organizations. 

9 ‘‘(e) APPLICATION TO URBAN INDIAN ORGANIZA10 TIONS.— 

11 ‘‘(1) IN GENERAL.—The provisions of sub12 section (a) shall apply with respect to grants and 

13 other funding to Urban Indian Organizations with 

14 respect to populations served by such organizations 

15 in the same manner they apply to grants and con16 tracts with Indian Tribes and Tribal Organizations 

17 with respect to programs on or near reservations. 

18 ‘‘(2) REQUIREMENTS.—The Secretary shall in19 clude in the grants or contracts made or provided 

20 under paragraph (1) requirements that are— 

21 ‘‘(A) consistent with the requirements im22 posed by the Secretary under subsection (b); 

23 ‘‘(B) appropriate to Urban Indian Organi24 zations and Urban Indians; and 


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1 ‘‘(C) necessary to effect the purposes of 

2 this section. 

3 ‘‘SEC. 403. REIMBURSEMENT FROM CERTAIN THIRD PAR4 TIES OF COSTS OF HEALTH SERVICES. 

5 ‘‘(a) RIGHT OF RECOVERY.—Except as provided in 

6 subsection (f), the United States, an Indian Tribe, or 

7 Tribal Organization shall have the right to recover from 

8 an insurance company, health maintenance organization, 

9 employee benefit plan, third-party tortfeasor, or any other 

10 responsible or liable third party (including a political sub11 division or local governmental entity of a State) the rea12 sonable charges as determined by the Secretary, and billed 

13 by the Secretary, an Indian Tribe, or Tribal Organization, 

14 in providing health services, through the Service, an In15 dian Tribe, or Tribal Organization to any individual to the 

16 same extent that such individual, or any nongovernmental 

17 provider of such services, would be eligible to receive dam18 ages, reimbursement, or indemnification for such charges 

19 or expenses if— 

20 ‘‘(1) such services had been provided by a non21 governmental provider; and 

22 ‘‘(2) such individual had been required to pay 

23 such charges or expenses and did pay such charges 

24 or expenses. 


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1 ‘‘(b) LIMITATIONS ON RECOVERIES FROM STATES.— 

2 Subsection (a) shall provide a right of recovery against 

3 any State, only if the injury, illness, or disability for which 

4 health services were provided is covered under— 

5 ‘‘(1) workers’ compensation laws; or 

6 ‘‘(2) a no-fault automobile accident insurance 

7 plan or program. 

8 ‘‘(c) NONAPPLICATION OF OTHER LAWS.—No law of 

9 any State, or of any political subdivision of a State and 

10 no provision of any contract, insurance or health mainte11 nance organization policy, employee benefit plan, self-in12 surance plan, managed care plan, or other health care plan 

13 or program entered into or renewed after the date of the 

14 enactment of the Indian Health Care Amendments of 

15 1988, shall prevent or hinder the right of recovery of the 

16 United States, an Indian Tribe, or Tribal Organization 

17 under subsection (a). 

18 ‘‘(d) NO EFFECT ON PRIVATE RIGHTS OF ACTION.— 

19 No action taken by the United States, an Indian Tribe, 

20 or Tribal Organization to enforce the right of recovery 

21 provided under this section shall operate to deny to the 

22 injured person the recovery for that portion of the person’s 

23 damage not covered hereunder. 

24 ‘‘(e) ENFORCEMENT.— 


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1 ‘‘(1) IN GENERAL.—The United States, an In2 dian Tribe, or Tribal Organization may enforce the 

3 right of recovery provided under subsection (a) by— 

4 ‘‘(A) intervening or joining in any civil ac5 tion or proceeding brought— 

6 ‘‘(i) by the individual for whom health 

7 services were provided by the Secretary, an 

8 Indian Tribe, or Tribal Organization; or 

9 ‘‘(ii) by any representative or heirs of 

10 such individual, or 

11 ‘‘(B) instituting a civil action, including a 

12 civil action for injunctive relief and other relief 

13 and including, with respect to a political sub14 division or local governmental entity of a State, 

15 such an action against an official thereof. 

16 ‘‘(2) NOTICE.—All reasonable efforts shall be 

17 made to provide notice of action instituted under 

18 paragraph (1)(B) to the individual to whom health 

19 services were provided, either before or during the 

20 pendency of such action. 

21 ‘‘(f) LIMITATION.—Absent specific written authoriza22 tion by the governing body of an Indian Tribe for the pe23 riod of such authorization (which may not be for a period 

24 of more than 1 year and which may be revoked at any 

25 time upon written notice by the governing body to the 


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1 Service), the United States shall not have a right of recov2 ery under this section if the injury, illness, or disability 

3 for which health services were provided is covered under 

4 a self-insurance plan funded by an Indian Tribe, Tribal 

5 Organization, or Urban Indian Organization. Where such 

6 authorization is provided, the Service may receive and ex7 pend such amounts for the provision of additional health 

8 services consistent with such authorization. 

9 ‘‘(g) COSTS AND ATTORNEYS’ FEES.—In any action 

10 brought to enforce the provisions of this section, a pre11 vailing plaintiff shall be awarded its reasonable attorneys’ 

12 fees and costs of litigation. 

13 ‘‘(h) NONAPPLICATION OF CLAIMS FILING REQUIRE14 MENTS.—An insurance company, health maintenance or15 ganization, self-insurance plan, managed care plan, or 

16 other health care plan or program (under the Social Secu17 rity Act or otherwise) may not deny a claim for benefits 

18 submitted by the Service or by an Indian Tribe or Tribal 

19 Organization based on the format in which the claim is 

20 submitted if such format complies with the format re21 quired for submission of claims under title XVIII of the 

22 Social Security Act or recognized under section 1175 of 

23 such Act. 

24 ‘‘(i) APPLICATION TO URBAN INDIAN ORGANIZA25 TIONS.—The previous provisions of this section shall apply 


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1 to Urban Indian Organizations with respect to populations 

2 served by such Organizations in the same manner they 

3 apply to Indian Tribes and Tribal Organizations with re4 spect to populations served by such Indian Tribes and 

5 Tribal Organizations. 

6 ‘‘(j) STATUTE OF LIMITATIONS.—The provisions of 

7 section 2415 of title 28, United States Code, shall apply 

8 to all actions commenced under this section, and the ref9 erences therein to the United States are deemed to include 

10 Indian Tribes, Tribal Organizations, and Urban Indian 

11 Organizations. 

12 ‘‘(k) SAVINGS.—Nothing in this section shall be con13 strued to limit any right of recovery available to the 

14 United States, an Indian Tribe, or Tribal Organization 

15 under the provisions of any applicable, Federal, State, or 

16 Tribal law, including medical lien laws and the Federal 

17 Medical Care Recovery Act (42 U.S.C. 2651 et seq.). 

18 ‘‘SEC. 404. CREDITING OF REIMBURSEMENTS. 

19 ‘‘(a) USE OF AMOUNTS.— 

20 ‘‘(1) RETENTION BY PROGRAM.—Except as pro21 vided in section 202(g) (relating to the Catastrophic 

22 Health Emergency Fund) and section 807 (relating 

23 to health services for ineligible persons), all reim24 bursements received or recovered under any of the 

25 programs described in paragraph (2), including 


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1 under section 807, by reason of the provision of 

2 health services by the Service, by an Indian Tribe or 

3 Tribal Organization, or by an Urban Indian Organi4 zation, shall be credited to the Service, such Indian 

5 Tribe or Tribal Organization, or such Urban Indian 

6 Organization, respectively, and may be used as pro7 vided in section 401. In the case of such a service 

8 provided by or through a Service Unit, such 

9 amounts shall be credited to such unit and used for 

10 such purposes. 

11 ‘‘(2) PROGRAMS COVERED.—The programs re12 ferred to in paragraph (1) are the following: 

13 ‘‘(A) Titles XVIII, XIX, and XXI of the 

14 Social Security Act. 

15 ‘‘(B) This Act, including section 807. 

16 ‘‘(C) Public Law 87–693. 

17 ‘‘(D) Any other provision of law. 

18 ‘‘(b) NO OFFSET OF AMOUNTS.—The Service may 

19 not offset or limit any amount obligated to any Service 

20 Unit or entity receiving funding from the Service because 

21 of the receipt of reimbursements under subsection (a). 

22 ‘‘SEC. 405. PURCHASING HEALTH CARE COVERAGE. 

23 ‘‘(a) IN GENERAL.—Insofar as amounts are made 

24 available under law (including a provision of the Social 

25 Security Act, the Indian Self-Determination and EduVerDate Aug 31 2005 05:25 Mar 17, 2006 Jkt 049200 PO 00000 Frm 00189 Fmt 6652 Sfmt 6401 E:\BILLS\S1057.RS S1057

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1 cation Assistance Act, or other law, other than under sec2 tion 402) to Indian Tribes, Tribal Organizations, and 

3 Urban Indian Organizations for health benefits for Service 

4 beneficiaries, Indian Tribes, Tribal Organizations, and 

5 Urban Indian Organizations may use such amounts to 

6 purchase health benefits coverage for such beneficiaries in 

7 any manner, including through— 

8 ‘‘(1) a tribally owned and operated health care 

9 plan; 

10 ‘‘(2) a State or locally authorized or licensed 

11 health care plan; 

12 ‘‘(3) a health insurance provider or managed 

13 care organization; or 

14 ‘‘(4) a self-insured plan. 

15 The purchase of such coverage by an Indian Tribe, Tribal 

16 Organization, or Urban Indian Organization may be based 

17 on the financial needs of such beneficiaries (as determined 

18 by the Indian Tribe or Tribes being served based on a 

19 schedule of income levels developed or implemented by 

20 such Indian Tribe or Tribes). 

21 ‘‘(b) EXPENSES FOR SELF-INSURED PLAN.—In the 

22 case of a self-insured plan under subsection (a)(4), the 

23 amounts may be used for expenses of operating the plan, 

24 including administration and insurance to limit the finan25 cial risks to the entity offering the plan. 


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1 ‘‘(c) CONSTRUCTION.—Nothing in this section shall 

2 be construed as affecting the use of any amounts not re3 ferred to in subsection (a). 

4 ‘‘SEC. 406. SHARING ARRANGEMENTS WITH FEDERAL AGEN5 CIES. 

6 ‘‘(a) AUTHORITY.— 

7 ‘‘(1) IN GENERAL.—The Secretary may enter 

8 into (or expand) arrangements for the sharing of 

9 medical facilities and services between the Service, 

10 Indian Tribes, and Tribal Organizations and the De11 partment of Veterans Affairs and the Department of 

12 Defense. 

13 ‘‘(2) CONSULTATION BY SECRETARY RE14 QUIRED.—The Secretary may not finalize any ar15 rangement between the Service and a Department 

16 described in paragraph (1) without first consulting 

17 with the Indian Tribes which will be significantly af18 fected by the arrangement. 

19 ‘‘(b) LIMITATIONS.—The Secretary shall not take 

20 any action under this section or under subchapter IV of 

21 chapter 81 of title 38, United States Code, which would 

22 impair— 

23 ‘‘(1) the priority access of any Indian to health 

24 care services provided through the Service and the 


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1 eligibility of any Indian to receive health services 

2 through the Service; 

3 ‘‘(2) the quality of health care services provided 

4 to any Indian through the Service; 

5 ‘‘(3) the priority access of any veteran to health 

6 care services provided by the Department of Vet7 erans Affairs; 

8 ‘‘(4) the quality of health care services provided 

9 by the Department of Veterans Affairs or the De10 partment of Defense; or 

11 ‘‘(5) the eligibility of any Indian who is a vet12 eran to receive health services through the Depart13 ment of Veterans Affairs. 

14 ‘‘(c) REIMBURSEMENT.—The Service, Indian Tribe, 

15 or Tribal Organization shall be reimbursed by the Depart16 ment of Veterans Affairs or the Department of Defense 

17 (as the case may be) where services are provided through 

18 the Service, an Indian Tribe, or a Tribal Organization to 

19 beneficiaries eligible for services from either such Depart20 ment, notwithstanding any other provision of law. 

21 ‘‘(d) CONSTRUCTION.—Nothing in this section may 

22 be construed as creating any right of a non-Indian veteran 

23 to obtain health services from the Service. 


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1 ‘‘SEC. 407. PAYOR OF LAST RESORT. 

2 ‘‘Indian Health Programs and health care programs 

3 operated by Urban Indian Organizations shall be the 

4 payor of last resort for services provided to persons eligible 

5 for services from Indian Health Programs and Urban In6 dian Organizations, notwithstanding any Federal, State, 

7 or local law to the contrary. 

8 ‘‘SEC. 408. NONDISCRIMINATION IN QUALIFICATIONS FOR 

9 REIMBURSEMENT FOR SERVICES. 

10 ‘‘For purposes of determining the eligibility of an en11 tity that is operated by the Service, an Indian Tribe, Trib12 al Organization, or Urban Indian Organization to receive 

13 payment or reimbursement from any federally funded 

14 health care program for health care services it furnishes 

15 to an Indian. Such program must provide that such entity, 

16 meeting generally applicable State or other requirements 

17 applicable for participation, must be accepted as a pro18 vider on the same basis as any other qualified provider, 

19 except that any requirement that the entity be licensed 

20 or recognized under State or local law to furnish such 

21 services shall be deemed to have been met if the entity 

22 meets all the applicable standards for such licensure, but 

23 the entity need not obtain a license or other documenta24 tion. In determining whether the entity meets such stand25 ards, the absence of licensure of any staff member of the 

26 entity may not be taken into account. 


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1 ‘‘SEC. 409. CONSULTATION. 

2 ‘‘(a) TRIBAL TECHNICAL ADVISORY GROUP

3 (TTAG).—The Secretary shall maintain within the Cen4 ters for Medicaid & Medicare Services (CMS) a Tribal 

5 Technical Advisory Group, established in accordance with 

6 requirements of the charter dated September 30, 2003, 

7 and in such group shall include a representative of the 

8 Urban Indian Organizations and the Service. The rep9 resentative of the Urban Indian Organization shall be 

10 deemed to be an elected officer of a tribal government for 

11 purposes of applying section 204(b) of the Unfunded Man12 dates Reform Act of 1995 (2 U.S.C. 1534(b)). 

13 ‘‘(b) SOLICITATION OF MEDICAID ADVICE.— 

14 ‘‘(1) IN GENERAL.—As part of its plan under 

15 title XIX of the Social Security Act, a State in 

16 which the Service operates or funds health care pro17 grams, or in which 1 or more Indian Health Pro18 grams or Urban Indian Organizations provide health 

19 care in the State for which medical assistance is 

20 available under such title, may establish a process 

21 under which the State seeks advice on a regular, on22 going basis from designees of such Indian Health 

23 Programs and Urban Indian Organizations on mat24 ters relating to the application of such title to and 

25 likely to have a direct effect on such Indian Health 

26 Programs and Urban Indian Organizations. 


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1 ‘‘(2) MANNER OF ADVICE.—The process de2 scribed in paragraph (1) should include solicitation 

3 of advice prior to submission of any plan amend4 ments, waiver requests, and proposals for dem5 onstration projects likely to have a direct effect on 

6 Indians, Indian Health Programs, or Urban Indian 

7 Organizations. Such process may include appoint8 ment of an advisory committee and of a designee of 

9 such Indian Health Programs and Urban Indian Or10 ganizations to the medical care advisory committee 

11 advising the State on its medicaid plan. 

12 ‘‘(3) PAYMENT OF EXPENSES.—The reasonable 

13 expenses of carrying out this subsection shall be eli14 gible for reimbursement under section 1903(a) of 

15 the Social Security Act. 

16 ‘‘(c) CONSTRUCTION.—Nothing in this section shall 

17 be construed as superseding existing advisory committees, 

18 working groups, or other advisory procedures established 

19 by the Secretary or by any State. 

20 ‘‘SEC. 410. STATE CHILDREN’S HEALTH INSURANCE PRO21 GRAM (SCHIP). 

22 ‘‘(a) OPTIONAL USE OF FUNDS FOR INDIAN HEALTH

23 PROGRAM PAYMENTS.—Subject to the succeeding provi24 sions of this section, a State may provide under its State 

25 child health plan under title XXI of the Social Security 


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1 Act (regardless of whether such plan is implemented under 

2 such title, title XIX of such Act, or both) for payments 

3 under this section to Indian Health Programs and Urban 

4 Indian Organizations operating in the State. Such pay5 ments shall be treated under title XXI of the Social Secu6 rity Act as expenditures described in section 

7 2105(a)(1)(A) of such Act. 

8 ‘‘(b) USE OF FUNDS.—Payments under this section 

9 may be used only for expenditures described in clauses (i) 

10 through (iii) of section 2105(a)(1)(D) of the Social Secu11 rity Act for targeted low-income children or other low-in12 come children (as defined in 2110 of such Act) who are— 

13 ‘‘(1) Indians; or 

14 ‘‘(2) otherwise eligible for health services from 

15 the Indian Health Program involved. 

16 ‘‘(c) SPECIAL RESTRICTIONS.—The following condi17 tions apply to a State electing to provide payments under 

18 this section: 

19 ‘‘(1) NO LIMITATION ON OTHER SCHIP PARTICI20 PATION OF, OR PROVIDER PAYMENTS TO, INDIAN

21 HEALTH PROGRAMS.—The State may not exclude or 

22 limit participation of otherwise eligible Indian 

23 Health Programs in its State child health program 

24 under title XXI of the Social Security Act or its 

25 medicaid program under title XIX of such Act or 


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1 pay such Programs less than they otherwise would 

2 as participating providers on the basis that pay3 ments are made to such Programs under this sec4 tion. 

5 ‘‘(2) NO LIMITATION ON OTHER SCHIP ELIGI6 BILITY OF INDIANS.—The State may not exclude or 

7 limit participation of otherwise eligible Indian chil8 dren in such State child health or medicaid program 

9 on the basis that payments are made for assistance 

10 for such children under this section. 

11 ‘‘(3) LIMITATION ON ACCEPTANCE OF CON12 TRIBUTIONS.— 

13 ‘‘(A) IN GENERAL.—The State may not ac14 cept contributions or condition making of pay15 ments under this section upon contribution of 

16 funds from any Indian Health Program to meet 

17 the State’s non-Federal matching fund require18 ments under titles XIX and XXI of the Social 

19 Security Act. 

20 ‘‘(B) CONTRIBUTION DEFINED.—For pur21 poses of subparagraph (A), the term ‘contribu22 tion’ includes any tax, donation, fee, or other 

23 payment made, whether made voluntarily or in24 voluntarily. 


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1 ‘‘(d) APPLICATION OF SEPARATE 10 PERCENT LIMI2 TATION.—Payment may be made under section 2105(a) 

3 of the Social Security Act to a State for a fiscal year for 

4 payments under this section up to an amount equal to 10 

5 percent of the total amount available under title XXI of 

6 such Act (including allotments and reallotments available 

7 from previous fiscal years) to the State with respect to 

8 the fiscal year. 

9 ‘‘(e) GENERAL TERMS.—A payment under this sec10 tion shall only be made upon application to the State from 

11 the Indian Health Program involved and under such terms 

12 and conditions, and in a form and manner, as the Sec13 retary determines appropriate. 

14 ‘‘SEC. 411. SOCIAL SECURITY ACT SANCTIONS. 

15 ‘‘(a) REQUESTS FOR WAIVER OF SANCTIONS.— 

16 ‘‘(1) IN GENERAL.—For purposes of applying 

17 any authority under a provision of title XI, XVIII, 

18 XIX, or XXI of the Social Security Act to seek a 

19 waiver of a sanction imposed against a health care 

20 provider insofar as that provider provides services to 

21 individuals through an Indian Health Program, the 

22 Indian Health Program shall request the State to 

23 seek such waiver, and if such State has not sought 

24 the waiver within 60 days of the Indian Health ProVerDate Aug 31 2005 05:25 Mar 17, 2006 Jkt 049200 PO 00000 Frm 00198 Fmt 6652 Sfmt 6401 E:\BILLS\S1057.RS S1057

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1 gram request, the Indian Health Program itself may 

2 petition the Secretary for such waiver. 

3 ‘‘(2) PROCEDURE.—In seeking a waiver under 

4 paragraph (1), the Indian Health Program must 

5 provide notice and a copy of the request, including 

6 the reasons for the waiver sought, to the State. The 

7 Secretary may consider the State’s views in the de8 termination of the waiver request, but may not with9 hold or delay a determination based on the lack of 

10 the State’s views. 

11 ‘‘(b) SAFE HARBOR FOR TRANSACTIONS BETWEEN

12 AND AMONG INDIAN HEALTH CARE PROGRAMS.—For 

13 purposes of applying section 1128B(b) of the Social Secu14 rity Act, the exchange of anything of value between or 

15 among the following shall not be treated as remuneration 

16 if the exchange arises from or relates to any of the fol17 lowing health programs: 

18 ‘‘(1) An exchange between or among the fol19 lowing: 

20 ‘‘(A) Any Indian Health Program. 

21 ‘‘(B) Any Urban Indian Organization. 

22 ‘‘(2) An exchange between an Indian Tribe, 

23 Tribal Organization, or an Urban Indian Organiza24 tion and any patient served or eligible for service 

25 from an Indian Tribe, Tribal Organization, or 


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1 Urban Indian Organization, including patients 

2 served or eligible for service pursuant to section 807, 

3 but only if such exchange— 

4 ‘‘(A) is for the purpose of transporting the 

5 patient for the provision of health care items or 

6 services; 

7 ‘‘(B) is for the purpose of providing hous8 ing to the patient (including a pregnant pa9 tient) and immediate family members or an es10 cort incidental to assuring the timely provision 

11 of health care items and services to the patient; 

12 ‘‘(C) is for the purpose of paying pre13 miums, copayments, deductibles, or other cost14 sharing on behalf of patients; or 

15 ‘‘(D) consists of an item or service of small 

16 value that is provided as a reasonable incentive 

17 to secure timely and necessary preventive and 

18 other items and services. 

19 ‘‘(3) Other exchanges involving an Indian 

20 Health Program, an Urban Indian Organization, or 

21 an Indian Tribe or Tribal Organization that meet 

22 such standards as the Secretary of Health and 

23 Human Services, in consultation with the Attorney 

24 General, determines is appropriate, taking into ac25 count the special circumstances of such Indian 


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1 Health Programs, Urban Indian Organizations, In2 dian Tribes, and Tribal Organizations and of pa3 tients served by Indian Health Programs, Urban In4 dian Organizations, Indian Tribes, and Tribal Orga5 nizations. 

6 ‘‘SEC. 412. COST SHARING. 

7 ‘‘(a) COINSURANCE, COPAYMENTS, AND

8 DEDUCTIBLES.—Notwithstanding any other provision of 

9 Federal or State law— 

10 ‘‘(1) PROTECTION FOR ELIGIBLE INDIANS

11 UNDER SOCIAL SECURITY ACT HEALTH PRO12 GRAMS.—No Indian who is furnished an item or 

13 service for which payment may be made under title 

14 XIX or XXI of the Social Security Act may be 

15 charged a deductible, copayment, or coinsurance. 

16 ‘‘(2) PROTECTION FOR INDIANS.—No Indian 

17 who is furnished an item or service by the Service 

18 may be charged a deductible, copayment, or coinsur19 ance. 

20 ‘‘(3) NO REDUCTION IN AMOUNT OF PAYMENT

21 TO INDIAN HEALTH PROVIDERS.—The payment or 

22 reimbursement due to the Service, Indian Tribe, 

23 Tribal Organization, or Urban Indian Organization 

24 under title XIX or XXI of the Social Security Act 

25 may not be reduced by the amount of the deductible, 


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1 copayment, or coinsurance that would be due from 

2 the Indian but for the operation of this section. 

3 ‘‘(b) EXEMPTION FROM MEDICAID AND SCHIP PRE4 MIUMS.—Notwithstanding any other provision of Federal 

5 or State law, no Indian who is otherwise eligible for serv6 ices under title XIX of the Social Security Act (relating 

7 to the medicaid program) or title XXI of such Act (relat8 ing to the State children’s health insurance program) may 

9 be charged a premium, enrollment fee, or similar charge 

10 as a condition of receiving benefits under the program 

11 under the respective title. 

12 ‘‘(c) TREATMENT OF CERTAIN PROPERTY FOR MED13 ICAID ELIGIBILITY.—Notwithstanding any other provision 

14 of Federal or State law, the following property may not 

15 be included when determining eligibility for services under 

16 title XIX of the Social Security Act: 

17 ‘‘(1) Property, including real property and im18 provements, located on a reservation, including any 

19 federally recognized Indian Tribe’s reservation, 

20 Pueblo, or Colony, including former reservations in 

21 Oklahoma, Alaska Native regions established by the 

22 Alaska Native Claims Settlement Act and Indian al23 lotments on or near a reservation as designated and 

24 approved by the Bureau of Indian Affairs of the De25 partment of the Interior. 


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1 ‘‘(2) For any federally recognized Tribe not de2 scribed in paragraph (1), property located within the 

3 most recent boundaries of a prior Federal reserva4 tion. 

5 ‘‘(3) Ownership interests in rents, leases, royal6 ties, or usage rights related to natural resources (in7 cluding extraction of natural resources or harvesting 

8 of timber, other plants and plant products, animals, 

9 fish, and shellfish) resulting from the exercise of fed10 erally protected rights. 

11 ‘‘(4) Ownership interests in or usage rights to 

12 items not covered by paragraphs (1) through (3) 

13 that have unique religious, spiritual, traditional, or 

14 cultural significance or rights that support subsist15 ence or a traditional life style according to applicable 

16 tribal law or custom. 

17 ‘‘(d) CONTINUATION OF CURRENT LAW PROTEC18 TIONS OF CERTAIN INDIAN PROPERTY FROM MEDICAID

19 ESTATE RECOVERY.—Income, resources, and property 

20 that are exempt from medicaid estate recovery under title 

21 XIX of the Social Security Act as of April 1, 2003, under 

22 manual instructions issued to carry out section 1917(b)(3) 

23 of such Act because of Federal responsibility for Indian 

24 Tribes and Alaska Native Villages shall remain so exempt. 

25 Nothing in this subsection shall be construed as preVerDate Aug 31 2005 05:25 Mar 17, 2006 Jkt 049200 PO 00000 Frm 00203 Fmt 6652 Sfmt 6401 E:\BILLS\S1057.RS S1057

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1 venting the Secretary from providing additional medicaid 

2 estate recovery exemptions for Indians. 

3 ‘‘SEC. 413. TREATMENT UNDER MEDICAID MANAGED CARE. 

4 ‘‘(a) PROVISION OF SERVICES, TO ENROLLEES WITH

5 NON-INDIAN MEDICAID MANAGED CARE ENTITIES, BY

6 INDIAN HEALTH PROGRAMS AND URBAN INDIAN ORGANI7 ZATIONS.— 

8 ‘‘(1) PAYMENT RULES.— 

9 ‘‘(A) IN GENERAL.—Subject to subpara10 graph (B), in the case of an Indian who is en11 rolled with a non-Indian medicaid managed care 

12 entity (as defined in subsection (c)) and who re13 ceives covered medicaid managed care services 

14 from an Indian Health Program or an Urban 

15 Indian Organization, whether or not it is a par16 ticipating provider with respect to such entity, 

17 the following rules apply: 

18 ‘‘(i) DIRECT PAYMENT.—The entity 

19 shall make prompt payment (in accordance 

20 with rules applicable to medicaid managed 

21 care entities under title XIX of the Social 

22 Security Act) to the Indian Health Pro23 gram or Urban Indian Organization at a 

24 rate established by the entity for such serv25 ices that is equal to the rate negotiated beVerDate Aug 31 2005 05:25 Mar 17, 2006 Jkt 049200 PO 00000 Frm 00204 Fmt 6652 Sfmt 6401 E:\BILLS\S1057.RS S1057

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1 tween such entity and the Program or Or2 ganization involved or, if such a rate has 

3 not been negotiated, a rate that is not less 

4 than the level and amount of payment 

5 which the entity would make for the serv6 ices if the services were furnished by a pro7 vider which is not such a Program or Or8 ganization. 

9 ‘‘(ii) PAYMENT THROUGH STATE.—If 

10 there is no arrangement for direct payment 

11 under clause (i) or if a State provides for 

12 this clause to apply in lieu of clause (i), 

13 the State shall provide for payment to the 

14 Indian Health Program or Urban Indian 

15 Organization under its State program 

16 under title XIX of such Act at the rate 

17 that would be otherwise applicable for such 

18 services under such program and shall pro19 vide for an appropriate adjustment of the 

20 capitation payment made to the entity to 

21 take into account such payment. 

22 ‘‘(B) COMPLIANCE WITH GENERALLY AP23 PLICABLE REQUIREMENTS.— 

24 ‘‘(i) IN GENERAL.—Except as other25 wise provided, as a condition of payment 


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1 under subparagraph (A), the Indian 

2 Health Program or Urban Indian Organi3 zation shall comply with the generally ap4 plicable requirements of title XIX of the 

5 Social Security Act with respect to covered 

6 services. 

7 ‘‘(ii) SATISFACTION OF CLAIM RE8 QUIREMENT.—Any requirement for the 

9 submission of a claim or other documenta10 tion for services covered under subpara11 graph (A) by the enrollee is deemed to be 

12 satisfied through the submission of a claim 

13 or other documentation by the Indian 

14 Health Program or Urban Indian Organi15 zation consistent with section 403(h). 

16 ‘‘(C) CONSTRUCTION.—Nothing in this 

17 subsection shall be construed as waiving the ap18 plication of section 1902(a)(30)(A) of the Social 

19 Security Act (relating to application of stand20 ards to assure that payments are consistent 

21 with efficiency, economy, and quality of care). 

22 ‘‘(2) ENROLLEE OPTION TO SELECT AN INDIAN

23 HEALTH PROGRAM OR URBAN INDIAN ORGANIZATION

24 AS PRIMARY CARE PROVIDER.—In the case of a non25 Indian medicaid managed care entity that— 


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1 ‘‘(A) has an Indian enrolled with the enti2 ty; and 

3 ‘‘(B) has an Indian Health Program or 

4 Urban Indian Organization that is participating 

5 as a primary care provider within the network 

6 of the entity, 

7 insofar as the Indian is otherwise eligible to receive 

8 services from such Program or Organization and the 

9 Program or Organization has the capacity to provide 

10 primary care services to such Indian, the Indian 

11 shall be allowed to choose such Program or Organi12 zation as the Indian’s primary care provider under 

13 the entity. 

14 ‘‘(b) OFFERING OF MANAGED CARE THROUGH IN15 DIAN MEDICAID MANAGED CARE ENTITIES.—If— 

16 ‘‘(1) a State elects to provide services through 

17 medicaid managed care entities under its medicaid 

18 managed care program; and 

19 ‘‘(2) an Indian Health Program or Urban In20 dian Organization that is funded in whole or in part 

21 by the Service, or a consortium thereof, has estab22 lished an Indian medicaid managed care entity in 

23 the State that meets generally applicable standards 

24 required of such an entity under such medicaid man25 aged care program, 


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1 the State shall offer to enter into an agreement with the 

2 entity to serve as a medicaid managed care entity with 

3 respect to eligible Indians served by such entity under 

4 such program. 

5 ‘‘(c) SPECIAL RULES FOR INDIAN MANAGED CARE

6 ENTITIES.—The following are special rules regarding the 

7 application of a medicaid managed care program to Indian 

8 medicaid managed care entities: 

9 ‘‘(1) ENROLLMENT.— 

10 ‘‘(A) LIMITATION TO INDIANS.—An Indian 

11 medicaid managed care entity may restrict en12 rollment under such program to Indians and to 

13 members of specific Tribes in the same manner 

14 as Indian Health Programs may restrict the de15 livery of services to such Indians and tribal 

16 members. 

17 ‘‘(B) NO LESS CHOICE OF PLANS.—Under 

18 such program the State may not limit the 

19 choice of an Indian among medicaid managed 

20 care entities only to Indian medicaid managed 

21 care entities or to be more restrictive than the 

22 choice of managed care entities offered to indi23 viduals who are not Indians. 

24 ‘‘(C) DEFAULT ENROLLMENT.— 


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1 ‘‘(i) IN GENERAL.—If such program 

2 of a State requires the enrollment of Indi3 ans in a medicaid managed care entity in 

4 order to receive benefits, the State shall 

5 provide for the enrollment of Indians de6 scribed in clause (ii) who are not otherwise 

7 enrolled with such an entity in an Indian 

8 medicaid managed care entity described in 

9 such clause. 

10 ‘‘(ii) INDIAN DESCRIBED.—An Indian 

11 described in this clause, with respect to an 

12 Indian medicaid managed care entity, is an 

13 Indian who, based upon the service area 

14 and capacity of the entity, is eligible to be 

15 enrolled with the entity consistent with 

16 subparagraph (A). 

17 ‘‘(D) EXCEPTION TO STATE LOCK-IN.—A 

18 request by an Indian who is enrolled under such 

19 program with a non-Indian medicaid managed 

20 care entity to change enrollment with that enti21 ty to enrollment with an Indian medicaid man22 aged care entity shall be considered cause for 

23 granting such request under procedures speci24 fied by the Secretary. 


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1 ‘‘(2) FLEXIBILITY IN APPLICATION OF SOL2 VENCY.—In applying section 1903(m)(1) of the So3 cial Security Act to an Indian medicaid managed 

4 care entity— 

5 ‘‘(A) any reference to a ‘State’ in subpara6 graph (A)(ii) of that section shall be deemed to 

7 be a reference to the ‘Secretary’; and 

8 ‘‘(B) the entity shall be deemed to be a 

9 public entity described in subparagraph (C)(ii) 

10 of that section. 

11 ‘‘(3) EXCEPTIONS TO ADVANCE DIRECTIVES.— 

12 The Secretary may modify or waive the require13 ments of section 1902(w) of the Social Security Act 

14 (relating to provision of written materials on ad15 vance directives) insofar as the Secretary finds that 

16 the requirements otherwise imposed are not an ap17 propriate or effective way of communicating the in18 formation to Indians. 

19 ‘‘(4) FLEXIBILITY IN INFORMATION AND MAR20 KETING.— 

21 ‘‘(A) MATERIALS.—The Secretary may 

22 modify requirements under section 1932(a)(5) 

23 of the Social Security Act in a manner that im24 proves the materials to take into account the 

25 special circumstances of such entities and their 


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1 enrollees while maintaining and clearly commu2 nicating to potential enrollees their rights, pro3 tections, and benefits. 

4 ‘‘(B) DISTRIBUTION OF MARKETING MATE5 RIALS.—The provisions of section 

6 1932(d)(2)(B) of the Social Security Act re7 quiring the distribution of marketing materials 

8 to an entire service area shall be deemed satis9 fied in the case of an Indian medicaid managed 

10 care entity that distributes appropriate mate11 rials only to those Indians who are potentially 

12 eligible to enroll with the entity in the service 

13 area. 

14 ‘‘(d) MALPRACTICE INSURANCE.—Insofar as, under 

15 a medicaid managed care program, a health care provider 

16 is required to have medical malpractice insurance coverage 

17 as a condition of contracting as a provider with a medicaid 

18 managed care entity, an Indian Health Program, or an 

19 Urban Indian Organization that is a Federally-qualified 

20 health center under title XIX of the Social Security Act, 

21 that is covered under the Federal Tort Claims Act (28 

22 U.S.C. 1346(b), 2671 et seq.) is deemed to satisfy such 

23 requirement. 

24 ‘‘(e) DEFINITIONS.—For purposes of this section: 


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1 ‘‘(1) MEDICAID MANAGED CARE ENTITY.—The 

2 term ‘medicaid managed care entity’ means a man3 aged care entity (whether a managed care organiza4 tion or a primary care case manager) under title 

5 XIX of the Social Security Act, whether pursuant to 

6 section 1903(m) or section 1932 of such Act, a waiv7 er under section 1115 or 1915(b) of such Act, or 

8 otherwise. 

9 ‘‘(2) INDIAN MEDICAID MANAGED CARE ENTI10 TY.—The term ‘Indian medicaid managed care enti11 ty’ means a managed care entity that is controlled 

12 (within the meaning of the last sentence of section 

13 1903(m)(1)(C) of the Social Security Act) by the In14 dian Health Service, a Tribe, Tribal Organization, or 

15 Urban Indian Organization (as such terms are de16 fined in section 4), or a consortium, which may be 

17 composed of 1 or more Tribes, Tribal Organizations, 

18 or Urban Indian Organizations, and which also may 

19 include the Service. 

20 ‘‘(3) NON-INDIAN MEDICAID MANAGED CARE

21 ENTITY.—The term ‘non-Indian medicaid managed 

22 care entity’ means a medicaid managed care entity 

23 that is not an Indian medicaid managed care entity. 

24 ‘‘(4) COVERED MEDICAID MANAGED CARE

25 SERVICES.—The term ‘covered medicaid managed 


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1 care services’ means, with respect to an individual 

2 enrolled with a medicaid managed care entity, items 

3 and services that are within the scope of items and 

4 services for which benefits are available with respect 

5 to the individual under the contract between the en6 tity and the State involved. 

7 ‘‘(5) MEDICAID MANAGED CARE PROGRAM.— 

8 The term ‘medicaid managed care program’ means 

9 a program under sections 1903(m) and 1932 of the 

10 Social Security Act and includes a managed care 

11 program operating under a waiver under section 

12 1915(b) or 1115 of such Act or otherwise. 

13 ‘‘SEC. 414. NAVAJO NATION MEDICAID AGENCY FEASI14 BILITY STUDY. 

15 ‘‘(a) STUDY.—The Secretary shall conduct a study 

16 to determine the feasibility of treating the Navajo Nation 

17 as a State for the purposes of title XIX of the Social Secu18 rity Act, to provide services to Indians living within the 

19 boundaries of the Navajo Nation through an entity estab20 lished having the same authority and performing the same 

21 functions as single-State medicaid agencies responsible for 

22 the administration of the State plan under title XIX of 

23 the Social Security Act. 

24 ‘‘(b) CONSIDERATIONS.—In conducting the study, 

25 the Secretary shall consider the feasibility of— 


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1 ‘‘(1) assigning and paying all expenditures for 

2 the provision of services and related administration 

3 funds, under title XIX of the Social Security Act, to 

4 Indians living within the boundaries of the Navajo 

5 Nation that are currently paid to or would otherwise 

6 be paid to the State of Arizona, New Mexico, or 

7 Utah; 

8 ‘‘(2) providing assistance to the Navajo Nation 

9 in the development and implementation of such enti10 ty for the administration, eligibility, payment, and 

11 delivery of medical assistance under title XIX of the 

12 Social Security Act; 

13 ‘‘(3) providing an appropriate level of matching 

14 funds for Federal medical assistance with respect to 

15 amounts such entity expends for medical assistance 

16 for services and related administrative costs; and 

17 ‘‘(4) authorizing the Secretary, at the option of 

18 the Navajo Nation, to treat the Navajo Nation as a 

19 State for the purposes of title XIX of the Social Se20 curity Act (relating to the State children’s health in21 surance program) under terms equivalent to those 

22 described in paragraphs (2) through (4). 

23 ‘‘(c) REPORT.—Not later then 3 years after the date 

24 of enactment of the Indian Health Act Improvement Act 

25 Amendments of 2005, the Secretary shall submit to the 


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1 Committee of Indian Affairs and Committee on Finance 

2 of the Senate and the Committee on Resources and Com3 mittee on Ways and Means of the House of Representa4 tives a report that includes— 

5 ‘‘(1) the results of the study under this section; 

6 ‘‘(2) a summary of any consultation that oc7 curred between the Secretary and the Navajo Na8 tion, other Indian Tribes, the States of Arizona, 

9 New Mexico, and Utah, counties which include Nav10 ajo Lands, and other interested parties, in con11 ducting this study; 

12 ‘‘(3) projected costs or savings associated with 

13 establishment of such entity, and any estimated im14 pact on services provided as described in this section 

15 in relation to probable costs or savings; and 

16 ‘‘(4) legislative actions that would be required 

17 to authorize the establishment of such entity if such 

18 entity is determined by the Secretary to be feasible. 

19 ‘‘SEC. 415. AUTHORIZATION OF APPROPRIATIONS. 

20 ‘‘There are authorized to be appropriated such sums 

21 as may be necessary for each fiscal year through fiscal 

22 year 2015 to carry out this title. 


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1 ‘‘TITLE V—HEALTH SERVICES 

2 FOR URBAN INDIANS 

3 ‘‘SEC. 501. PURPOSE. 

4 ‘‘The purpose of this title is to establish and maintain 

5 programs in Urban Centers to make health services more 

6 accessible and available to Urban Indians. 

7 ‘‘SEC. 502. CONTRACTS WITH, AND GRANTS TO, URBAN IN8 DIAN ORGANIZATIONS. 

9 ‘‘Under authority of the Act of November 2, 1921 

10 (25 U.S.C. 13) (commonly known as the ‘Snyder Act’), 

11 the Secretary, acting through the Service, shall enter into 

12 contracts with, or make grants to, Urban Indian Organi13 zations to assist such organizations in the establishment 

14 and administration, within Urban Centers, of programs 

15 which meet the requirements set forth in this title. Subject 

16 to section 506, the Secretary, acting through the Service, 

17 shall include such conditions as the Secretary considers 

18 necessary to effect the purpose of this title in any contract 

19 into which the Secretary enters with, or in any grant the 

20 Secretary makes to, any Urban Indian Organization pur21 suant to this title. 

22 ‘‘SEC. 503. CONTRACTS AND GRANTS FOR THE PROVISION 

23 OF HEALTH CARE AND REFERRAL SERVICES. 

24 ‘‘(a) REQUIREMENTS FOR GRANTS AND CON25 TRACTS.—Under authority of the Act of November 2, 


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1 1921 (25 U.S.C. 13) (commonly known as the ‘Snyder 

2 Act’), the Secretary, acting through the Service, shall 

3 enter into contracts with, and make grants to, Urban In4 dian Organizations for the provision of health care and 

5 referral services for Urban Indians. Any such contract or 

6 grant shall include requirements that the Urban Indian 

7 Organization successfully undertake to— 

8 ‘‘(1) estimate the population of Urban Indians 

9 residing in the Urban Center or centers that the or10 ganization proposes to serve who are or could be re11 cipients of health care or referral services; 

12 ‘‘(2) estimate the current health status of 

13 Urban Indians residing in such Urban Center or 

14 centers; 

15 ‘‘(3) estimate the current health care needs of 

16 Urban Indians residing in such Urban Center or 

17 centers; 

18 ‘‘(4) provide basic health education, including 

19 health promotion and disease prevention education, 

20 to Urban Indians; 

21 ‘‘(5) make recommendations to the Secretary 

22 and Federal, State, local, and other resource agen23 cies on methods of improving health service pro24 grams to meet the needs of Urban Indians; and 


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1 ‘‘(6) where necessary, provide, or enter into 

2 contracts for the provision of, health care services 

3 for Urban Indians. 

4 ‘‘(b) CRITERIA.—The Secretary, acting through the 

5 Service, shall by regulation adopted pursuant to section 

6 520 prescribe the criteria for selecting Urban Indian Or7 ganizations to enter into contracts or receive grants under 

8 this section. Such criteria shall, among other factors, in9 clude— 

10 ‘‘(1) the extent of unmet health care needs of 

11 Urban Indians in the Urban Center or centers in12 volved; 

13 ‘‘(2) the size of the Urban Indian population in 

14 the Urban Center or centers involved; 

15 ‘‘(3) the extent, if any, to which the activities 

16 set forth in subsection (a) would duplicate any 

17 project funded under this title; 

18 ‘‘(4) the capability of an Urban Indian Organi19 zation to perform the activities set forth in sub20 section (a) and to enter into a contract with the Sec21 retary or to meet the requirements for receiving a 

22 grant under this section; 

23 ‘‘(5) the satisfactory performance and success24 ful completion by an Urban Indian Organization of 

25 other contracts with the Secretary under this title; 


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1 ‘‘(6) the appropriateness and likely effectiveness 

2 of conducting the activities set forth in subsection 

3 (a) in an Urban Center or centers; and 

4 ‘‘(7) the extent of existing or likely future par5 ticipation in the activities set forth in subsection (a) 

6 by appropriate health and health-related Federal, 

7 State, local, and other agencies. 

8 ‘‘(c) ACCESS TO HEALTH PROMOTION AND DISEASE

9 PREVENTION PROGRAMS.—The Secretary, acting through 

10 the Service, shall facilitate access to or provide health pro11 motion and disease prevention services for Urban Indians 

12 through grants made to Urban Indian Organizations ad13 ministering contracts entered into or receiving grants 

14 under subsection (a). 

15 ‘‘(d) IMMUNIZATION SERVICES.— 

16 ‘‘(1) ACCESS OR SERVICES PROVIDED.—The 

17 Secretary, acting through the Service, shall facilitate 

18 access to, or provide, immunization services for 

19 Urban Indians through grants made to Urban In20 dian Organizations administering contracts entered 

21 into or receiving grants under this section. 

22 ‘‘(2) DEFINITION.—For purposes of this sub23 section, the term ‘immunization services’ means 

24 services to provide without charge immunizations 

25 against vaccine-preventable diseases. 


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1 ‘‘(e) BEHAVIORAL HEALTH SERVICES.— 

2 ‘‘(1) ACCESS OR SERVICES PROVIDED.—The 

3 Secretary, acting through the Service, shall facilitate 

4 access to, or provide, behavioral health services for 

5 Urban Indians through grants made to Urban In6 dian Organizations administering contracts entered 

7 into or receiving grants under subsection (a). 

8 ‘‘(2) ASSESSMENT REQUIRED.—Except as pro9 vided by paragraph (3)(A), a grant may not be made 

10 under this subsection to an Urban Indian Organiza11 tion until that organization has prepared, and the 

12 Service has approved, an assessment of the fol13 lowing: 

14 ‘‘(A) The behavioral health needs of the 

15 Urban Indian population concerned. 

16 ‘‘(B) The behavioral health services and 

17 other related resources available to that popu18 lation. 

19 ‘‘(C) The barriers to obtaining those serv20 ices and resources. 

21 ‘‘(D) The needs that are unmet by such 

22 services and resources. 

23 ‘‘(3) PURPOSES OF GRANTS.—Grants may be 

24 made under this subsection for the following: 


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1 ‘‘(A) To prepare assessments required 

2 under paragraph (2). 

3 ‘‘(B) To provide outreach, educational, and 

4 referral services to Urban Indians regarding the 

5 availability of direct behavioral health services, 

6 to educate Urban Indians about behavioral 

7 health issues and services, and effect coordina8 tion with existing behavioral health providers in 

9 order to improve services to Urban Indians. 

10 ‘‘(C) To provide outpatient behavioral 

11 health services to Urban Indians, including the 

12 identification and assessment of illness, thera13 peutic treatments, case management, support 

14 groups, family treatment, and other treatment. 

15 ‘‘(D) To develop innovative behavioral 

16 health service delivery models which incorporate 

17 Indian cultural support systems and resources. 

18 ‘‘(f) PREVENTION OF CHILD ABUSE.— 

19 ‘‘(1) ACCESS OR SERVICES PROVIDED.—The 

20 Secretary, acting through the Service, shall facilitate 

21 access to or provide services for Urban Indians 

22 through grants to Urban Indian Organizations ad23 ministering contracts entered into or receiving 

24 grants under subsection (a) to prevent and treat 


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1 child abuse (including sexual abuse) among Urban 

2 Indians. 

3 ‘‘(2) EVALUATION REQUIRED.—Except as pro4 vided by paragraph (3)(A), a grant may not be made 

5 under this subsection to an Urban Indian Organiza6 tion until that organization has prepared, and the 

7 Service has approved, an assessment that documents 

8 the prevalence of child abuse in the Urban Indian 

9 population concerned and specifies the services and 

10 programs (which may not duplicate existing services 

11 and programs) for which the grant is requested. 

12 ‘‘(3) PURPOSES OF GRANTS.—Grants may be 

13 made under this subsection for the following: 

14 ‘‘(A) To prepare assessments required 

15 under paragraph (2). 

16 ‘‘(B) For the development of prevention, 

17 training, and education programs for Urban In18 dians, including child education, parent edu19 cation, provider training on identification and 

20 intervention, education on reporting require21 ments, prevention campaigns, and establishing 

22 service networks of all those involved in Indian 

23 child protection. 

24 ‘‘(C) To provide direct outpatient treat25 ment services (including individual treatment, 


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1 family treatment, group therapy, and support 

2 groups) to Urban Indians who are child victims 

3 of abuse (including sexual abuse) or adult sur4 vivors of child sexual abuse, to the families of 

5 such child victims, and to Urban Indian per6 petrators of child abuse (including sexual 

7 abuse). 

8 ‘‘(4) CONSIDERATIONS WHEN MAKING

9 GRANTS.—In making grants to carry out this sub10 section, the Secretary shall take into consideration— 

11 ‘‘(A) the support for the Urban Indian Or12 ganization demonstrated by the child protection 

13 authorities in the area, including committees or 

14 other services funded under the Indian Child 

15 Welfare Act of 1978 (25 U.S.C. 1901 et seq.), 

16 if any; 

17 ‘‘(B) the capability and expertise dem18 onstrated by the Urban Indian Organization to 

19 address the complex problem of child sexual 

20 abuse in the community; and 

21 ‘‘(C) the assessment required under para22 graph (2). 

23 ‘‘(g) OTHER GRANTS.—The Secretary, acting 

24 through the Service, may enter into a contract with or 

25 make grants to an Urban Indian Organization that proVerDate Aug 31 2005 05:25 Mar 17, 2006 Jkt 049200 PO 00000 Frm 00223 Fmt 6652 Sfmt 6401 E:\BILLS\S1057.RS S1057

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1 vides or arranges for the provision of health care services 

2 (through satellite facilities, provider networks, or other3 wise) to Urban Indians in more than 1 Urban Center. 

4 ‘‘SEC. 504. CONTRACTS AND GRANTS FOR THE DETERMINA5 TION OF UNMET HEALTH CARE NEEDS. 

6 ‘‘(a) GRANTS AND CONTRACTS AUTHORIZED.— 

7 Under authority of the Act of November 2, 1921 (25 

8 U.S.C. 13) (commonly known as the ‘Snyder Act’), the 

9 Secretary, acting through the Service, may enter into con10 tracts with or make grants to Urban Indian Organizations 

11 situated in Urban Centers for which contracts have not 

12 been entered into or grants have not been made under sec13 tion 503. 

14 ‘‘(b) PURPOSE.—The purpose of a contract or grant 

15 made under this section shall be the determination of the 

16 matters described in subsection (c)(1) in order to assist 

17 the Secretary in assessing the health status and health 

18 care needs of Urban Indians in the Urban Center involved 

19 and determining whether the Secretary should enter into 

20 a contract or make a grant under section 503 with respect 

21 to the Urban Indian Organization which the Secretary has 

22 entered into a contract with, or made a grant to, under 

23 this section. 


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1 ‘‘(c) GRANT AND CONTRACT REQUIREMENTS.—Any 

2 contract entered into, or grant made, by the Secretary 

3 under this section shall include requirements that— 

4 ‘‘(1) the Urban Indian Organization success5 fully undertakes to— 

6 ‘‘(A) document the health care status and 

7 unmet health care needs of Urban Indians in 

8 the Urban Center involved; and 

9 ‘‘(B) with respect to Urban Indians in the 

10 Urban Center involved, determine the matters 

11 described in paragraphs (2), (3), (4), and (7) of 

12 section 503(b); and 

13 ‘‘(2) the Urban Indian Organization complete 

14 performance of the contract, or carry out the re15 quirements of the grant, within 1 year after the date 

16 on which the Secretary and such organization enter 

17 into such contract, or within 1 year after such orga18 nization receives such grant, whichever is applicable. 

19 ‘‘(d) NO RENEWALS.—The Secretary may not renew 

20 any contract entered into or grant made under this sec21 tion. 

22 ‘‘SEC. 505. EVALUATIONS; RENEWALS. 

23 ‘‘(a) PROCEDURES FOR EVALUATIONS.—The Sec24 retary, acting through the Service, shall develop proce25 dures to evaluate compliance with grant requirements and 


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1 compliance with and performance of contracts entered into 

2 by Urban Indian Organizations under this title. Such pro3 cedures shall include provisions for carrying out the re4 quirements of this section. 

5 ‘‘(b) EVALUATIONS.—The Secretary, acting through 

6 the Service, shall evaluate the compliance of each Urban 

7 Indian Organization which has entered into a contract or 

8 received a grant under section 503 with the terms of such 

9 contract or grant. For purposes of this evaluation, in de10 termining the capacity of an Urban Indian Organization 

11 to deliver quality patient care the Secretary shall, at the 

12 option of the organization— 

13 ‘‘(1) acting through the Service, conduct an an14 nual onsite evaluation of the organization; or 

15 ‘‘(2) accept in lieu of such onsite evaluation evi16 dence of the organization’s provisional or full accred17 itation by a private independent entity recognized by 

18 the Secretary for purposes of conducting quality re19 views of providers participating in the Medicare pro20 gram under title XVIII of the Social Security Act. 

21 ‘‘(c) NONCOMPLIANCE; UNSATISFACTORY PERFORM22 ANCE.—If, as a result of the evaluations conducted under 

23 this section, the Secretary determines that an Urban In24 dian Organization has not complied with the requirements 

25 of a grant or complied with or satisfactorily performed a 


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1 contract under section 503, the Secretary shall, prior to 

2 renewing such contract or grant, attempt to resolve with 

3 the organization the areas of noncompliance or unsatisfac4 tory performance and modify the contract or grant to pre5 vent future occurrences of noncompliance or unsatisfac6 tory performance. If the Secretary determines that the 

7 noncompliance or unsatisfactory performance cannot be 

8 resolved and prevented in the future, the Secretary shall 

9 not renew the contract or grant with the organization and 

10 is authorized to enter into a contract or make a grant 

11 under section 503 with another Urban Indian Organiza12 tion which is situated in the same Urban Center as the 

13 Urban Indian Organization whose contract or grant is not 

14 renewed under this section. 

15 ‘‘(d) CONSIDERATIONS FOR RENEWALS.—In deter16 mining whether to renew a contract or grant with an 

17 Urban Indian Organization under section 503 which has 

18 completed performance of a contract or grant under sec19 tion 504, the Secretary shall review the records of the 

20 Urban Indian Organization, the reports submitted under 

21 section 507, and shall consider the results of the onsite 

22 evaluations or accreditations under subsection (b). 

23 ‘‘SEC. 506. OTHER CONTRACT AND GRANT REQUIREMENTS. 

24 ‘‘(a) PROCUREMENT.—Contracts with Urban Indian 

25 Organizations entered into pursuant to this title shall be 


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1 in accordance with all Federal contracting laws and regu2 lations relating to procurement except that in the discre3 tion of the Secretary, such contracts may be negotiated 

4 without advertising and need not conform to the provisions 

5 of sections 1304 and 3131 through 3133 of title 40, 

6 United States Code. 

7 ‘‘(b) PAYMENTS UNDER CONTRACTS OR GRANTS.— 

8 Payments under any contracts or grants pursuant to this 

9 title shall, notwithstanding any term or condition of such 

10 contract or grant— 

11 ‘‘(1) be made in their entirety by the Secretary 

12 to the Urban Indian Organization by no later than 

13 the end of the first 30 days of the funding period 

14 with respect to which the payments apply, unless the 

15 Secretary determines through an evaluation under 

16 section 505 that the organization is not capable of 

17 administering such payments in their entirety; and 

18 ‘‘(2) if any portion thereof is unexpended by the 

19 Urban Indian Organization during the funding pe20 riod with respect to which the payments initially 

21 apply, shall be carried forward for expenditure with 

22 respect to allowable or reimbursable costs incurred 

23 by the organization during 1 or more subsequent 

24 funding periods without additional justification or 

25 documentation by the organization as a condition of 


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1 carrying forward the availability for expenditure of 

2 such funds. 

3 ‘‘(c) REVISION OR AMENDMENT OF CONTRACTS.— 

4 Notwithstanding any provision of law to the contrary, the 

5 Secretary may, at the request and consent of an Urban 

6 Indian Organization, revise or amend any contract entered 

7 into by the Secretary with such organization under this 

8 title as necessary to carry out the purposes of this title. 

9 ‘‘(d) FAIR AND UNIFORM SERVICES AND ASSIST10 ANCE.—Contracts with or grants to Urban Indian Organi11 zations and regulations adopted pursuant to this title shall 

12 include provisions to assure the fair and uniform provision 

13 to Urban Indians of services and assistance under such 

14 contracts or grants by such organizations. 

15 ‘‘SEC. 507. REPORTS AND RECORDS. 

16 ‘‘(a) REPORTS.—For each fiscal year during which 

17 an Urban Indian Organization receives or expends funds 

18 pursuant to a contract entered into or a grant received 

19 pursuant to this title, such Urban Indian Organization 

20 shall submit to the Secretary not more frequently than 

21 every 6 months, a report that includes the following: 

22 ‘‘(1) In the case of a contract or grant under 

23 section 503, recommendations pursuant to section 

24 503(a)(5). 


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1 ‘‘(2) Information on activities conducted by the 

2 organization pursuant to the contract or grant. 

3 ‘‘(3) An accounting of the amounts and purpose 

4 for which Federal funds were expended. 

5 ‘‘(4) A minimum set of data, using uniformly 

6 defined elements, as specified by the Secretary after 

7 consultation with Urban Indian Organizations. 

8 ‘‘(b) AUDIT.—The reports and records of the Urban 

9 Indian Organization with respect to a contract or grant 

10 under this title shall be subject to audit by the Secretary 

11 and the Comptroller General of the United States. 

12 ‘‘(c) COSTS OF AUDITS.—The Secretary shall allow 

13 as a cost of any contract or grant entered into or awarded 

14 under section 502 or 503 the cost of an annual inde15 pendent financial audit conducted by— 

16 ‘‘(1) a certified public accountant; or 

17 ‘‘(2) a certified public accounting firm qualified 

18 to conduct Federal compliance audits. 

19 ‘‘SEC. 508. LIMITATION ON CONTRACT AUTHORITY. 

20 ‘‘The authority of the Secretary to enter into con21 tracts or to award grants under this title shall be to the 

22 extent, and in an amount, provided for in appropriation 

23 Acts. 


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1 ‘‘SEC. 509. FACILITIES. 

2 ‘‘(a) GRANTS.—The Secretary, acting through the 

3 Service, may make grants to contractors or grant recipi4 ents under this title for the lease, purchase, renovation, 

5 construction, or expansion of facilities, including leased fa6 cilities, in order to assist such contractors or grant recipi7 ents in complying with applicable licensure or certification 

8 requirements. 

9 ‘‘(b) LOAN FUND STUDY.—The Secretary, acting 

10 through the Services, may carry out a study to determine 

11 the feasibility of establishing a loan fund to provide to 

12 Urban Indian Organizations direct loans or guarantees for 

13 loans for the construction of health care facilities in a 

14 manner consistent with section 309. 

15 ‘‘SEC. 510. OFFICE OF URBAN INDIAN HEALTH. 

16 ‘‘There is established within the Service an Office of 

17 Urban Indian Health, which shall be responsible for— 

18 ‘‘(1) carrying out the provisions of this title; 

19 ‘‘(2) providing central oversight of the pro20 grams and services authorized under this title; and 

21 ‘‘(3) providing technical assistance to Urban In22 dian Organizations. 

23 ‘‘SEC. 511. GRANTS FOR ALCOHOL AND SUBSTANCE ABUSE24 RELATED SERVICES. 

25 ‘‘(a) GRANTS AUTHORIZED.—The Secretary, acting 

26 through the Service, may make grants for the provision 


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1 of health-related services in prevention of, treatment of, 

2 rehabilitation of, or school- and community-based edu3 cation regarding, alcohol and substance abuse in Urban 

4 Centers to those Urban Indian Organizations with which 

5 the Secretary has entered into a contract under this title 

6 or under section 201. 

7 ‘‘(b) GOALS.—Each grant made pursuant to sub8 section (a) shall set forth the goals to be accomplished 

9 pursuant to the grant. The goals shall be specific to each 

10 grant as agreed to between the Secretary and the grantee. 

11 ‘‘(c) CRITERIA.—The Secretary shall establish cri12 teria for the grants made under subsection (a), including 

13 criteria relating to the following: 

14 ‘‘(1) The size of the Urban Indian population. 

15 ‘‘(2) Capability of the organization to ade16 quately perform the activities required under the 

17 grant. 

18 ‘‘(3) Satisfactory performance standards for the 

19 organization in meeting the goals set forth in such 

20 grant. The standards shall be negotiated and agreed 

21 to between the Secretary and the grantee on a 

22 grant-by-grant basis. 

23 ‘‘(4) Identification of the need for services. 

24 ‘‘(d) ALLOCATION OF GRANTS.—The Secretary shall 

25 develop a methodology for allocating grants made pursuVerDate Aug 31 2005 05:25 Mar 17, 2006 Jkt 049200 PO 00000 Frm 00232 Fmt 6652 Sfmt 6401 E:\BILLS\S1057.RS S1057

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1 ant to this section based on the criteria established pursu2 ant to subsection (c). 

3 ‘‘(e) GRANTS SUBJECT TO CRITERIA.—Any funds re4 ceived by an Urban Indian Organization under this Act 

5 for substance abuse prevention, treatment, and rehabilita6 tion shall be subject to the criteria set forth in subsection 

7 (c). 

8 ‘‘SEC. 512. TREATMENT OF CERTAIN DEMONSTRATION 

9 PROJECTS. 

10 ‘‘Notwithstanding any other provision of law, the 

11 Tulsa Clinic and Oklahoma City Clinic demonstration 

12 projects shall— 

13 ‘‘(1) be permanent programs within the Serv14 ice’s direct care program; 

15 ‘‘(2) continue to be treated as Service Units in 

16 the allocation of resources and coordination of care; 

17 and 

18 ‘‘(3) continue to meet the requirements and 

19 definitions of an urban Indian organization in this 

20 Act, and shall not be subject to the provisions of the 

21 Indian Self-Determination and Education Assistance 

22 Act. 

23 ‘‘SEC. 513. URBAN NIAAA TRANSFERRED PROGRAMS. 

24 ‘‘(a) GRANTS AND CONTRACTS.—The Secretary, 

25 through the Office of Urban Indian Health, shall make 


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1 grants or enter into contracts with Urban Indian Organi2 zations for the administration of Urban Indian alcohol 

3 programs that were originally established under the Na4 tional Institute on Alcoholism and Alcohol Abuse (here5 after in this section referred to as ‘NIAAA’) and trans6 ferred to the Service. Such grants and contracts shall be7 come effective no later than September 30, 2008. 

8 ‘‘(b) USE OF FUNDS.—Grants provided or contracts 

9 entered into under this section shall be used to provide 

10 support for the continuation of alcohol prevention and 

11 treatment services for Urban Indian populations and such 

12 other objectives as are agreed upon between the Service 

13 and a recipient of a grant or contract under this section. 

14 ‘‘(c) ELIGIBILITY.—Urban Indian Organizations that 

15 operate Indian alcohol programs originally funded under 

16 the NIAAA and subsequently transferred to the Service 

17 are eligible for grants or contracts under this section. 

18 ‘‘(d) REPORT.—The Secretary shall evaluate and re19 port to Congress on the activities of programs funded 

20 under this section not less than every 5 years. 

21 ‘‘SEC. 514. CONSULTATION WITH URBAN INDIAN ORGANIZA22 TIONS. 

23 ‘‘(a) IN GENERAL.—The Secretary shall ensure that 

24 the Service consults, to the greatest extent practicable, 

25 with Urban Indian Organizations. 


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1 ‘‘(b) DEFINITION OF CONSULTATION.—For purposes 

2 of subsection (a), consultation is the open and free ex3 change of information and opinions which leads to mutual 

4 understanding and comprehension and which emphasizes 

5 trust, respect, and shared responsibility. 

6 ‘‘SEC. 515. FEDERAL TORT CLAIM ACT COVERAGE. 

7 ‘‘(a) IN GENERAL.—With respect to claims resulting 

8 from the performance of functions during fiscal year 2005 

9 and thereafter, or claims asserted after September 30, 

10 2004, but resulting from the performance of functions 

11 prior to fiscal year 2005, under a contract, grant agree12 ment, or any other agreement authorized under this title, 

13 an Urban Indian Organization is deemed hereafter to be 

14 part of the Service in the Department of Health and 

15 Human Services while carrying out any such contract or 

16 agreement and its employees are deemed employees of the 

17 Service while acting within the scope of their employment 

18 in carrying out the contract or agreement. After Sep19 tember 30, 2003, any civil action or proceeding involving 

20 such claims brought hereafter against any Urban Indian 

21 Organization or any employee of such Urban Indian Orga22 nization covered by this provision shall be deemed to be 

23 an action against the United States and will be defended 

24 by the Attorney General and be afforded the full protec25 tion and coverage of the Federal Tort Claims Act (28 


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1 U.S.C. 1346(b), 2671 et seq.). Future coverage under that 

2 Act shall be contingent on cooperation of the Urban In3 dian Organization with the Attorney General in pros4 ecuting past claims. 

5 ‘‘(b) CLAIMS RESULTING FROM PERFORMANCE OF

6 CONTRACT OR GRANT.—Beginning for fiscal year 2005 

7 and thereafter, the Secretary shall request through annual 

8 appropriations funds sufficient to reimburse the Treasury 

9 for any claims paid in the prior fiscal year pursuant to 

10 the foregoing provisions. 

11 ‘‘SEC. 516. URBAN YOUTH TREATMENT CENTER DEM12 ONSTRATION. 

13 ‘‘(a) CONSTRUCTION AND OPERATION.—The Sec14 retary, acting through the Service, through grant or con15 tract, is authorized to fund the construction and operation 

16 of at least 2 residential treatment centers in each State 

17 described in subsection (b) to demonstrate the provision 

18 of alcohol and substance abuse treatment services to 

19 Urban Indian youth in a culturally competent residential 

20 setting. 

21 ‘‘(b) DEFINITION OF STATE.—A State described in 

22 this subsection is a State in which— 

23 ‘‘(1) there resides Urban Indian youth with 

24 need for alcohol and substance abuse treatment serv25 ices in a residential setting; and 


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1 ‘‘(2) there is a significant shortage of culturally 

2 competent residential treatment services for Urban 

3 Indian youth. 

4 ‘‘SEC. 517. USE OF FEDERAL GOVERNMENT FACILITIES AND 

5 SOURCES OF SUPPLY. 

6 ‘‘(a) AUTHORIZATION FOR USE.—The Secretary, act7 ing through the Service, shall allow an Urban Indian Or8 ganization that has entered into a contract or received a 

9 grant pursuant to this title, in carrying out such contract 

10 or grant, to use existing facilities and all equipment there11 in or pertaining thereto and other personal property 

12 owned by the Federal Government within the Secretary’s 

13 jurisdiction under such terms and conditions as may be 

14 agreed upon for their use and maintenance. 

15 ‘‘(b) DONATIONS.—Subject to subsection (d), the 

16 Secretary may donate to an Urban Indian Organization 

17 that has entered into a contract or received a grant pursu18 ant to this title any personal or real property determined 

19 to be excess to the needs of the Service or the General 

20 Services Administration for purposes of carrying out the 

21 contract or grant. 

22 ‘‘(c) ACQUISITION OF PROPERTY FOR DONATION.— 

23 The Secretary may acquire excess or surplus government 

24 personal or real property for donation (subject to sub25 section (d)), to an Urban Indian Organization that has 


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1 entered into a contract or received a grant pursuant to 

2 this title if the Secretary determines that the property is 

3 appropriate for use by the Urban Indian Organization for 

4 a purpose for which a contract or grant is authorized 

5 under this title. 

6 ‘‘(d) PRIORITY.—In the event that the Secretary re7 ceives a request for donation of a specific item of personal 

8 or real property described in subsection (b) or (c) from 

9 both an Urban Indian Organization and from an Indian 

10 Tribe or Tribal Organization, the Secretary shall give pri11 ority to the request for donation of the Indian Tribe or 

12 Tribal Organization if the Secretary receives the request 

13 from the Indian Tribe or Tribal Organization before the 

14 date the Secretary transfers title to the property or, if ear15 lier, the date the Secretary transfers the property phys16 ically to the Urban Indian Organization. 

17 ‘‘(e) URBAN INDIAN ORGANIZATIONS DEEMED EX18 ECUTIVE AGENCY FOR CERTAIN PURPOSES.—For pur19 poses of section 501 of title 40, United States Code, (relat20 ing to Federal sources of supply, including lodging pro21 viders, airlines, and other transportation providers), an 

22 Urban Indian Organization that has entered into a con23 tract or received a grant pursuant to this title shall be 

24 deemed an executive agency when carrying out such con25 tract or grant. 


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1 ‘‘SEC. 518. GRANTS FOR DIABETES PREVENTION, TREAT2 MENT, AND CONTROL. 

3 ‘‘(a) GRANTS AUTHORIZED.—The Secretary may 

4 make grants to those Urban Indian Organizations that 

5 have entered into a contract or have received a grant 

6 under this title for the provision of services for the preven7 tion and treatment of, and control of the complications 

8 resulting from, diabetes among Urban Indians. 

9 ‘‘(b) GOALS.—Each grant made pursuant to sub10 section (a) shall set forth the goals to be accomplished 

11 under the grant. The goals shall be specific to each grant 

12 as agreed to between the Secretary and the grantee. 

13 ‘‘(c) ESTABLISHMENT OF CRITERIA.—The Secretary 

14 shall establish criteria for the grants made under sub15 section (a) relating to— 

16 ‘‘(1) the size and location of the Urban Indian 

17 population to be served; 

18 ‘‘(2) the need for prevention of and treatment 

19 of, and control of the complications resulting from, 

20 diabetes among the Urban Indian population to be 

21 served; 

22 ‘‘(3) performance standards for the organiza23 tion in meeting the goals set forth in such grant 

24 that are negotiated and agreed to by the Secretary 

25 and the grantee; 


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1 ‘‘(4) the capability of the organization to ade2 quately perform the activities required under the 

3 grant; and 

4 ‘‘(5) the willingness of the organization to col5 laborate with the registry, if any, established by the 

6 Secretary under section 204(e) in the Area Office of 

7 the Service in which the organization is located. 

8 ‘‘(d) FUNDS SUBJECT TO CRITERIA.—Any funds re9 ceived by an Urban Indian Organization under this Act 

10 for the prevention, treatment, and control of diabetes 

11 among Urban Indians shall be subject to the criteria devel12 oped by the Secretary under subsection (c). 

13 ‘‘SEC. 519. COMMUNITY HEALTH REPRESENTATIVES. 

14 ‘‘The Secretary, acting through the Service, may 

15 enter into contracts with, and make grants to, Urban In16 dian Organizations for the employment of Indians trained 

17 as health service providers through the Community Health 

18 Representatives Program under section 109 in the provi19 sion of health care, health promotion, and disease preven20 tion services to Urban Indians. 

21 ‘‘SEC. 520. REGULATIONS. 

22 ‘‘(a) REQUIREMENTS FOR REGULATIONS.—The Sec23 retary may promulgate regulations to implement the provi24 sions of this title in accordance with the following: 


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1 ‘‘(1) Proposed regulations to implement this 

2 Act shall be published in the Federal Register by the 

3 Secretary no later than 9 months after the date of 

4 enactment of this Act and shall have no less than a 

5 4-month comment period. 

6 ‘‘(2) The authority to promulgate regulations 

7 under this Act shall expire 18 months from the date 

8 of enactment of this Act. 

9 ‘‘(b) EFFECTIVE DATE OF TITLE.—The amendments 

10 to this title made by the Indian Health Care Improvement 

11 Act Amendments of 2005 shall be effective on the date 

12 of enactment of such amendments, regardless of whether 

13 the Secretary has promulgated regulations implementing 

14 such amendments have been promulgated. 

15 ‘‘SEC. 521. ELIGIBILITY FOR SERVICES. 

16 ‘‘Urban Indians shall be eligible and the ultimate 

17 beneficiaries for health care or referral services provided 

18 pursuant to this title. 

19 ‘‘SEC. 522. AUTHORIZATION OF APPROPRIATIONS. 

20 ‘‘There are authorized to be appropriated such sums 

21 as may be necessary for each fiscal year through fiscal 

22 year 2015 to carry out this title. 


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1 ‘‘TITLE VI—ORGANIZATIONAL 

2 IMPROVEMENTS 

3 ‘‘SEC. 601. ESTABLISHMENT OF THE INDIAN HEALTH SERV4 ICE AS AN AGENCY OF THE PUBLIC HEALTH 

5 SERVICE. 

6 ‘‘(a) ESTABLISHMENT.— 

7 ‘‘(1) IN GENERAL.—In order to more effectively 

8 and efficiently carry out the responsibilities, authori9 ties, and functions of the United States to provide 

10 health care services to Indians and Indian Tribes, as 

11 are or may be hereafter provided by Federal statute 

12 or treaties, there is established within the Public 

13 Health Service of the Department the Indian Health 

14 Service. 

15 ‘‘(2) ASSISTANT SECRETARY OF INDIAN

16 HEALTH.—The Service shall be administered by an 

17 Assistant Secretary of Indian Health, who shall be 

18 appointed by the President, by and with the advice 

19 and consent of the Senate. The Assistant Secretary 

20 shall report to the Secretary. Effective with respect 

21 to an individual appointed by the President, by and 

22 with the advice and consent of the Senate, after 

23 January 1, 2005, the term of service of the Assist24 ant Secretary shall be 4 years. An Assistant Sec25 retary may serve more than 1 term. 


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1 ‘‘(3) INCUMBENT.—The individual serving in 

2 the position of Director of the Indian Health Service 

3 on the day before the date of enactment of the In4 dian Health Care Improvement Act Amendments of 

5 2005 shall serve as Assistant Secretary. 

6 ‘‘(4) ADVOCACY AND CONSULTATION.—The po7 sition of Assistant Secretary is established to, in a 

8 manner consistent with the government-to-govern9 ment relationship between the United States and In10 dian Tribes— 

11 ‘‘(A) facilitate advocacy for the develop12 ment of appropriate Indian health policy; and 

13 ‘‘(B) promote consultation on matters re14 lating to Indian health. 

15 ‘‘(b) AGENCY.—The Service shall be an agency within 

16 the Public Health Service of the Department, and shall 

17 not be an office, component, or unit of any other agency 

18 of the Department. 

19 ‘‘(c) DUTIES.—The Assistant Secretary of Indian 

20 Health shall— 

21 ‘‘(1) perform all functions that were, on the day 

22 before the date of enactment of the Indian Health 

23 Care Improvement Act Amendments of 2005, car24 ried out by or under the direction of the individual 

25 serving as Director of the Service on that day; 


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1 ‘‘(2) perform all functions of the Secretary re2 lating to the maintenance and operation of hospital 

3 and health facilities for Indians and the planning 

4 for, and provision and utilization of, health services 

5 for Indians; 

6 ‘‘(3) administer all health programs under 

7 which health care is provided to Indians based upon 

8 their status as Indians which are administered by 

9 the Secretary, including programs under— 

10 ‘‘(A) this Act; 

11 ‘‘(B) the Act of November 2, 1921 (25 

12 U.S.C. 13); 

13 ‘‘(C) the Act of August 5, 1954 (42 U.S.C. 

14 2001 et seq.); 

15 ‘‘(D) the Act of August 16, 1957 (42 

16 U.S.C. 2005 et seq.); and 

17 ‘‘(E) the Indian Self-Determination and 

18 Education Assistance Act (25 U.S.C. 450 et 

19 seq.); 

20 ‘‘(4) administer all scholarship and loan func21 tions carried out under title I; 

22 ‘‘(5) report directly to the Secretary concerning 

23 all policy- and budget-related matters affecting In24 dian health; 


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1 ‘‘(6) collaborate with the Assistant Secretary 

2 for Health concerning appropriate matters of Indian 

3 health that affect the agencies of the Public Health 

4 Service; 

5 ‘‘(7) advise each Assistant Secretary of the De6 partment concerning matters of Indian health with 

7 respect to which that Assistant Secretary has au8 thority and responsibility; 

9 ‘‘(8) advise the heads of other agencies and pro10 grams of the Department concerning matters of In11 dian health with respect to which those heads have 

12 authority and responsibility; 

13 ‘‘(9) coordinate the activities of the Department 

14 concerning matters of Indian health; and 

15 ‘‘(10) perform such other functions as the Sec16 retary may designate. 

17 ‘‘(d) AUTHORITY.— 

18 ‘‘(1) IN GENERAL.—The Secretary, acting 

19 through the Assistant Secretary, shall have the au20 thority— 

21 ‘‘(A) except to the extent provided for in 

22 paragraph (2), to appoint and compensate em23 ployees for the Service in accordance with title 

24 5, United States Code; 


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1 ‘‘(B) to enter into contracts for the pro2 curement of goods and services to carry out the 

3 functions of the Service; and 

4 ‘‘(C) to manage, expend, and obligate all 

5 funds appropriated for the Service. 

6 ‘‘(2) PERSONNEL ACTIONS.—Notwithstanding 

7 any other provision of law, the provisions of section 

8 12 of the Act of June 18, 1934 (48 Stat. 986; 25 

9 U.S.C. 472), shall apply to all personnel actions 

10 taken with respect to new positions created within 

11 the Service as a result of its establishment under 

12 subsection (a). 

13 ‘‘(e) REFERENCES.—Any reference to the Director of 

14 the Indian Health Service in any other Federal law, Exec15 utive order, rule, regulation, or delegation of authority, or 

16 in any document of or relating to the Director of the In17 dian Health Service, shall be deemed to refer to the Assist18 ant Secretary. 

19 ‘‘SEC. 602. AUTOMATED MANAGEMENT INFORMATION SYS20 TEM. 

21 ‘‘(a) ESTABLISHMENT.— 

22 ‘‘(1) IN GENERAL.—The Secretary shall estab23 lish an automated management information system 

24 for the Service. 


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1 ‘‘(2) REQUIREMENTS OF SYSTEM.—The infor2 mation system established under paragraph (1) shall 

3 include— 

4 ‘‘(A) a financial management system; 

5 ‘‘(B) a patient care information system for 

6 each area served by the Service; 

7 ‘‘(C) a privacy component that protects the 

8 privacy of patient information held by, or on be9 half of, the Service; 

10 ‘‘(D) a services-based cost accounting com11 ponent that provides estimates of the costs as12 sociated with the provision of specific medical 

13 treatments or services in each Area office of the 

14 Service; 

15 ‘‘(E) an interface mechanism for patient 

16 billing and accounts receivable system; and 

17 ‘‘(F) a training component. 

18 ‘‘(b) PROVISION OF SYSTEMS TO TRIBES AND ORGA19 NIZATIONS.—The Secretary shall provide each Tribal 

20 Health Program automated management information sys21 tems which— 

22 ‘‘(1) meet the management information needs 

23 of such Tribal Health Program with respect to the 

24 treatment by the Tribal Health Program of patients 

25 of the Service; and 


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1 ‘‘(2) meet the management information needs 

2 of the Service. 

3 ‘‘(c) ACCESS TO RECORDS.—Notwithstanding any 

4 other provision of law, each patient shall have reasonable 

5 access to the medical or health records of such patient 

6 which are held by, or on behalf of, the Service. 

7 ‘‘(d) AUTHORITY TO ENHANCE INFORMATION TECH8 NOLOGY.—The Secretary, acting through the Assistant 

9 Secretary, shall have the authority to enter into contracts, 

10 agreements, or joint ventures with other Federal agencies, 

11 States, private and nonprofit organizations, for the pur12 pose of enhancing information technology in Indian health 

13 programs and facilities. 

14 ‘‘SEC. 603. AUTHORIZATION OF APPROPRIATIONS. 

15 ‘‘There is authorized to be appropriated such sums 

16 as may be necessary for each fiscal year through fiscal 

17 year 2015 to carry out this title. 

18 ‘‘TITLE VII—BEHAVIORAL 

19 HEALTH PROGRAMS 

20 ‘‘SEC. 701. BEHAVIORAL HEALTH PREVENTION AND TREAT21 MENT SERVICES. 

22 ‘‘(a) PURPOSES.—The purposes of this section are as 

23 follows: 

24 ‘‘(1) To authorize and direct the Secretary, act25 ing through the Service, Indian Tribes, Tribal OrgaVerDate Aug 31 2005 05:25 Mar 17, 2006 Jkt 049200 PO 00000 Frm 00248 Fmt 6652 Sfmt 6401 E:\BILLS\S1057.RS S1057

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1 nizations, and Urban Indian Organizations, to de2 velop a comprehensive behavioral health prevention 

3 and treatment program which emphasizes collabora4 tion among alcohol and substance abuse, social serv5 ices, and mental health programs. 

6 ‘‘(2) To provide information, direction, and 

7 guidance relating to mental illness and dysfunction 

8 and self-destructive behavior, including child abuse 

9 and family violence, to those Federal, tribal, State, 

10 and local agencies responsible for programs in In11 dian communities in areas of health care, education, 

12 social services, child and family welfare, alcohol and 

13 substance abuse, law enforcement, and judicial serv14 ices. 

15 ‘‘(3) To assist Indian Tribes to identify services 

16 and resources available to address mental illness and 

17 dysfunctional and self-destructive behavior. 

18 ‘‘(4) To provide authority and opportunities for 

19 Indian Tribes and Tribal Organizations to develop, 

20 implement, and coordinate with community-based 

21 programs which include identification, prevention, 

22 education, referral, and treatment services, including 

23 through multidisciplinary resource teams. 

24 ‘‘(5) To ensure that Indians, as citizens of the 

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1 side, have the same access to behavioral health serv2 ices to which all citizens have access. 

3 ‘‘(6) To modify or supplement existing pro4 grams and authorities in the areas identified in 

5 paragraph (2). 

6 ‘‘(b) PLANS.— 

7 ‘‘(1) DEVELOPMENT.—The Secretary, acting 

8 through the Service, Indian Tribes, Tribal Organiza9 tions, and Urban Indian Organizations, shall encour10 age Indian Tribes and Tribal Organizations to de11 velop tribal plans, and Urban Indian Organizations 

12 to develop local plans, and for all such groups to 

13 participate in developing areawide plans for Indian 

14 Behavioral Health Services. The plans shall include, 

15 to the extent feasible, the following components: 

16 ‘‘(A) An assessment of the scope of alcohol 

17 or other substance abuse, mental illness, and 

18 dysfunctional and self-destructive behavior, in19 cluding suicide, child abuse, and family vio20 lence, among Indians, including— 

21 ‘‘(i) the number of Indians served who 

22 are directly or indirectly affected by such 

23 illness or behavior; or 


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1 ‘‘(ii) an estimate of the financial and 

2 human cost attributable to such illness or 

3 behavior. 

4 ‘‘(B) An assessment of the existing and 

5 additional resources necessary for the preven6 tion and treatment of such illness and behavior, 

7 including an assessment of the progress toward 

8 achieving the availability of the full continuum 

9 of care described in subsection (c). 

10 ‘‘(C) An estimate of the additional funding 

11 needed by the Service, Indian Tribes, Tribal 

12 Organizations, and Urban Indian Organizations 

13 to meet their responsibilities under the plans. 

14 ‘‘(2) NATIONAL CLEARINGHOUSE.—The Sec15 retary, acting through the Service, shall establish a 

16 national clearinghouse of plans and reports on the 

17 outcomes of such plans developed by Indian Tribes, 

18 Tribal Organizations, Urban Indian Organizations, 

19 and Service Areas relating to behavioral health. The 

20 Secretary shall ensure access to these plans and out21 comes by any Indian Tribe, Tribal Organization, 

22 Urban Indian Organization, or the Service. 

23 ‘‘(3) TECHNICAL ASSISTANCE.—The Secretary 

24 shall provide technical assistance to Indian Tribes, 

25 Tribal Organizations, and Urban Indian OrganizaVerDate Aug 31 2005 05:25 Mar 17, 2006 Jkt 049200 PO 00000 Frm 00251 Fmt 6652 Sfmt 6401 E:\BILLS\S1057.RS S1057

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1 tions in preparation of plans under this section and 

2 in developing standards of care that may be used 

3 and adopted locally. 

4 ‘‘(c) PROGRAMS.—The Secretary, acting through the 

5 Service, Indian Tribes, and Tribal Organizations, shall 

6 provide, to the extent feasible and if funding is available, 

7 programs including the following: 

8 ‘‘(1) COMPREHENSIVE CARE.—A comprehensive 

9 continuum of behavioral health care which pro10 vides— 

11 ‘‘(A) community-based prevention, inter12 vention, outpatient, and behavioral health 

13 aftercare; 

14 ‘‘(B) detoxification (social and medical); 

15 ‘‘(C) acute hospitalization; 

16 ‘‘(D) intensive outpatient/day treatment; 

17 ‘‘(E) residential treatment; 

18 ‘‘(F) transitional living for those needing a 

19 temporary, stable living environment that is 

20 supportive of treatment and recovery goals; 

21 ‘‘(G) emergency shelter; 

22 ‘‘(H) intensive case management; 

23 ‘‘(I) Traditional Health Care Practices; 

24 and 

25 ‘‘(J) diagnostic services. 


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1 ‘‘(2) CHILD CARE.—Behavioral health services 

2 for Indians from birth through age 17, including— 

3 ‘‘(A) preschool and school age fetal alcohol 

4 disorder services, including assessment and be5 havioral intervention; 

6 ‘‘(B) mental health and substance abuse 

7 services (emotional, organic, alcohol, drug, in8 halant, and tobacco); 

9 ‘‘(C) identification and treatment of co-oc10 curring disorders and comorbidity; 

11 ‘‘(D) prevention of alcohol, drug, inhalant, 

12 and tobacco use; 

13 ‘‘(E) early intervention, treatment, and 

14 aftercare; 

15 ‘‘(F) promotion of healthy approaches to 

16 risk and safety issues; and 

17 ‘‘(G) identification and treatment of ne18 glect and physical, mental, and sexual abuse. 

19 ‘‘(3) ADULT CARE.—Behavioral health services 

20 for Indians from age 18 through 55, including— 

21 ‘‘(A) early intervention, treatment, and 

22 aftercare; 

23 ‘‘(B) mental health and substance abuse 

24 services (emotional, alcohol, drug, inhalant, and 

25 tobacco), including sex specific services; 


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1 ‘‘(C) identification and treatment of co-oc2 curring disorders (dual diagnosis) and comor3 bidity; 

4 ‘‘(D) promotion of healthy approaches for 

5 risk-related behavior; 

6 ‘‘(E) treatment services for women at risk 

7 of giving birth to a child with a fetal alcohol 

8 disorder; and 

9 ‘‘(F) sex specific treatment for sexual as10 sault and domestic violence. 

11 ‘‘(4) FAMILY CARE.—Behavioral health services 

12 for families, including— 

13 ‘‘(A) early intervention, treatment, and 

14 aftercare for affected families; 

15 ‘‘(B) treatment for sexual assault and do16 mestic violence; and 

17 ‘‘(C) promotion of healthy approaches re18 lating to parenting, domestic violence, and other 

19 abuse issues. 

20 ‘‘(5) ELDER CARE.—Behavioral health services 

21 for Indians 56 years of age and older, including— 

22 ‘‘(A) early intervention, treatment, and 

23 aftercare; 


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1 ‘‘(B) mental health and substance abuse 

2 services (emotional, alcohol, drug, inhalant, and 

3 tobacco), including sex specific services; 

4 ‘‘(C) identification and treatment of co-oc5 curring disorders (dual diagnosis) and comor6 bidity; 

7 ‘‘(D) promotion of healthy approaches to 

8 managing conditions related to aging; 

9 ‘‘(E) sex specific treatment for sexual as10 sault, domestic violence, neglect, physical and 

11 mental abuse and exploitation; and 

12 ‘‘(F) identification and treatment of de13 mentias regardless of cause. 

14 ‘‘(d) COMMUNITY BEHAVIORAL HEALTH PLAN.— 

15 ‘‘(1) ESTABLISHMENT.—The governing body of 

16 any Indian Tribe, Tribal Organization, or Urban In17 dian Organization may adopt a resolution for the es18 tablishment of a community behavioral health plan 

19 providing for the identification and coordination of 

20 available resources and programs to identify, pre21 vent, or treat substance abuse, mental illness, or 

22 dysfunctional and self-destructive behavior, including 

23 child abuse and family violence, among its members 

24 or its service population. This plan should include 


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1 behavioral health services, social services, intensive 

2 outpatient services, and continuing aftercare. 

3 ‘‘(2) TECHNICAL ASSISTANCE.—At the request 

4 of an Indian Tribe, Tribal Organization, or Urban 

5 Indian Organization, the Bureau of Indian Affairs 

6 and the Service shall cooperate with and provide 

7 technical assistance to the Indian Tribe, Tribal Or8 ganization, or Urban Indian Organization in the de9 velopment and implementation of such plan. 

10 ‘‘(3) FUNDING.—The Secretary, acting through 

11 the Service, may make funding available to Indian 

12 Tribes and Tribal Organizations which adopt a reso13 lution pursuant to paragraph (1) to obtain technical 

14 assistance for the development of a community be15 havioral health plan and to provide administrative 

16 support in the implementation of such plan. 

17 ‘‘(e) COORDINATION FOR AVAILABILITY OF SERV18 ICES.—The Secretary, acting through the Service, Indian 

19 Tribes, Tribal Organizations, and Urban Indian Organiza20 tions, shall coordinate behavioral health planning, to the 

21 extent feasible, with other Federal agencies and with State 

22 agencies, to encourage comprehensive behavioral health 

23 services for Indians regardless of their place of residence. 

24 ‘‘(f) MENTAL HEALTH CARE NEED ASSESSMENT.— 

25 Not later than 1 year after the date of enactment of the 


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1 Indian Health Care Improvement Act Amendments of 

2 2005, the Secretary, acting through the Service, shall 

3 make an assessment of the need for inpatient mental 

4 health care among Indians and the availability and cost 

5 of inpatient mental health facilities which can meet such 

6 need. In making such assessment, the Secretary shall con7 sider the possible conversion of existing, underused Service 

8 hospital beds into psychiatric units to meet such need. 

9 ‘‘SEC. 702. MEMORANDA OF AGREEMENT WITH THE DE10 PARTMENT OF THE INTERIOR. 

11 ‘‘(a) CONTENTS.—Not later than 12 months after the 

12 date of enactment of the Indian Health Care Improvement 

13 Act Amendments of 2005, the Secretary, acting through 

14 the Service, and the Secretary of the Interior shall develop 

15 and enter into a memoranda of agreement, or review and 

16 update any existing memoranda of agreement, as required 

17 by section 4205 of the Indian Alcohol and Substance 

18 Abuse Prevention and Treatment Act of 1986 (25 U.S.C. 

19 2411) under which the Secretaries address the following: 

20 ‘‘(1) The scope and nature of mental illness and 

21 dysfunctional and self-destructive behavior, including 

22 child abuse and family violence, among Indians. 

23 ‘‘(2) The existing Federal, tribal, State, local, 

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1 able to provide behavioral health services for Indi2 ans. 

3 ‘‘(3) The unmet need for additional services, re4 sources, and programs necessary to meet the needs 

5 identified pursuant to paragraph (1). 

6 ‘‘(4)(A) The right of Indians, as citizens of the 

7 United States and of the States in which they re8 side, to have access to behavioral health services to 

9 which all citizens have access. 

10 ‘‘(B) The right of Indians to participate in, and 

11 receive the benefit of, such services. 

12 ‘‘(C) The actions necessary to protect the exer13 cise of such right. 

14 ‘‘(5) The responsibilities of the Bureau of In15 dian Affairs and the Service, including mental illness 

16 identification, prevention, education, referral, and 

17 treatment services (including services through multi18 disciplinary resource teams), at the central, area, 

19 and agency and Service Unit, Service Area, and 

20 headquarters levels to address the problems identi21 fied in paragraph (1). 

22 ‘‘(6) A strategy for the comprehensive coordina23 tion of the behavioral health services provided by the 

24 Bureau of Indian Affairs and the Service to meet 


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1 the problems identified pursuant to paragraph (1), 

2 including— 

3 ‘‘(A) the coordination of alcohol and sub4 stance abuse programs of the Service, the Bu5 reau of Indian Affairs, and Indian Tribes and 

6 Tribal Organizations (developed under the In7 dian Alcohol and Substance Abuse Prevention 

8 and Treatment Act of 1986) with behavioral 

9 health initiatives pursuant to this Act, particu10 larly with respect to the referral and treatment 

11 of dually diagnosed individuals requiring behav12 ioral health and substance abuse treatment; and 

13 ‘‘(B) ensuring that the Bureau of Indian 

14 Affairs and Service programs and services (in15 cluding multidisciplinary resource teams) ad16 dressing child abuse and family violence are co17 ordinated with such non-Federal programs and 

18 services. 

19 ‘‘(7) Directing appropriate officials of the Bu20 reau of Indian Affairs and the Service, particularly 

21 at the agency and Service Unit levels, to cooperate 

22 fully with tribal requests made pursuant to commu23 nity behavioral health plans adopted under section 

24 701(c) and section 4206 of the Indian Alcohol and 


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1 Substance Abuse Prevention and Treatment Act of 

2 1986 (25 U.S.C. 2412). 

3 ‘‘(8) Providing for an annual review of such 

4 agreement by the Secretaries which shall be provided 

5 to Congress and Indian Tribes and Tribal Organiza6 tions. 

7 ‘‘(b) SPECIFIC PROVISIONS REQUIRED.—The memo8 randa of agreement updated or entered into pursuant to 

9 subsection (a) shall include specific provisions pursuant to 

10 which the Service shall assume responsibility for— 

11 ‘‘(1) the determination of the scope of the prob12 lem of alcohol and substance abuse among Indians, 

13 including the number of Indians within the jurisdic14 tion of the Service who are directly or indirectly af15 fected by alcohol and substance abuse and the finan16 cial and human cost; 

17 ‘‘(2) an assessment of the existing and needed 

18 resources necessary for the prevention of alcohol and 

19 substance abuse and the treatment of Indians af20 fected by alcohol and substance abuse; and 

21 ‘‘(3) an estimate of the funding necessary to 

22 adequately support a program of prevention of alco23 hol and substance abuse and treatment of Indians 

24 affected by alcohol and substance abuse. 


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1 ‘‘(c) CONSULTATION.—The Secretary, acting through 

2 the Service, and the Secretary of the Interior shall, in de3 veloping the memoranda of agreement under subsection 

4 (a), consult with and solicit the comments from— 

5 ‘‘(1) Indian Tribes and Tribal Organizations; 

6 ‘‘(2) Indians; 

7 ‘‘(3) Urban Indian Organizations and other In8 dian organizations; and 

9 ‘‘(4) behavioral health service providers. 

10 ‘‘(d) PUBLICATION.—Each memorandum of agree11 ment entered into or renewed (and amendments or modi12 fications thereto) under subsection (a) shall be published 

13 in the Federal Register. At the same time as publication 

14 in the Federal Register, the Secretary shall provide a copy 

15 of such memoranda, amendment, or modification to each 

16 Indian Tribe, Tribal Organization, and Urban Indian Or17 ganization. 

18 ‘‘SEC. 703. COMPREHENSIVE BEHAVIORAL HEALTH PRE19 VENTION AND TREATMENT PROGRAM. 

20 ‘‘(a) ESTABLISHMENT.— 

21 ‘‘(1) IN GENERAL.—The Secretary, acting 

22 through the Service, Indian Tribes, and Tribal Orga23 nizations, shall provide a program of comprehensive 

24 behavioral health, prevention, treatment, and 


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1 aftercare, including Traditional Health Care Prac2 tices, which shall include— 

3 ‘‘(A) prevention, through educational inter4 vention, in Indian communities; 

5 ‘‘(B) acute detoxification, psychiatric hos6 pitalization, residential, and intensive outpatient 

7 treatment; 

8 ‘‘(C) community-based rehabilitation and 

9 aftercare; 

10 ‘‘(D) community education and involve11 ment, including extensive training of health 

12 care, educational, and community-based per13 sonnel; 

14 ‘‘(E) specialized residential treatment pro15 grams for high-risk populations, including preg16 nant and postpartum women and their children; 

17 and 

18 ‘‘(F) diagnostic services. 

19 ‘‘(2) TARGET POPULATIONS.—The target popu20 lation of such programs shall be members of Indian 

21 Tribes. Efforts to train and educate key members of 

22 the Indian community shall also target employees of 

23 health, education, judicial, law enforcement, legal, 

24 and social service programs. 

25 ‘‘(b) CONTRACT HEALTH SERVICES.— 


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1 ‘‘(1) IN GENERAL.—The Secretary, acting 

2 through the Service, Indian Tribes, and Tribal Orga3 nizations, may enter into contracts with public or 

4 private providers of behavioral health treatment 

5 services for the purpose of carrying out the program 

6 required under subsection (a). 

7 ‘‘(2) PROVISION OF ASSISTANCE.—In carrying 

8 out this subsection, the Secretary shall provide as9 sistance to Indian Tribes and Tribal Organizations 

10 to develop criteria for the certification of behavioral 

11 health service providers and accreditation of service 

12 facilities which meet minimum standards for such 

13 services and facilities. 

14 ‘‘SEC. 704. MENTAL HEALTH TECHNICIAN PROGRAM. 

15 ‘‘(a) IN GENERAL.—Under the authority of the Act 

16 of November 2, 1921 (25 U.S.C. 13) (commonly known 

17 as the ‘Snyder Act’), the Secretary shall establish and 

18 maintain a mental health technician program within the 

19 Service which— 

20 ‘‘(1) provides for the training of Indians as 

21 mental health technicians; and 

22 ‘‘(2) employs such technicians in the provision 

23 of community-based mental health care that includes 

24 identification, prevention, education, referral, and 

25 treatment services. 


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1 ‘‘(b) PARAPROFESSIONAL TRAINING.—In carrying 

2 out subsection (a), the Secretary, acting through the Serv3 ice, Indian Tribes, and Tribal Organizations, shall provide 

4 high-standard paraprofessional training in mental health 

5 care necessary to provide quality care to the Indian com6 munities to be served. Such training shall be based upon 

7 a curriculum developed or approved by the Secretary 

8 which combines education in the theory of mental health 

9 care with supervised practical experience in the provision 

10 of such care. 

11 ‘‘(c) SUPERVISION AND EVALUATION OF TECHNI12 CIANS.—The Secretary, acting through the Service, Indian 

13 Tribes, and Tribal Organizations, shall supervise and 

14 evaluate the mental health technicians in the training pro15 gram. 

16 ‘‘(d) TRADITIONAL HEALTH CARE PRACTICES.—The 

17 Secretary, acting through the Service, shall ensure that 

18 the program established pursuant to this subsection in19 volves the use and promotion of the Traditional Health 

20 Care Practices of the Indian Tribes to be served. 

21 ‘‘SEC. 705. LICENSING REQUIREMENT FOR MENTAL 

22 HEALTH CARE WORKERS. 

23 ‘‘Subject to the provisions of section 221, any person 

24 employed as a psychologist, social worker, or marriage and 

25 family therapist for the purpose of providing mental health 


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1 care services to Indians in a clinical setting under this Act 

2 is required to be licensed as a clinical psychologist, social 

3 worker, or marriage and family therapist, respectively, or 

4 working under the direct supervision of a licensed clinical 

5 psychologist, social worker, or marriage and family thera6 pist, respectively. 

7 ‘‘SEC. 706. INDIAN WOMEN TREATMENT PROGRAMS. 

8 ‘‘(a) FUNDING.—The Secretary, consistent with sec9 tion 701, shall make funds available to Indian Tribes, 

10 Tribal Organizations, and Urban Indian Organizations to 

11 develop and implement a comprehensive behavioral health 

12 program of prevention, intervention, treatment, and re13 lapse prevention services that specifically addresses the 

14 spiritual, cultural, historical, social, and child care needs 

15 of Indian women, regardless of age. 

16 ‘‘(b) USE OF FUNDS.—Funds made available pursu17 ant to this section may be used to— 

18 ‘‘(1) develop and provide community training, 

19 education, and prevention programs for Indian 

20 women relating to behavioral health issues, including 

21 fetal alcohol disorders; 

22 ‘‘(2) identify and provide psychological services, 

23 counseling, advocacy, support, and relapse preven24 tion to Indian women and their families; and 


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1 ‘‘(3) develop prevention and intervention models 

2 for Indian women which incorporate Traditional 

3 Health Care Practices, cultural values, and commu4 nity and family involvement. 

5 ‘‘(c) CRITERIA.—The Secretary, in consultation with 

6 Indian Tribes and Tribal Organizations, shall establish 

7 criteria for the review and approval of applications and 

8 proposals for funding under this section. 

9 ‘‘(d) EARMARK OF CERTAIN FUNDS.—Twenty per10 cent of the funds appropriated pursuant to this section 

11 shall be used to make grants to Urban Indian Organiza12 tions. 

13 ‘‘SEC. 707. INDIAN YOUTH PROGRAM. 

14 ‘‘(a) DETOXIFICATION AND REHABILITATION.—The 

15 Secretary, acting through the Service, consistent with sec16 tion 701, shall develop and implement a program for acute 

17 detoxification and treatment for Indian youths, including 

18 behavioral health services. The program shall include re19 gional treatment centers designed to include detoxification 

20 and rehabilitation for both sexes on a referral basis and 

21 programs developed and implemented by Indian Tribes or 

22 Tribal Organizations at the local level under the Indian 

23 Self-Determination and Education Assistance Act. Re24 gional centers shall be integrated with the intake and reVerDate Aug 31 2005 05:25 Mar 17, 2006 Jkt 049200 PO 00000 Frm 00266 Fmt 6652 Sfmt 6401 E:\BILLS\S1057.RS S1057

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1 habilitation programs based in the referring Indian com2 munity. 

3 ‘‘(b) ALCOHOL AND SUBSTANCE ABUSE TREATMENT

4 CENTERS OR FACILITIES.— 

5 ‘‘(1) ESTABLISHMENT.— 

6 ‘‘(A) IN GENERAL.—The Secretary, acting 

7 through the Service, Indian Tribes, and Tribal 

8 Organizations, shall construct, renovate, or, as 

9 necessary, purchase, and appropriately staff 

10 and operate, at least 1 youth regional treatment 

11 center or treatment network in each area under 

12 the jurisdiction of an Area Office. 

13 ‘‘(B) AREA OFFICE IN CALIFORNIA.—For 

14 the purposes of this subsection, the Area Office 

15 in California shall be considered to be 2 Area 

16 Offices, 1 office whose jurisdiction shall be con17 sidered to encompass the northern area of the 

18 State of California, and 1 office whose jurisdic19 tion shall be considered to encompass the re20 mainder of the State of California for the pur21 pose of implementing California treatment net22 works. 

23 ‘‘(2) FUNDING.—For the purpose of staffing 

24 and operating such centers or facilities, funding 


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1 shall be pursuant to the Act of November 2, 1921 

2 (25 U.S.C. 13). 

3 ‘‘(3) LOCATION.—A youth treatment center 

4 constructed or purchased under this subsection shall 

5 be constructed or purchased at a location within the 

6 area described in paragraph (1) agreed upon (by ap7 propriate tribal resolution) by a majority of the In8 dian Tribes to be served by such center. 

9 ‘‘(4) SPECIFIC PROVISION OF FUNDS.— 

10 ‘‘(A) IN GENERAL.—Notwithstanding any 

11 other provision of this title, the Secretary may, 

12 from amounts authorized to be appropriated for 

13 the purposes of carrying out this section, make 

14 funds available to— 

15 ‘‘(i) the Tanana Chiefs Conference, 

16 Incorporated, for the purpose of leasing, 

17 constructing, renovating, operating, and 

18 maintaining a residential youth treatment 

19 facility in Fairbanks, Alaska; and 

20 ‘‘(ii) the Southeast Alaska Regional 

21 Health Corporation to staff and operate a 

22 residential youth treatment facility without 

23 regard to the proviso set forth in section 

24 4(l) of the Indian Self-Determination and 


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1 Education Assistance Act (25 U.S.C. 

2 450b(l)). 

3 ‘‘(B) PROVISION OF SERVICES TO ELIGI4 BLE YOUTHS.—Until additional residential 

5 youth treatment facilities are established in 

6 Alaska pursuant to this section, the facilities 

7 specified in subparagraph (A) shall make every 

8 effort to provide services to all eligible Indian 

9 youths residing in Alaska. 

10 ‘‘(c) INTERMEDIATE ADOLESCENT BEHAVIORAL

11 HEALTH SERVICES.— 

12 ‘‘(1) IN GENERAL.—The Secretary, acting 

13 through the Service, Indian Tribes, and Tribal Orga14 nizations, may provide intermediate behavioral 

15 health services, which may incorporate Traditional 

16 Health Care Practices, to Indian children and ado17 lescents, including— 

18 ‘‘(A) pretreatment assistance; 

19 ‘‘(B) inpatient, outpatient, and aftercare 

20 services; 

21 ‘‘(C) emergency care; 

22 ‘‘(D) suicide prevention and crisis interven23 tion; and 

24 ‘‘(E) prevention and treatment of mental 

25 illness and dysfunctional and self-destructive 


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1 behavior, including child abuse and family vio2 lence. 

3 ‘‘(2) USE OF FUNDS.—Funds provided under 

4 this subsection may be used— 

5 ‘‘(A) to construct or renovate an existing 

6 health facility to provide intermediate behav7 ioral health services; 

8 ‘‘(B) to hire behavioral health profes9 sionals; 

10 ‘‘(C) to staff, operate, and maintain an in11 termediate mental health facility, group home, 

12 sober housing, transitional housing or similar 

13 facilities, or youth shelter where intermediate 

14 behavioral health services are being provided; 

15 ‘‘(D) to make renovations and hire appro16 priate staff to convert existing hospital beds 

17 into adolescent psychiatric units; and 

18 ‘‘(E) for intensive home- and community19 based services. 

20 ‘‘(3) CRITERIA.—The Secretary, acting through 

21 the Service, shall, in consultation with Indian Tribes 

22 and Tribal Organizations, establish criteria for the 

23 review and approval of applications or proposals for 

24 funding made available pursuant to this subsection. 

25 ‘‘(d) FEDERALLY OWNED STRUCTURES.— 


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1 ‘‘(1) IN GENERAL.—The Secretary, in consulta2 tion with Indian Tribes and Tribal Organizations, 

3 shall— 

4 ‘‘(A) identify and use, where appropriate, 

5 federally owned structures suitable for local res6 idential or regional behavioral health treatment 

7 for Indian youths; and 

8 ‘‘(B) establish guidelines, in consultation 

9 with Indian Tribes and Tribal Organizations, 

10 for determining the suitability of any such fed11 erally owned structure to be used for local resi12 dential or regional behavioral health treatment 

13 for Indian youths. 

14 ‘‘(2) TERMS AND CONDITIONS FOR USE OF

15 STRUCTURE.—Any structure described in paragraph 

16 (1) may be used under such terms and conditions as 

17 may be agreed upon by the Secretary and the agency 

18 having responsibility for the structure and any In19 dian Tribe or Tribal Organization operating the pro20 gram. 

21 ‘‘(e) REHABILITATION AND AFTERCARE SERVICES.— 

22 ‘‘(1) IN GENERAL.—The Secretary, Indian 

23 Tribes, or Tribal Organizations, in cooperation with 

24 the Secretary of the Interior, shall develop and im25 plement within each Service Unit, community-based 


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1 rehabilitation and follow-up services for Indian 

2 youths who are having significant behavioral health 

3 problems, and require long-term treatment, commu4 nity reintegration, and monitoring to support the In5 dian youths after their return to their home commu6 nity. 

7 ‘‘(2) ADMINISTRATION.—Services under para8 graph (1) shall be provided by trained staff within 

9 the community who can assist the Indian youths in 

10 their continuing development of self-image, positive 

11 problem-solving skills, and nonalcohol or substance 

12 abusing behaviors. Such staff may include alcohol 

13 and substance abuse counselors, mental health pro14 fessionals, and other health professionals and para15 professionals, including community health represent16 atives. 

17 ‘‘(f) INCLUSION OF FAMILY IN YOUTH TREATMENT

18 PROGRAM.—In providing the treatment and other services 

19 to Indian youths authorized by this section, the Secretary, 

20 acting through the Service, Indian Tribes, and Tribal Or21 ganizations, shall provide for the inclusion of family mem22 bers of such youths in the treatment programs or other 

23 services as may be appropriate. Not less than 10 percent 

24 of the funds appropriated for the purposes of carrying out 

25 subsection (e) shall be used for outpatient care of adult 


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1 family members related to the treatment of an Indian 

2 youth under that subsection. 

3 ‘‘(g) MULTIDRUG ABUSE PROGRAM.—The Secretary, 

4 acting through the Service, Indian Tribes, Tribal Organi5 zations, and Urban Indian Organizations, shall provide, 

6 consistent with section 701, programs and services to pre7 vent and treat the abuse of multiple forms of substances, 

8 including alcohol, drugs, inhalants, and tobacco, among 

9 Indian youths residing in Indian communities, on or near 

10 reservations, and in urban areas and provide appropriate 

11 mental health services to address the incidence of mental 

12 illness among such youths. 

13 ‘‘SEC. 708. INPATIENT AND COMMUNITY-BASED MENTAL 

14 HEALTH FACILITIES DESIGN, CONSTRUC15 TION, AND STAFFING. 

16 ‘‘Not later than 1 year after the date of enactment 

17 of the Indian Health Care Improvement Act Amendments 

18 of 2005, the Secretary, acting through the Service, Indian 

19 Tribes, and Tribal Organizations, may provide, in each 

20 area of the Service, not less than 1 inpatient mental health 

21 care facility, or the equivalent, for Indians with behavioral 

22 health problems. For the purposes of this subsection, Cali23 fornia shall be considered to be 2 Area Offices, 1 office 

24 whose location shall be considered to encompass the north25 ern area of the State of California and 1 office whose juVerDate Aug 31 2005 05:25 Mar 17, 2006 Jkt 049200 PO 00000 Frm 00273 Fmt 6652 Sfmt 6401 E:\BILLS\S1057.RS S1057

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1 risdiction shall be considered to encompass the remainder 

2 of the State of California. The Secretary shall consider 

3 the possible conversion of existing, underused Service hos4 pital beds into psychiatric units to meet such need. 

5 ‘‘SEC. 709. TRAINING AND COMMUNITY EDUCATION. 

6 ‘‘(a) PROGRAM.—The Secretary, in cooperation with 

7 the Secretary of the Interior, shall develop and implement 

8 or provide funding for Indian Tribes and Tribal Organiza9 tions to develop and implement, within each Service Unit 

10 or tribal program, a program of community education and 

11 involvement which shall be designed to provide concise and 

12 timely information to the community leadership of each 

13 tribal community. Such program shall include education 

14 about behavioral health issues to political leaders, Tribal 

15 judges, law enforcement personnel, members of tribal 

16 health and education boards, health care providers includ17 ing traditional practitioners, and other critical members 

18 of each tribal community. Community-based training (ori19 ented toward local capacity development) shall also include 

20 tribal community provider training (designed for adult 

21 learners from the communities receiving services for pre22 vention, intervention, treatment, and aftercare). 

23 ‘‘(b) INSTRUCTION.—The Secretary, acting through 

24 the Service, shall, either directly or through Indian Tribes 

25 and Tribal Organizations, provide instruction in the area 


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1 of behavioral health issues, including instruction in crisis 

2 intervention and family relations in the context of alcohol 

3 and substance abuse, child sexual abuse, youth alcohol and 

4 substance abuse, and the causes and effects of fetal alco5 hol disorders to appropriate employees of the Bureau of 

6 Indian Affairs and the Service, and to personnel in schools 

7 or programs operated under any contract with the Bureau 

8 of Indian Affairs or the Service, including supervisors of 

9 emergency shelters and halfway houses described in sec10 tion 4213 of the Indian Alcohol and Substance Abuse Pre11 vention and Treatment Act of 1986 (25 U.S.C. 2433). 

12 ‘‘(c) TRAINING MODELS.—In carrying out the edu13 cation and training programs required by this section, the 

14 Secretary, in consultation with Indian Tribes, Tribal Or15 ganizations, Indian behavioral health experts, and Indian 

16 alcohol and substance abuse prevention experts, shall de17 velop and provide community-based training models. Such 

18 models shall address— 

19 ‘‘(1) the elevated risk of alcohol and behavioral 

20 health problems faced by children of alcoholics; 

21 ‘‘(2) the cultural, spiritual, and 

22 multigenerational aspects of behavioral health prob23 lem prevention and recovery; and 


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1 ‘‘(3) community-based and multidisciplinary 

2 strategies for preventing and treating behavioral 

3 health problems. 

4 ‘‘SEC. 710. BEHAVIORAL HEALTH PROGRAM. 

5 ‘‘(a) INNOVATIVE PROGRAMS.—The Secretary, acting 

6 through the Service, Indian Tribes, and Tribal Organiza7 tions, consistent with section 701, may plan, develop, im8 plement, and carry out programs to deliver innovative 

9 community-based behavioral health services to Indians. 

10 ‘‘(b) FUNDING; CRITERIA.—The Secretary may 

11 award such funding for a project under subsection (a) to 

12 an Indian Tribe or Tribal Organization and may consider 

13 the following criteria: 

14 ‘‘(1) The project will address significant unmet 

15 behavioral health needs among Indians. 

16 ‘‘(2) The project will serve a significant number 

17 of Indians. 

18 ‘‘(3) The project has the potential to deliver 

19 services in an efficient and effective manner. 

20 ‘‘(4) The Indian Tribe or Tribal Organization 

21 has the administrative and financial capability to ad22 minister the project. 

23 ‘‘(5) The project may deliver services in a man24 ner consistent with Traditional Health Care Prac25 tices. 


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1 ‘‘(6) The project is coordinated with, and avoids 

2 duplication of, existing services. 

3 ‘‘(c) EQUITABLE TREATMENT.—For purposes of this 

4 subsection, the Secretary shall, in evaluating project appli5 cations or proposals, use the same criteria that the Sec6 retary uses in evaluating any other application or proposal 

7 for such funding. 

8 ‘‘SEC. 711. FETAL ALCOHOL DISORDER FUNDING. 

9 ‘‘(a) PROGRAMS.— 

10 ‘‘(1) ESTABLISHMENT.—The Secretary, con11 sistent with section 701, acting through the Service, 

12 Indian Tribes, and Tribal Organizations, is author13 ized to establish and operate fetal alcohol disorder 

14 programs as provided in this section for the pur15 poses of meeting the health status objectives speci16 fied in section 3. 

17 ‘‘(2) USE OF FUNDS.—Funding provided pursu18 ant to this section shall be used for the following: 

19 ‘‘(A) To develop and provide for Indians 

20 community and in school training, education, 

21 and prevention programs relating to fetal alco22 hol disorders. 

23 ‘‘(B) To identify and provide behavioral 

24 health treatment to high-risk Indian women 


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1 and high-risk women pregnant with an Indian’s 

2 child. 

3 ‘‘(C) To identify and provide appropriate 

4 psychological services, educational and voca5 tional support, counseling, advocacy, and infor6 mation to fetal alcohol disorder affected Indians 

7 and their families or caretakers. 

8 ‘‘(D) To develop and implement counseling 

9 and support programs in schools for fetal alco10 hol disorder affected Indian children. 

11 ‘‘(E) To develop prevention and interven12 tion models which incorporate practitioners of 

13 Traditional Health Care Practices, cultural and 

14 spiritual values, and community involvement. 

15 ‘‘(F) To develop, print, and disseminate 

16 education and prevention materials on fetal al17 cohol disorder. 

18 ‘‘(G) To develop and implement, through 

19 the tribal consultation process, culturally sen20 sitive assessment and diagnostic tools including 

21 dysmorphology clinics and multidisciplinary 

22 fetal alcohol disorder clinics for use in Indian 

23 communities and Urban Centers. 


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1 ‘‘(H) To develop early childhood interven2 tion projects from birth on to mitigate the ef3 fects of fetal alcohol disorder among Indians. 

4 ‘‘(I) To develop and fund community-based 

5 adult fetal alcohol disorder housing and support 

6 services for Indians and for women pregnant 

7 with an Indian’s child. 

8 ‘‘(3) CRITERIA FOR APPLICATIONS.—The Sec9 retary shall establish criteria for the review and ap10 proval of applications for funding under this section. 

11 ‘‘(b) SERVICES.—The Secretary, acting through the 

12 Service and Indian Tribes, Tribal Organizations, and 

13 Urban Indian Organizations, shall— 

14 ‘‘(1) develop and provide services for the pre15 vention, intervention, treatment, and aftercare for 

16 those affected by fetal alcohol disorder in Indian 

17 communities; and 

18 ‘‘(2) provide supportive services, directly or 

19 through an Indian Tribe, Tribal Organization, or 

20 Urban Indian Organization, including services to 

21 meet the special educational, vocational, school-to22 work transition, and independent living needs of ad23 olescent and adult Indians with fetal alcohol dis24 order. 


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1 ‘‘(c) TASK FORCE.—The Secretary shall establish a 

2 task force to be known as the Fetal Alcohol Disorder Task 

3 Force to advise the Secretary in carrying out subsection 

4 (b). Such task force shall be composed of representatives 

5 from the following: 

6 ‘‘(1) The National Institute on Drug Abuse. 

7 ‘‘(2) The National Institute on Alcohol and Al8 coholism. 

9 ‘‘(3) The Office of Substance Abuse Prevention. 

10 ‘‘(4) The National Institute of Mental Health. 

11 ‘‘(5) The Service. 

12 ‘‘(6) The Office of Minority Health of the De13 partment of Health and Human Services. 

14 ‘‘(7) The Administration for Native Americans. 

15 ‘‘(8) The National Institute of Child Health 

16 and Human Development (NICHD). 

17 ‘‘(9) The Centers for Disease Control and Pre18 vention. 

19 ‘‘(10) The Bureau of Indian Affairs. 

20 ‘‘(11) Indian Tribes. 

21 ‘‘(12) Tribal Organizations. 

22 ‘‘(13) Urban Indian Organizations. 

23 ‘‘(14) Indian fetal alcohol disorder experts. 

24 ‘‘(d) APPLIED RESEARCH PROJECTS.—The Sec25 retary, acting through the Substance Abuse and Mental 


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1 Health Services Administration, shall make funding avail2 able to Indian Tribes, Tribal Organizations, and Urban 

3 Indian Organizations for applied research projects which 

4 propose to elevate the understanding of methods to pre5 vent, intervene, treat, or provide rehabilitation and behav6 ioral health aftercare for Indians and Urban Indians af7 fected by fetal alcohol disorder. 

8 ‘‘(e) FUNDING FOR URBAN INDIAN ORGANIZA9 TIONS.—Ten percent of the funds appropriated pursuant 

10 to this section shall be used to make grants to Urban In11 dian Organizations funded under title V. 

12 ‘‘SEC. 712. CHILD SEXUAL ABUSE AND PREVENTION TREAT13 MENT PROGRAMS. 

14 ‘‘(a) ESTABLISHMENT.—The Secretary, acting 

15 through the Service, and the Secretary of the Interior, In16 dian Tribes, and Tribal Organizations shall establish, con17 sistent with section 701, in every Service Area, programs 

18 involving treatment for— 

19 ‘‘(1) victims of sexual abuse who are Indian 

20 children or children in an Indian household; and 

21 ‘‘(2) perpetrators of child sexual abuse who are 

22 Indian or members of an Indian household. 

23 ‘‘(b) USE OF FUNDS.—Funding provided pursuant to 

24 this section shall be used for the following: 


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1 ‘‘(1) To develop and provide community edu2 cation and prevention programs related to sexual 

3 abuse of Indian children or children in an Indian 

4 household. 

5 ‘‘(2) To identify and provide behavioral health 

6 treatment to victims of sexual abuse who are Indian 

7 children or children in an Indian household, and to 

8 their family members who are affected by sexual 

9 abuse. 

10 ‘‘(3) To develop prevention and intervention 

11 models which incorporate Traditional Health Care 

12 Practices, cultural and spiritual values, and commu13 nity involvement. 

14 ‘‘(4) To develop and implement, through the 

15 tribal consultation process, culturally sensitive as16 sessment and diagnostic tools for use in Indian com17 munities and Urban Centers. 

18 ‘‘(5) To identify and provide behavioral health 

19 treatment to Indian perpetrators and perpetrators 

20 who are members of an Indian household— 

21 ‘‘(A) making efforts to begin offender and 

22 behavioral health treatment while the perpe23 trator is incarcerated or at the earliest possible 

24 date if the perpetrator is not incarcerated; and 


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1 ‘‘(B) providing treatment after the perpe2 trator is released, until it is determined that the 

3 perpetrator is not a threat to children. 

4 ‘‘SEC. 713. BEHAVIORAL HEALTH RESEARCH. 

5 ‘‘The Secretary, in consultation with appropriate 

6 Federal agencies, shall provide funding to Indian Tribes, 

7 Tribal Organizations, and Urban Indian Organizations or 

8 enter into contracts with, or make grants to appropriate 

9 institutions for, the conduct of research on the incidence 

10 and prevalence of behavioral health problems among Indi11 ans served by the Service, Indian Tribes, or Tribal Organi12 zations and among Indians in urban areas. Research pri13 orities under this section shall include— 

14 ‘‘(1) the interrelationship and interdependence 

15 of behavioral health problems with alcoholism and 

16 other substance abuse, suicide, homicides, other in17 juries, and the incidence of family violence; and 

18 ‘‘(2) the development of models of prevention 

19 techniques. 

20 The effect of the interrelationships and interdependencies 

21 referred to in paragraph (1) on children, and the develop22 ment of prevention techniques under paragraph (2) appli23 cable to children, shall be emphasized. 


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1 ‘‘SEC. 714. DEFINITIONS. 

2 ‘‘For the purpose of this title, the following defini3 tions shall apply: 

4 ‘‘(1) ASSESSMENT.—The term ‘assessment’ 

5 means the systematic collection, analysis, and dis6 semination of information on health status, health 

7 needs, and health problems. 

8 ‘‘(2) ALCOHOL-RELATED

9 NEURODEVELOPMENTAL DISORDERS OR ARND.—The 

10 term ‘alcohol-related neurodevelopmental disorders’ 

11 or ‘ARND’ means, with a history of maternal alco12 hol consumption during pregnancy, central nervous 

13 system involvement such as developmental delay, in14 tellectual deficit, or neurologic abnormalities. Behav15 iorally, there can be problems with irritability, and 

16 failure to thrive as infants. As children become older 

17 there will likely be hyperactivity, attention deficit, 

18 language dysfunction, and perceptual and judgment 

19 problems. 

20 ‘‘(3) BEHAVIORAL HEALTH AFTERCARE.—The 

21 term ‘behavioral health aftercare’ includes those ac22 tivities and resources used to support recovery fol23 lowing inpatient, residential, intensive substance 

24 abuse, or mental health outpatient or outpatient 

25 treatment. The purpose is to help prevent or deal 

26 with relapse by ensuring that by the time a client or 


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1 patient is discharged from a level of care, such as 

2 outpatient treatment, an aftercare plan has been de3 veloped with the client. An aftercare plan may use 

4 such resources a as community-based therapeutic 

5 group, transitional living facilities, a 12-step spon6 sor, a local 12-step or other related support group, 

7 and other community-based providers (mental health 

8 professionals, traditional health care practitioners, 

9 community health aides, community health rep10 resentatives, mental health technicians, ministers, 

11 etc.) 

12 ‘‘(4) DUAL DIAGNOSIS.—The term ‘dual diag13 nosis’ means coexisting substance abuse and mental 

14 illness conditions or diagnosis. Such clients are 

15 sometimes referred to as mentally ill chemical abus16 ers (MICAs). 

17 ‘‘(5) FETAL ALCOHOL DISORDERS.—The term 

18 ‘fetal alcohol disorders’ means fetal alcohol syn19 drome, partial fetal alcohol syndrome and alcohol re20 lated neurodevelopmental disorder (ARND). 

21 ‘‘(6) FETAL ALCOHOL SYNDROME OR FAS.— 

22 The term ‘fetal alcohol syndrome’ or ‘FAS’ means a 

23 syndrome in which, with a history of maternal alco24 hol consumption during pregnancy, the following cri25 teria are met: 


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1 ‘‘(A) Central nervous system involvement 

2 such as developmental delay, intellectual deficit, 

3 microencephaly, or neurologic abnormalities. 

4 ‘‘(B) Craniofacial abnormalities with at 

5 least 2 of the following: microophthalmia, short 

6 palpebral fissures, poorly developed philtrum, 

7 thin upper lip, flat nasal bridge, and short 

8 upturned nose. 

9 ‘‘(C) Prenatal or postnatal growth delay. 

10 ‘‘(7) PARTIAL FAS.—The term ‘partial FAS’ 

11 means, with a history of maternal alcohol consump12 tion during pregnancy, having most of the criteria of 

13 FAS, though not meeting a minimum of at least 2 

14 of the following: microophthalmia, short palpebral 

15 fissures, poorly developed philtrum, thin upper lip, 

16 flat nasal bridge, and short upturned nose. 

17 ‘‘(8) REHABILITATION.—The term ‘rehabilita18 tion’ means to restore the ability or capacity to en19 gage in usual and customary life activities through 

20 education and therapy. 

21 ‘‘(9) SUBSTANCE ABUSE.—The term ‘substance 

22 abuse’ includes inhalant abuse. 


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1 ‘‘SEC. 715. AUTHORIZATION OF APPROPRIATIONS. 

2 ‘‘There is authorized to be appropriated such sums 

3 as may be necessary for each fiscal year through fiscal 

4 year 2015 to carry out the provisions of this title. 

5 ‘‘TITLE VIII—MISCELLANEOUS 

6 ‘‘SEC. 801. REPORTS. 

7 ‘‘The President shall, at the time the budget is sub8 mitted under section 1105 of title 31, United States Code, 

9 for each fiscal year transmit to Congress a report con10 taining the following: 

11 ‘‘(1) A report on the progress made in meeting 

12 the objectives of this Act, including a review of pro13 grams established or assisted pursuant to this Act 

14 and assessments and recommendations of additional 

15 programs or additional assistance necessary to, at a 

16 minimum, provide health services to Indians and en17 sure a health status for Indians, which are at a par18 ity with the health services available to and the 

19 health status of the general population, including 

20 specific comparisons of appropriations provided and 

21 those required for such parity. 

22 ‘‘(2) A report on whether, and to what extent, 

23 new national health care programs, benefits, initia24 tives, or financing systems have had an impact on 

25 the purposes of this Act and any steps that the Sec26 retary may have taken to consult with Indian Tribes, 


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1 Tribal Organizations, and Urban Indian Organiza2 tions to address such impact, including a report on 

3 proposed changes in allocation of funding pursuant 

4 to section 808. 

5 ‘‘(3) A report on the use of health services by 

6 Indians— 

7 ‘‘(A) on a national and area or other rel8 evant geographical basis; 

9 ‘‘(B) by gender and age; 

10 ‘‘(C) by source of payment and type of 

11 service; 

12 ‘‘(D) comparing such rates of use with 

13 rates of use among comparable non-Indian pop14 ulations; and 

15 ‘‘(E) provided under contracts. 

16 ‘‘(4) A report of contractors to the Secretary on 

17 Health Care Educational Loan Repayments every 6 

18 months required by section 110. 

19 ‘‘(5) A general audit report of the Secretary on 

20 the Health Care Educational Loan Repayment Pro21 gram as required by section 110(n). 

22 ‘‘(6) A report of the findings and conclusions of 

23 demonstration programs on development of edu24 cational curricula for substance abuse counseling as 

25 required in section 125(f). 


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1 ‘‘(7) A separate statement which specifies the 

2 amount of funds requested to carry out the provi3 sions of section 201. 

4 ‘‘(8) A report of the evaluations of health pro5 motion and disease prevention as required in section 

6 203(c). 

7 ‘‘(9) A biennial report to Congress on infectious 

8 diseases as required by section 212. 

9 ‘‘(10) A report on environmental and nuclear 

10 health hazards as required by section 215. 

11 ‘‘(11) An annual report on the status of all 

12 health care facilities needs as required by section 

13 301(c)(2) and 301(d). 

14 ‘‘(12) Reports on safe water and sanitary waste 

15 disposal facilities as required by section 302(h). 

16 ‘‘(13) An annual report on the expenditure of 

17 nonservice funds for renovation as required by sec18 tions 304(b)(2). 

19 ‘‘(14) A report identifying the backlog of main20 tenance and repair required at Service and tribal fa21 cilities required by section 313(a). 

22 ‘‘(15) A report providing an accounting of reim23 bursement funds made available to the Secretary 

24 under titles XVIII, XIX, and XXI of the Social Se25 curity Act. 


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1 ‘‘(16) A report on any arrangements for the 

2 sharing of medical facilities or services, as author3 ized by section 406. 

4 ‘‘(17) A report on evaluation and renewal of 

5 Urban Indian programs under section 505. 

6 ‘‘(18) A report on the evaluation of programs 

7 as required by section 513(d). 

8 ‘‘(19) A report on alcohol and substance abuse 

9 as required by section 701(f). 

10 ‘‘SEC. 802. REGULATIONS. 

11 ‘‘(a) DEADLINES.— 

12 ‘‘(1) PROCEDURES.—Not later than 90 days 

13 after the date of enactment of the Indian Health 

14 Care Improvement Act Amendments of 2005, the 

15 Secretary shall initiate procedures under subchapter 

16 III of chapter 5 of title 5, United States Code, to 

17 negotiate and promulgate such regulations or 

18 amendments thereto that are necessary to carry out 

19 titles I (except sections 105, 115, and 117), II, III, 

20 and VII. The Secretary may promulgate regulations 

21 to carry out sections 105, 115, 117, and titles IV 

22 and V, using the procedures required by chapter V 

23 of title 5, United States Code (commonly known as 

24 the ‘Administrative Procedure Act’). The Secretary 


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1 shall issue no regulations to carry out titles VI and 

2 VIII. 

3 ‘‘(2) PROPOSED REGULATIONS.—Proposed reg4 ulations to implement this Act shall be published in 

5 the Federal Register by the Secretary no later than 

6 1 year after the date of enactment of the Indian 

7 Health Care Improvement Act Amendments of 2005 

8 and shall have no less than a 120-day comment pe9 riod. 

10 ‘‘(3) EXPIRATION OF AUTHORITY.—Except as 

11 otherwise provided herein, the authority to promul12 gate regulations under this Act shall expire 24 

13 months from the date of enactment of this Act. 

14 ‘‘(b) COMMITTEE.—A negotiated rulemaking com15 mittee established pursuant to section 565 of title 5, 

16 United States Code, to carry out this section shall have 

17 as its members only representatives of the Federal Gov18 ernment and representatives of Indian Tribes and Tribal 

19 Organizations, a majority of whom shall be nominated by 

20 and be representatives of Indian Tribes, Tribal Organiza21 tions, and Urban Indian Organizations from each Service 

22 Area. The representative of the Urban Indian Organiza23 tion shall be deemed to be an elected officer of a tribal 

24 government for purposes of applying section 204(b) of the 


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1 Unfunded Mandates Reform Act of 1995 (2 U.S.C. 

2 1534(b)). 

3 ‘‘(c) ADAPTATION OF PROCEDURES.—The Secretary 

4 shall adapt the negotiated rulemaking procedures to the 

5 unique context of self-governance and the government-to6 government relationship between the United States and 

7 Indian Tribes. 

8 ‘‘(d) LACK OF REGULATIONS.—The lack of promul9 gated regulations shall not limit the effect of this Act. 

10 ‘‘(e) INCONSISTENT REGULATIONS.—The provisions 

11 of this Act shall supersede any conflicting provisions of 

12 law) in effect on the day before the date of enactment of 

13 the Indian Health Care Improvement Act Amendments of 

14 2005, and the Secretary is authorized to repeal any regu15 lation inconsistent with the provisions of this Act. 

16 ‘‘SEC. 803. PLAN OF IMPLEMENTATION. 

17 ‘‘Not later than 9 months after the date of enactment 

18 of the Indian Health Care Improvement Act Amendments 

19 of 2005, the Secretary in consultation with Indian Tribes, 

20 Tribal Organizations, and Urban Indian Organizations, 

21 shall submit to Congress a plan explaining the manner and 

22 schedule (including a schedule of appropriation requests), 

23 by title and section, by which the Secretary will implement 

24 the provisions of this Act. 


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1 ‘‘SEC. 804. AVAILABILITY OF FUNDS. 

2 ‘‘The funds appropriated pursuant to this Act shall 

3 remain available until expended. 

4 ‘‘SEC. 805. LIMITATION ON USE OF FUNDS APPROPRIATED 

5 TO THE INDIAN HEALTH SERVICE. 

6 ‘‘Any limitation on the use of funds contained in an 

7 Act providing appropriations for the Department for a pe8 riod with respect to the performance of abortions shall 

9 apply for that period with respect to the performance of 

10 abortions using funds contained in an Act providing ap11 propriations for the Service. 

12 ‘‘SEC. 806. ELIGIBILITY OF CALIFORNIA INDIANS. 

13 ‘‘(a) IN GENERAL.—The following California Indians 

14 shall be eligible for health services provided by the Service: 

15 ‘‘(1) Any member of a federally recognized In16 dian Tribe. 

17 ‘‘(2) Any descendant of an Indian who was re18 siding in California on June 1, 1852, if such de19 scendant— 

20 ‘‘(A) is a member of the Indian community 

21 served by a local program of the Service; and 

22 ‘‘(B) is regarded as an Indian by the com23 munity in which such descendant lives. 

24 ‘‘(3) Any Indian who holds trust interests in 

25 public domain, national forest, or reservation allot26 ments in California. 


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1 ‘‘(4) Any Indian in California who is listed on 

2 the plans for distribution of the assets of rancherias 

3 and reservations located within the State of Cali4 fornia under the Act of August 18, 1958 (72 Stat. 

5 619), and any descendant of such an Indian. 

6 ‘‘(b) CLARIFICATION.—Nothing in this section may 

7 be construed as expanding the eligibility of California Indi8 ans for health services provided by the Service beyond the 

9 scope of eligibility for such health services that applied on 

10 May 1, 1986. 

11 ‘‘SEC. 807. HEALTH SERVICES FOR INELIGIBLE PERSONS. 

12 ‘‘(a) CHILDREN.—Any individual who— 

13 ‘‘(1) has not attained 19 years of age; 

14 ‘‘(2) is the natural or adopted child, stepchild, 

15 foster child, legal ward, or orphan of an eligible In16 dian; and 

17 ‘‘(3) is not otherwise eligible for health services 

18 provided by the Service, 

19 shall be eligible for all health services provided by the 

20 Service on the same basis and subject to the same rules 

21 that apply to eligible Indians until such individual attains 

22 19 years of age. The existing and potential health needs 

23 of all such individuals shall be taken into consideration 

24 by the Service in determining the need for, or the alloca25 tion of, the health resources of the Service. If such an indiVerDate Aug 31 2005 05:25 Mar 17, 2006 Jkt 049200 PO 00000 Frm 00294 Fmt 6652 Sfmt 6401 E:\BILLS\S1057.RS S1057

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1 vidual has been determined to be legally incompetent prior 

2 to attaining 19 years of age, such individual shall remain 

3 eligible for such services until 1 year after the date of a 

4 determination of competency. 

5 ‘‘(b) SPOUSES.—Any spouse of an eligible Indian who 

6 is not an Indian, or who is of Indian descent but is not 

7 otherwise eligible for the health services provided by the 

8 Service, shall be eligible for such health services if all such 

9 spouses or spouses who are married to members of each 

10 Indian Tribe being served are made eligible, as a class, 

11 by an appropriate resolution of the governing body of the 

12 Indian Tribe or Tribal Organization providing such serv13 ices. The health needs of persons made eligible under this 

14 paragraph shall not be taken into consideration by the 

15 Service in determining the need for, or allocation of, its 

16 health resources. 

17 ‘‘(c) PROVISION OF SERVICES TO OTHER INDIVID18 UALS.— 

19 ‘‘(1) IN GENERAL.—The Secretary is authorized 

20 to provide health services under this subsection 

21 through health programs operated directly by the 

22 Service to individuals who reside within the Service 

23 Unit and who are not otherwise eligible for such 

24 health services if— 


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1 ‘‘(A) the Indian Tribes served by such 

2 Service Unit request such provision of health 

3 services to such individuals; and 

4 ‘‘(B) the Secretary and the served Indian 

5 Tribes have jointly determined that— 

6 ‘‘(i) the provision of such health serv7 ices will not result in a denial or diminu8 tion of health services to eligible Indians; 

9 and 

10 ‘‘(ii) there is no reasonable alternative 

11 health facilities or services, within or with12 out the Service Unit, available to meet the 

13 health needs of such individuals. 

14 ‘‘(2) ISDEAA PROGRAMS.—In the case of 

15 health programs and facilities operated under a con16 tract or compact entered into under the Indian Self17 Determination and Education Assistance Act (25 

18 U.S.C. 450 et seq.), the governing body of the In19 dian Tribe or Tribal Organization providing health 

20 services under such contract or compact is author21 ized to determine whether health services should be 

22 provided under such contract or compact to individ23 uals who are not otherwise eligible for such services 

24 under any other subsection of this section or under 

25 any other provision of law. In making such deterVerDate Aug 31 2005 05:25 Mar 17, 2006 Jkt 049200 PO 00000 Frm 00296 Fmt 6652 Sfmt 6401 E:\BILLS\S1057.RS S1057

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1 mination, the governing body of the Indian Tribe or 

2 Tribal organization shall take into account the con3 siderations described in clauses (i) and (ii) of para4 graph (1)(B). 

5 ‘‘(3) PAYMENT FOR SERVICES.— 

6 ‘‘(A) IN GENERAL.—Persons receiving 

7 health services provided by the Service under of 

8 this subsection shall be liable for payment of 

9 such health services under a schedule of charges 

10 prescribed by the Secretary which, in the judg11 ment of the Secretary, results in reimbursement 

12 in an amount not less than the actual cost of 

13 providing the health services. Notwithstanding 

14 section 404 of this Act or any other provision 

15 of law, amounts collected under this subsection, 

16 including medicare, medicaid, or SCHIP reim17 bursements under titles XVIII, XIX, and XXI 

18 of the Social Security Act, shall be credited to 

19 the account of the program providing the serv20 ice and shall be used for the purposes listed in 

21 section 401(d)(2) and amounts collected under 

22 this subsection shall be available for expendi23 ture within such program. 

24 ‘‘(B) INDIGENT PEOPLE.—Health services 

25 may be provided by the Secretary through the 


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1 Service under this subsection to an indigent in2 dividual who would not be otherwise eligible for 

3 such health services but for the provisions of 

4 paragraph (1) only if an agreement has been 

5 entered into with a State or local government 

6 under which the State or local government 

7 agrees to reimburse the Service for the expenses 

8 incurred by the Service in providing such health 

9 services to such indigent individual. 

10 ‘‘(4) REVOCATION OF CONSENT FOR SERV11 ICES.— 

12 ‘‘(A) SINGLE TRIBE SERVICE AREA.—In 

13 the case of a Service Area which serves only 1 

14 Indian Tribe, the authority of the Secretary to 

15 provide health services under paragraph (1) 

16 shall terminate at the end of the fiscal year suc17 ceeding the fiscal year in which the governing 

18 body of the Indian Tribe revokes its concur19 rence to the provision of such health services. 

20 ‘‘(B) MULTITRIBAL SERVICE AREA.—In 

21 the case of a multitribal Service Area, the au22 thority of the Secretary to provide health serv23 ices under paragraph (1) shall terminate at the 

24 end of the fiscal year succeeding the fiscal year 

25 in which at least 51 percent of the number of 


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1 Indian Tribes in the Service Area revoke their 

2 concurrence to the provisions of such health 

3 services. 

4 ‘‘(d) OTHER SERVICES.—The Service may provide 

5 health services under this subsection to individuals who 

6 are not eligible for health services provided by the Service 

7 under any other provision of law in order to— 

8 ‘‘(1) achieve stability in a medical emergency; 

9 ‘‘(2) prevent the spread of a communicable dis10 ease or otherwise deal with a public health hazard; 

11 ‘‘(3) provide care to non-Indian women preg12 nant with an eligible Indian’s child for the duration 

13 of the pregnancy through postpartum; or 

14 ‘‘(4) provide care to immediate family members 

15 of an eligible individual if such care is directly re16 lated to the treatment of the eligible individual. 

17 ‘‘(e) HOSPITAL PRIVILEGES FOR PRACTITIONERS.— 

18 Hospital privileges in health facilities operated and main19 tained by the Service or operated under a contract or com20 pact pursuant to the Indian Self-Determination and Edu21 cation Assistance Act (25 U.S.C. 450 et seq.) may be ex22 tended to non-Service health care practitioners who pro23 vide services to individuals described in subsection (a), (b), 

24 (c), or (d). Such non-Service health care practitioners 

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1 ployees of the Federal Government for purposes of section 

2 1346(b) and chapter 171 of title 28, United States Code 

3 (relating to Federal tort claims) only with respect to acts 

4 or omissions which occur in the course of providing serv5 ices to eligible individuals as a part of the conditions under 

6 which such hospital privileges are extended. 

7 ‘‘(f) ELIGIBLE INDIAN.—For purposes of this sec8 tion, the term ‘eligible Indian’ means any Indian who is 

9 eligible for health services provided by the Service without 

10 regard to the provisions of this section. 

11 ‘‘SEC. 808. REALLOCATION OF BASE RESOURCES. 

12 ‘‘(a) REPORT REQUIRED.—Notwithstanding any 

13 other provision of law, any allocation of Service funds for 

14 a fiscal year that reduces by 5 percent or more from the 

15 previous fiscal year the funding for any recurring pro16 gram, project, or activity of a Service Unit may be imple17 mented only after the Secretary has submitted to the 

18 President, for inclusion in the report required to be trans19 mitted to Congress under section 801, a report on the pro20 posed change in allocation of funding, including the rea21 sons for the change and its likely effects. 

22 ‘‘(b) EXCEPTION.—Subsection (a) shall not apply if 

23 the total amount appropriated to the Service for a fiscal 

24 year is at least 5 percent less than the amount appro25 priated to the Service for the previous fiscal year. 


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1 ‘‘SEC. 809. RESULTS OF DEMONSTRATION PROJECTS. 

2 ‘‘The Secretary shall provide for the dissemination to 

3 Indian Tribes, Tribal Organizations, and Urban Indian 

4 Organizations of the findings and results of demonstration 

5 projects conducted under this Act. 

6 ‘‘SEC. 810. PROVISION OF SERVICES IN MONTANA. 

7 ‘‘(a) CONSISTENT WITH COURT DECISION.—The 

8 Secretary, acting through the Service, shall provide serv9 ices and benefits for Indians in Montana in a manner con10 sistent with the decision of the United States Court of Ap11 peals for the Ninth Circuit in McNabb for McNabb v. 

12 Bowen, 829 F.2d 787 (9th Cir. 1987). 

13 ‘‘(b) CLARIFICATION.—The provisions of subsection 

14 (a) shall not be construed to be an expression of the sense 

15 of Congress on the application of the decision described 

16 in subsection (a) with respect to the provision of services 

17 or benefits for Indians living in any State other than Mon18 tana. 

19 ‘‘SEC. 811. MORATORIUM. 

20 ‘‘During the period of the moratorium imposed on 

21 implementation of the final rule published in the Federal 

22 Register on September 16, 1987, by the Health Resources 

23 and Services Administration of the Public Health Service, 

24 relating to eligibility for the health care services of the 

25 Indian Health Service, the Indian Health Service shall 

26 provide services pursuant to the criteria for eligibility for 


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1 such services that were in effect on September 15, 1987, 

2 subject to the provisions of sections 806 and 807 until 

3 such time as new criteria governing eligibility for services 

4 are developed in accordance with section 802. 

5 ‘‘SEC. 812. TRIBAL EMPLOYMENT. 

6 ‘‘For purposes of section 2(2) of the Act of July 5, 

7 1935 (49 Stat. 450, chapter 372), an Indian Tribe or 

8 Tribal Organization carrying out a contract or compact 

9 pursuant to the Indian Self-Determination and Education 

10 Assistance Act (25 U.S.C. 450 et seq.) shall not be consid11 ered an ‘employer’. 

12 ‘‘SEC. 813. SEVERABILITY PROVISIONS. 

13 ‘‘If any provision of this Act, any amendment made 

14 by the Act, or the application of such provision or amend15 ment to any person or circumstances is held to be invalid, 

16 the remainder of this Act, the remaining amendments 

17 made by this Act, and the application of such provisions 

18 to persons or circumstances other than those to which it 

19 is held invalid, shall not be affected thereby. 

20 ‘‘SEC. 814. ESTABLISHMENT OF NATIONAL BIPARTISAN 

21 COMMISSION ON INDIAN HEALTH CARE. 

22 ‘‘(a) ESTABLISHMENT.—There is established the Na23 tional Bipartisan Indian Health Care Commission (the 

24 ‘Commission’). 


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1 ‘‘(b) DUTIES OF COMMISSION.—The duties of the 

2 Commission are the following: 

3 ‘‘(1) To establish a study committee composed 

4 of those members of the Commission appointed by 

5 the Director and at least 4 members of Congress 

6 from among the members of the Commission, the 

7 duties of which shall be the following: 

8 ‘‘(A) To the extent necessary to carry out 

9 its duties, collect and compile data necessary to 

10 understand the extent of Indian needs with re11 gard to the provision of health services, regard12 less of the location of Indians, including holding 

13 hearings and soliciting the views of Indians, In14 dian Tribes, Tribal Organizations, and Urban 

15 Indian Organizations, which may include au16 thorizing and making funds available for feasi17 bility studies of various models for providing 

18 and funding health services for all Indian bene19 ficiaries, including those who live outside of a 

20 reservation, temporarily or permanently. 

21 ‘‘(B) To make legislative recommendations 

22 to the Commission regarding the delivery of 

23 Federal health care services to Indians. Such 

24 recommendations shall include those related to 

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1 ice providers, the cost of such services, financ2 ing such services, and the optimal manner in 

3 which to provide such services. 

4 ‘‘(C) To determine the effect of the enact5 ment of such recommendations on (i) the exist6 ing system of delivery of health services for In7 dians, and (ii) the sovereign status of Indian 

8 Tribes. 

9 ‘‘(D) Not later than 12 months after the 

10 appointment of all members of the Commission, 

11 to submit a written report of its findings and 

12 recommendations to the full Commission. The 

13 report shall include a statement of the minority 

14 and majority position of the Committee and 

15 shall be disseminated, at a minimum, to every 

16 Indian Tribe, Tribal Organization, and Urban 

17 Indian Organization for comment to the Com18 mission. 

19 ‘‘(E) To report regularly to the full Com20 mission regarding the findings and rec21 ommendations developed by the study com22 mittee in the course of carrying out its duties 

23 under this section. 

24 ‘‘(2) To review and analyze the recommenda25 tions of the report of the study committee. 


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1 ‘‘(3) To make legislative recommendations to 

2 Congress regarding the delivery of Federal health 

3 care services to Indians. Such recommendations 

4 shall include those related to issues of eligibility, 

5 benefits, the range of service providers, the cost of 

6 such services, financing such services, and the opti7 mal manner in which to provide such services. 

8 ‘‘(4) Not later than 18 months following the 

9 date of appointment of all members of the Commis10 sion, submit a written report to Congress regarding 

11 the delivery of Federal health care services to Indi12 ans. Such recommendations shall include those re13 lated to issues of eligibility, benefits, the range of 

14 service providers, the cost of such services, financing 

15 such services, and the optimal manner in which to 

16 provide such services. 

17 ‘‘(c) MEMBERS.— 

18 ‘‘(1) APPOINTMENT.—The Commission shall be 

19 composed of 25 members, appointed as follows: 

20 ‘‘(A) Ten members of Congress, including 

21 3 from the House of Representatives and 2 

22 from the Senate, appointed by their respective 

23 majority leaders, and 3 from the House of Rep24 resentatives and 2 from the Senate, appointed 

25 by their respective minority leaders, and who 


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1 shall be members of the standing committees of 

2 Congress that consider legislation affecting 

3 health care to Indians. 

4 ‘‘(B) Twelve persons chosen by the con5 gressional members of the Commission, 1 from 

6 each Service Area as currently designated by 

7 the Director to be chosen from among 3 nomi8 nees from each Service Area put forward by the 

9 Indian Tribes within the area, with due regard 

10 being given to the experience and expertise of 

11 the nominees in the provision of health care to 

12 Indians and to a reasonable representation on 

13 the commission of members who are familiar 

14 with various health care delivery modes and 

15 who represent Indian Tribes of various size 

16 populations. 

17 ‘‘(C) Three persons appointed by the Di18 rector who are knowledgeable about the provi19 sion of health care to Indians, at least 1 of 

20 whom shall be appointed from among 3 nomi21 nees put forward by those programs whose 

22 funds are provided in whole or in part by the 

23 Service primarily or exclusively for the benefit 

24 of Urban Indians. 


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1 ‘‘(D) All those persons chosen by the con2 gressional members of the Commission and by 

3 the Director shall be members of federally rec4 ognized Indian Tribes. 

5 ‘‘(2) CHAIR; VICE CHAIR.—The Chair and Vice 

6 Chair of the Commission shall be selected by the 

7 congressional members of the Commission. 

8 ‘‘(3) TERMS.—The terms of members of the 

9 Commission shall be for the life of the Commission. 

10 ‘‘(4) DEADLINE FOR APPOINTMENTS.—Con11 gressional members of the Commission shall be ap12 pointed not later than 180 days after the date of en13 actment of the Indian Health Care Improvement Act 

14 Amendments of 2005, and the remaining members 

15 of the Commission shall be appointed not later than 

16 60 days following the appointment of the congres17 sional members. 

18 ‘‘(5) VACANCY.—A vacancy in the Commission 

19 shall be filled in the manner in which the original 

20 appointment was made. 

21 ‘‘(d) COMPENSATION.— 

22 ‘‘(1) CONGRESSIONAL MEMBERS.—Each con23 gressional member of the Commission shall receive 

24 no additional pay, allowances, or benefits by reason 

25 of their service on the Commission and shall receive 


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1 travel expenses and per diem in lieu of subsistence 

2 in accordance with sections 5702 and 5703 of title 

3 5, United States Code. 

4 ‘‘(2) OTHER MEMBERS.—Remaining members 

5 of the Commission, while serving on the business of 

6 the Commission (including travel time), shall be en7 titled to receive compensation at the per diem equiv8 alent of the rate provided for level IV of the Execu9 tive Schedule under section 5315 of title 5, United 

10 States Code, and while so serving away from home 

11 and the member’s regular place of business, a mem12 ber may be allowed travel expenses, as authorized by 

13 the Chairman of the Commission. For purpose of 

14 pay (other than pay of members of the Commission) 

15 and employment benefits, rights, and privileges, all 

16 personnel of the Commission shall be treated as if 

17 they were employees of the United States Senate. 

18 ‘‘(e) MEETINGS.—The Commission shall meet at the 

19 call of the Chair. 

20 ‘‘(f) QUORUM.—A quorum of the Commission shall 

21 consist of not less than 15 members, provided that no less 

22 than 6 of the members of Congress who are Commission 

23 members are present and no less than 9 of the members 

24 who are Indians are present. 

25 ‘‘(g) EXECUTIVE DIRECTOR; STAFF; FACILITIES.— 


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1 ‘‘(1) APPOINTMENT; PAY.—The Commission 

2 shall appoint an executive director of the Commis3 sion. The executive director shall be paid the rate of 

4 basic pay for level V of the Executive Schedule. 

5 ‘‘(2) STAFF APPOINTMENT.—With the approval 

6 of the Commission, the executive director may ap7 point such personnel as the executive director deems 

8 appropriate. 

9 ‘‘(3) STAFF PAY.—The staff of the Commission 

10 shall be appointed without regard to the provisions 

11 of title 5, United States Code, governing appoint12 ments in the competitive service, and shall be paid 

13 without regard to the provisions of chapter 51 and 

14 subchapter III of chapter 53 of such title (relating 

15 to classification and General Schedule pay rates). 

16 ‘‘(4) TEMPORARY SERVICES.—With the ap17 proval of the Commission, the executive director may 

18 procure temporary and intermittent services under 

19 section 3109(b) of title 5, United States Code. 

20 ‘‘(5) FACILITIES.—The Administrator of Gen21 eral Services shall locate suitable office space for the 

22 operation of the Commission. The facilities shall 

23 serve as the headquarters of the Commission and 

24 shall include all necessary equipment and incidentals 


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1 required for the proper functioning of the Commis2 sion. 

3 ‘‘(h) HEARINGS.—(1) For the purpose of carrying 

4 out its duties, the Commission may hold such hearings 

5 and undertake such other activities as the Commission de6 termines to be necessary to carry out its duties, provided 

7 that at least 6 regional hearings are held in different areas 

8 of the United States in which large numbers of Indians 

9 are present. Such hearings are to be held to solicit the 

10 views of Indians regarding the delivery of health care serv11 ices to them. To constitute a hearing under this sub12 section, at least 5 members of the Commission, including 

13 at least 1 member of Congress, must be present. Hearings 

14 held by the study committee established in this section 

15 may count toward the number of regional hearings re16 quired by this subsection. 

17 ‘‘(2) Upon request of the Commission, the Comp18 troller General shall conduct such studies or investigations 

19 as the Commission determines to be necessary to carry 

20 out its duties. 

21 ‘‘(3)(A) The Director of the Congressional Budget 

22 Office or the Chief Actuary of the Centers for Medicare 

23 & Medicaid Services, or both, shall provide to the Commis24 sion, upon the request of the Commission, such cost estiVerDate Aug 31 2005 05:25 Mar 17, 2006 Jkt 049200 PO 00000 Frm 00310 Fmt 6652 Sfmt 6401 E:\BILLS\S1057.RS S1057

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1 mates as the Commission determines to be necessary to 

2 carry out its duties. 

3 ‘‘(B) The Commission shall reimburse the Director 

4 of the Congressional Budget Office for expenses relating 

5 to the employment in the office of the Director of such 

6 additional staff as may be necessary for the Director to 

7 comply with requests by the Commission under subpara8 graph (A). 

9 ‘‘(4) Upon the request of the Commission, the head 

10 of any Federal agency is authorized to detail, without re11 imbursement, any of the personnel of such agency to the 

12 Commission to assist the Commission in carrying out its 

13 duties. Any such detail shall not interrupt or otherwise 

14 affect the civil service status or privileges of the Federal 

15 employee. 

16 ‘‘(5) Upon the request of the Commission, the head 

17 of a Federal agency shall provide such technical assistance 

18 to the Commission as the Commission determines to be 

19 necessary to carry out its duties. 

20 ‘‘(6) The Commission may use the United States 

21 mails in the same manner and under the same conditions 

22 as Federal agencies and shall, for purposes of the frank, 

23 be considered a commission of Congress as described in 

24 section 3215 of title 39, United States Code. 


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1 ‘‘(7) The Commission may secure directly from any 

2 Federal agency information necessary to enable it to carry 

3 out its duties, if the information may be disclosed under 

4 section 552 of title 4, United States Code. Upon request 

5 of the Chairman of the Commission, the head of such 

6 agency shall furnish such information to the Commission. 

7 ‘‘(8) Upon the request of the Commission, the Ad8 ministrator of General Services shall provide to the Com9 mission on a reimbursable basis such administrative sup10 port services as the Commission may request. 

11 ‘‘(9) For purposes of costs relating to printing and 

12 binding, including the cost of personnel detailed from the 

13 Government Printing Office, the Commission shall be 

14 deemed to be a committee of Congress. 

15 ‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—There is 

16 authorized to be appropriated $4,000,000 to carry out the 

17 provisions of this section, which sum shall not be deducted 

18 from or affect any other appropriation for health care for 

19 Indian persons. 

20 ‘‘(j) FACA.—The Federal Advisory Committee Act 

21 (5 U.S.C. App.) shall not apply to the Commission. 

22 ‘‘SEC. 815. APPROPRIATIONS; AVAILABILITY. 

23 ‘‘Any new spending authority (described in subsection 

24 (c)(2)(A) or (B) of section 401 of the Congressional Budg25 et Act of 1974) which is provided under this Act shall 


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1 be effective for any fiscal year only to such extent or in 

2 such amounts as are provided in appropriation Acts. 

3 ‘‘SEC. 816. AUTHORIZATION OF APPROPRIATIONS. 

4 ‘‘(a) IN GENERAL.—There are authorized to be ap5 propriated such sums as may be necessary for each fiscal 

6 year through fiscal year 2015 to carry out this title.’’. 

7 (b) RATE OF PAY.— 

8 (1) POSITIONS AT LEVEL IV.—Section 5315 of 

9 title 5, United States Code, is amended by striking 

10 ‘‘Assistant Secretaries of Health and Human Serv11 ices (6).’’ and inserting ‘‘Assistant Secretaries of 

12 Health and Human Services (7)’’. 

13 (2) POSITIONS AT LEVEL V.—Section 5316 of 

14 title 5, United States Code, is amended by striking 

15 ‘‘Director, Indian Health Service, Department of 

16 Health and Human Services’’. 

17 (c) AMENDMENTS TO OTHER PROVISIONS OF LAW.— 

18 (1) Section 3307(b)(1)(C) of the Children’s 

19 Health Act of 2000 (25 U.S.C. 1671 note; Public 

20 Law 106–310) is amended by striking ‘‘Director of 

21 the Indian Health Service’’ and inserting ‘‘Assistant 

22 Secretary for Indian Health’’. 

23 (2) The Indian Lands Open Dump Cleanup Act 

24 of 1994 is amended— 

25 (A) in section 3 (25 U.S.C. 3902)— 


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1 (i) by striking paragraph (2); 

2 (ii) by redesignating paragraphs (1), 

3 (3), (4), (5), and (6) as paragraphs (4), 

4 (5), (2), (6), and (1), respectively, and 

5 moving those paragraphs so as to appear 

6 in numerical order; and 

7 (iii) by inserting before paragraph (4) 

8 (as redesignated by subclause (II)) the fol9 lowing: 

10 ‘‘(3) ASSISTANT SECRETARY.—The term ‘As11 sistant Secretary’ means the Assistant Secretary for 

12 Indian Health.’’; 

13 (B) in section 5 (25 U.S.C. 3904), by 

14 striking the section heading and inserting the 

15 following: 

16 ‘‘SEC. 5. AUTHORITY OF ASSISTANT SECRETARY FOR IN17 DIAN HEALTH.’’; 

18 (C) in section 6(a) (25 U.S.C. 3905(a)), in 

19 the subsection heading, by striking ‘‘DIREC20 TOR’’ and inserting ‘‘ASSISTANT SECRETARY’’; 

21 (D) in section 9(a) (25 U.S.C. 3908(a)), in 

22 the subsection heading, by striking ‘‘DIREC23 TOR’’ and inserting ‘‘ASSISTANT SECRETARY’’; 

24 and 


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1 (E) by striking ‘‘Director’’ each place it 

2 appears and inserting ‘‘Assistant Secretary’’. 

3 (3) Section 5504(d)(2) of the Augustus F. 

4 Hawkins-Robert T. Stafford Elementary and Sec5 ondary School Improvement Amendments of 1988 

6 (25 U.S.C. 2001 note; Public Law 100–297) is 

7 amended by striking ‘‘Director of the Indian Health 

8 Service’’ and inserting ‘‘Assistant Secretary for In9 dian Health’’. 

10 (4) Section 203(a)(1) of the Rehabilitation Act 

11 of 1973 (29 U.S.C. 763(a)(1)) is amended by strik12 ing ‘‘Director of the Indian Health Service’’ and in13 serting ‘‘Assistant Secretary for Indian Health’’. 

14 (5) Subsections (b) and (e) of section 518 of 

15 the Federal Water Pollution Control Act (33 U.S.C. 

16 1377) are amended by striking ‘‘Director of the In17 dian Health Service’’ each place it appears and in18 serting ‘‘Assistant Secretary for Indian Health’’. 

19 (6) Section 317M(b) of the Public Health Serv20 ice Act (42 U.S.C. 247b–14(b)) is amended— 

21 (A) by striking ‘‘Director of the Indian 

22 Health Service’’ each place it appears and in23 serting ‘‘Assistant Secretary for Indian 

24 Health’’; and 


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1 (B) in paragraph (2)(A), by striking ‘‘the 

2 Directors referred to in such paragraph’’ and 

3 inserting ‘‘the Director of the Centers for Dis4 ease Control and Prevention and the Assistant 

5 Secretary for Indian Health’’. 

6 (7) Section 417C(b) of the Public Health Serv7 ice Act (42 U.S.C. 285–9(b)) is amended by striking 

8 ‘‘Director of the Indian Health Service’’ and insert9 ing ‘‘Assistant Secretary for Indian Health’’. 

10 (8) Section 1452(i) of the Safe Drinking Water 

11 Act (42 U.S.C. 300j–12(i)) is amended by striking 

12 ‘‘Director of the Indian Health Service’’ each place 

13 it appears and inserting ‘‘Assistant Secretary for In14 dian Health’’. 

15 (9) Section 803B(d)(1) of the Native American 

16 Programs Act of 1974 (42 U.S.C. 2991b–2(d)(1)) is 

17 amended in the last sentence by striking ‘‘Director 

18 of the Indian Health Service’’ and inserting ‘‘Assist19 ant Secretary for Indian Health’’. 

20 (10) Section 203(b) of the Michigan Indian 

21 Land Claims Settlement Act (Public Law 105–143; 

22 111 Stat. 2666) is amended by striking ‘‘Director of 

23 the Indian Health Service’’ and inserting ‘‘Assistant 

24 Secretary for Indian Health’’. 


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1 SEC. 3. SOBOBA SANITATION FACILITIES. 

2 The Act of December 17, 1970 (84 Stat. 1465), is 

3 amended by adding at the end the following new section: 

4 ‘‘SEC. 9. NOTHING IN THIS ACT SHALL PRECLUDE THE 

5 SOBOBA BAND OF MISSION INDIANS AND THE 

6 SOBOBA INDIAN RESERVATION FROM BEING 

7 PROVIDED WITH SANITATION FACILITIES 

8 AND SERVICES UNDER THE AUTHORITY OF 

9 SECTION 7 OF THE ACT OF AUGUST 5, 1954 (68 

10 STAT. 674), AS AMENDED BY THE ACT OF JULY 

11 31, 1959 (73 STAT. 267).’’. 

12 SEC. 4. AMENDMENTS TO THE MEDICAID AND STATE CHIL13 DREN’S HEALTH INSURANCE PROGRAMS. 

14 (a) EXPANSION OF MEDICAID PAYMENT FOR ALL

15 COVERED SERVICES FURNISHED BY INDIAN HEALTH

16 PROGRAMS.— 

17 (1) EXPANSION TO ALL COVERED SERVICES.— 

18 Section 1911 of the Social Security Act (42 U.S.C. 

19 1396j) is amended— 

20 (A) by amending the heading to read as 

21 follows: 

22 ‘‘SEC. INDIAN HEALTH PROGRAMS.’’; AND 

23 (B) by amending subsection (a) to read as 

24 follows: 

25 ‘‘(a) ELIGIBILITY FOR REIMBURSEMENT FOR MED26 ICAL ASSISTANCE.—The Indian Health Service and an InVerDate Aug 31 2005 05:25 Mar 17, 2006 Jkt 049200 PO 00000 Frm 00317 Fmt 6652 Sfmt 6401 E:\BILLS\S1057.RS S1057

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1 dian Tribe, Tribal Organization, or an urban Indian Orga2 nization (as such terms are defined in section 4 of the 

3 Indian Health Care Improvement Act) shall be eligible for 

4 reimbursement for medical assistance provided under a 

5 State plan or under waiver authority with respect to items 

6 and services furnished by the Indian Health Service, In7 dian Tribe, Tribal Organization, or Urban Indian Organi8 zation if the furnishing of such services meets all the con9 ditions and requirements which are applicable generally to 

10 the furnishing of items and services under this title and 

11 under such plan or waiver authority.’’. 

12 (2) ELIMINATION OF TEMPORARY DEEMING

13 PROVISION.—Such section is amended by striking 

14 subsection (b). 

15 (3) REVISION OF AUTHORITY TO ENTER INTO

16 AGREEMENTS.—Subsection (c) of such section is re17 designated as subsection (b) and is amended to read 

18 as follows: 

19 ‘‘(b) AUTHORITY TO ENTER INTO AGREEMENTS.— 

20 The Secretary may enter into an agreement with a State 

21 for the purpose of reimbursing the State for medical as22 sistance provided by the Indian Health Service, an Indian 

23 Tribe, Tribal Organizations, or an Urban Indian Organi24 zation (as so defined), directly, through referral, or under 

25 contracts or other arrangements between the Indian 


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1 Health Service, an Indian Tribe, Tribal Organization, or 

2 an Urban Indian Organization and another health care 

3 provider to Indians who are eligible for medical assistance 

4 under the State plan or under waiver authority.’’. 

5 (4) REFERENCE CORRECTION.—Subsection (d) 

6 of such section is redesignated as subsection (c) and 

7 is amended— 

8 (A) by striking ‘‘For’’ and inserting ‘‘DI9 RECT BILLING.—For’’; and 

10 (B) by striking ‘‘section 405’’ and insert11 ing ‘‘section 401(d)’’. 

12 (b) SPECIAL RULES FOR INDIANS, INDIAN HEALTH

13 CARE PROVIDERS, AND INDIAN MANAGED CARE ENTI14 TIES.— 

15 (1) IN GENERAL.—Section 1932 of the Social 

16 Security Act (42 U.S.C. 1396u–2) is amended by 

17 adding at the end the following new subsection: 

18 ‘‘(h) SPECIAL RULES FOR INDIANS, INDIAN HEALTH

19 CARE PROVIDERS, AND INDIAN MANAGED CARE ENTI20 TIES.—A State shall comply with the provisions of section 

21 413 of the Indian Health Care Improvement Act (relating 

22 to the treatment of Indians, Indian health care providers, 

23 and Indian managed care entities under a medicaid man24 aged care program).’’. 


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1 (2) APPLICATION TO SCHIP.—Section 

2 2107(e)(1) of the Social Security Act (42 U.S.C. 

3 1397gg(1)) is amended by adding at the end the fol4 lowing: 

5 ‘‘(E) Subsections (a)(2)(C) and (h) of sec6 tion 1932.’’. 

7 (c) SCHIP TREATMENT OF INDIAN TRIBES, TRIBAL

8 ORGANIZATIONS, AND URBAN INDIAN ORGANIZATIONS.— 

9 Section 2105(c) of the Social Security Act (42 U.S.C. 

10 1397ee(c)) is amended— 

11 (1) in paragraph (2), by adding at the end the 

12 following: 

13 ‘‘(C) INDIAN HEALTH PROGRAM PAY14 MENTS.—For provisions relating to authorizing 

15 use of allotments under this title for payments 

16 to Indian Health Programs and Urban Indian 

17 Organizations, see section 410 of the Indian 

18 Health Care Improvement Act.’’; and 

19 (2) in paragraph (6)(B), by inserting ‘‘or by an 

20 Indian Tribe, Tribal Organization, or Urban Indian 

21 Organization (as such terms are defined in section 

22 4 of the Indian Health Care Improvement Act)’’ 

23 after ‘‘Service’’. 


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1 SEC. 5. NATIVE AMERICAN HEALTH AND WELLNESS FOUN2 DATION. 

3 (a) IN GENERAL.—The Indian Self-Determination 

4 and Education Assistance Act (25 U.S.C. 450 et seq.) is 

5 amended by adding at the end the following: 

6 ‘‘TITLE VIII—NATIVE AMERICAN 

7 HEALTH AND WELLNESS 

8 FOUNDATION 

9 ‘‘SEC. 801. DEFINITIONS. 

10 ‘‘In this title: 

11 ‘‘(1) BOARD.—The term ‘Board’ means the 

12 Board of Directors of the Foundation. 

13 ‘‘(2) COMMITTEE.—The term ‘Committee’ 

14 means the Committee for the Establishment of Na15 tive American Health and Wellness Foundation es16 tablished under section 802(f). 

17 ‘‘(3) FOUNDATION.—The term ‘Foundation’ 

18 means the Native American Health and Wellness 

19 Foundation established under section 802. 

20 ‘‘(4) SECRETARY.—The term ‘Secretary’ means 

21 the Secretary of Health and Human Services. 

22 ‘‘(5) SERVICE.—The term ‘Service’ means the 

23 Indian Health Service of the Department of Health 

24 and Human Services. 


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1 ‘‘SEC. 802. NATIVE AMERICAN HEALTH AND WELLNESS 

2 FOUNDATION. 

3 ‘‘(a) IN GENERAL.—As soon as practicable after the 

4 date of enactment of this title, the Secretary shall estab5 lish, under the laws of the District of Columbia and in 

6 accordance with this title, the Native American Health 

7 and Wellness Foundation. 

8 ‘‘(b) PERPETUAL EXISTENCE.—The Foundation 

9 shall have perpetual existence. 

10 ‘‘(c) NATURE OF CORPORATION.—The Foundation— 

11 ‘‘(1) shall be a charitable and nonprofit feder12 ally chartered corporation; and 

13 ‘‘(2) shall not be an agency or instrumentality 

14 of the United States. 

15 ‘‘(d) PLACE OF INCORPORATION AND DOMICILE.— 

16 The Foundation shall be incorporated and domiciled in the 

17 District of Columbia. 

18 ‘‘(e) DUTIES.—The Foundation shall— 

19 ‘‘(1) encourage, accept, and administer private 

20 gifts of real and personal property, and any income 

21 from or interest in such gifts, for the benefit of, or 

22 in support of, the mission of the Service; 

23 ‘‘(2) undertake and conduct such other activi24 ties as will further the health and wellness activities 

25 and opportunities of Native Americans; and 


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1 ‘‘(3) participate with and assist Federal, State, 

2 and tribal governments, agencies, entities, and indi3 viduals in undertaking and conducting activities that 

4 will further the health and wellness activities and op5 portunities of Native Americans. 

6 ‘‘(f) COMMITTEE FOR THE ESTABLISHMENT OF NA7 TIVE AMERICAN HEALTH AND WELLNESS FOUNDA8 TION.— 

9 ‘‘(1) IN GENERAL.—The Secretary shall estab10 lish the Committee for the Establishment of Native 

11 American Health and Wellness Foundation to assist 

12 the Secretary in establishing the Foundation. 

13 ‘‘(2) DUTIES.—Not later than 180 days after 

14 the date of enactment of this section, the Committee 

15 shall— 

16 ‘‘(A) carry out such activities as are nec17 essary to incorporate the Foundation under the 

18 laws of the District of Columbia, including act19 ing as incorporators of the Foundation; 

20 ‘‘(B) ensure that the Foundation qualifies 

21 for and maintains the status required to carry 

22 out this section, until the Board is established; 

23 ‘‘(C) establish the constitution and initial 

24 bylaws of the Foundation; 


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1 ‘‘(D) provide for the initial operation of 

2 the Foundation, including providing for tem3 porary or interim quarters, equipment, and 

4 staff; and 

5 ‘‘(E) appoint the initial members of the 

6 Board in accordance with the constitution and 

7 initial bylaws of the Foundation. 

8 ‘‘(g) BOARD OF DIRECTORS.— 

9 ‘‘(1) IN GENERAL.—The Board of Directors 

10 shall be the governing body of the Foundation. 

11 ‘‘(2) POWERS.—The Board may exercise, or 

12 provide for the exercise of, the powers of the Foun13 dation. 

14 ‘‘(3) SELECTION.— 

15 ‘‘(A) IN GENERAL.—Subject to subpara16 graph (B), the number of members of the 

17 Board, the manner of selection of the members 

18 (including the filling of vacancies), and the 

19 terms of office of the members shall be as pro20 vided in the constitution and bylaws of the 

21 Foundation. 

22 ‘‘(B) REQUIREMENTS.— 

23 ‘‘(i) NUMBER OF MEMBERS.—The 

24 Board shall have at least 11 members, who 

25 shall have staggered terms. 


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1 ‘‘(ii) INITIAL VOTING MEMBERS.—The 

2 initial voting members of the Board— 

3 ‘‘(I) shall be appointed by the 

4 Committee not later than 180 days 

5 after the date on which the Founda6 tion is established; and 

7 ‘‘(II) shall have staggered terms. 

8 ‘‘(iii) QUALIFICATION.—The members 

9 of the Board shall be United States citi10 zens who are knowledgeable or experienced 

11 in Native American health care and related 

12 matters. 

13 ‘‘(C) COMPENSATION.—A member of the 

14 Board shall not receive compensation for service 

15 as a member, but shall be reimbursed for actual 

16 and necessary travel and subsistence expenses 

17 incurred in the performance of the duties of the 

18 Foundation. 

19 ‘‘(h) OFFICERS.— 

20 ‘‘(1) IN GENERAL.—The officers of the Founda21 tion shall be— 

22 ‘‘(A) a secretary, elected from among the 

23 members of the Board; and 

24 ‘‘(B) any other officers provided for in the 

25 constitution and bylaws of the Foundation. 


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1 ‘‘(2) SECRETARY.—The secretary of the Foun2 dation shall serve, at the direction of the Board, as 

3 the chief operating officer of the Foundation. 

4 ‘‘(3) ELECTION.—The manner of election, term 

5 of office, and duties of the officers of the Founda6 tion shall be as provided in the constitution and by7 laws of the Foundation. 

8 ‘‘(i) POWERS.—The Foundation— 

9 ‘‘(1) shall adopt a constitution and bylaws for 

10 the management of the property of the Foundation 

11 and the regulation of the affairs of the Foundation; 

12 ‘‘(2) may adopt and alter a corporate seal; 

13 ‘‘(3) may enter into contracts; 

14 ‘‘(4) may acquire (through a gift or otherwise), 

15 own, lease, encumber, and transfer real or personal 

16 property as necessary or convenient to carry out the 

17 purposes of the Foundation; 

18 ‘‘(5) may sue and be sued; and 

19 ‘‘(6) may perform any other act necessary and 

20 proper to carry out the purposes of the Foundation. 

21 ‘‘(j) PRINCIPAL OFFICE.— 

22 ‘‘(1) IN GENERAL.—The principal office of the 

23 Foundation shall be in the District of Columbia. 

24 ‘‘(2) ACTIVITIES; OFFICES.—The activities of 

25 the Foundation may be conducted, and offices may 


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1 be maintained, throughout the United States in ac2 cordance with the constitution and bylaws of the 

3 Foundation. 

4 ‘‘(k) SERVICE OF PROCESS.—The Foundation shall 

5 comply with the law on service of process of each State 

6 in which the Foundation is incorporated and of each State 

7 in which the Foundation carries on activities. 

8 ‘‘(l) LIABILITY OF OFFICERS, EMPLOYEES, AND

9 AGENTS.— 

10 ‘‘(1) IN GENERAL.—The Foundation shall be 

11 liable for the acts of the officers, employees, and 

12 agents of the Foundation acting within the scope of 

13 their authority. 

14 ‘‘(2) PERSONAL LIABILITY.—A member of the 

15 Board shall be personally liable only for gross neg16 ligence in the performance of the duties of the mem17 ber. 

18 ‘‘(m) RESTRICTIONS.— 

19 ‘‘(1) LIMITATION ON SPENDING.—Beginning 

20 with the fiscal year following the first full fiscal year 

21 during which the Foundation is in operation, the ad22 ministrative costs of the Foundation shall not exceed 

23 10 percent of the sum of— 


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1 ‘‘(A) the amounts transferred to the Foun2 dation under subsection (o) during the pre3 ceding fiscal year; and 

4 ‘‘(B) donations received from private 

5 sources during the preceding fiscal year. 

6 ‘‘(2) APPOINTMENT AND HIRING.—The ap7 pointment of officers and employees of the Founda8 tion shall be subject to the availability of funds. 

9 ‘‘(3) STATUS.—A member of the Board or offi10 cer, employee, or agent of the Foundation shall not 

11 by reason of association with the Foundation be con12 sidered to be an officer, employee, or agent of the 

13 United States. 

14 ‘‘(n) AUDITS.—The Foundation shall comply with 

15 section 10101 of title 36, United States Code, as if the 

16 Foundation were a corporation under part B of subtitle 

17 II of that title. 

18 ‘‘(o) FUNDING.— 

19 ‘‘(1) AUTHORIZATION OF APPROPRIATIONS.— 

20 There is authorized to be appropriated to carry out 

21 subsection (e)(1) $500,000 for each fiscal year, as 

22 adjusted to reflect changes in the Consumer Price 

23 Index for all-urban consumers published by the De24 partment of Labor. 


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1 ‘‘(2) TRANSFER OF DONATED FUNDS.—The 

2 Secretary shall transfer to the Foundation funds 

3 held by the Department of Health and Human Serv4 ices under the Act of August 5, 1954 (42 U.S.C. 

5 2001 et seq.), if the transfer or use of the funds is 

6 not prohibited by any term under which the funds 

7 were donated. 

8 ‘‘SEC. 803. ADMINISTRATIVE SERVICES AND SUPPORT. 

9 ‘‘(a) PROVISION OF SUPPORT BY SECRETARY.—Sub10 ject to subsection (b), during the 5-year period beginning 

11 on the date on which the Foundation is established, the 

12 Secretary— 

13 ‘‘(1) may provide personnel, facilities, and other 

14 administrative support services to the Foundation; 

15 ‘‘(2) may provide funds for initial operating 

16 costs and to reimburse the travel expenses of the 

17 members of the Board; and 

18 ‘‘(3) shall require and accept reimbursements 

19 from the Foundation for— 

20 ‘‘(A) services provided under paragraph 

21 (1); and 

22 ‘‘(B) funds provided under paragraph (2). 

23 ‘‘(b) REIMBURSEMENT.—Reimbursements accepted 

24 under subsection (a)(3)— 


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1 ‘‘(1) shall be deposited in the Treasury of the 

2 United States to the credit of the applicable appro3 priations account; and 

4 ‘‘(2) shall be chargeable for the cost of pro5 viding services described in subsection (a)(1) and 

6 travel expenses described in subsection (a)(2). 

7 ‘‘(c) CONTINUATION OF CERTAIN SERVICES.—The 

8 Secretary may continue to provide facilities and necessary 

9 support services to the Foundation after the termination 

10 of the 5-year period specified in subsection (a) if the facili11 ties and services— 

12 ‘‘(1) are available; and 

13 ‘‘(2) are provided on reimbursable cost basis.’’. 

14 (b) TECHNICAL AMENDMENTS.—The Indian Self-De15 termination and Education Assistance Act is amended— 

16 (1) by redesignating title V (as added by sec17 tion 1302 of the American Indian Education Foun18 dation Act of 2000) (25 U.S.C. 458bbb et seq.)) as 

19 title VII; 

20 (2) by redesignating sections 501, 502, and 503 

21 (as added by section 1302 of the American Indian 

22 Education Foundation Act of 2000) as sections 701, 

23 702, and 703, respectively; and 

24 (3) in subsection (a)(2) of section 702 and 

25 paragraph (2) of section 703 (as redesignated by 


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1 paragraph (2)), by striking ‘‘section 501’’ and in2 serting ‘‘section 701’’. 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Indian Health Care Im5 provement Act Amendments of 2005’’. 

6 SEC. 2. INDIAN HEALTH CARE IMPROVEMENT ACT AMEND7 ED. 

8 (a) IN GENERAL.—The Indian Health Care Improve9 ment Act (25 U.S.C. 1601 et seq.) is amended to read as 

10 follows: 

11 ‘‘SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

12 ‘‘(a) SHORT TITLE.—This Act may be cited as the ‘In13 dian Health Care Improvement Act’. 

14 ‘‘(b) TABLE OF CONTENTS.—The table of contents for 

15 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. 


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‘‘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. Authorization of appropriations. 

‘‘TITLE II—HEALTH SERVICES 

‘‘Sec. 201. Indian Health Care Improvement Fund. 

‘‘Sec. 202. Catastrophic Health Emergency Fund. 

‘‘Sec. 203. Health promotion and disease prevention services. 

‘‘Sec. 204. Diabetes prevention, treatment, and control. 

‘‘Sec. 205. Shared services for long-term care. 

‘‘Sec. 206. Health services research. 

‘‘Sec. 207. Mammography and other cancer screening. 

‘‘Sec. 208. Patient travel costs. 

‘‘Sec. 209. Epidemiology centers. 

‘‘Sec. 210. Comprehensive school health education programs. 

‘‘Sec. 211. Indian youth program. 

‘‘Sec. 212. Prevention, control, and elimination of communicable and infectious 

diseases. 

‘‘Sec. 213. Authority for provision of other services. 

‘‘Sec. 214. Indian women’s health care. 

‘‘Sec. 215. Environmental and nuclear health hazards. 

‘‘Sec. 216. Arizona as a contract health service delivery area. 

‘‘Sec. 216A. North Dakota and South Dakota as a 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. 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 nonservice 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. 


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‘‘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 care programs. 

‘‘Sec. 402. Grants to and contracts with the Service, Indian Tribes, Tribal Organizations, and Urban Indian Organizations. 

‘‘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. Payor of last resort. 

‘‘Sec. 408. Nondiscrimination in qualifications for reimbursement for services. 

‘‘Sec. 409. Consultation. 

‘‘Sec. 410. State Children’s Health Insurance Program (SCHIP). 

‘‘Sec. 411. Social Security Act sanctions. 

‘‘Sec. 412. Cost sharing. 

‘‘Sec. 413. Treatment under Medicaid managed care. 

‘‘Sec. 414. Navajo Nation Medicaid Agency feasibility study. 

‘‘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. Contracts and grants for the determination of unmet health care needs. 

‘‘Sec. 505. Evaluations; renewals. 

‘‘Sec. 506. Other contract and grant requirements. 

‘‘Sec. 507. Reports and records. 

‘‘Sec. 508. Limitation on contract authority. 

‘‘Sec. 509. Facilities. 

‘‘Sec. 510. Division of Urban Indian Health. 

‘‘Sec. 511. Grants for alcohol and substance abuse-related services. 

‘‘Sec. 512. Treatment of certain demonstration projects. 

‘‘Sec. 513. Urban NIAAA transferred programs. 

‘‘Sec. 514. Consultation with Urban Indian Organizations. 

‘‘Sec. 515. Federal Tort Claim Act coverage. 

‘‘Sec. 516. Urban youth treatment center demonstration. 

‘‘Sec. 517. Use of Federal Government facilities and sources of supply. 

‘‘Sec. 518. Grants for diabetes prevention, treatment, and control. 

‘‘Sec. 519. Community health representatives. 

‘‘Sec. 520. Effective date. 

‘‘Sec. 521. Eligibility for services. 

‘‘Sec. 522. Authorization of appropriations. 


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‘‘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. Behavioral health research. 

‘‘Sec. 715. Definitions. 

‘‘Sec. 716. Authorization of appropriations. 

‘‘TITLE VIII—MISCELLANEOUS 

‘‘Sec. 801. Reports. 

‘‘Sec. 802. Regulations. 

‘‘Sec. 803. Plan of implementation. 

‘‘Sec. 804. Availability of funds. 

‘‘Sec. 805. Limitation on use of funds appropriated to the Indian Health Service. 

‘‘Sec. 806. Eligibility of California Indians. 

‘‘Sec. 807. Health services for ineligible persons. 

‘‘Sec. 808. Reallocation of base resources. 

‘‘Sec. 809. Results of demonstration projects. 

‘‘Sec. 810. Provision of services in Montana. 

‘‘Sec. 811. Moratorium. 

‘‘Sec. 812. Tribal employment. 

‘‘Sec. 813. Severability provisions. 

‘‘Sec. 814. Establishment of National Bipartisan Commission on Indian Health 

Care. 

‘‘Sec. 815. Appropriations; availability. 

‘‘Sec. 816. Authorization of appropriations. 

1 ‘‘SEC. 2. FINDINGS. 

2 ‘‘Congress makes the following findings: 

3 ‘‘(1) Federal health services to maintain and im4 prove the health of the Indians are consonant with 


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1 and required by the Federal Government’s historical 

2 and unique legal relationship with, and resulting re3 sponsibility to, the American Indian people. 

4 ‘‘(2) A major national goal of the United States 

5 is to provide the quantity and quality of health serv6 ices which will permit the health status of Indians to 

7 be raised to the highest possible level and to encourage 

8 the maximum participation of Indians in the plan9 ning and management of those services. 

10 ‘‘(3) Federal health services to Indians have re11 sulted in a reduction in the prevalence and incidence 

12 of preventable illnesses among, and unnecessary and 

13 premature deaths of, Indians. 

14 ‘‘(4) Despite such services, the unmet health 

15 needs of the American Indian people are severe and 

16 the health status of the Indians is far below that of 

17 the general population of the United States. 

18 ‘‘SEC. 3. DECLARATION OF NATIONAL INDIAN HEALTH POL19 ICY. 

20 ‘‘Congress declares that it is the policy of this Nation, 

21 in fulfillment of its special trust responsibilities and legal 

22 obligations to Indians— 

23 ‘‘(1) to assure the highest possible health status 

24 for Indians and to provide all resources necessary to 

25 effect that policy; 


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1 ‘‘(2) to raise the health status of Indians by the 

2 year 2010 to at least the levels set forth in the goals 

3 contained within the Healthy People 2010 or suc4 cessor objectives; 

5 ‘‘(3) to the greatest extent possible, to allow Indi6 ans to set their own health care priorities and estab7 lish goals that reflect their unmet needs; 

8 ‘‘(4) to increase the proportion of all degrees in 

9 the health professions and allied and associated health 

10 professions awarded to Indians so that the proportion 

11 of Indian health professionals in each Service Area is 

12 raised to at least the level of that of the general popu13 lation; 

14 ‘‘(5) to require meaningful consultation with In15 dian Tribes, Tribal Organizations, and Urban Indian 

16 Organizations to implement this Act and the national 

17 policy of Indian self-determination; and 

18 ‘‘(6) to provide funding for programs and facili19 ties operated by Indian Tribes and Tribal Organiza20 tions in amounts that are not less than the amounts 

21 provided to programs and facilities operated directly 

22 by the Service. 

23 ‘‘SEC. 4. DEFINITIONS. 

24 ‘‘For purposes of this Act: 


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1 ‘‘(1) The term ‘accredited and accessible’ means 

2 on or near a reservation and accredited by a national 

3 or regional organization with accrediting authority. 

4 ‘‘(2) The term ‘Area Office’ means an adminis5 trative entity, including a program office, within the 

6 Service through which services and funds are pro7 vided to the Service Units within a defined geo8 graphic area. 

9 ‘‘(3) The term ‘Assistant Secretary’ means the 

10 Assistant Secretary of Indian Health. 

11 ‘‘(4)(A) The term ‘behavioral health’ means the 

12 blending of substance (alcohol, drugs, inhalants, and 

13 tobacco) abuse and mental health prevention and 

14 treatment, for the purpose of providing comprehensive 

15 services. 

16 ‘‘(B) The term ‘behavioral health’ includes the 

17 joint development of substance abuse and mental 

18 health treatment planning and coordinated case man19 agement using a multidisciplinary approach. 

20 ‘‘(5) The term ‘California Indians’ means those 

21 Indians who are eligible for health services of the 

22 Service pursuant to section 806. 

23 ‘‘(6) The term ‘community college’ means— 

24 ‘‘(A) a tribal college or university, or 

25 ‘‘(B) a junior or community college. 


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1 ‘‘(7) The term ‘contract health service’ means 

2 health services provided at the expense of the Service 

3 or a Tribal Health Program by public or private 

4 medical providers or hospitals, other than the Service 

5 Unit or the Tribal Health Program at whose expense 

6 the services are provided. 

7 ‘‘(8) The term ‘Department’ means, unless other8 wise designated, the Department of Health and 

9 Human Services. 

10 ‘‘(9) The term ‘disease prevention’ means the re11 duction, limitation, and prevention of disease and its 

12 complications and reduction in the consequences of 

13 disease, including— 

14 ‘‘(A) controlling— 

15 ‘‘(i) the development of diabetes; 

16 ‘‘(ii) high blood pressure; 

17 ‘‘(iii) infectious agents; 

18 ‘‘(iv) injuries; 

19 ‘‘(v) occupational hazards and disabil20 ities; 

21 ‘‘(vi) sexually transmittable diseases; 

22 and 

23 ‘‘(vii) toxic agents; and 

24 ‘‘(B) providing— 

25 ‘‘(i) fluoridation of water; and 


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1 ‘‘(ii) immunizations. 

2 ‘‘(10) The term ‘health profession’ means 

3 allopathic medicine, family medicine, internal medi4 cine, pediatrics, geriatric medicine, obstetrics and 

5 gynecology, podiatric medicine, nursing, public health 

6 nursing, dentistry, psychiatry, osteopathy, optometry, 

7 pharmacy, psychology, public health, social work, 

8 marriage and family therapy, chiropractic medicine, 

9 environmental health and engineering, allied health 

10 professions, and any other health profession. 

11 ‘‘(11) The term ‘health promotion’ means— 

12 ‘‘(A) fostering social, economic, environ13 mental, and personal factors conducive to health, 

14 including raising public awareness about health 

15 matters and enabling the people to cope with 

16 health problems by increasing their knowledge 

17 and providing them with valid information; 

18 ‘‘(B) encouraging adequate and appropriate 

19 diet, exercise, and sleep; 

20 ‘‘(C) promoting education and work in con21 formity with physical and mental capacity; 

22 ‘‘(D) making available suitable housing, 

23 safe water, and sanitary facilities; 

24 ‘‘(E) improving the physical, economic, cul25 tural, psychological, and social environment; 


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1 ‘‘(F) promoting adequate opportunity for 

2 spiritual, religious, and Traditional Health Care 

3 Practices; and 

4 ‘‘(G) providing adequate and appropriate 

5 programs, including— 

6 ‘‘(i) abuse prevention (mental and 

7 physical); 

8 ‘‘(ii) community health; 

9 ‘‘(iii) community safety; 

10 ‘‘(iv) consumer health education; 

11 ‘‘(v) diet and nutrition; 

12 ‘‘(vi) immunization and other preven13 tion of communicable diseases, including 

14 HIV/AIDS; 

15 ‘‘(vii) environmental health; 

16 ‘‘(viii) exercise and physical fitness; 

17 ‘‘(ix) avoidance of fetal alcohol dis18 orders; 

19 ‘‘(x) first aid and CPR education; 

20 ‘‘(xi) human growth and development; 

21 ‘‘(xii) injury prevention and personal 

22 safety; 

23 ‘‘(xiii) behavioral health; 

24 ‘‘(xiv) monitoring of disease indicators 

25 between health care provider visits, through 


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1 appropriate means, including Internet2 based health care management systems; 

3 ‘‘(xv) personal health and wellness 

4 practices; 

5 ‘‘(xvi) personal capacity building; 

6 ‘‘(xvii) prenatal, pregnancy, and in7 fant care; 

8 ‘‘(xviii) psychological well-being; 

9 ‘‘(xix) reproductive health and family 

10 planning; 

11 ‘‘(xx) safe and adequate water; 

12 ‘‘(xxi) safe housing, relating to elimi13 nation, reduction, and prevention of con14 taminants that create unhealthy housing 

15 conditions; 

16 ‘‘(xxii) safe work environments; 

17 ‘‘(xxiii) stress control; 

18 ‘‘(xxiv) substance abuse; 

19 ‘‘(xxv) sanitary facilities; 

20 ‘‘(xxvi) sudden infant death syndrome 

21 prevention; 

22 ‘‘(xxvii) tobacco use cessation and re23 duction; 

24 ‘‘(xxviii) violence prevention; and 


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1 ‘‘(xxix) such other activities identified 

2 by the Service, a Tribal Health Program, or 

3 an Urban Indian Organization, to promote 

4 achievement of any of the objectives de5 scribed in section 3(2). 

6 ‘‘(12) The term ‘Indian’, unless otherwise des7 ignated, means any person who is a member of an In8 dian Tribe or is eligible for health services under sec9 tion 806, except that, for the purpose of sections 102 

10 and 103, the term also means any individual who— 

11 ‘‘(A)(i) irrespective of whether the indi12 vidual lives on or near a reservation, is a mem13 ber of a tribe, band, or other organized group of 

14 Indians, including those tribes, bands, or groups 

15 terminated since 1940 and those recognized now 

16 or in the future by the State in which they re17 side; or 

18 ‘‘(ii) is a descendant, in the first or second 

19 degree, of any such member; 

20 ‘‘(B) is an Eskimo or Aleut or other Alaska 

21 Native; 

22 ‘‘(C) is considered by the Secretary of the 

23 Interior to be an Indian for any purpose; or 

24 ‘‘(D) is determined to be an Indian under 

25 regulations promulgated by the Secretary. 


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1 ‘‘(13) The term ‘Indian Health Program’ 

2 means— 

3 ‘‘(A) any health program administered di4 rectly by the Service; 

5 ‘‘(B) any Tribal Health Program; or 

6 ‘‘(C) any Indian Tribe or Tribal Organiza7 tion to which the Secretary provides funding 

8 pursuant to section 23 of the Act of June 25, 

9 1910 (25 U.S.C. 47) (commonly known as the 

10 ‘Buy Indian Act’). 

11 ‘‘(14) The term ‘Indian Tribe’ has the meaning 

12 given the term in the Indian Self-Determination and 

13 Education Assistance Act (25 U.S.C. 450 et seq.). 

14 ‘‘(15) The term ‘junior or community college’ has 

15 the meaning given the term by section 312(e) of the 

16 Higher Education Act of 1965 (20 U.S.C. 1058(e)). 

17 ‘‘(16) The term ‘reservation’ means any federally 

18 recognized Indian Tribe’s reservation, Pueblo, or col19 ony, including former reservations in Oklahoma, In20 dian allotments, and Alaska Native Regions estab21 lished pursuant to the Alaska Native Claims Settle22 ment Act (25 U.S.C. 1601 et seq.). 

23 ‘‘(17) The term ‘Secretary’, unless otherwise des24 ignated, means the Secretary of Health and Human 

25 Services. 


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1 ‘‘(18) The term ‘Service’ means the Indian 

2 Health Service. 

3 ‘‘(19) The term ‘Service Area’ means the geo4 graphical area served by each Area Office. 

5 ‘‘(20) The term ‘Service Unit’ means an admin6 istrative entity of the Service, or a Tribal Health Pro7 gram through which services are provided, directly or 

8 by contract, to eligible Indians within a defined geo9 graphic area. 

10 ‘‘(21) The term ‘telehealth’ has the meaning 

11 given the term in section 330K(a) of the Public 

12 Health Service Act (42 U.S.C. 254c–16(a)). 

13 ‘‘(22) The term ‘telemedicine’ means a tele14 communications link to an end user through the use 

15 of eligible equipment that electronically links health 

16 professionals or patients and health professionals at 

17 separate sites in order to exchange health care infor18 mation in audio, video, graphic, or other format for 

19 the purpose of providing improved health care serv20 ices. 

21 ‘‘(23) The term ‘Traditional Health Care Prac22 tices’ means the application by Native healing practi23 tioners of the Native healing sciences (as opposed or 

24 in contradistinction to Western healing sciences) 

25 which embody the influences or forces of innate Tribal 


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1 discovery, history, description, explanation and 

2 knowledge of the states of wellness and illness and 

3 which call upon these influences or forces in the pro4 motion, restoration, preservation, and maintenance of 

5 health, well-being, and life’s harmony. 

6 ‘‘(24) The term ‘tribal college or university’ has 

7 the meaning given the term in section 316(b)(3) of the 

8 Higher Education Act (20 U.S.C. 1059c(b)(3)). 

9 ‘‘(25) The term ‘Tribal Health Program’ means 

10 an Indian Tribe or Tribal Organization that operates 

11 any health program, service, function, activity, or fa12 cility funded, in whole or part, by the Service 

13 through, or provided for in, a contract or compact 

14 with the Service under the Indian Self-Determination 

15 and Education Assistance Act (25 U.S.C. 450 et seq.). 

16 ‘‘(26) The term ‘Tribal Organization’ has the 

17 meaning given the term in the Indian Self-Deter18 mination and Education Assistance Act (25 U.S.C. 

19 450 et seq.). 

20 ‘‘(27) The term ‘Urban Center’ means any com21 munity which has a sufficient Urban Indian popu22 lation with unmet health needs to warrant assistance 

23 under title V of this Act, as determined by the Sec24 retary. 


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1 ‘‘(28) The term ‘Urban Indian’ means any indi2 vidual who resides in an Urban Center and who 

3 meets 1 or more of the following criteria: 

4 ‘‘(A) Irrespective of whether the individual 

5 lives on or near a reservation, the individual is 

6 a member of a tribe, band, or other organized 

7 group of Indians, including those tribes, bands, 

8 or groups terminated since 1940 and those tribes, 

9 bands, or groups that are recognized by the 

10 States in which they reside, or who is a descend11 ant in the first or second degree of any such 

12 member. 

13 ‘‘(B) The individual is an Eskimo, Aleut, or 

14 other Alaska Native. 

15 ‘‘(C) The individual is considered by the 

16 Secretary of the Interior to be an Indian for any 

17 purpose. 

18 ‘‘(D) The individual is determined to be an 

19 Indian under regulations promulgated by the 

20 Secretary. 

21 ‘‘(29) The term ‘Urban Indian Organization’ 

22 means a nonprofit corporate body that (A) is situated 

23 in an Urban Center; (B) is governed by an Urban In24 dian-controlled board of directors; (C) provides for the 

25 participation of all interested Indian groups and inVerDate Aug 31 2005 05:25 Mar 17, 2006 Jkt 049200 PO 00000 Frm 00346 Fmt 6652 Sfmt 6203 E:\BILLS\S1057.RS S1057

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1 dividuals; and (D) is capable of legally cooperating 

2 with other public and private entities for the purpose 

3 of performing the activities described in section 

4 503(a). 

5 ‘‘TITLE I—INDIAN HEALTH, 

6 HUMAN RESOURCES, AND DE7 VELOPMENT 

8 ‘‘SEC. 101. PURPOSE. 

9 ‘‘The purpose of this title is to increase, to the max10 imum extent feasible, the number of Indians entering the 

11 health professions and providing health services, and to as12 sure an optimum supply of health professionals to the In13 dian Health Programs and Urban Indian Organizations 

14 involved in the provision of health services to Indians. 

15 ‘‘SEC. 102. HEALTH PROFESSIONS RECRUITMENT PROGRAM 

16 FOR INDIANS. 

17 ‘‘(a) IN GENERAL.—The Secretary, acting through the 

18 Service, shall make grants to public or nonprofit private 

19 health or educational entities, Tribal Health Programs, or 

20 Urban Indian Organizations to assist such entities in meet21 ing the costs of— 

22 ‘‘(1) identifying Indians with a potential for 

23 education or training in the health professions and 

24 encouraging and assisting them— 


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1 ‘‘(A) to enroll in courses of study in such 

2 health professions; or 

3 ‘‘(B) if they are not qualified to enroll in 

4 any such courses of study, to undertake such 

5 postsecondary education or training as may be 

6 required to qualify them for enrollment; 

7 ‘‘(2) publicizing existing sources of financial aid 

8 available to Indians enrolled in any course of study 

9 referred to in paragraph (1) or who are undertaking 

10 training necessary to qualify them to enroll in any 

11 such course of study; or 

12 ‘‘(3) establishing other programs which the Sec13 retary determines will enhance and facilitate the en14 rollment of Indians in, and the subsequent pursuit 

15 and completion by them of, courses of study referred 

16 to in paragraph (1). 

17 ‘‘(b) FUNDING.— 

18 ‘‘(1) APPLICATION.—The Secretary shall not 

19 make a grant under this section unless an application 

20 has been submitted to, and approved by, the Sec21 retary. Such application shall be in such form, sub22 mitted in such manner, and contain such informa23 tion, as the Secretary shall by regulation prescribe 

24 pursuant to this Act. The Secretary shall give a prefVerDate Aug 31 2005 05:25 Mar 17, 2006 Jkt 049200 PO 00000 Frm 00348 Fmt 6652 Sfmt 6203 E:\BILLS\S1057.RS S1057

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1 erence to applications submitted by Tribal Health 

2 Programs or Urban Indian Organizations. 

3 ‘‘(2) AMOUNT OF GRANTS; PAYMENT.—The 

4 amount of a grant under this section shall be deter5 mined by the Secretary. Payments pursuant to this 

6 section may be made in advance or by way of reim7 bursement, and at such intervals and on such condi8 tions as provided for in regulations issued pursuant 

9 to this Act. To the extent not otherwise prohibited by 

10 law, funding commitments shall be for 3 years, as 

11 provided in regulations issued pursuant to this Act. 

12 ‘‘SEC. 103. HEALTH PROFESSIONS PREPARATORY SCHOLAR13 SHIP PROGRAM FOR INDIANS. 

14 ‘‘(a) SCHOLARSHIPS AUTHORIZED.—The Secretary, 

15 acting through the Service, shall provide scholarship grants 

16 to Indians who— 

17 ‘‘(1) have successfully completed their high school 

18 education or high school equivalency; and 

19 ‘‘(2) have demonstrated the potential to success20 fully complete courses of study in the health profes21 sions. 

22 ‘‘(b) PURPOSES.—Scholarship grants provided pursu23 ant to this section shall be for the following purposes: 

24 ‘‘(1) Compensatory preprofessional education of 

25 any recipient, such scholarship not to exceed 2 years 


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1 on a full-time basis (or the part-time equivalent there2 of, as determined by the Secretary pursuant to regu3 lations issued under this Act). 

4 ‘‘(2) Pregraduate education of any recipient 

5 leading to a baccalaureate degree in an approved 

6 course of study preparatory to a field of study in a 

7 health profession, such scholarship not to exceed 4 

8 years. An extension of up to 2 years (or the part-time 

9 equivalent thereof, as determined by the Secretary 

10 pursuant to regulations issued pursuant to this Act) 

11 may be approved. 

12 ‘‘(c) OTHER CONDITIONS.—Scholarships under this 

13 section— 

14 ‘‘(1) may cover costs of tuition, books, transpor15 tation, board, and other necessary related expenses of 

16 a recipient while attending school; 

17 ‘‘(2) shall not be denied solely on the basis of the 

18 applicant’s scholastic achievement if such applicant 

19 has been admitted to, or maintained good standing 

20 at, an accredited institution; and 

21 ‘‘(3) shall not be denied solely by reason of such 

22 applicant’s eligibility for assistance or benefits under 

23 any other Federal program. 

24 ‘‘SEC. 104. INDIAN HEALTH PROFESSIONS SCHOLARSHIPS. 

25 ‘‘(a) IN GENERAL.— 


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1 ‘‘(1) AUTHORITY.—The Secretary, acting through 

2 the Service, shall make scholarship grants to Indians 

3 who are enrolled full or part time in accredited 

4 schools pursuing courses of study in the health profes5 sions. Such scholarships shall be designated Indian 

6 Health Scholarships and shall be made in accordance 

7 with section 338A of the Public Health Services Act 

8 (42 U.S.C. 2541), except as provided in subsection (b) 

9 of this section. 

10 ‘‘(2) DETERMINATIONS BY SECRETARY.—The 

11 Secretary, acting through the Service, shall deter12 mine— 

13 ‘‘(A) who shall receive scholarship grants 

14 under subsection (a); and 

15 ‘‘(B) the distribution of the scholarships 

16 among health professions on the basis of the rel17 ative needs of Indians for additional service in 

18 the health professions. 

19 ‘‘(3) CERTAIN DELEGATION NOT ALLOWED.—The 

20 administration of this section shall be a responsibility 

21 of the Assistant Secretary and shall not be delegated 

22 in a contract or compact under the Indian Self-Deter23 mination and Education Assistance Act (25 U.S.C. 

24 450 et seq.). 

25 ‘‘(b) ACTIVE DUTY SERVICE OBLIGATION.— 


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1 ‘‘(1) OBLIGATION MET.—The active duty service 

2 obligation under a written contract with the Sec3 retary under this section that an Indian has entered 

4 into shall, if that individual is a recipient of an In5 dian Health Scholarship, be met in full-time practice 

6 on an equivalent year-for-year obligation, by service 

7 in 1 or more of the following: 

8 ‘‘(A) In an Indian Health Program. 

9 ‘‘(B) In a program assisted under title V of 

10 this Act. 

11 ‘‘(C) In the private practice of the applica12 ble profession if, as determined by the Secretary, 

13 in accordance with guidelines promulgated by 

14 the Secretary, such practice is situated in a phy15 sician or other health professional shortage area 

16 and addresses the health care needs of a substan17 tial number of Indians. 

18 ‘‘(D) In a teaching capacity in a tribal col19 lege or university nursing program (or a related 

20 health profession program) if, as determined by 

21 the Secretary, the health service provided to In22 dians would not decrease. 

23 ‘‘(2) OBLIGATION DEFERRED.—At the request of 

24 any individual who has entered into a contract re25 ferred to in paragraph (1) and who receives a degree 


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1 in medicine (including osteopathic or allopathic med2 icine), dentistry, optometry, podiatry, or pharmacy, 

3 the Secretary shall defer the active duty service obli4 gation of that individual under that contract, in 

5 order that such individual may complete any intern6 ship, residency, or other advanced clinical training 

7 that is required for the practice of that health profes8 sion, for an appropriate period (in years, as deter9 mined by the Secretary), subject to the following con10 ditions: 

11 ‘‘(A) No period of internship, residency, or 

12 other advanced clinical training shall be counted 

13 as satisfying any period of obligated service 

14 under this subsection. 

15 ‘‘(B) The active duty service obligation of 

16 that individual shall commence not later than 90 

17 days after the completion of that advanced clin18 ical training (or by a date specified by the Sec19 retary). 

20 ‘‘(C) The active duty service obligation will 

21 be served in the health profession of that indi22 vidual in a manner consistent with paragraph 

23 (1). 

24 ‘‘(D) A recipient of a scholarship under this 

25 section may, at the election of the recipient, meet 


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1 the active duty service obligation described in 

2 paragraph (1) by service in a program specified 

3 under that paragraph that— 

4 ‘‘(i) is located on the reservation of the 

5 Indian Tribe in which the recipient is en6 rolled; or 

7 ‘‘(ii) serves the Indian Tribe in which 

8 the recipient is enrolled. 

9 ‘‘(3) PRIORITY WHEN MAKING ASSIGNMENTS.— 

10 Subject to paragraph (2), the Secretary, in making 

11 assignments of Indian Health Scholarship recipients 

12 required to meet the active duty service obligation de13 scribed in paragraph (1), shall give priority to as14 signing individuals to service in those programs spec15 ified in paragraph (1) that have a need for health 

16 professionals to provide health care services as a re17 sult of individuals having breached contracts entered 

18 into under this section. 

19 ‘‘(c) PART-TIME STUDENTS.—In the case of an indi20 vidual receiving a scholarship under this section who is en21 rolled part time in an approved course of study— 

22 ‘‘(1) such scholarship shall be for a period of 

23 years not to exceed the part-time equivalent of 4 

24 years, as determined by the Area Office; 


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1 ‘‘(2) the period of obligated service described in 

2 subsection (b)(1) shall be equal to the greater of— 

3 ‘‘(A) the part-time equivalent of 1 year for 

4 each year for which the individual was provided 

5 a scholarship (as determined by the Area Office); 

6 or 

7 ‘‘(B) 2 years; and 

8 ‘‘(3) the amount of the monthly stipend specified 

9 in section 338A(g)(1)(B) of the Public Health Service 

10 Act (42 U.S.C. 254l(g)(1)(B)) shall be reduced pro 

11 rata (as determined by the Secretary) based on the 

12 number of hours such student is enrolled. 

13 ‘‘(d) BREACH OF CONTRACT.— 

14 ‘‘(1) SPECIFIED BREACHES.—An individual 

15 shall be liable to the United States for the amount 

16 which has been paid to the individual, or on behalf 

17 of the individual, under a contract entered into with 

18 the Secretary under this section on or after the date 

19 of enactment of the Indian Health Care Improvement 

20 Act Amendments of 2005 if that individual— 

21 ‘‘(A) fails to maintain an acceptable level of 

22 academic standing in the educational institution 

23 in which he or she is enrolled (such level deter24 mined by the educational institution under regu25 lations of the Secretary); 


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1 ‘‘(B) is dismissed from such educational in2 stitution for disciplinary reasons; 

3 ‘‘(C) voluntarily terminates the training in 

4 such an educational institution for which he or 

5 she is provided a scholarship under such contract 

6 before the completion of such training; or 

7 ‘‘(D) fails to accept payment, or instructs 

8 the educational institution in which he or she is 

9 enrolled not to accept payment, in whole or in 

10 part, of a scholarship under such contract, in 

11 lieu of any service obligation arising under such 

12 contract. 

13 ‘‘(2) OTHER BREACHES.—If for any reason not 

14 specified in paragraph (1) an individual breaches a 

15 written contract by failing either to begin such indi16 vidual’s service obligation required under such con17 tract or to complete such service obligation, the 

18 United States shall be entitled to recover from the in19 dividual an amount determined in accordance with 

20 the formula specified in subsection (l) of section 110 

21 in the manner provided for in such subsection. 

22 ‘‘(3) CANCELLATION UPON DEATH OF RECIPI23 ENT.—Upon the death of an individual who receives 

24 an Indian Health Scholarship, any outstanding obliVerDate Aug 31 2005 05:25 Mar 17, 2006 Jkt 049200 PO 00000 Frm 00356 Fmt 6652 Sfmt 6203 E:\BILLS\S1057.RS S1057

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1 gation of that individual for service or payment that 

2 relates to that scholarship shall be canceled. 

3 ‘‘(4) WAIVERS AND SUSPENSIONS.— 

4 ‘‘(A) IN GENERAL.—The Secretary shall 

5 provide for the partial or total waiver or suspen6 sion of any obligation of service or payment of 

7 a recipient of an Indian Health Scholarship if 

8 the Secretary, in consultation with the affected 

9 Area Office, Indian Tribes, Tribal Organiza10 tions, and Urban Indian Organizations, deter11 mines that— 

12 ‘‘(i) it is not possible for the recipient 

13 to meet that obligation or make that pay14 ment; 

15 ‘‘(ii) requiring that recipient to meet 

16 that obligation or make that payment would 

17 result in extreme hardship to the recipient; 

18 or 

19 ‘‘(iii) the enforcement of the require20 ment to meet the obligation or make the 

21 payment would be unconscionable. 

22 ‘‘(B) FACTORS FOR CONSIDERATION.—Be23 fore waiving or suspending an obligation of serv24 ice or payment under subparagraph (A), the Sec25 retary may take into consideration whether the 


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1 obligation may be satisfied in a teaching capac2 ity at a tribal college or university nursing pro3 gram under subsection (b)(1)(D). 

4 ‘‘(5) EXTREME HARDSHIP.—Notwithstanding 

5 any other provision of law, in any case of extreme 

6 hardship or for other good cause shown, the Secretary 

7 may waive, in whole or in part, the right of the 

8 United States to recover funds made available under 

9 this section. 

10 ‘‘(6) BANKRUPTCY.—Notwithstanding any other 

11 provision of law, with respect to a recipient of an In12 dian Health Scholarship, no obligation for payment 

13 may be released by a discharge in bankruptcy under 

14 title 11, United States Code, unless that discharge is 

15 granted after the expiration of the 5-year period be16 ginning on the initial date on which that payment is 

17 due, and only if the bankruptcy court finds that the 

18 nondischarge of the obligation would be unconscion19 able. 

20 ‘‘SEC. 105. AMERICAN INDIANS INTO PSYCHOLOGY PRO21 GRAM. 

22 ‘‘(a) GRANTS AUTHORIZED.—The Secretary, acting 

23 through the Service, shall make grants of not more than 

24 $300,000 to each of 9 colleges and universities for the pur25 pose of developing and maintaining Indian psychology caVerDate Aug 31 2005 05:25 Mar 17, 2006 Jkt 049200 PO 00000 Frm 00358 Fmt 6652 Sfmt 6203 E:\BILLS\S1057.RS S1057

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1 reer recruitment programs as a means of encouraging Indi2 ans to enter the behavioral health field. These programs 

3 shall be located at various locations throughout the country 

4 to maximize their availability to Indian students and new 

5 programs shall be established in different locations from 

6 time to time. 

7 ‘‘(b) QUENTIN N. BURDICK PROGRAM GRANT.—The 

8 Secretary shall provide a grant authorized under subsection 

9 (a) to develop and maintain a program at the University 

10 of North Dakota to be known as the ‘Quentin N. Burdick 

11 American Indians Into Psychology Program’. Such pro12 gram shall, to the maximum extent feasible, coordinate with 

13 the Quentin N. Burdick Indian Health Programs author14 ized under section 117(b), the Quentin N. Burdick Amer15 ican Indians Into Nursing Program authorized under sec16 tion 115(e), and existing university research and commu17 nications networks. 

18 ‘‘(c) REGULATIONS.—The Secretary shall issue regula19 tions pursuant to this Act for the competitive awarding of 

20 grants provided under this section. 

21 ‘‘(d) CONDITIONS OF GRANT.—Applicants under this 

22 section shall agree to provide a program which, at a min23 imum— 

24 ‘‘(1) provides outreach and recruitment for 

25 health professions to Indian communities including 


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1 elementary, secondary, and accredited and accessible 

2 community colleges that will be served by the pro3 gram; 

4 ‘‘(2) incorporates a program advisory board 

5 comprised of representatives from the tribes and com6 munities that will be served by the program; 

7 ‘‘(3) provides summer enrichment programs to 

8 expose Indian students to the various fields of psy9 chology through research, clinical, and experimental 

10 activities; 

11 ‘‘(4) provides stipends to undergraduate and 

12 graduate students to pursue a career in psychology; 

13 ‘‘(5) develops affiliation agreements with tribal 

14 colleges and universities, the Service, university affili15 ated programs, and other appropriate accredited and 

16 accessible entities to enhance the education of Indian 

17 students; 

18 ‘‘(6) to the maximum extent feasible, uses exist19 ing university tutoring, counseling, and student sup20 port services; and 

21 ‘‘(7) to the maximum extent feasible, employs 

22 qualified Indians in the program. 

23 ‘‘(e) ACTIVE DUTY SERVICE REQUIREMENT.—The ac24 tive duty service obligation prescribed under section 338C 

25 of the Public Health Service Act (42 U.S.C. 254m) shall 


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1 be met by each graduate who receives a stipend described 

2 in subsection (d)(4) that is funded under this section. Such 

3 obligation shall be met by service— 

4 ‘‘(1) in an Indian Health Program; 

5 ‘‘(2) in a program assisted under title V of this 

6 Act; or 

7 ‘‘(3) in the private practice of psychology if, as 

8 determined by the Secretary, in accordance with 

9 guidelines promulgated by the Secretary, such prac10 tice is situated in a physician or other health profes11 sional shortage area and addresses the health care 

12 needs of a substantial number of Indians. 

13 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 

14 is authorized to be appropriated to carry out this section 

15 $2,700,000 for each of fiscal years 2006 through 2015. 

16 ‘‘SEC. 106. SCHOLARSHIP PROGRAMS FOR INDIAN TRIBES. 

17 ‘‘(a) IN GENERAL.— 

18 ‘‘(1) GRANTS AUTHORIZED.—The Secretary, act19 ing through the Service, shall make grants to Tribal 

20 Health Programs for the purpose of providing schol21 arships for Indians to serve as health professionals in 

22 Indian communities. 

23 ‘‘(2) AMOUNT.—Amounts available under para24 graph (1) for any fiscal year shall not exceed 5 perVerDate Aug 31 2005 05:25 Mar 17, 2006 Jkt 049200 PO 00000 Frm 00361 Fmt 6652 Sfmt 6203 E:\BILLS\S1057.RS S1057

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1 cent of the amounts available for each fiscal year for 

2 Indian Health Scholarships under section 104. 

3 ‘‘(3) APPLICATION.—An application for a grant 

4 under paragraph (1) shall be in such form and con5 tain such agreements, assurances, and information as 

6 consistent with this section. 

7 ‘‘(b) REQUIREMENTS.— 

8 ‘‘(1) IN GENERAL.—A Tribal Health Program 

9 receiving a grant under subsection (a) shall provide 

10 scholarships to Indians in accordance with the re11 quirements of this section. 

12 ‘‘(2) COSTS.—With respect to costs of providing 

13 any scholarship pursuant to subsection (a)— 

14 ‘‘(A) 80 percent of the costs of the scholar15 ship shall be paid from the funds made available 

16 pursuant to subsection (a)(1) provided to the 

17 Tribal Health Program; and 

18 ‘‘(B) 20 percent of such costs may be paid 

19 from any other source of funds. 

20 ‘‘(c) COURSE OF STUDY.—A Tribal Health Program 

21 shall provide scholarships under this section only to Indians 

22 enrolled or accepted for enrollment in a course of study (ap23 proved by the Secretary) in 1 of the health professions con24 templated by this Act. 


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1 ‘‘(d) CONTRACT.—In providing scholarships under 

2 subsection (b), the Secretary and the Tribal Health Pro3 gram shall enter into a written contract with each recipient 

4 of such scholarship. Such contract shall— 

5 ‘‘(1) obligate such recipient to provide service in 

6 an Indian Health Program or Urban Indian Organi7 zation, in the same Service Area where the Tribal 

8 Health Program providing the scholarship is located, 

9 for— 

10 ‘‘(A) a number of years for which the schol11 arship is provided (or the part-time equivalent 

12 thereof, as determined by the Secretary), or for 

13 a period of 2 years, whichever period is greater; 

14 or 

15 ‘‘(B) such greater period of time as the re16 cipient and the Tribal Health Program may 

17 agree; 

18 ‘‘(2) provide that the amount of the scholar19 ship— 

20 ‘‘(A) may only be expended for— 

21 ‘‘(i) tuition expenses, other reasonable 

22 educational expenses, and reasonable living 

23 expenses incurred in attendance at the edu24 cational institution; and 


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1 ‘‘(ii) payment to the recipient of a 

2 monthly stipend of not more than the 

3 amount authorized by section 338(g)(1)(B) 

4 of the Public Health Service Act (42 U.S.C. 

5 254m(g)(1)(B)), with such amount to be re6 duced pro rata (as determined by the Sec7 retary) based on the number of hours such 

8 student is enrolled, and not to exceed, for 

9 any year of attendance for which the schol10 arship is provided, the total amount re11 quired for the year for the purposes author12 ized in this clause; and 

13 ‘‘(B) may not exceed, for any year of at14 tendance for which the scholarship is provided, 

15 the total amount required for the year for the 

16 purposes authorized in subparagraph (A); 

17 ‘‘(3) require the recipient of such scholarship to 

18 maintain an acceptable level of academic standing as 

19 determined by the educational institution in accord20 ance with regulations issued pursuant to this Act; 

21 and 

22 ‘‘(4) require the recipient of such scholarship to 

23 meet the educational and licensure requirements ap24 propriate to each health profession. 

25 ‘‘(e) BREACH OF CONTRACT.— 


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1 ‘‘(1) SPECIFIC BREACHES.—An individual who 

2 has entered into a written contract with the Secretary 

3 and a Tribal Health Program under subsection (d) 

4 shall be liable to the United States for the Federal 

5 share of the amount which has been paid to him or 

6 her, or on his or her behalf, under the contract if that 

7 individual— 

8 ‘‘(A) fails to maintain an acceptable level of 

9 academic standing in the educational institution 

10 in which he or she is enrolled (such level as de11 termined by the educational institution under 

12 regulations of the Secretary); 

13 ‘‘(B) is dismissed from such educational in14 stitution for disciplinary reasons; 

15 ‘‘(C) voluntarily terminates the training in 

16 such an educational institution for which he or 

17 she is provided a scholarship under such contract 

18 before the completion of such training; or 

19 ‘‘(D) fails to accept payment, or instructs 

20 the educational institution in which he or she is 

21 enrolled not to accept payment, in whole or in 

22 part, of a scholarship under such contract, in 

23 lieu of any service obligation arising under such 

24 contract. 


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1 ‘‘(2) OTHER BREACHES.—If for any reason not 

2 specified in paragraph (1), an individual breaches a 

3 written contract by failing to either begin such indi4 vidual’s service obligation required under such con5 tract or to complete such service obligation, the 

6 United States shall be entitled to recover from the in7 dividual an amount determined in accordance with 

8 the formula specified in subsection (l) of section 110 

9 in the manner provided for in such subsection. 

10 ‘‘(3) CANCELLATION UPON DEATH OF RECIPI11 ENT.—Upon the death of an individual who receives 

12 an Indian Health Scholarship, any outstanding obli13 gation of that individual for service or payment that 

14 relates to that scholarship shall be canceled. 

15 ‘‘(4) INFORMATION.—The Secretary may carry 

16 out this subsection on the basis of information re17 ceived from Tribal Health Programs involved or on 

18 the basis of information collected through such other 

19 means as the Secretary deems appropriate. 

20 ‘‘(f) RELATION TO SOCIAL SECURITY ACT.—The re21 cipient of a scholarship under this section shall agree, in 

22 providing health care pursuant to the requirements here23 in— 

24 ‘‘(1) not to discriminate against an individual 

25 seeking care on the basis of the ability of the indiVerDate Aug 31 2005 05:25 Mar 17, 2006 Jkt 049200 PO 00000 Frm 00366 Fmt 6652 Sfmt 6203 E:\BILLS\S1057.RS S1057

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1 vidual to pay for such care or on the basis that pay2 ment for such care will be made pursuant to a pro3 gram established in title XVIII of the Social Security 

4 Act or pursuant to the programs established in title 

5 XIX or title XXI of such Act; and 

6 ‘‘(2) to accept assignment under section 

7 1842(b)(3)(B)(ii) of the Social Security Act for all 

8 services for which payment may be made under part 

9 B of title XVIII of such Act, and to enter into an ap10 propriate agreement with the State agency that ad11 ministers the State plan for medical assistance under 

12 title XIX, or the State child health plan under title 

13 XXI, of such Act to provide service to individuals en14 titled to medical assistance or child health assistance, 

15 respectively, under the plan. 

16 ‘‘(g) CONTINUANCE OF FUNDING.—The Secretary shall 

17 make payments under this section to a Tribal Health Pro18 gram for any fiscal year subsequent to the first fiscal year 

19 of such payments unless the Secretary determines that, for 

20 the immediately preceding fiscal year, the Tribal Health 

21 Program has not complied with the requirements of this sec22 tion. 

23 ‘‘SEC. 107. INDIAN HEALTH SERVICE EXTERN PROGRAMS. 

24 ‘‘(a) EMPLOYMENT PREFERENCE.—Any individual 

25 who receives a scholarship pursuant to section 104 or 106 


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1 shall be given preference for employment in the Service, or 

2 may be employed by a Tribal Health Program or an Urban 

3 Indian Organization, or other agencies of the Department 

4 as available, during any nonacademic period of the year. 

5 ‘‘(b) NOT COUNTED TOWARD ACTIVE DUTY SERVICE

6 OBLIGATION.—Periods of employment pursuant to this sub7 section shall not be counted in determining fulfillment of 

8 the service obligation incurred as a condition of the scholar9 ship. 

10 ‘‘(c) TIMING; LENGTH OF EMPLOYMENT.—Any indi11 vidual enrolled in a program, including a high school pro12 gram, authorized under section 102(a) may be employed by 

13 the Service or by a Tribal Health Program or an Urban 

14 Indian Organization during any nonacademic period of the 

15 year. Any such employment shall not exceed 120 days dur16 ing any calendar year. 

17 ‘‘(d) NONAPPLICABILITY OF COMPETITIVE PERSONNEL

18 SYSTEM.—Any employment pursuant to this section shall 

19 be made without regard to any competitive personnel sys20 tem or agency personnel limitation and to a position which 

21 will enable the individual so employed to receive practical 

22 experience in the health profession in which he or she is 

23 engaged in study. Any individual so employed shall receive 

24 payment for his or her services comparable to the salary 

25 he or she would receive if he or she were employed in the 


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1 competitive system. Any individual so employed shall not 

2 be counted against any employment ceiling affecting the 

3 Service or the Department. 

4 ‘‘SEC. 108. CONTINUING EDUCATION ALLOWANCES. 

5 ‘‘In order to encourage health professionals, including 

6 community health representatives and emergency medical 

7 technicians, to join or continue in an Indian Health Pro8 gram or an Urban Indian Organization and to provide 

9 their services in the rural and remote areas where a signifi10 cant portion of Indians reside, the Secretary, acting 

11 through the Service, may provide allowances to health pro12 fessionals employed in an Indian Health Program or an 

13 Urban Indian Organization to enable them for a period of 

14 time each year prescribed by regulation of the Secretary to 

15 take leave of their duty stations for professional consulta16 tion and refresher training courses. 

17 ‘‘SEC. 109. COMMUNITY HEALTH REPRESENTATIVE PRO18 GRAM. 

19 ‘‘(a) IN GENERAL.—Under the authority of the Act of 

20 November 2, 1921 (25 U.S.C. 13) (commonly known as the 

21 ‘Snyder Act’), the Secretary, acting through the Service, 

22 shall maintain a Community Health Representative Pro23 gram under which Indian Health Programs— 

24 ‘‘(1) provide for the training of Indians as com25 munity health representatives; and 


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1 ‘‘(2) use such community health representatives 

2 in the provision of health care, health promotion, and 

3 disease prevention services to Indian communities. 

4 ‘‘(b) DUTIES.—The Community Health Representative 

5 Program of the Service, shall— 

6 ‘‘(1) provide a high standard of training for 

7 community health representatives to ensure that the 

8 community health representatives provide quality 

9 health care, health promotion, and disease prevention 

10 services to the Indian communities served by the Pro11 gram; 

12 ‘‘(2) in order to provide such training, develop 

13 and maintain a curriculum that— 

14 ‘‘(A) combines education in the theory of 

15 health care with supervised practical experience 

16 in the provision of health care; and 

17 ‘‘(B) provides instruction and practical ex18 perience in health promotion and disease preven19 tion activities, with appropriate consideration 

20 given to lifestyle factors that have an impact on 

21 Indian health status, such as alcoholism, family 

22 dysfunction, and poverty; 

23 ‘‘(3) maintain a system which identifies the 

24 needs of community health representatives for con25 tinuing education in health care, health promotion, 


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1 and disease prevention and develop programs that 

2 meet the needs for continuing education; 

3 ‘‘(4) maintain a system that provides close su4 pervision of Community Health Representatives; 

5 ‘‘(5) maintain a system under which the work of 

6 Community Health Representatives is reviewed and 

7 evaluated; and 

8 ‘‘(6) promote Traditional Health Care Practices 

9 of the Indian Tribes served consistent with the Service 

10 standards for the provision of health care, health pro11 motion, and disease prevention. 

12 ‘‘SEC. 110. INDIAN HEALTH SERVICE LOAN REPAYMENT 

13 PROGRAM. 

14 ‘‘(a) ESTABLISHMENT.—The Secretary, acting through 

15 the Service, shall establish and administer a program to 

16 be known as the Service Loan Repayment Program (herein17 after referred to as the ‘Loan Repayment Program’) in 

18 order to ensure an adequate supply of trained health profes19 sionals necessary to maintain accreditation of, and provide 

20 health care services to Indians through, Indian Health Pro21 grams and Urban Indian Organizations. 

22 ‘‘(b) ELIGIBLE INDIVIDUALS.—To be eligible to par23 ticipate in the Loan Repayment Program, an individual 

24 must— 

25 ‘‘(1)(A) be enrolled— 


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1 ‘‘(i) in a course of study or program in an 

2 accredited educational institution (as determined 

3 by the Secretary under section 338B(b)(1)(c)(i) 

4 of the Public Health Service Act (42 U.S.C. 

5 254l–1(b)(1)(c)(i))) and be scheduled to complete 

6 such course of study in the same year such indi7 vidual applies to participate in such program; 

8 or 

9 ‘‘(ii) in an approved graduate training pro10 gram in a health profession; or 

11 ‘‘(B) have— 

12 ‘‘(i) a degree in a health profession; and 

13 ‘‘(ii) a license to practice a health profes14 sion; 

15 ‘‘(2)(A) be eligible for, or hold, an appointment 

16 as a commissioned officer in the Regular or Reserve 

17 Corps of the Public Health Service; 

18 ‘‘(B) be eligible for selection for civilian service 

19 in the Regular or Reserve Corps of the Public Health 

20 Service; 

21 ‘‘(C) meet the professional standards for civil 

22 service employment in the Service; or 

23 ‘‘(D) be employed in an Indian Health Program 

24 or Urban Indian Organization without a service obli25 gation; and 


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1 ‘‘(3) submit to the Secretary an application for 

2 a contract described in subsection (e). 

3 ‘‘(c) APPLICATION.— 

4 ‘‘(1) INFORMATION TO BE INCLUDED WITH

5 FORMS.—In disseminating application forms and 

6 contract forms to individuals desiring to participate 

7 in the Loan Repayment Program, the Secretary shall 

8 include with such forms a fair summary of the rights 

9 and liabilities of an individual whose application is 

10 approved (and whose contract is accepted) by the Sec11 retary, including in the summary a clear explanation 

12 of the damages to which the United States is entitled 

13 under subsection (l) in the case of the individual’s 

14 breach of contract. The Secretary shall provide such 

15 individuals with sufficient information regarding the 

16 advantages and disadvantages of service as a commis17 sioned officer in the Regular or Reserve Corps of the 

18 Public Health Service or a civilian employee of the 

19 Service to enable the individual to make a decision on 

20 an informed basis. 

21 ‘‘(2) CLEAR LANGUAGE.—The application form, 

22 contract form, and all other information furnished by 

23 the Secretary under this section shall be written in a 

24 manner calculated to be understood by the average inVerDate Aug 31 2005 05:25 Mar 17, 2006 Jkt 049200 PO 00000 Frm 00373 Fmt 6652 Sfmt 6203 E:\BILLS\S1057.RS S1057

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1 dividual applying to participate in the Loan Repay2 ment Program. 

3 ‘‘(3) TIMELY AVAILABILITY OF FORMS.—The Sec4 retary shall make such application forms, contract 

5 forms, and other information available to individuals 

6 desiring to participate in the Loan Repayment Pro7 gram on a date sufficiently early to ensure that such 

8 individuals have adequate time to carefully review 

9 and evaluate such forms and information. 

10 ‘‘(d) PRIORITIES.— 

11 ‘‘(1) LIST.—Consistent with subsection (k), the 

12 Secretary shall annually— 

13 ‘‘(A) identify the positions in each Indian 

14 Health Program or Urban Indian Organization 

15 for which there is a need or a vacancy; and 

16 ‘‘(B) rank those positions in order of pri17 ority. 

18 ‘‘(2) APPROVALS.—Notwithstanding the priority 

19 determined under paragraph (1), the Secretary, in de20 termining which applications under the Loan Repay21 ment Program to approve (and which contracts to ac22 cept), shall— 

23 ‘‘(A) give first priority to applications 

24 made by individual Indians; and 


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1 ‘‘(B) after making determinations on all 

2 applications submitted by individual Indians as 

3 required under subparagraph (A), give priority 

4 to— 

5 ‘‘(i) individuals recruited through the 

6 efforts of an Indian Health Program or 

7 Urban Indian Organization; and 

8 ‘‘(ii) other individuals based on the 

9 priority rankings under paragraph (1). 

10 ‘‘(e) RECIPIENT CONTRACTS.— 

11 ‘‘(1) CONTRACT REQUIRED.—An individual be12 comes a participant in the Loan Repayment Program 

13 only upon the Secretary and the individual entering 

14 into a written contract described in paragraph (2). 

15 ‘‘(2) CONTENTS OF CONTRACT.—The written con16 tract referred to in this section between the Secretary 

17 and an individual shall contain— 

18 ‘‘(A) an agreement under which— 

19 ‘‘(i) subject to subparagraph (C), the 

20 Secretary agrees— 

21 ‘‘(I) to pay loans on behalf of the 

22 individual in accordance with the pro23 visions of this section; and 

24 ‘‘(II) to accept (subject to the 

25 availability of appropriated funds for 


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1 carrying out this section) the indi2 vidual into the Service or place the in3 dividual with a Tribal Health Pro4 gram or Urban Indian Organization 

5 as provided in clause (ii)(III); and 

6 ‘‘(ii) subject to subparagraph (C), the 

7 individual agrees— 

8 ‘‘(I) to accept loan payments on 

9 behalf of the individual; 

10 ‘‘(II) in the case of an individual 

11 described in subsection (b)(1)— 

12 ‘‘(aa) to maintain enrollment 

13 in a course of study or training 

14 described in subsection (b)(1)(A) 

15 until the individual completes the 

16 course of study or training; and 

17 ‘‘(bb) while enrolled in such 

18 course of study or training, to 

19 maintain an acceptable level of 

20 academic standing (as determined 

21 under regulations of the Secretary 

22 by the educational institution of23 fering such course of study or 

24 training); and 


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1 ‘‘(III) to serve for a time period 

2 (hereinafter in this section referred to 

3 as the ‘period of obligated service’) 

4 equal to 2 years or such longer period 

5 as the individual may agree to serve in 

6 the full-time clinical practice of such 

7 individual’s profession in an Indian 

8 Health Program or Urban Indian Or9 ganization to which the individual 

10 may be assigned by the Secretary; 

11 ‘‘(B) a provision permitting the Secretary 

12 to extend for such longer additional periods, as 

13 the individual may agree to, the period of obli14 gated service agreed to by the individual under 

15 subparagraph (A)(ii)(III); 

16 ‘‘(C) a provision that any financial obliga17 tion of the United States arising out of a con18 tract entered into under this section and any ob19 ligation of the individual which is conditioned 

20 thereon is contingent upon funds being appro21 priated for loan repayments under this section; 

22 ‘‘(D) a statement of the damages to which 

23 the United States is entitled under subsection (l) 

24 for the individual’s breach of the contract; and 


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1 ‘‘(E) such other statements of the rights and 

2 liabilities of the Secretary and of the individual, 

3 not inconsistent with this section. 

4 ‘‘(f) DEADLINE FOR DECISION ON APPLICATION.—The 

5 Secretary shall provide written notice to an individual 

6 within 21 days on— 

7 ‘‘(1) the Secretary’s approving, under subsection 

8 (e)(1), of the individual’s participation in the Loan 

9 Repayment Program, including extensions resulting 

10 in an aggregate period of obligated service in excess 

11 of 4 years; or 

12 ‘‘(2) the Secretary’s disapproving an individ13 ual’s participation in such Program. 

14 ‘‘(g) PAYMENTS.— 

15 ‘‘(1) IN GENERAL.—A loan repayment provided 

16 for an individual under a written contract under the 

17 Loan Repayment Program shall consist of payment, 

18 in accordance with paragraph (2), on behalf of the in19 dividual of the principal, interest, and related ex20 penses on government and commercial loans received 

21 by the individual regarding the undergraduate or 

22 graduate education of the individual (or both), which 

23 loans were made for— 

24 ‘‘(A) tuition expenses; 


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1 ‘‘(B) all other reasonable educational ex2 penses, including fees, books, and laboratory ex3 penses, incurred by the individual; and 

4 ‘‘(C) reasonable living expenses as deter5 mined by the Secretary. 

6 ‘‘(2) AMOUNT.—For each year of obligated serv7 ice that an individual contracts to serve under sub8 section (e), the Secretary may pay up to $35,000 or 

9 an amount equal to the amount specified in section 

10 338B(g)(2)(A) of the Public Health Service Act, 

11 whichever is more, on behalf of the individual for 

12 loans described in paragraph (1). In making a deter13 mination of the amount to pay for a year of such 

14 service by an individual, the Secretary shall consider 

15 the extent to which each such determination— 

16 ‘‘(A) affects the ability of the Secretary to 

17 maximize the number of contracts that can be 

18 provided under the Loan Repayment Program 

19 from the amounts appropriated for such con20 tracts; 

21 ‘‘(B) provides an incentive to serve in In22 dian Health Programs and Urban Indian Orga23 nizations with the greatest shortages of health 

24 professionals; and 


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1 ‘‘(C) provides an incentive with respect to 

2 the health professional involved remaining in an 

3 Indian Health Program or Urban Indian Orga4 nization with such a health professional short5 age, and continuing to provide primary health 

6 services, after the completion of the period of ob7 ligated service under the Loan Repayment Pro8 gram. 

9 ‘‘(3) TIMING.—Any arrangement made by the 

10 Secretary for the making of loan repayments in ac11 cordance with this subsection shall provide that any 

12 repayments for a year of obligated service shall be 

13 made no later than the end of the fiscal year in which 

14 the individual completes such year of service. 

15 ‘‘(4) REIMBURSEMENTS FOR TAX LIABILITY.— 

16 For the purpose of providing reimbursements for tax 

17 liability resulting from a payment under paragraph 

18 (2) on behalf of an individual, the Secretary— 

19 ‘‘(A) in addition to such payments, may 

20 make payments to the individual in an amount 

21 equal to not less than 20 percent and not more 

22 than 39 percent of the total amount of loan re23 payments made for the taxable year involved; 

24 and 


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1 ‘‘(B) may make such additional payments 

2 as the Secretary determines to be appropriate 

3 with respect to such purpose. 

4 ‘‘(5) PAYMENT SCHEDULE.—The Secretary may 

5 enter into an agreement with the holder of any loan 

6 for which payments are made under the Loan Repay7 ment Program to establish a schedule for the making 

8 of such payments. 

9 ‘‘(h) EMPLOYMENT CEILING.—Notwithstanding any 

10 other provision of law, individuals who have entered into 

11 written contracts with the Secretary under this section shall 

12 not be counted against any employment ceiling affecting the 

13 Department while those individuals are undergoing aca14 demic training. 

15 ‘‘(i) RECRUITMENT.—The Secretary shall conduct re16 cruiting programs for the Loan Repayment Program and 

17 other manpower programs of the Service at educational in18 stitutions training health professionals or specialists identi19 fied in subsection (a). 

20 ‘‘(j) APPLICABILITY OF LAW.—Section 214 of the Pub21 lic Health Service Act (42 U.S.C. 215) shall not apply to 

22 individuals during their period of obligated service under 

23 the Loan Repayment Program. 

24 ‘‘(k) ASSIGNMENT OF INDIVIDUALS.—The Secretary, 

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1 grams or Urban Indian Organizations pursuant to con2 tracts entered into under this section, shall— 

3 ‘‘(1) ensure that the staffing needs of Tribal 

4 Health Programs and Urban Indian Organizations 

5 receive consideration on an equal basis with programs 

6 that are administered directly by the Service; and 

7 ‘‘(2) give priority to assigning individuals to In8 dian Health Programs and Urban Indian Organiza9 tions that have a need for health professionals to pro10 vide health care services as a result of individuals 

11 having breached contracts entered into under this sec12 tion. 

13 ‘‘(l) BREACH OF CONTRACT.— 

14 ‘‘(1) SPECIFIC BREACHES.—An individual who 

15 has entered into a written contract with the Secretary 

16 under this section and has not received a waiver 

17 under subsection (m) shall be liable, in lieu of any 

18 service obligation arising under such contract, to the 

19 United States for the amount which has been paid on 

20 such individual’s behalf under the contract if that in21 dividual— 

22 ‘‘(A) is enrolled in the final year of a course 

23 of study and— 

24 ‘‘(i) fails to maintain an acceptable 

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1 cational institution in which he or she is 

2 enrolled (such level determined by the edu3 cational institution under regulations of the 

4 Secretary); 

5 ‘‘(ii) voluntarily terminates such en6 rollment; or 

7 ‘‘(iii) is dismissed from such edu8 cational institution before completion of 

9 such course of study; or 

10 ‘‘(B) is enrolled in a graduate training pro11 gram and fails to complete such training pro12 gram. 

13 ‘‘(2) OTHER BREACHES; FORMULA FOR AMOUNT

14 OWED.—If, for any reason not specified in paragraph 

15 (1), an individual breaches his or her written con16 tract under this section by failing either to begin, or 

17 complete, such individual’s period of obligated service 

18 in accordance with subsection (e)(2), the United 

19 States shall be entitled to recover from such indi20 vidual an amount to be determined in accordance 

21 with the following formula: A=3Z(t¥s/t) in which— 

22 ‘‘(A) ‘A’ is the amount the United States is 

23 entitled to recover; 

24 ‘‘(B) ‘Z’ is the sum of the amounts paid 

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1 vidual and the interest on such amounts which 

2 would be payable if, at the time the amounts 

3 were paid, they were loans bearing interest at 

4 the maximum legal prevailing rate, as deter5 mined by the Secretary of the Treasury; 

6 ‘‘(C) ‘t’ is the total number of months in the 

7 individual’s period of obligated service in accord8 ance with subsection (f); and 

9 ‘‘(D) ‘s’ is the number of months of such pe10 riod served by such individual in accordance 

11 with this section. 

12 ‘‘(3) DEDUCTIONS IN MEDICARE PAYMENTS.— 

13 Amounts not paid within such period shall be subject 

14 to collection through deductions in medicare pay15 ments pursuant to section 1892 of the Social Security 

16 Act. 

17 ‘‘(4) TIME PERIOD FOR REPAYMENT.—Any 

18 amount of damages which the United States is enti19 tled to recover under this subsection shall be paid to 

20 the United States within the 1-year period beginning 

21 on the date of the breach or such longer period begin22 ning on such date as shall be specified by the Sec23 retary. 

24 ‘‘(5) RECOVERY OF DELINQUENCY.— 


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1 ‘‘(A) IN GENERAL.—If damages described in 

2 paragraph (4) are delinquent for 3 months, the 

3 Secretary shall, for the purpose of recovering 

4 such damages— 

5 ‘‘(i) use collection agencies contracted 

6 with by the Administrator of General Serv7 ices; or 

8 ‘‘(ii) enter into contracts for the recov9 ery of such damages with collection agencies 

10 selected by the Secretary. 

11 ‘‘(B) REPORT.—Each contract for recov12 ering damages pursuant to this subsection shall 

13 provide that the contractor will, not less than 

14 once each 6 months, submit to the Secretary a 

15 status report on the success of the contractor in 

16 collecting such damages. Section 3718 of title 31, 

17 United States Code, shall apply to any such con18 tract to the extent not inconsistent with this sub19 section. 

20 ‘‘(m) WAIVER OR SUSPENSION OF OBLIGATION.— 

21 ‘‘(1) IN GENERAL.—The Secretary shall by regu22 lation provide for the partial or total waiver or sus23 pension of any obligation of service or payment by an 

24 individual under the Loan Repayment Program 

25 whenever compliance by the individual is impossible 


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1 or would involve extreme hardship to the individual 

2 and if enforcement of such obligation with respect to 

3 any individual would be unconscionable. 

4 ‘‘(2) CANCELED UPON DEATH.—Any obligation 

5 of an individual under the Loan Repayment Program 

6 for service or payment of damages shall be canceled 

7 upon the death of the individual. 

8 ‘‘(3) HARDSHIP WAIVER.—The Secretary may 

9 waive, in whole or in part, the rights of the United 

10 States to recover amounts under this section in any 

11 case of extreme hardship or other good cause shown, 

12 as determined by the Secretary. 

13 ‘‘(4) BANKRUPTCY.—Any obligation of an indi14 vidual under the Loan Repayment Program for pay15 ment of damages may be released by a discharge in 

16 bankruptcy under title 11 of the United States Code 

17 only if such discharge is granted after the expiration 

18 of the 5-year period beginning on the first date that 

19 payment of such damages is required, and only if the 

20 bankruptcy court finds that nondischarge of the obli21 gation would be unconscionable. 

22 ‘‘(n) REPORT.—The Secretary shall submit to the 

23 President, for inclusion in the report required to be sub24 mitted to Congress under section 801, a report concerning 


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1 the previous fiscal year which sets forth by Service Area 

2 the following: 

3 ‘‘(1) A list of the health professional positions 

4 maintained by Indian Health Programs and Urban 

5 Indian Organizations for which recruitment or reten6 tion is difficult. 

7 ‘‘(2) The number of Loan Repayment Program 

8 applications filed with respect to each type of health 

9 profession. 

10 ‘‘(3) The number of contracts described in sub11 section (e) that are entered into with respect to each 

12 health profession. 

13 ‘‘(4) The amount of loan payments made under 

14 this section, in total and by health profession. 

15 ‘‘(5) The number of scholarships that are pro16 vided under sections 104 and 106 with respect to each 

17 health profession. 

18 ‘‘(6) The amount of scholarship grants provided 

19 under section 104 and 106, in total and by health 

20 profession. 

21 ‘‘(7) The number of providers of health care that 

22 will be needed by Indian Health Programs and 

23 Urban Indian Organizations, by location and profes24 sion, during the 3 fiscal years beginning after the 

25 date the report is filed. 


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1 ‘‘(8) The measures the Secretary plans to take to 

2 fill the health professional positions maintained by 

3 Indian Health Programs or Urban Indian Organiza4 tions for which recruitment or retention is difficult. 

5 ‘‘SEC. 111. SCHOLARSHIP AND LOAN REPAYMENT RECOV6 ERY FUND. 

7 ‘‘(a) ESTABLISHMENT.—There is established in the 

8 Treasury of the United States a fund to be known as the 

9 Indian Health Scholarship and Loan Repayment Recovery 

10 Fund (hereafter in this section referred to as the ‘LRRF’). 

11 The LRRF shall consist of such amounts as may be collected 

12 from individuals under section 104(d), section 106(e), and 

13 section 110(l) for breach of contract, such funds as may be 

14 appropriated to the LRRF, and interest earned on amounts 

15 in the LRRF. All amounts collected, appropriated, or 

16 earned relative to the LRRF shall remain available until 

17 expended. 

18 ‘‘(b) USE OF FUNDS.— 

19 ‘‘(1) BY SECRETARY.—Amounts in the LRRF 

20 may be expended by the Secretary, acting through the 

21 Service, to make payments to an Indian Health Pro22 gram— 

23 ‘‘(A) to which a scholarship recipient under 

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1 signed to meet the obligated service requirements 

2 pursuant to such sections; and 

3 ‘‘(B) that has a need for a health profes4 sional to provide health care services as a result 

5 of such recipient or participant having breached 

6 the contract entered into under section 104, 106, 

7 or section 110. 

8 ‘‘(2) BY TRIBAL HEALTH PROGRAMS.—A Tribal 

9 Health Program receiving payments pursuant to 

10 paragraph (1) may expend the payments to provide 

11 scholarships or recruit and employ, directly or by 

12 contract, health professionals to provide health care 

13 services. 

14 ‘‘(c) INVESTMENT OF FUNDS.—The Secretary of the 

15 Treasury shall invest such amounts of the LRRF as the Sec16 retary of Health and Human Services determines are not 

17 required to meet current withdrawals from the LRRF. Such 

18 investments may be made only in interest bearing obliga19 tions of the United States. For such purpose, such obliga20 tions may be acquired on original issue at the issue price, 

21 or by purchase of outstanding obligations at the market 

22 price. 

23 ‘‘(d) SALE OF OBLIGATIONS.—Any obligation acquired 

24 by the LRRF may be sold by the Secretary of the Treasury 

25 at the market price. 


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1 ‘‘SEC. 112. RECRUITMENT ACTIVITIES. 

2 ‘‘(a) REIMBURSEMENT FOR TRAVEL.—The Secretary, 

3 acting through the Service, may reimburse health profes4 sionals seeking positions with Indian Health Programs or 

5 Urban Indian Organizations, including individuals consid6 ering entering into a contract under section 110 and their 

7 spouses, for actual and reasonable expenses incurred in 

8 traveling to and from their places of residence to an area 

9 in which they may be assigned for the purpose of evaluating 

10 such area with respect to such assignment. 

11 ‘‘(b) RECRUITMENT PERSONNEL.—The Secretary, act12 ing through the Service, shall assign 1 individual in each 

13 Area Office to be responsible on a full-time basis for recruit14 ment activities. 

15 ‘‘SEC. 113. INDIAN RECRUITMENT AND RETENTION PRO16 GRAM. 

17 ‘‘(a) IN GENERAL.—The Secretary, acting through the 

18 Service, shall fund, on a competitive basis, innovative dem19 onstration projects for a period not to exceed 3 years to 

20 enable Tribal Health Programs and Urban Indian Organi21 zations to recruit, place, and retain health professionals to 

22 meet their staffing needs. 

23 ‘‘(b) ELIGIBLE ENTITIES; APPLICATION.—Any Tribal 

24 Health Program or Urban Indian Organization may sub25 mit an application for funding of a project pursuant to 

26 this section. 


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1 ‘‘SEC. 114. ADVANCED TRAINING AND RESEARCH. 

2 ‘‘(a) DEMONSTRATION PROGRAM.—The Secretary, act3 ing through the Service, shall establish a demonstration 

4 project to enable health professionals who have worked in 

5 an Indian Health Program or Urban Indian Organization 

6 for a substantial period of time to pursue advanced train7 ing or research areas of study for which the Secretary deter8 mines a need exists. 

9 ‘‘(b) SERVICE OBLIGATION.—An individual who par10 ticipates in a program under subsection (a), where the edu11 cational costs are borne by the Service, shall incur an obli12 gation to serve in an Indian Health Program or Urban 

13 Indian Organization for a period of obligated service equal 

14 to at least the period of time during which the individual 

15 participates in such program. In the event that the indi16 vidual fails to complete such obligated service, the indi17 vidual shall be liable to the United States for the period 

18 of service remaining. In such event, with respect to individ19 uals entering the program after the date of enactment of 

20 the Indian Health Care Improvement Act Amendments of 

21 2005, the United States shall be entitled to recover from 

22 such individual an amount to be determined in accordance 

23 with the formula specified in subsection (l) of section 110 

24 in the manner provided for in such subsection. 

25 ‘‘(c) EQUAL OPPORTUNITY FOR PARTICIPATION.— 

26 Health professionals from Tribal Health Programs and 


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1 Urban Indian Organizations shall be given an equal oppor2 tunity to participate in the program under subsection (a). 

3 ‘‘SEC. 115. QUENTIN N. BURDICK AMERICAN INDIANS INTO 

4 NURSING PROGRAM. 

5 ‘‘(a) GRANTS AUTHORIZED.—For the purpose of in6 creasing the number of nurses, nurse midwives, and nurse 

7 practitioners who deliver health care services to Indians, 

8 the Secretary, acting through the Service, shall provide 

9 grants to the following: 

10 ‘‘(1) Public or private schools of nursing. 

11 ‘‘(2) Tribal colleges or universities. 

12 ‘‘(3) Nurse midwife programs and advanced 

13 practice nurse programs that are provided by any 

14 tribal college or university accredited nursing pro15 gram, or in the absence of such, any other public or 

16 private institutions. 

17 ‘‘(b) USE OF GRANTS.—Grants provided under sub18 section (a) may be used for 1 or more of the following: 

19 ‘‘(1) To recruit individuals for programs which 

20 train individuals to be nurses, nurse midwives, or ad21 vanced practice nurses. 

22 ‘‘(2) To provide scholarships to Indians enrolled 

23 in such programs that may pay the tuition charged 

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1 nection with such program, including books, fees, 

2 room and board, and stipends for living expenses. 

3 ‘‘(3) To provide a program that encourages 

4 nurses, nurse midwives, and advanced practice nurses 

5 to provide, or continue to provide, health care services 

6 to Indians. 

7 ‘‘(4) To provide a program that increases the 

8 skills of, and provides continuing education to, 

9 nurses, nurse midwives, and advanced practice 

10 nurses. 

11 ‘‘(5) To provide any program that is designed to 

12 achieve the purpose described in subsection (a). 

13 ‘‘(c) APPLICATIONS.—Each application for funding 

14 under subsection (a) shall include such information as the 

15 Secretary may require to establish the connection between 

16 the program of the applicant and a health care facility that 

17 primarily serves Indians. 

18 ‘‘(d) PREFERENCES FOR GRANT RECIPIENTS.—In pro19 viding grants under subsection (a), the Secretary shall ex20 tend a preference to the following: 

21 ‘‘(1) Programs that provide a preference to Indi22 ans. 

23 ‘‘(2) Programs that train nurse midwives or ad24 vanced practice nurses. 

25 ‘‘(3) Programs that are interdisciplinary. 


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1 ‘‘(4) Programs that are conducted in cooperation 

2 with a program for gifted and talented Indian stu3 dents. 

4 ‘‘(5) Programs conducted by tribal colleges and 

5 universities. 

6 ‘‘(e) QUENTIN N. BURDICK PROGRAM GRANT.—The 

7 Secretary shall provide 1 of the grants authorized under 

8 subsection (a) to establish and maintain a program at the 

9 University of North Dakota to be known as the ‘Quentin 

10 N. Burdick American Indians Into Nursing Program’. 

11 Such program shall, to the maximum extent feasible, coordi12 nate with the Quentin N. Burdick Indian Health Programs 

13 established under section 117(b) and the Quentin N. Bur14 dick American Indians Into Psychology Program estab15 lished under section 105(b). 

16 ‘‘(f) ACTIVE DUTY SERVICE OBLIGATION.—The active 

17 duty service obligation prescribed under section 338C of the 

18 Public Health Service Act (42 U.S.C. 254m) shall be met 

19 by each individual who receives training or assistance de20 scribed in paragraph (1) or (2) of subsection (b) that is 

21 funded by a grant provided under subsection (a). Such obli22 gation shall be met by service— 

23 ‘‘(1) in the Service; 

24 ‘‘(2) in a program of an Indian Tribe or Tribal 

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1 mination and Education Assistance Act (25 U.S.C. 

2 450 et seq.) (including programs under agreements 

3 with the Bureau of Indian Affairs); 

4 ‘‘(3) in a program assisted under title V of this 

5 Act; 

6 ‘‘(4) in the private practice of nursing if, as de7 termined by the Secretary, in accordance with guide8 lines promulgated by the Secretary, such practice is 

9 situated in a physician or other health shortage area 

10 and addresses the health care needs of a substantial 

11 number of Indians; or 

12 ‘‘(5) in a teaching capacity in a tribal college or 

13 university nursing program (or a related health pro14 fession program) if, as determined by the Secretary, 

15 health services provided to Indians would not de16 crease. 

17 ‘‘SEC. 116. TRIBAL CULTURAL ORIENTATION. 

18 ‘‘(a) CULTURAL EDUCATION OF EMPLOYEES.—The 

19 Secretary, acting through the Service, shall require that ap20 propriate employees of the Service who serve Indian Tribes 

21 in each Service Area receive educational instruction in the 

22 history and culture of such Indian Tribes and their rela23 tionship to the Service. 


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1 ‘‘(b) PROGRAM.—In carrying out subsection (a), the 

2 Secretary shall establish a program which shall, to the ex3 tent feasible— 

4 ‘‘(1) be developed in consultation with the af5 fected Indian Tribes, Tribal Organizations, and 

6 Urban Indian Organizations; 

7 ‘‘(2) be carried out through tribal colleges or uni8 versities; 

9 ‘‘(3) include instruction in American Indian 

10 studies; and 

11 ‘‘(4) describe the use and place of Traditional 

12 Health Care Practices of the Indian Tribes in the 

13 Service Area. 

14 ‘‘SEC. 117. INMED PROGRAM. 

15 ‘‘(a) GRANTS AUTHORIZED.—The Secretary, acting 

16 through the Service, is authorized to provide grants to col17 leges and universities for the purpose of maintaining and 

18 expanding the Indian health careers recruitment program 

19 known as the ‘Indians Into Medicine Program’ (hereinafter 

20 in this section referred to as ‘INMED’) as a means of en21 couraging Indians to enter the health professions. 

22 ‘‘(b) QUENTIN N. BURDICK GRANT.—The Secretary 

23 shall provide 1 of the grants authorized under subsection 

24 (a) to maintain the INMED program at the University of 

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1 dian Health Programs’, unless the Secretary makes a deter2 mination, based upon program reviews, that the program 

3 is not meeting the purposes of this section. Such program 

4 shall, to the maximum extent feasible, coordinate with the 

5 Quentin N. Burdick American Indians Into Psychology 

6 Program established under section 105(b) and the Quentin 

7 N. Burdick American Indians Into Nursing Program estab8 lished under section 115. 

9 ‘‘(c) REGULATIONS.—The Secretary, pursuant to this 

10 Act, shall develop regulations to govern grants pursuant to 

11 this section. 

12 ‘‘(d) REQUIREMENTS.—Applicants for grants provided 

13 under this section shall agree to provide a program which— 

14 ‘‘(1) provides outreach and recruitment for 

15 health professions to Indian communities including 

16 elementary and secondary schools and community col17 leges located on reservations which will be served by 

18 the program; 

19 ‘‘(2) incorporates a program advisory board 

20 comprised of representatives from the Indian Tribes 

21 and Indian communities which will be served by the 

22 program; 

23 ‘‘(3) provides summer preparatory programs for 

24 Indian students who need enrichment in the subjects 


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1 of math and science in order to pursue training in 

2 the health professions; 

3 ‘‘(4) provides tutoring, counseling, and support 

4 to students who are enrolled in a health career pro5 gram of study at the respective college or university; 

6 and 

7 ‘‘(5) to the maximum extent feasible, employs 

8 qualified Indians in the program. 

9 ‘‘SEC. 118. HEALTH TRAINING PROGRAMS OF COMMUNITY 

10 COLLEGES. 

11 ‘‘(a) GRANTS TO ESTABLISH PROGRAMS.— 

12 ‘‘(1) IN GENERAL.—The Secretary, acting 

13 through the Service, shall award grants to accredited 

14 and accessible community colleges for the purpose of 

15 assisting such community colleges in the establish16 ment of programs which provide education in a 

17 health profession leading to a degree or diploma in a 

18 health profession for individuals who desire to prac19 tice such profession on or near a reservation or in an 

20 Indian Health Program. 

21 ‘‘(2) AMOUNT OF GRANTS.—The amount of any 

22 grant awarded to a community college under para23 graph (1) for the first year in which such a grant is 

24 provided to the community college shall not exceed 

25 $250,000. 


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1 ‘‘(b) GRANTS FOR MAINTENANCE AND RECRUITING.— 

2 ‘‘(1) IN GENERAL.—The Secretary, acting 

3 through the Service, shall award grants to accredited 

4 and accessible community colleges that have estab5 lished a program described in subsection (a)(1) for the 

6 purpose of maintaining the program and recruiting 

7 students for the program. 

8 ‘‘(2) REQUIREMENTS.—Grants may only be 

9 made under this section to a community college 

10 which— 

11 ‘‘(A) is accredited; 

12 ‘‘(B) has a relationship with a hospital fa13 cility, Service facility, or hospital that could 

14 provide training of nurses or health profes15 sionals; 

16 ‘‘(C) has entered into an agreement with an 

17 accredited college or university medical school, 

18 the terms of which— 

19 ‘‘(i) provide a program that enhances 

20 the transition and recruitment of students 

21 into advanced baccalaureate or graduate 

22 programs that train health professionals; 

23 and 


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1 ‘‘(ii) stipulate certifications necessary 

2 to approve internship and field placement 

3 opportunities at Indian Health Programs; 

4 ‘‘(D) has a qualified staff which has the ap5 propriate certifications; 

6 ‘‘(E) is capable of obtaining State or re7 gional accreditation of the program described in 

8 subsection (a)(1); and 

9 ‘‘(F) agrees to provide for Indian preference 

10 for applicants for programs under this section. 

11 ‘‘(c) TECHNICAL ASSISTANCE.—The Secretary shall 

12 encourage community colleges described in subsection (b)(2) 

13 to establish and maintain programs described in subsection 

14 (a)(1) by— 

15 ‘‘(1) entering into agreements with such colleges 

16 for the provision of qualified personnel of the Service 

17 to teach courses of study in such programs; and 

18 ‘‘(2) providing technical assistance and support 

19 to such colleges. 

20 ‘‘(d) ADVANCED TRAINING.— 

21 ‘‘(1) REQUIRED.—Any program receiving assist22 ance under this section that is conducted with respect 

23 to a health profession shall also offer courses of study 

24 which provide advanced training for any health pro25 fessional who— 


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1 ‘‘(A) has already received a degree or di2 ploma in such health profession; and 

3 ‘‘(B) provides clinical services on or near a 

4 reservation or for an Indian Health Program. 

5 ‘‘(2) MAY BE OFFERED AT ALTERNATE SITE.— 

6 Such courses of study may be offered in conjunction 

7 with the college or university with which the commu8 nity college has entered into the agreement required 

9 under subsection (b)(2)(C). 

10 ‘‘(e) FUNDING PRIORITY.—Where the requirements of 

11 subsection (b) are met, funding priority shall be provided 

12 to tribal colleges and universities in Service Areas where 

13 they exist. 

14 ‘‘SEC. 119. RETENTION BONUS. 

15 ‘‘(a) BONUS AUTHORIZED.—The Secretary may pay 

16 a retention bonus to any health professional employed by, 

17 or assigned to, and serving in, an Indian Health Program 

18 or Urban Indian Organization either as a civilian em19 ployee or as a commissioned officer in the Regular or Re20 serve Corps of the Public Health Service who— 

21 ‘‘(1) is assigned to, and serving in, a position for 

22 which recruitment or retention of personnel is dif23 ficult; 


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1 ‘‘(2) the Secretary determines is needed by In2 dian Health Programs and Urban Indian Organiza3 tions; 

4 ‘‘(3) has— 

5 ‘‘(A) completed 3 years of employment with 

6 an Indian Health Program or Urban Indian Or7 ganization; or 

8 ‘‘(B) completed any service obligations in9 curred as a requirement of— 

10 ‘‘(i) any Federal scholarship program; 

11 or 

12 ‘‘(ii) any Federal education loan re13 payment program; and 

14 ‘‘(4) enters into an agreement with an Indian 

15 Health Program or Urban Indian Organization for 

16 continued employment for a period of not less than 1 

17 year. 

18 ‘‘(b) RATES.—The Secretary may establish rates for 

19 the retention bonus which shall provide for a higher annual 

20 rate for multiyear agreements than for single year agree21 ments referred to in subsection (a)(4), but in no event shall 

22 the annual rate be more than $25,000 per annum. 

23 ‘‘(c) DEFAULT OF RETENTION AGREEMENT.—Any 

24 health professional failing to complete the agreed upon term 

25 of service, except where such failure is through no fault of 


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1 the individual, shall be obligated to refund to the Govern2 ment the full amount of the retention bonus for the period 

3 covered by the agreement, plus interest as determined by 

4 the Secretary in accordance with section 110(l)(2)(B). 

5 ‘‘(d) OTHER RETENTION BONUS.—The Secretary may 

6 pay a retention bonus to any health professional employed 

7 by a Tribal Health Program if such health professional is 

8 serving in a position which the Secretary determines is— 

9 ‘‘(1) a position for which recruitment or reten10 tion is difficult; and 

11 ‘‘(2) necessary for providing health care services 

12 to Indians. 

13 ‘‘SEC. 120. NURSING RESIDENCY PROGRAM. 

14 ‘‘(a) ESTABLISHMENT OF PROGRAM.—The Secretary, 

15 acting through the Service, shall establish a program to en16 able Indians who are licensed practical nurses, licensed vo17 cational nurses, and registered nurses who are working in 

18 an Indian Health Program or Urban Indian Organization, 

19 and have done so for a period of not less than 1 year, to 

20 pursue advanced training. Such program shall include a 

21 combination of education and work study in an Indian 

22 Health Program or Urban Indian Organization leading to 

23 an associate or bachelor’s degree (in the case of a licensed 

24 practical nurse or licensed vocational nurse), a bachelor’s 


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1 degree (in the case of a registered nurse), or advanced de2 grees or certifications in nursing and public health. 

3 ‘‘(b) SERVICE OBLIGATION.—An individual who par4 ticipates in a program under subsection (a), where the edu5 cational costs are paid by the Service, shall incur an obliga6 tion to serve in an Indian Health Program or Urban In7 dian Organization for a period of obligated service equal 

8 to the amount of time during which the individual partici9 pates in such program. In the event that the individual fails 

10 to complete such obligated service, the United States shall 

11 be entitled to recover from such individual an amount deter12 mined in accordance with the formula specified in sub13 section (l) of section 110 in the manner provided for in 

14 such subsection. 

15 ‘‘SEC. 121. COMMUNITY HEALTH AIDE PROGRAM. 

16 ‘‘(a) GENERAL PURPOSES OF PROGRAM.—Under the 

17 authority of the Act of November 2, 1921 (25 U.S.C. 13) 

18 (commonly known as the ‘Snyder Act’), the Secretary, act19 ing through the Service, shall develop and operate a Com20 munity Health Aide Program in Alaska under which the 

21 Service— 

22 ‘‘(1) provides for the training of Alaska Natives 

23 as health aides or community health practitioners; 

24 ‘‘(2) uses such aides or practitioners in the pro25 vision of health care, health promotion, and disease 


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1 prevention services to Alaska Natives living in vil2 lages in rural Alaska; and 

3 ‘‘(3) provides for the establishment of teleconfer4 encing capacity in health clinics located in or near 

5 such villages for use by community health aides or 

6 community health practitioners. 

7 ‘‘(b) SPECIFIC PROGRAM REQUIREMENTS.—The Sec8 retary, acting through the Community Health Aide Pro9 gram of the Service, shall— 

10 ‘‘(1) using trainers accredited by the Program, 

11 provide a high standard of training to community 

12 health aides and community health practitioners to 

13 ensure that such aides and practitioners provide qual14 ity health care, health promotion, and disease preven15 tion services to the villages served by the Program; 

16 ‘‘(2) in order to provide such training, develop 

17 a curriculum that— 

18 ‘‘(A) combines education in the theory of 

19 health care with supervised practical experience 

20 in the provision of health care; 

21 ‘‘(B) provides instruction and practical ex22 perience in the provision of acute care, emer23 gency care, health promotion, disease prevention, 

24 and the efficient and effective management of 


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1 clinic pharmacies, supplies, equipment, and fa2 cilities; and 

3 ‘‘(C) promotes the achievement of the health 

4 status objectives specified in section 3(2); 

5 ‘‘(3) establish and maintain a Community 

6 Health Aide Certification Board to certify as commu7 nity health aides or community health practitioners 

8 individuals who have successfully completed the train9 ing described in paragraph (1) or can demonstrate 

10 equivalent experience; 

11 ‘‘(4) develop and maintain a system which iden12 tifies the needs of community health aides and com13 munity health practitioners for continuing education 

14 in the provision of health care, including the areas 

15 described in paragraph (2)(B), and develop programs 

16 that meet the needs for such continuing education; 

17 ‘‘(5) develop and maintain a system that pro18 vides close supervision of community health aides and 

19 community health practitioners; and 

20 ‘‘(6) develop a system under which the work of 

21 community health aides and community health prac22 titioners is reviewed and evaluated to assure the pro23 vision of quality health care, health promotion, and 

24 disease prevention services. 

25 ‘‘(c) PROGRAM REVIEW.— 


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1 ‘‘(1) NEUTRAL PANEL.— 

2 ‘‘(A) ESTABLISHMENT.—The Secretary, act3 ing through the Service, shall establish a neutral 

4 panel to carry out the study under paragraph 

5 (2). 

6 ‘‘(B) MEMBERSHIP.—Members of the neu7 tral panel shall be appointed by the Secretary 

8 from among clinicians, economists, community 

9 practitioners, oral epidemiologists, and Alaska 

10 Natives. 

11 ‘‘(2) STUDY.— 

12 ‘‘(A) IN GENERAL.—The neutral panel es13 tablished under paragraph (1) shall conduct a 

14 study of the dental health aide therapist services 

15 provided by the Community Health Aide Pro16 gram under this section to ensure that the qual17 ity of care provided through those services is ade18 quate and appropriate. 

19 ‘‘(B) PARAMETERS OF STUDY.—The Sec20 retary, in consultation with interested parties, 

21 including professional dental organizations, shall 

22 develop the parameters of the study. 

23 ‘‘(C) INCLUSIONS.—The study shall include 

24 a determination by the neutral panel with re25 spect to— 


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1 ‘‘(i) the ability of the dental health 

2 aide therapist services under this section to 

3 address the dental care needs of Alaska Na4 tives; 

5 ‘‘(ii) the quality of care provided 

6 through those services, including any train7 ing, improvement, or additional oversight 

8 required to improve the quality of care; and 

9 ‘‘(iii) whether safer and less costly al10 ternatives to the dental health aide therapist 

11 services exist. 

12 ‘‘(D) CONSULTATION.—In carrying out the 

13 study under this paragraph, the neutral panel 

14 shall consult with Alaska Tribal Organizations 

15 with respect to the adequacy and accuracy of the 

16 study. 

17 ‘‘(3) REPORT.—The neutral panel shall submit 

18 to the Secretary, the Committee on Indian Affairs of 

19 the Senate, and the Committee on Resources of the 

20 House of Representatives a report describing the re21 sults of the study under paragraph (2), including a 

22 description of— 

23 ‘‘(A) any determination of the neutral panel 

24 under paragraph (2)(C); and 


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1 ‘‘(B) any comments received from an Alaska 

2 Tribal Organization under paragraph (2)(D). 

3 ‘‘(d) NATIONALIZATION OF PROGRAM.— 

4 ‘‘(1) IN GENERAL.—Except as provided in para5 graph (2), the Secretary, acting through the Service, 

6 may establish a national Community Health Aide 

7 Program in accordance with the program under this 

8 section, as the Secretary determines to be appropriate. 

9 ‘‘(2) EXCEPTION.—The national Community 

10 Health Aide Program under paragraph (1) shall not 

11 include dental health aide therapist services. 

12 ‘‘(3) REQUIREMENT.—In establishing a national 

13 program under paragraph (1), the Secretary shall not 

14 reduce the amount of funds provided for the Commu15 nity Health Aide Program described in subsections 

16 (a) and (b). 

17 ‘‘SEC. 122. TRIBAL HEALTH PROGRAM ADMINISTRATION. 

18 ‘‘The Secretary, acting through the Service, shall, by 

19 contract or otherwise, provide training for Indians in the 

20 administration and planning of Tribal Health Programs. 

21 ‘‘SEC. 123. HEALTH PROFESSIONAL CHRONIC SHORTAGE 

22 DEMONSTRATION PROGRAMS. 

23 ‘‘(a) DEMONSTRATION PROGRAMS AUTHORIZED.—The 

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1 tion programs for Tribal Health Programs to address the 

2 chronic shortages of health professionals. 

3 ‘‘(b) PURPOSES OF PROGRAMS.—The purposes of dem4 onstration programs funded under subsection (a) shall be— 

5 ‘‘(1) to provide direct clinical and practical ex6 perience at a Service Unit to health profession stu7 dents and residents from medical schools; 

8 ‘‘(2) to improve the quality of health care for In9 dians by assuring access to qualified health care pro10 fessionals; and 

11 ‘‘(3) to provide academic and scholarly opportu12 nities for health professionals serving Indians by 

13 identifying all academic and scholarly resources of 

14 the region. 

15 ‘‘(c) ADVISORY BOARD.—The demonstration programs 

16 established pursuant to subsection (a) shall incorporate a 

17 program advisory board composed of representatives from 

18 the Indian Tribes and Indian communities in the area 

19 which will be served by the program. 

20 ‘‘SEC. 124. NATIONAL HEALTH SERVICE CORPS. 

21 ‘‘(a) NO REDUCTION IN SERVICES.—The Secretary 

22 shall not— 

23 ‘‘(1) remove a member of the National Health 

24 Service Corps from an Indian Health Program or 

25 Urban Indian Organization; or 


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1 ‘‘(2) withdraw funding used to support such 

2 member, unless the Secretary, acting through the 

3 Service, Indian Tribes, or Tribal Organizations, has 

4 ensured that the Indians receiving services from such 

5 member will experience no reduction in services. 

6 ‘‘(b) EXEMPTION FROM LIMITATIONS.—National 

7 Health Service Corps scholars qualifying for the Commis8 sioned Corps in the United States Public Health Service 

9 shall be exempt from the full-time equivalent limitations of 

10 the National Health Service Corps and the Service when 

11 serving as a commissioned corps officer in a Tribal Health 

12 Program or an Urban Indian Organization. 

13 ‘‘SEC. 125. SUBSTANCE ABUSE COUNSELOR EDUCATIONAL 

14 CURRICULA DEMONSTRATION PROGRAMS. 

15 ‘‘(a) GRANTS AND CONTRACTS.—The Secretary, acting 

16 through the Service, may enter into contracts with, or make 

17 grants to, accredited tribal colleges and universities and eli18 gible accredited and accessible community colleges to estab19 lish demonstration programs to develop educational cur20 ricula for substance abuse counseling. 

21 ‘‘(b) USE OF FUNDS.—Funds provided under this sec22 tion shall be used only for developing and providing edu23 cational curriculum for substance abuse counseling (includ24 ing paying salaries for instructors). Such curricula may 

25 be provided through satellite campus programs. 


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1 ‘‘(c) TIME PERIOD OF ASSISTANCE; RENEWAL.—A 

2 contract entered into or a grant provided under this section 

3 shall be for a period of 3 years. Such contract or grant may 

4 be renewed for an additional 2-year period upon the ap5 proval of the Secretary. 

6 ‘‘(d) CRITERIA FOR REVIEW AND APPROVAL OF APPLI7 CATIONS.—Not later than 180 days after the date of enact8 ment of the Indian Health Care Improvement Act Amend9 ments of 2005, the Secretary, after consultation with Indian 

10 Tribes and administrators of tribal colleges and universities 

11 and eligible accredited and accessible community colleges, 

12 shall develop and issue criteria for the review and approval 

13 of applications for funding (including applications for re14 newals of funding) under this section. Such criteria shall 

15 ensure that demonstration programs established under this 

16 section promote the development of the capacity of such en17 tities to educate substance abuse counselors. 

18 ‘‘(e) ASSISTANCE.—The Secretary shall provide such 

19 technical and other assistance as may be necessary to enable 

20 grant recipients to comply with the provisions of this sec21 tion. 

22 ‘‘(f) REPORT.—Each fiscal year, the Secretary shall 

23 submit to the President, for inclusion in the report which 

24 is required to be submitted under section 801 for that fiscal 

25 year, a report on the findings and conclusions derived from 


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1 the demonstration programs conducted under this section 

2 during that fiscal year. 

3 ‘‘(g) DEFINITION.—For the purposes of this section, the 

4 term ‘educational curriculum’ means 1 or more of the fol5 lowing: 

6 ‘‘(1) Classroom education. 

7 ‘‘(2) Clinical work experience. 

8 ‘‘(3) Continuing education workshops. 

9 ‘‘SEC. 126. BEHAVIORAL HEALTH TRAINING AND COMMU10 NITY EDUCATION PROGRAMS. 

11 ‘‘(a) STUDY; LIST.—The Secretary, acting through the 

12 Service, and the Secretary of the Interior, in consultation 

13 with Indian Tribes and Tribal Organizations, shall conduct 

14 a study and compile a list of the types of staff positions 

15 specified in subsection (b) whose qualifications include, or 

16 should include, training in the identification, prevention, 

17 education, referral, or treatment of mental illness, or dys18 functional and self destructive behavior. 

19 ‘‘(b) POSITIONS.—The positions referred to in sub20 section (a) are— 

21 ‘‘(1) staff positions within the Bureau of Indian 

22 Affairs, including existing positions, in the fields of— 

23 ‘‘(A) elementary and secondary education; 

24 ‘‘(B) social services and family and child 

25 welfare; 


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1 ‘‘(C) law enforcement and judicial services; 

2 and 

3 ‘‘(D) alcohol and substance abuse; 

4 ‘‘(2) staff positions within the Service; and 

5 ‘‘(3) staff positions similar to those identified in 

6 paragraphs (1) and (2) established and maintained 

7 by Indian Tribes, Tribal Organizations (without re8 gard to the funding source), and Urban Indian Orga9 nizations. 

10 ‘‘(c) TRAINING CRITERIA.— 

11 ‘‘(1) IN GENERAL.—The appropriate Secretary 

12 shall provide training criteria appropriate to each 

13 type of position identified in subsection (b)(1) and 

14 (b)(2) and ensure that appropriate training has been, 

15 or shall be provided to any individual in any such 

16 position. With respect to any such individual in a po17 sition identified pursuant to subsection (b)(3), the re18 spective Secretaries shall provide appropriate train19 ing to, or provide funds to, an Indian Tribe, Tribal 

20 Organization, or Urban Indian Organization for 

21 training of appropriate individuals. In the case of po22 sitions funded under a contract or compact under the 

23 Indian Self-Determination and Education Assistance 

24 Act (25 U.S.C. 450 et seq.), the appropriate Secretary 

25 shall ensure that such training costs are included in 


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1 the contract or compact, as the Secretary determines 

2 necessary. 

3 ‘‘(2) POSITION SPECIFIC TRAINING CRITERIA.— 

4 Position specific training criteria shall be culturally 

5 relevant to Indians and Indian Tribes and shall en6 sure that appropriate information regarding Tradi7 tional Health Care Practices is provided. 

8 ‘‘(d) COMMUNITY EDUCATION ON MENTAL ILLNESS.— 

9 The Service shall develop and implement, on request of an 

10 Indian Tribe, Tribal Organization, or Urban Indian Orga11 nization, or assist the Indian Tribe, Tribal Organization, 

12 or Urban Indian Organization to develop and implement, 

13 a program of community education on mental illness. In 

14 carrying out this subsection, the Service shall, upon request 

15 of an Indian Tribe, Tribal Organization, or Urban Indian 

16 Organization, provide technical assistance to the Indian 

17 Tribe, Tribal Organization, or Urban Indian Organization 

18 to obtain and develop community educational materials on 

19 the identification, prevention, referral, and treatment of 

20 mental illness and dysfunctional and self-destructive behav21 ior. 

22 ‘‘(e) PLAN.—Not later than 90 days after the date of 

23 enactment of the Indian Health Care Improvement Act 

24 Amendments of 2005, the Secretary shall develop a plan 

25 under which the Service will increase the health care staff 


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1 providing behavioral health services by at least 500 posi2 tions within 5 years after the date of enactment of this sec3 tion, with at least 200 of such positions devoted to child, 

4 adolescent, and family services. The plan developed under 

5 this subsection shall be implemented under the Act of No6 vember 2, 1921 (25 U.S.C. 13) (commonly known as the 

7 ‘Snyder Act’). 

8 ‘‘SEC. 127. AUTHORIZATION OF APPROPRIATIONS. 

9 ‘‘There are authorized to be appropriated such sums 

10 as may be necessary for each fiscal year through fiscal year 

11 2015 to carry out this title. 

12 ‘‘TITLE II—HEALTH SERVICES 

13 ‘‘SEC. 201. INDIAN HEALTH CARE IMPROVEMENT FUND. 

14 ‘‘(a) USE OF FUNDS.—The Secretary, acting through 

15 the Service, is authorized to expend funds, directly or under 

16 the authority of the Indian Self-Determination and Edu17 cation Assistance Act (25 U.S.C. 450 et seq.), which are 

18 appropriated under the authority of this section, for the 

19 purposes of— 

20 ‘‘(1) eliminating the deficiencies in health status 

21 and health resources of all Indian Tribes; 

22 ‘‘(2) eliminating backlogs in the provision of 

23 health care services to Indians; 


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1 ‘‘(3) meeting the health needs of Indians in an 

2 efficient and equitable manner, including the use of 

3 telehealth and telemedicine when appropriate; 

4 ‘‘(4) eliminating inequities in funding for both 

5 direct care and contract health service programs; and 

6 ‘‘(5) augmenting the ability of the Service to 

7 meet the following health service responsibilities with 

8 respect to those Indian Tribes with the highest levels 

9 of health status deficiencies and resource deficiencies: 

10 ‘‘(A) Clinical care, including inpatient 

11 care, outpatient care (including audiology, clin12 ical eye, and vision care), primary care, sec13 ondary and tertiary care, and long-term care. 

14 ‘‘(B) Preventive health, including mammog15 raphy and other cancer screening in accordance 

16 with section 207. 

17 ‘‘(C) Dental care. 

18 ‘‘(D) Mental health, including community 

19 mental health services, inpatient mental health 

20 services, dormitory mental health services, thera21 peutic and residential treatment centers, and 

22 training of traditional health care practitioners. 

23 ‘‘(E) Emergency medical services. 

24 ‘‘(F) Treatment and control of, and reha25 bilitative care related to, alcoholism and drug 


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1 abuse (including fetal alcohol syndrome) among 

2 Indians. 

3 ‘‘(G) Injury prevention programs. 

4 ‘‘(H) Home health care. 

5 ‘‘(I) Community health representatives. 

6 ‘‘(J) Maintenance and improvement. 

7 ‘‘(K) Traditional Health Care Practices. 

8 ‘‘(b) NO OFFSET OR LIMITATION.—Any funds appro9 priated under the authority of this section shall not be used 

10 to offset or limit any other appropriations made to the 

11 Service under this Act or the Act of November 2, 1921 (25 

12 U.S.C. 13) (commonly known as the ‘Snyder Act’), or any 

13 other provision of law. 

14 ‘‘(c) ALLOCATION; USE.— 

15 ‘‘(1) IN GENERAL.—Funds appropriated under 

16 the authority of this section shall be allocated to Serv17 ice Units, Indian Tribes, or Tribal Organizations. 

18 The funds allocated to each Indian Tribe, Tribal Or19 ganization, or Service Unit under this paragraph 

20 shall be used by the Indian Tribe, Tribal Organiza21 tion, or Service Unit under this paragraph to im22 prove the health status and reduce the resource defi23 ciency of each Indian Tribe served by such Service 

24 Unit, Indian Tribe, or Tribal Organization. 


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1 ‘‘(2) APPORTIONMENT OF ALLOCATED FUNDS.— 

2 The apportionment of funds allocated to a Service 

3 Unit, Indian Tribe, or Tribal Organization under 

4 paragraph (1) among the health service responsibil5 ities described in subsection (a)(5) shall be determined 

6 by the Service in consultation with, and with the ac7 tive participation of, the affected Indian Tribes and 

8 Tribal Organizations. 

9 ‘‘(d) PROVISIONS RELATING TO HEALTH STATUS AND

10 RESOURCE DEFICIENCIES.—For the purposes of this sec11 tion, the following definitions apply: 

12 ‘‘(1) DEFINITION.—The term ‘health status and 

13 resource deficiency’ means the extent to which— 

14 ‘‘(A) the health status objectives set forth in 

15 section 3(2) are not being achieved; and 

16 ‘‘(B) the Indian Tribe or Tribal Organiza17 tion does not have available to it the health re18 sources it needs, taking into account the actual 

19 cost of providing health care services given local 

20 geographic, climatic, rural, or other cir21 cumstances. 

22 ‘‘(2) AVAILABLE RESOURCES.—The health re23 sources available to an Indian Tribe or Tribal Orga24 nization include health resources provided by the 

25 Service as well as health resources used by the Indian 


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1 Tribe or Tribal Organization, including services and 

2 financing systems provided by any Federal programs, 

3 private insurance, and programs of State or local 

4 governments. 

5 ‘‘(3) PROCESS FOR REVIEW OF DETERMINA6 TIONS.—The Secretary shall establish procedures 

7 which allow any Indian Tribe or Tribal Organization 

8 to petition the Secretary for a review of any deter9 mination of the extent of the health status and re10 source deficiency of such Indian Tribe or Tribal Or11 ganization. 

12 ‘‘(e) ELIGIBILITY FOR FUNDS.—Tribal Health Pro13 grams shall be eligible for funds appropriated under the au14 thority of this section on an equal basis with programs that 

15 are administered directly by the Service. 

16 ‘‘(f) REPORT.—By no later than the date that is 3 

17 years after the date of enactment of the Indian Health Care 

18 Improvement Act Amendments of 2005, the Secretary shall 

19 submit to Congress the current health status and resource 

20 deficiency report of the Service for each Service Unit, in21 cluding newly recognized or acknowledged Indian Tribes. 

22 Such report shall set out— 

23 ‘‘(1) the methodology then in use by the Service 

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1 ficiencies, as well as the most recent application of 

2 that methodology; 

3 ‘‘(2) the extent of the health status and resource 

4 deficiency of each Indian Tribe served by the Service 

5 or a Tribal Health Program; 

6 ‘‘(3) the amount of funds necessary to eliminate 

7 the health status and resource deficiencies of all In8 dian Tribes served by the Service or a Tribal Health 

9 Program; and 

10 ‘‘(4) an estimate of— 

11 ‘‘(A) the amount of health service funds ap12 propriated under the authority of this Act, or 

13 any other Act, including the amount of any 

14 funds transferred to the Service for the preceding 

15 fiscal year which is allocated to each Service 

16 Unit, Indian Tribe, or Tribal Organization; 

17 ‘‘(B) the number of Indians eligible for 

18 health services in each Service Unit or Indian 

19 Tribe or Tribal Organization; and 

20 ‘‘(C) the number of Indians using the Serv21 ice resources made available to each Service 

22 Unit, Indian Tribe or Tribal Organization, and, 

23 to the extent available, information on the wait24 ing lists and number of Indians turned away for 

25 services due to lack of resources. 


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1 ‘‘(g) INCLUSION IN BASE BUDGET.—Funds appro2 priated under this section for any fiscal year shall be in3 cluded in the base budget of the Service for the purpose of 

4 determining appropriations under this section in subse5 quent fiscal years. 

6 ‘‘(h) CLARIFICATION.—Nothing in this section is in7 tended to diminish the primary responsibility of the Service 

8 to eliminate existing backlogs in unmet health care needs, 

9 nor are the provisions of this section intended to discourage 

10 the Service from undertaking additional efforts to achieve 

11 equity among Indian Tribes and Tribal Organizations. 

12 ‘‘(i) FUNDING DESIGNATION.—Any funds appro13 priated under the authority of this section shall be des14 ignated as the ‘Indian Health Care Improvement Fund’. 

15 ‘‘SEC. 202. CATASTROPHIC HEALTH EMERGENCY FUND. 

16 ‘‘(a) ESTABLISHMENT.—There is established an In17 dian Catastrophic Health Emergency Fund (hereafter in 

18 this section referred to as the ‘CHEF’) consisting of— 

19 ‘‘(1) the amounts deposited under subsection (f); 

20 and 

21 ‘‘(2) the amounts appropriated to CHEF under 

22 this section. 

23 ‘‘(b) ADMINISTRATION.—CHEF shall be administered 

24 by the Secretary, acting through the central office of the 

25 Service, solely for the purpose of meeting the extraordinary 


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1 medical costs associated with the treatment of victims of 

2 disasters or catastrophic illnesses who are within the re3 sponsibility of the Service. 

4 ‘‘(c) CONDITIONS ON USE OF FUND.—No part of 

5 CHEF or its administration shall be subject to contract or 

6 grant under any law, including the Indian Self-Determina7 tion and Education Assistance Act (25 U.S.C. 450 et seq.), 

8 nor shall CHEF funds be allocated, apportioned, or dele9 gated on an Area Office, Service Unit, or other similar 

10 basis. 

11 ‘‘(d) REGULATIONS.—The Secretary shall, through the 

12 negotiated rulemaking process under title VIII, promulgate 

13 regulations consistent with the provisions of this section 

14 to— 

15 ‘‘(1) establish a definition of disasters and cata16 strophic illnesses for which the cost of the treatment 

17 provided under contract would qualify for payment 

18 from CHEF; 

19 ‘‘(2) provide that a Service Unit shall not be eli20 gible for reimbursement for the cost of treatment from 

21 CHEF until its cost of treating any victim of such 

22 catastrophic illness or disaster has reached a certain 

23 threshold cost which the Secretary shall establish at— 

24 ‘‘(A) the 2000 level of $19,000; and 


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1 ‘‘(B) for any subsequent year, not less than 

2 the threshold cost of the previous year increased 

3 by the percentage increase in the medical care 

4 expenditure category of the consumer price index 

5 for all urban consumers (United States city av6 erage) for the 12-month period ending with De7 cember of the previous year; 

8 ‘‘(3) establish a procedure for the reimbursement 

9 of the portion of the costs that exceeds such threshold 

10 cost incurred by— 

11 ‘‘(A) Service Units; or 

12 ‘‘(B) whenever otherwise authorized by the 

13 Service, non-Service facilities or providers; 

14 ‘‘(4) establish a procedure for payment from 

15 CHEF in cases in which the exigencies of the medical 

16 circumstances warrant treatment prior to the author17 ization of such treatment by the Service; and 

18 ‘‘(5) establish a procedure that will ensure that 

19 no payment shall be made from CHEF to any pro20 vider of treatment to the extent that such provider is 

21 eligible to receive payment for the treatment from any 

22 other Federal, State, local, or private source of reim23 bursement for which the patient is eligible. 

24 ‘‘(e) NO OFFSET OR LIMITATION.—Amounts appro25 priated to CHEF under this section shall not be used to 


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1 offset or limit appropriations made to the Service under 

2 the authority of the Act of November 2, 1921 (25 U.S.C. 

3 13) (commonly known as the ‘Snyder Act’), or any other 

4 law. 

5 ‘‘(f) DEPOSIT OF REIMBURSEMENT FUNDS.—There 

6 shall be deposited into CHEF all reimbursements to which 

7 the Service is entitled from any Federal, State, local, or 

8 private source (including third party insurance) by reason 

9 of treatment rendered to any victim of a disaster or cata10 strophic illness the cost of which was paid from CHEF. 

11 ‘‘SEC. 203. HEALTH PROMOTION AND DISEASE PREVENTION 

12 SERVICES. 

13 ‘‘(a) FINDINGS.—Congress finds that health promotion 

14 and disease prevention activities— 

15 ‘‘(1) improve the health and well-being of Indi16 ans; and 

17 ‘‘(2) reduce the expenses for health care of Indi18 ans. 

19 ‘‘(b) PROVISION OF SERVICES.—The Secretary, acting 

20 through the Service and Tribal Health Programs, shall pro21 vide health promotion and disease prevention services to In22 dians to achieve the health status objectives set forth in sec23 tion 3(2). 

24 ‘‘(c) EVALUATION.—The Secretary, after obtaining 

25 input from the affected Tribal Health Programs, shall subVerDate Aug 31 2005 05:25 Mar 17, 2006 Jkt 049200 PO 00000 Frm 00425 Fmt 6652 Sfmt 6203 E:\BILLS\S1057.RS S1057

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1 mit to the President for inclusion in the report which is 

2 required to be submitted to Congress under section 801 an 

3 evaluation of— 

4 ‘‘(1) the health promotion and disease prevention 

5 needs of Indians; 

6 ‘‘(2) the health promotion and disease prevention 

7 activities which would best meet such needs; 

8 ‘‘(3) the internal capacity of the Service and 

9 Tribal Health Programs to meet such needs; and 

10 ‘‘(4) the resources which would be required to en11 able the Service and Tribal Health Programs to un12 dertake the health promotion and disease prevention 

13 activities necessary to meet such needs. 

14 ‘‘SEC. 204. DIABETES PREVENTION, TREATMENT, AND CON15 TROL. 

16 ‘‘(a) DETERMINATIONS REGARDING DIABETES.—The 

17 Secretary, acting through the Service, and in consultation 

18 with Indian Tribes and Tribal Organizations, shall deter19 mine— 

20 ‘‘(1) by Indian Tribe and by Service Unit, the 

21 incidence of, and the types of complications resulting 

22 from, diabetes among Indians; and 

23 ‘‘(2) based on the determinations made pursuant 

24 to paragraph (1), the measures (including patient 

25 education and effective ongoing monitoring of disease 


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1 indicators) each Service Unit should take to reduce 

2 the incidence of, and prevent, treat, and control the 

3 complications resulting from, diabetes among Indian 

4 Tribes within that Service Unit. 

5 ‘‘(b) DIABETES SCREENING.—To the extent medically 

6 indicated and with informed consent, the Secretary shall 

7 screen each Indian who receives services from the Service 

8 for diabetes and for conditions which indicate a high risk 

9 that the individual will become diabetic and, in consulta10 tion with Indian Tribes, Urban Indian Organizations, and 

11 appropriate health care providers, establish a cost-effective 

12 approach to ensure ongoing monitoring of disease indica13 tors. Such screening and monitoring may be conducted by 

14 a Tribal Health Program and may be conducted through 

15 appropriate Internet-based health care management pro16 grams. 

17 ‘‘(c) FUNDING FOR DIABETES.—The Secretary shall 

18 continue to maintain each model diabetes project in exist19 ence on the date of enactment of the Indian Health Care 

20 Improvement Act Amendments of 2005, any such other dia21 betes programs operated by the Service or Tribal Health 

22 Programs, and any additional diabetes projects, such as the 

23 Medical Vanguard program provided for in title IV of Pub24 lic Law 108–87, as implemented to serve Indian Tribes. 

25 Tribal Health Programs shall receive recurring funding for 


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1 the diabetes projects that they operate pursuant to this sec2 tion, both at the date of enactment of the Indian Health 

3 Care Improvement Act Amendments of 2005 and for 

4 projects which are added and funded thereafter. 

5 ‘‘(d) FUNDING FOR DIALYSIS PROGRAMS.—The Sec6 retary is authorized to provide funding through the Service, 

7 Indian Tribes, and Tribal Organizations to establish dialy8 sis programs, including funding to purchase dialysis equip9 ment and provide necessary staffing. 

10 ‘‘(e) OTHER DUTIES OF THE SECRETARY.— 

11 ‘‘(1) IN GENERAL.—The Secretary shall, to the 

12 extent funding is available— 

13 ‘‘(A) in each Area Office, consult with In14 dian Tribes and Tribal Organizations regarding 

15 programs for the prevention, treatment, and con16 trol of diabetes; 

17 ‘‘(B) establish in each Area Office a registry 

18 of patients with diabetes to track the incidence 

19 of diabetes and the complications from diabetes 

20 in that area; and 

21 ‘‘(C) ensure that data collected in each Area 

22 Office regarding diabetes and related complica23 tions among Indians are disseminated to all 

24 other Area Offices, subject to applicable patient 

25 privacy laws. 


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1 ‘‘(2) DIABETES CONTROL OFFICERS.— 

2 ‘‘(A) IN GENERAL.—The Secretary may es3 tablish and maintain in each Area Office a posi4 tion of diabetes control officer to coordinate and 

5 manage any activity of that Area Office relating 

6 to the prevention, treatment, or control of diabe7 tes to assist the Secretary in carrying out a pro8 gram under this section or section 330C of the 

9 Public Health Service Act (42 U.S.C. 254c–3). 

10 ‘‘(B) CERTAIN ACTIVITIES.—Any activity 

11 carried out by a diabetes control officer under 

12 subparagraph (A) that is the subject of a con13 tract or compact under the Indian Self-Deter14 mination and Education Assistance Act (25 

15 U.S.C. 450 et seq.), and any funds made avail16 able to carry out such an activity, shall not be 

17 divisible for purposes of that Act. 

18 ‘‘SEC. 205. SHARED SERVICES FOR LONG-TERM CARE. 

19 ‘‘(a) LONG-TERM CARE.—Notwithstanding any other 

20 provision of law, the Secretary, acting through the Service, 

21 is authorized to provide directly, or enter into contracts or 

22 compacts under the Indian Self-Determination and Edu23 cation Assistance Act (25 U.S.C. 450 et seq.) with Indian 

24 Tribes or Tribal Organizations for, the delivery of long-term 

25 care and similar services to Indians. Such agreements shall 


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1 provide for the sharing of staff or other services between the 

2 Service or a Tribal Health Program and a long-term care 

3 or other similar facility owned and operated (directly or 

4 through a contract or compact under the Indian Self-Deter5 mination and Education Assistance Act (25 U.S.C. 450 et 

6 seq.)) by such Indian Tribe or Tribal Organization. 

7 ‘‘(b) CONTENTS OF AGREEMENTS.—An agreement en8 tered into pursuant to subsection (a)— 

9 ‘‘(1) may, at the request of the Indian Tribe or 

10 Tribal Organization, delegate to such Indian Tribe or 

11 Tribal Organization such powers of supervision and 

12 control over Service employees as the Secretary deems 

13 necessary to carry out the purposes of this section; 

14 ‘‘(2) shall provide that expenses (including sala15 ries) relating to services that are shared between the 

16 Service and the Tribal Health Program be allocated 

17 proportionately between the Service and the Indian 

18 Tribe or Tribal Organization; and 

19 ‘‘(3) may authorize such Indian Tribe or Tribal 

20 Organization to construct, renovate, or expand a 

21 long-term care or other similar facility (including the 

22 construction of a facility attached to a Service facil23 ity). 

24 ‘‘(c) MINIMUM REQUIREMENT.—Any nursing facility 

25 provided for under this section shall meet the requirements 


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1 for nursing facilities under section 1919 of the Social Secu2 rity Act. 

3 ‘‘(d) OTHER ASSISTANCE.—The Secretary shall pro4 vide such technical and other assistance as may be nec5 essary to enable applicants to comply with the provisions 

6 of this section. 

7 ‘‘(e) USE OF EXISTING OR UNDERUSED FACILITIES.— 

8 The Secretary shall encourage the use of existing facilities 

9 that are underused or allow the use of swing beds for long10 term or similar care. 

11 ‘‘SEC. 206. HEALTH SERVICES RESEARCH. 

12 ‘‘The Secretary, acting through the Service, shall make 

13 funding available for research to further the performance 

14 of the health service responsibilities of Indian Health Pro15 grams. The Secretary shall also, to the maximum extent 

16 practicable, coordinate departmental research resources and 

17 activities to address relevant Indian Health Program re18 search needs. Tribal Health Programs shall be given an 

19 equal opportunity to compete for, and receive, research 

20 funds under this section. This funding may be used for both 

21 clinical and nonclinical research. 

22 ‘‘SEC. 207. MAMMOGRAPHY AND OTHER CANCER SCREEN23 ING. 

24 ‘‘The Secretary, acting through the Service or Tribal 

25 Health Programs, shall provide for screening as follows: 


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1 ‘‘(1) Screening mammography (as defined in sec2 tion 1861(jj) of the Social Security Act) for Indian 

3 women at a frequency appropriate to such women 

4 under accepted and appropriate national standards, 

5 and under such terms and conditions as are con6 sistent with standards established by the Secretary to 

7 ensure the safety and accuracy of screening mammog8 raphy under part B of title XVIII of such Act. 

9 ‘‘(2) Other cancer screening meeting accepted 

10 and appropriate national standards. 

11 ‘‘SEC. 208. PATIENT TRAVEL COSTS. 

12 ‘‘The Secretary, acting through the Service and Tribal 

13 Health Programs, is authorized to provide funds for the fol14 lowing patient travel costs, including appropriate and nec15 essary qualified escorts, associated with receiving health 

16 care services provided (either through direct or contract care 

17 or through a contract or compact under the Indian Self18 Determination and Education Assistance Act (25 U.S.C. 

19 450 et seq.)) under this Act— 

20 ‘‘(1) emergency air transportation and non21 emergency air transportation where ground transpor22 tation is infeasible; 

23 ‘‘(2) transportation by private vehicle (where no 

24 other means of transportation is available), specially 

25 equipped vehicle, and ambulance; and 


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1 ‘‘(3) transportation by such other means as may 

2 be available and required when air or motor vehicle 

3 transportation is not available. 

4 ‘‘SEC. 209. EPIDEMIOLOGY CENTERS. 

5 ‘‘(a) ADDITIONAL CENTERS.—In addition to those epi6 demiology centers already established as of the date of enact7 ment of this Act, and without reducing the funding levels 

8 for such centers, not later than 180 days after the date of 

9 enactment of the Indian Health Care Improvement Act 

10 Amendments of 2005, the Secretary, acting through the 

11 Service, shall establish an epidemiology center in each Serv12 ice Area which does not yet have one to carry out the func13 tions described in subsection (b). Any new centers so estab14 lished may be operated by Tribal Health Programs, but 

15 such funding shall not be divisible. 

16 ‘‘(b) FUNCTIONS OF CENTERS.—In consultation with 

17 and upon the request of Indian Tribes, Tribal Organiza18 tions, and Urban Indian Organizations, each Service Area 

19 epidemiology center established under this subsection shall, 

20 with respect to such Service Area— 

21 ‘‘(1) collect data relating to, and monitor 

22 progress made toward meeting, each of the health sta23 tus objectives of the Service, the Indian Tribes, Tribal 

24 Organizations, and Urban Indian Organizations in 

25 the Service Area; 


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1 ‘‘(2) evaluate existing delivery systems, data sys2 tems, and other systems that impact the improvement 

3 of Indian health; 

4 ‘‘(3) assist Indian Tribes, Tribal Organizations, 

5 and Urban Indian Organizations in identifying their 

6 highest priority health status objectives and the serv7 ices needed to achieve such objectives, based on epide8 miological data; 

9 ‘‘(4) make recommendations for the targeting of 

10 services needed by the populations served; 

11 ‘‘(5) make recommendations to improve health 

12 care delivery systems for Indians and Urban Indians; 

13 ‘‘(6) provide requested technical assistance to In14 dian Tribes, Tribal Organizations, and Urban Indian 

15 Organizations in the development of local health serv16 ice priorities and incidence and prevalence rates of 

17 disease and other illness in the community; and 

18 ‘‘(7) provide disease surveillance and assist In19 dian Tribes, Tribal Organizations, and Urban Indian 

20 Organizations to promote public health. 

21 ‘‘(c) TECHNICAL ASSISTANCE.—The Director of the 

22 Centers for Disease Control and Prevention shall provide 

23 technical assistance to the centers in carrying out the re24 quirements of this subsection. 


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1 ‘‘(d) FUNDING FOR STUDIES.—The Secretary may 

2 make funding available to Indian Tribes, Tribal Organiza3 tions, and Urban Indian Organizations to conduct epide4 miological studies of Indian communities. 

5 ‘‘SEC. 210. COMPREHENSIVE SCHOOL HEALTH EDUCATION 

6 PROGRAMS. 

7 ‘‘(a) FUNDING FOR DEVELOPMENT OF PROGRAMS.— 

8 In addition to carrying out any other program for health 

9 promotion or disease prevention, the Secretary, acting 

10 through the Service, is authorized to award grants to In11 dian Tribes, Tribal Organizations, and Urban Indian Or12 ganizations to develop comprehensive school health edu13 cation programs for children from pre-school through grade 

14 12 in schools for the benefit of Indian and Urban Indian 

15 children. 

16 ‘‘(b) USE OF GRANT FUNDS.—A grant awarded under 

17 this section may be used for purposes which may include, 

18 but are not limited to, the following: 

19 ‘‘(1) Developing and implementing health edu20 cation curricula both for regular school programs and 

21 afterschool programs. 

22 ‘‘(2) Training teachers in comprehensive school 

23 health education curricula. 

24 ‘‘(3) Integrating school-based, community-based, 

25 and other public and private health promotion efforts. 


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1 ‘‘(4) Encouraging healthy, tobacco-free school en2 vironments. 

3 ‘‘(5) Coordinating school-based health programs 

4 with existing services and programs available in the 

5 community. 

6 ‘‘(6) Developing school programs on nutrition 

7 education, personal health, oral health, and fitness. 

8 ‘‘(7) Developing behavioral health wellness pro9 grams. 

10 ‘‘(8) Developing chronic disease prevention pro11 grams. 

12 ‘‘(9) Developing substance abuse prevention pro13 grams. 

14 ‘‘(10) Developing injury prevention and safety 

15 education programs. 

16 ‘‘(11) Developing activities for the prevention 

17 and control of communicable diseases. 

18 ‘‘(12) Developing community and environmental 

19 health education programs that include traditional 

20 health care practitioners. 

21 ‘‘(13) Violence prevention. 

22 ‘‘(14) Such other health issues as are appro23 priate. 

24 ‘‘(c) TECHNICAL ASSISTANCE.—Upon request, the Sec25 retary, acting through the Service, shall provide technical 


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1 assistance to Indian Tribes, Tribal Organizations, and 

2 Urban Indian Organizations in the development of com3 prehensive health education plans and the dissemination of 

4 comprehensive health education materials and information 

5 on existing health programs and resources. 

6 ‘‘(d) CRITERIA FOR REVIEW AND APPROVAL OF APPLI7 CATIONS.—The Secretary, acting through the Service, and 

8 in consultation with Indian Tribes, Tribal Organizations, 

9 and Urban Indian Organizations, shall establish criteria 

10 for the review and approval of applications for grants 

11 awarded under this section. 

12 ‘‘(e) DEVELOPMENT OF PROGRAM FOR BIA FUNDED

13 SCHOOLS.— 

14 ‘‘(1) IN GENERAL.—The Secretary of the Inte15 rior, acting through the Bureau of Indian Affairs and 

16 in cooperation with the Secretary, acting through the 

17 Service, and affected Indian Tribes and Tribal Orga18 nizations, shall develop a comprehensive school health 

19 education program for children from preschool 

20 through grade 12 in schools for which support is pro21 vided by the Bureau of Indian Affairs. 

22 ‘‘(2) REQUIREMENTS FOR PROGRAMS.—Such 

23 programs shall include— 

24 ‘‘(A) school programs on nutrition edu25 cation, personal health, oral health, and fitness; 


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1 ‘‘(B) behavioral health wellness programs; 

2 ‘‘(C) chronic disease prevention programs; 

3 ‘‘(D) substance abuse prevention programs; 

4 ‘‘(E) injury prevention and safety education 

5 programs; and 

6 ‘‘(F) activities for the prevention and con7 trol of communicable diseases. 

8 ‘‘(3) DUTIES OF THE SECRETARY.—The Sec9 retary of the Interior shall— 

10 ‘‘(A) provide training to teachers in com11 prehensive school health education curricula; 

12 ‘‘(B) ensure the integration and coordina13 tion of school-based programs with existing serv14 ices and health programs available in the com15 munity; and 

16 ‘‘(C) encourage healthy, tobacco-free school 

17 environments. 

18 ‘‘SEC. 211. INDIAN YOUTH PROGRAM. 

19 ‘‘(a) PROGRAM AUTHORIZED.—The Secretary, acting 

20 through the Service, is authorized to establish and admin21 ister a program to provide grants to Indian Tribes, Tribal 

22 Organizations, and Urban Indian Organizations for inno23 vative mental and physical disease prevention and health 

24 promotion and treatment programs for Indian and Urban 

25 Indian preadolescent and adolescent youths. 


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1 ‘‘(b) USE OF FUNDS.— 

2 ‘‘(1) ALLOWABLE USES.—Funds made available 

3 under this section may be used to— 

4 ‘‘(A) develop prevention and treatment pro5 grams for Indian youth which promote mental 

6 and physical health and incorporate cultural 

7 values, community and family involvement, and 

8 traditional health care practitioners; and 

9 ‘‘(B) develop and provide community train10 ing and education. 

11 ‘‘(2) PROHIBITED USE.—Funds made available 

12 under this section may not be used to provide services 

13 described in section 707(c). 

14 ‘‘(c) DUTIES OF THE SECRETARY.—The Secretary 

15 shall— 

16 ‘‘(1) disseminate to Indian Tribes, Tribal Orga17 nizations, and Urban Indian Organizations informa18 tion regarding models for the delivery of comprehen19 sive health care services to Indian and Urban Indian 

20 adolescents; 

21 ‘‘(2) encourage the implementation of such mod22 els; and 

23 ‘‘(3) at the request of an Indian Tribe, Tribal 

24 Organization, or Urban Indian Organization, provide 


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1 technical assistance in the implementation of such 

2 models. 

3 ‘‘(d) CRITERIA FOR REVIEW AND APPROVAL OF APPLI4 CATIONS.—The Secretary, in consultation with Indian 

5 Tribes, Tribal Organizations, and Urban Indian Organiza6 tions, shall establish criteria for the review and approval 

7 of applications or proposals under this section. 

8 ‘‘SEC. 212. PREVENTION, CONTROL, AND ELIMINATION OF 

9 COMMUNICABLE AND INFECTIOUS DISEASES. 

10 ‘‘(a) FUNDING AUTHORIZED.—The Secretary, acting 

11 through the Service, and after consultation with Indian 

12 Tribes, Tribal Organizations, Urban Indian Organizations, 

13 and the Centers for Disease Control and Prevention, may 

14 make funding available to Indian Tribes, Tribal Organiza15 tions, and Urban Indian Organizations for the following: 

16 ‘‘(1) Projects for the prevention, control, and 

17 elimination of communicable and infectious diseases, 

18 including tuberculosis, hepatitis, HIV, respiratory 

19 syncitial virus, hanta virus, sexually transmitted dis20 eases, and H. Pylori. 

21 ‘‘(2) Public information and education programs 

22 for the prevention, control, and elimination of com23 municable and infectious diseases. 

24 ‘‘(3) Education, training, and clinical skills im25 provement activities in the prevention, control, and 


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1 elimination of communicable and infectious diseases 

2 for health professionals, including allied health profes3 sionals. 

4 ‘‘(4) Demonstration projects for the screening, 

5 treatment, and prevention of hepatitis C virus (HCV). 

6 ‘‘(b) APPLICATION REQUIRED.—The Secretary may 

7 provide funding under subsection (a) only if an application 

8 or proposal for funding is submitted to the Secretary. 

9 ‘‘(c) COORDINATION WITH HEALTH AGENCIES.—In10 dian Tribes, Tribal Organizations, and Urban Indian Or11 ganizations receiving funding under this section are encour12 aged to coordinate their activities with the Centers for Dis13 ease Control and Prevention and State and local health 

14 agencies. 

15 ‘‘(d) TECHNICAL ASSISTANCE; REPORT.—In carrying 

16 out this section, the Secretary— 

17 ‘‘(1) may, at the request of an Indian Tribe, 

18 Tribal Organization, or Urban Indian Organization, 

19 provide technical assistance; and 

20 ‘‘(2) shall prepare and submit a report to Con21 gress biennially on the use of funds under this section 

22 and on the progress made toward the prevention, con23 trol, and elimination of communicable and infectious 

24 diseases among Indians and Urban Indians. 


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1 ‘‘SEC. 213. AUTHORITY FOR PROVISION OF OTHER SERV2 ICES. 

3 ‘‘(a) FUNDING AUTHORIZED.—The Secretary, acting 

4 through the Service, Indian Tribes, and Tribal Organiza5 tions, may provide funding under this Act to meet the objec6 tives set forth in section 3 through health care-related serv7 ices and programs not otherwise described in this Act, in8 cluding— 

9 ‘‘(1) hospice care; 

10 ‘‘(2) assisted living; 

11 ‘‘(3) long-term health care; 

12 ‘‘(4) home- and community-based services, in ac13 cordance with subsection (d); and 

14 ‘‘(5) public health functions. 

15 ‘‘(b) SERVICES TO OTHERWISE INELIGIBLE PER16 SONS.—Subject to section 807, at the discretion of the Serv17 ice, Indian Tribes, or Tribal Organizations, services pro18 vided for hospice care, home- and community-based care, 

19 assisted living, and long-term care may be provided (subject 

20 to reimbursement) to persons otherwise ineligible for the 

21 health care benefits of the Service. Any funds received under 

22 this subsection shall not be used to offset or limit the fund23 ing allocated to the Service or an Indian Tribe or Tribal 

24 Organization. 

25 ‘‘(c) TERMS AND CONDITIONS.—The Secretary shall re26 quire that any service provided under this section shall be 


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1 in accordance with such terms and conditions as the Sec2 retary determines to be consistent with accepted and appro3 priate standards relating to the service, including any li4 censing term or condition under this Act. 

5 ‘‘(d) DEFINITIONS.—For the purposes of this section, 

6 the following definitions shall apply: 

7 ‘‘(1)(A) The term ‘home- and community-based 

8 services’ means 1 or more of the following: 

9 ‘‘(i) Home health aide services. 

10 ‘‘(ii) Personal care services. 

11 ‘‘(iii) Nursing care services provided outside 

12 of a nursing facility by, or under the supervision 

13 of, a registered nurse. 

14 ‘‘(iv) Respite care. 

15 ‘‘(v) Training for family members. 

16 ‘‘(vi) Adult day care. 

17 ‘‘(vii) Such other home- and community18 based services as the Secretary, an Indian Tribe, 

19 or a Tribal Organization may approve. 

20 ‘‘(B) The term ‘home- and community-based 

21 services’ does not include a service provided by an in22 dividual that is legally responsible for providing the 

23 service. 

24 ‘‘(2) The term ‘hospice care’ means the items and 

25 services specified in subparagraphs (A) through (H) 


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1 of section 1861(dd)(1) of the Social Security Act (42 

2 U.S.C. 1395x(dd)(1)), and such other services which 

3 an Indian Tribe or Tribal Organization determines 

4 are necessary and appropriate to provide in further5 ance of this care. 

6 ‘‘(3)(A) The term ‘personal care services’ means 

7 services relating to assistance in carrying out activi8 ties of daily living. 

9 ‘‘(B) The term ‘personal care services’ does not 

10 include a service solely relating to assistance in car11 rying out an ancillary activity, such as housekeeping 

12 or household chores, as determined by the Secretary. 

13 ‘‘(4) The term ‘public health functions’ means 

14 the provision of public health-related programs, func15 tions, and services, including assessment, assurance, 

16 and policy development which Indian Tribes and 

17 Tribal Organizations are authorized and encouraged, 

18 in those circumstances where it meets their needs, to 

19 do by forming collaborative relationships with all lev20 els of local, State, and Federal Government. 

21 ‘‘SEC. 214. INDIAN WOMEN’S HEALTH CARE. 

22 ‘‘The Secretary, acting through the Service and Indian 

23 Tribes, Tribal Organizations, and Urban Indian Organiza24 tions, shall monitor and improve the quality of health care 

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1 livery of programs administered by the Service, in order 

2 to improve and enhance the treatment models of care for 

3 Indian women. 

4 ‘‘SEC. 215. ENVIRONMENTAL AND NUCLEAR HEALTH HAZ5 ARDS. 

6 ‘‘(a) STUDIES AND MONITORING.—The Secretary and 

7 the Service shall conduct, in conjunction with other appro8 priate Federal agencies and in consultation with concerned 

9 Indian Tribes and Tribal Organizations, studies and ongo10 ing monitoring programs to determine trends in the health 

11 hazards to Indian miners and to Indians on or near res12 ervations and Indian communities as a result of environ13 mental hazards which may result in chronic or life threat14 ening health problems, such as nuclear resource develop15 ment, petroleum contamination, and contamination of 

16 water source and of the food chain. Such studies shall in17 clude— 

18 ‘‘(1) an evaluation of the nature and extent of 

19 health problems caused by environmental hazards cur20 rently exhibited among Indians and the causes of such 

21 health problems; 

22 ‘‘(2) an analysis of the potential effect of ongoing 

23 and future environmental resource development on or 

24 near reservations and Indian communities, including 

25 the cumulative effect over time on health; 


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1 ‘‘(3) an evaluation of the types and nature of ac2 tivities, practices, and conditions causing or affecting 

3 such health problems, including uranium mining and 

4 milling, uranium mine tailing deposits, nuclear 

5 power plant operation and construction, and nuclear 

6 waste disposal; oil and gas production or transpor7 tation on or near reservations or Indian commu8 nities; and other development that could affect the 

9 health of Indians and their water supply and food 

10 chain; 

11 ‘‘(4) a summary of any findings and rec12 ommendations provided in Federal and State studies, 

13 reports, investigations, and inspections during the 5 

14 years prior to the date of enactment of the Indian 

15 Health Care Improvement Act Amendments of 2005 

16 that directly or indirectly relate to the activities, 

17 practices, and conditions affecting the health or safety 

18 of such Indians; and 

19 ‘‘(5) the efforts that have been made by Federal 

20 and State agencies and resource and economic devel21 opment companies to effectively carry out an edu22 cation program for such Indians regarding the health 

23 and safety hazards of such development. 

24 ‘‘(b) HEALTH CARE PLANS.—Upon completion of such 

25 studies, the Secretary and the Service shall take into acVerDate Aug 31 2005 05:25 Mar 17, 2006 Jkt 049200 PO 00000 Frm 00446 Fmt 6652 Sfmt 6203 E:\BILLS\S1057.RS S1057

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1 count the results of such studies and, in consultation with 

2 Indian Tribes and Tribal Organizations, develop health 

3 care plans to address the health problems studied under sub4 section (a). The plans shall include— 

5 ‘‘(1) methods for diagnosing and treating Indi6 ans currently exhibiting such health problems; 

7 ‘‘(2) preventive care and testing for Indians who 

8 may be exposed to such health hazards, including the 

9 monitoring of the health of individuals who have or 

10 may have been exposed to excessive amounts of radi11 ation or affected by other activities that have had or 

12 could have a serious impact upon the health of such 

13 individuals; and 

14 ‘‘(3) a program of education for Indians who, by 

15 reason of their work or geographic proximity to such 

16 nuclear or other development activities, may experi17 ence health problems. 

18 ‘‘(c) SUBMISSION OF REPORT AND PLAN TO CON19 GRESS.—The Secretary and the Service shall submit to 

20 Congress the study prepared under subsection (a) no later 

21 than 18 months after the date of enactment of the Indian 

22 Health Care Improvement Act Amendments of 2005. The 

23 health care plan prepared under subsection (b) shall be sub24 mitted in a report no later than 1 year after the study pre25 pared under subsection (a) is submitted to Congress. Such 


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1 report shall include recommended activities for the imple2 mentation of the plan, as well as an evaluation of any ac3 tivities previously undertaken by the Service to address such 

4 health problems. 

5 ‘‘(d) INTERGOVERNMENTAL TASK FORCE.— 

6 ‘‘(1) ESTABLISHMENT; MEMBERS.—There is es7 tablished an Intergovernmental Task Force to be com8 posed of the following individuals (or their designees): 

9 ‘‘(A) The Secretary of Energy. 

10 ‘‘(B) The Secretary of the Environmental 

11 Protection Agency. 

12 ‘‘(C) The Director of the Bureau of Mines. 

13 ‘‘(D) The Assistant Secretary for Occupa14 tional Safety and Health. 

15 ‘‘(E) The Secretary of the Interior. 

16 ‘‘(F) The Secretary of Health and Human 

17 Services. 

18 ‘‘(G) The Director of the Indian Health 

19 Service. 

20 ‘‘(2) DUTIES.—The Task Force shall— 

21 ‘‘(A) identify existing and potential oper22 ations related to nuclear resource development or 

23 other environmental hazards that affect or may 

24 affect the health of Indians on or near a reserva25 tion or in an Indian community; and 


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1 ‘‘(B) enter into activities to correct existing 

2 health hazards and ensure that current and fu3 ture health problems resulting from nuclear re4 source or other development activities are mini5 mized or reduced. 

6 ‘‘(3) CHAIRMAN; MEETINGS.—The Secretary of 

7 Health and Human Services shall be the Chairman 

8 of the Task Force. The Task Force shall meet at least 

9 twice each year. 

10 ‘‘(e) HEALTH SERVICES TO CERTAIN EMPLOYEES.— 

11 In the case of any Indian who— 

12 ‘‘(1) as a result of employment in or near a ura13 nium mine or mill or near any other environmental 

14 hazard, suffers from a work-related illness or condi15 tion; 

16 ‘‘(2) is eligible to receive diagnosis and treatment 

17 services from an Indian Health Program; and 

18 ‘‘(3) by reason of such Indian’s employment, is 

19 entitled to medical care at the expense of such mine 

20 or mill operator or entity responsible for the environ21 mental hazard, the Indian Health Program shall, at 

22 the request of such Indian, render appropriate med23 ical care to such Indian for such illness or condition 

24 and may be reimbursed for any medical care so ren25 dered to which such Indian is entitled at the expense 


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1 of such operator or entity from such operator or enti2 ty. Nothing in this subsection shall affect the rights 

3 of such Indian to recover damages other than such 

4 amounts paid to the Indian Health Program from the 

5 employer for providing medical care for such illness 

6 or condition. 

7 ‘‘SEC. 216. ARIZONA AS A CONTRACT HEALTH SERVICE DE8 LIVERY AREA. 

9 ‘‘(a) IN GENERAL.—For fiscal years beginning with 

10 the fiscal year ending September 30, 1983, and ending with 

11 the fiscal year ending September 30, 2015, the State of Ari12 zona shall be designated as a contract health service delivery 

13 area by the Service for the purpose of providing contract 

14 health care services to members of federally recognized In15 dian Tribes of Arizona. 

16 ‘‘(b) MAINTENANCE OF SERVICES.—The Service shall 

17 not curtail any health care services provided to Indians re18 siding on reservations in the State of Arizona if such cur19 tailment is due to the provision of contract services in such 

20 State pursuant to the designation of such State as a con21 tract health service delivery area pursuant to subsection (a). 

22 ‘‘SEC. 216A. NORTH DAKOTA AND SOUTH DAKOTA AS CON23 TRACT HEALTH SERVICE DELIVERY AREA. 

24 ‘‘(a) IN GENERAL.—Beginning in fiscal year 2003, the 

25 States of North Dakota and South Dakota shall be desVerDate Aug 31 2005 05:25 Mar 17, 2006 Jkt 049200 PO 00000 Frm 00450 Fmt 6652 Sfmt 6203 E:\BILLS\S1057.RS S1057

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1 ignated as a contract health service delivery area by the 

2 Service for the purpose of providing contract health care 

3 services to members of federally recognized Indian Tribes 

4 of North Dakota and South Dakota. 

5 ‘‘(b) LIMITATION.—The Service shall not curtail any 

6 health care services provided to Indians residing on any 

7 reservation, or in any county that has a common boundary 

8 with any reservation, in the State of North Dakota or South 

9 Dakota if such curtailment is due to the provision of con10 tract services in such States pursuant to the designation 

11 of such States as a contract health service delivery area pur12 suant to subsection (a). 

13 ‘‘SEC. 217. CALIFORNIA CONTRACT HEALTH SERVICES PRO14 GRAM. 

15 ‘‘(a) FUNDING AUTHORIZED.—The Secretary is au16 thorized to fund a program using the California Rural In17 dian Health Board (hereafter in this section referred to as 

18 the ‘CRIHB’) as a contract care intermediary to improve 

19 the accessibility of health services to California Indians. 

20 ‘‘(b) REIMBURSEMENT CONTRACT.—The Secretary 

21 shall enter into an agreement with the CRIHB to reimburse 

22 the CRIHB for costs (including reasonable administrative 

23 costs) incurred pursuant to this section, in providing med24 ical treatment under contract to California Indians de25 scribed in section 806(a) throughout the California contract 


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1 health services delivery area described in section 218 with 

2 respect to high cost contract care cases. 

3 ‘‘(c) ADMINISTRATIVE EXPENSES.—Not more than 5 

4 percent of the amounts provided to the CRIHB under this 

5 section for any fiscal year may be for reimbursement for 

6 administrative expenses incurred by the CRIHB during 

7 such fiscal year. 

8 ‘‘(d) LIMITATION ON PAYMENT.—No payment may be 

9 made for treatment provided hereunder to the extent pay10 ment may be made for such treatment under the Indian 

11 Catastrophic Health Emergency Fund described in section 

12 202 or from amounts appropriated or otherwise made 

13 available to the California contract health service delivery 

14 area for a fiscal year. 

15 ‘‘(e) ADVISORY BOARD.—There is established an advi16 sory board which shall advise the CRIHB in carrying out 

17 this section. The advisory board shall be composed of rep18 resentatives, selected by the CRIHB, from not less than 8 

19 Tribal Health Programs serving California Indians covered 

20 under this section at least one half of whom of whom are 

21 not affiliated with the CRIHB. 

22 ‘‘SEC. 218. CALIFORNIA AS A CONTRACT HEALTH SERVICE 

23 DELIVERY AREA. 

24 ‘‘The State of California, excluding the counties of Ala25 meda, Contra Costa, Los Angeles, Marin, Orange, SacVerDate Aug 31 2005 05:25 Mar 17, 2006 Jkt 049200 PO 00000 Frm 00452 Fmt 6652 Sfmt 6203 E:\BILLS\S1057.RS S1057

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1 ramento, San Francisco, San Mateo, Santa Clara, Kern, 

2 Merced, Monterey, Napa, San Benito, San Joaquin, San 

3 Luis Obispo, Santa Cruz, Solano, Stanislaus, and Ventura, 

4 shall be designated as a contract health service delivery area 

5 by the Service for the purpose of providing contract health 

6 services to California Indians. However, any of the counties 

7 listed herein may only be included in the contract health 

8 services delivery area if funding is specifically provided by 

9 the Service for such services in those counties. 

10 ‘‘SEC. 219. CONTRACT HEALTH SERVICES FOR THE TREN11 TON SERVICE AREA. 

12 ‘‘(a) AUTHORIZATION FOR SERVICES.—The Secretary, 

13 acting through the Service, is directed to provide contract 

14 health services to members of the Turtle Mountain Band 

15 of Chippewa Indians that reside in the Trenton Service 

16 Area of Divide, McKenzie, and Williams counties in the 

17 State of North Dakota and the adjoining counties of Rich18 land, Roosevelt, and Sheridan in the State of Montana. 

19 ‘‘(b) NO EXPANSION OF ELIGIBILITY.—Nothing in this 

20 section may be construed as expanding the eligibility of 

21 members of the Turtle Mountain Band of Chippewa Indians 

22 for health services provided by the Service beyond the scope 

23 of eligibility for such health services that applied on May 

24 1, 1986. 


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1 ‘‘SEC. 220. PROGRAMS OPERATED BY INDIAN TRIBES AND 

2 TRIBAL ORGANIZATIONS. 

3 ‘‘The Service shall provide funds for health care pro4 grams and facilities operated by Tribal Health Programs 

5 on the same basis as such funds are provided to programs 

6 and facilities operated directly by the Service. 

7 ‘‘SEC. 221. LICENSING. 

8 ‘‘Health care professionals employed by a Tribal 

9 Health Program shall, if licensed in any State, be exempt 

10 from the licensing requirements of the State in which the 

11 Tribal Health Program performs the services described in 

12 its contract or compact under the Indian Self-Determina13 tion and Education Assistance Act (25 U.S.C. 450 et seq.). 

14 ‘‘SEC. 222. NOTIFICATION OF PROVISION OF EMERGENCY 

15 CONTRACT HEALTH SERVICES. 

16 ‘‘With respect to an elderly Indian or an Indian with 

17 a disability receiving emergency medical care or services 

18 from a non-Service provider or in a non-Service facility 

19 under the authority of this Act, the time limitation (as a 

20 condition of payment) for notifying the Service of such 

21 treatment or admission shall be 30 days. 

22 ‘‘SEC. 223. PROMPT ACTION ON PAYMENT OF CLAIMS. 

23 ‘‘(a) DEADLINE FOR RESPONSE.—The Service shall re24 spond to a notification of a claim by a provider of a con25 tract care service with either an individual purchase order 


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1 or a denial of the claim within 5 working days after the 

2 receipt of such notification. 

3 ‘‘(b) EFFECT OF UNTIMELY RESPONSE.—If the Service 

4 fails to respond to a notification of a claim in accordance 

5 with subsection (a), the Service shall accept as valid the 

6 claim submitted by the provider of a contract care service. 

7 ‘‘(c) DEADLINE FOR PAYMENT OF VALID CLAIM.—The 

8 Service shall pay a valid contract care service claim within 

9 30 days after the completion of the claim. 

10 ‘‘SEC. 224. LIABILITY FOR PAYMENT. 

11 ‘‘(a) NO PATIENT LIABILITY.—A patient who receives 

12 contract health care services that are authorized by the 

13 Service shall not be liable for the payment of any charges 

14 or costs associated with the provision of such services. 

15 ‘‘(b) NOTIFICATION.—The Secretary shall notify a con16 tract care provider and any patient who receives contract 

17 health care services authorized by the Service that such pa18 tient is not liable for the payment of any charges or costs 

19 associated with the provision of such services not later than 

20 5 business days after receipt of a notification of a claim 

21 by a provider of contract care services. 

22 ‘‘(c) NO RECOURSE.—Following receipt of the notice 

23 provided under subsection (b), or, if a claim has been 

24 deemed accepted under section 223(b), the provider shall 


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1 have no further recourse against the patient who received 

2 the services. 

3 ‘‘SEC. 225. OFFICE OF INDIAN MEN’S HEALTH. 

4 ‘‘(a) ESTABLISHMENT.—The Secretary shall establish 

5 within the Service an office to be known as the ‘Office of 

6 Indian Men’s Health’ (referred to in this section as the ‘Of7 fice’). 

8 ‘‘(b) DIRECTOR.— 

9 ‘‘(1) IN GENERAL.—The Office shall be headed by 

10 a Director, to be appointed by the Secretary. 

11 ‘‘(2) DUTIES.—The Director shall coordinate 

12 and promote the status of the health of Indian men 

13 in the United States. 

14 ‘‘(c) REPORT.—Not later than 2 years after the date 

15 of enactment of the Indian Health Care Improvement Act 

16 Amendments of 2005, the Secretary, acting through the Di17 rector of the Office, shall submit to Congress a report de18 scribing— 

19 ‘‘(1) any activity carried out by the Director as 

20 of the date on which the report is prepared; and 

21 ‘‘(2) any finding of the Director with respect to 

22 the health of Indian men. 


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1 ‘‘SEC. 226. AUTHORIZATION OF APPROPRIATIONS. 

2 ‘‘There are authorized to be appropriated such sums 

3 as may be necessary for each fiscal year through fiscal year 

4 2015 to carry out this title. 

5 ‘‘TITLE III—FACILITIES 

6 ‘‘SEC. 301. CONSULTATION; CONSTRUCTION AND RENOVA7 TION OF FACILITIES; REPORTS. 

8 ‘‘(a) PREREQUISITES FOR EXPENDITURE OF

9 FUNDS.—Prior to the expenditure of, or the making of any 

10 binding commitment to expend, any funds appropriated for 

11 the planning, design, construction, or renovation of facili12 ties pursuant to the Act of November 2, 1921 (25 U.S.C. 

13 13) (commonly known as the ‘Snyder Act’), the Secretary, 

14 acting through the Service, shall— 

15 ‘‘(1) consult with any Indian Tribe that would 

16 be significantly affected by such expenditure for the 

17 purpose of determining and, whenever practicable, 

18 honoring tribal preferences concerning size, location, 

19 type, and other characteristics of any facility on 

20 which such expenditure is to be made; and 

21 ‘‘(2) ensure, whenever practicable and applicable, 

22 that such facility meets the construction standards of 

23 any accrediting body recognized by the Secretary for 

24 the purposes of the medicare, medicaid, and SCHIP 

25 programs under titles XVIII, XIX, and XXI of the 

26 Social Security Act by not later than 1 year after the 


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1 date on which the construction or renovation of such 

2 facility is completed. 

3 ‘‘(b) CLOSURES.— 

4 ‘‘(1) EVALUATION REQUIRED.—Notwithstanding 

5 any other provision of law, no facility operated by the 

6 Service may be closed if the Secretary has not sub7 mitted to Congress at least 1 year prior to the date 

8 of the proposed closure an evaluation of the impact of 

9 the proposed closure which specifies, in addition to 

10 other considerations— 

11 ‘‘(A) the accessibility of alternative health 

12 care resources for the population served by such 

13 facility; 

14 ‘‘(B) the cost-effectiveness of such closure; 

15 ‘‘(C) the quality of health care to be pro16 vided to the population served by such facility 

17 after such closure; 

18 ‘‘(D) the availability of contract health care 

19 funds to maintain existing levels of service; 

20 ‘‘(E) the views of the Indian Tribes served 

21 by such facility concerning such closure; 

22 ‘‘(F) the level of use of such facility by all 

23 eligible Indians; and 

24 ‘‘(G) the distance between such facility and 

25 the nearest operating Service hospital. 


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1 ‘‘(2) EXCEPTION FOR CERTAIN TEMPORARY CLO2 SURES.—Paragraph (1) shall not apply to any tem3 porary closure of a facility or any portion of a facil4 ity if such closure is necessary for medical, environ5 mental, or construction safety reasons. 

6 ‘‘(c) HEALTH CARE FACILITY PRIORITY SYSTEM.— 

7 ‘‘(1) IN GENERAL.— 

8 ‘‘(A) ESTABLISHMENT.—The Secretary, act9 ing through the Service, shall establish a health 

10 care facility priority system, which shall— 

11 ‘‘(i) be developed with Indian Tribes 

12 and Tribal Organizations through nego13 tiated rulemaking under section 802; 

14 ‘‘(ii) give Indian Tribes’ needs the 

15 highest priority; and 

16 ‘‘(iii) at a minimum, include the lists 

17 required in paragraph (2)(B) and the meth18 odology required in paragraph (2)(E). 

19 ‘‘(B) PRIORITY OF CERTAIN PROJECTS PRO20 TECTED.—The priority of any project established 

21 under the construction priority system in effect 

22 on the date of the Indian Health Care Improve23 ment Act Amendments of 2005 shall not be af24 fected by any change in the construction priority 

25 system taking place thereafter if the project was 


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1 identified as 1 of the 10 top-priority inpatient 

2 projects, 1 of the 10 top-priority outpatient 

3 projects, 1 of the 10 top-priority staff quarters 

4 developments, or 1 of the 10 top-priority Youth 

5 Regional Treatment Centers in the fiscal year 

6 2005 Indian Health Service budget justification, 

7 or if the project had completed both Phase I and 

8 Phase II of the construction priority system in 

9 effect on the date of enactment of such Act. 

10 ‘‘(2) REPORT; CONTENTS.—The Secretary shall 

11 submit to the President, for inclusion in the report re12 quired to be transmitted to Congress under section 

13 801, a report which sets forth the following: 

14 ‘‘(A) A description of the health care facil15 ity priority system of the Service, established 

16 under paragraph (1). 

17 ‘‘(B) Health care facilities lists, including— 

18 ‘‘(i) the 10 top-priority inpatient 

19 health care facilities; 

20 ‘‘(ii) the 10 top-priority outpatient 

21 health care facilities; 

22 ‘‘(iii) the 10 top-priority specialized 

23 health care facilities (such as long-term care 

24 and alcohol and drug abuse treatment); 


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1 ‘‘(iv) the 10 top-priority staff quarters 

2 developments associated with health care fa3 cilities; and 

4 ‘‘(v) the 10 top-priority hostels associ5 ated with health care facilities. 

6 ‘‘(C) The justification for such order of pri7 ority. 

8 ‘‘(D) The projected cost of such projects. 

9 ‘‘(E) The methodology adopted by the Serv10 ice in establishing priorities under its health 

11 care facility priority system. 

12 ‘‘(3) REQUIREMENTS FOR PREPARATION OF RE13 PORTS.—In preparing each report required under 

14 paragraph (2) (other than the initial report), the Sec15 retary shall annually— 

16 ‘‘(A) consult with and obtain information 

17 on all health care facilities needs from Indian 

18 Tribes, Tribal Organizations, and Urban Indian 

19 Organizations; and 

20 ‘‘(B) review the total unmet needs of all In21 dian Tribes, Tribal Organizations, and Urban 

22 Indian Organizations for health care facilities 

23 (including hostels and staff quarters), including 

24 needs for renovation and expansion of existing 

25 facilities. 


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1 ‘‘(4) CRITERIA FOR EVALUATING NEEDS.—For 

2 purposes of this subsection, the Secretary shall, in 

3 evaluating the needs of facilities operated under any 

4 contract or compact under the Indian Self-Deter5 mination and Education Assistance Act (25 U.S.C. 

6 450 et seq.) use the same criteria that the Secretary 

7 uses in evaluating the needs of facilities operated di8 rectly by the Service. 

9 ‘‘(5) NEEDS OF FACILITIES UNDER ISDEAA

10 AGREEMENTS.—The Secretary shall ensure that the 

11 planning, design, construction, and renovation needs 

12 of Service and non-Service facilities operated under 

13 contracts or compacts in accordance with the Indian 

14 Self-Determination and Education Assistance Act (25 

15 U.S.C. 450 et seq.) are fully and equitably integrated 

16 into the health care facility priority system. 

17 ‘‘(d) REVIEW OF NEED FOR FACILITIES.— 

18 ‘‘(1) INITIAL REPORT.—In the year 2006, the 

19 Government Accountability Office shall prepare and 

20 finalize a report which sets forth the needs of the 

21 Service, Indian Tribes, Tribal Organizations, and 

22 Urban Indian Organizations, for the types of facili23 ties listed under subsection (c)(2)(B), including the 

24 needs for renovation and expansion of existing facili25 ties. The Government Accountability Office shall subVerDate Aug 31 2005 05:25 Mar 17, 2006 Jkt 049200 PO 00000 Frm 00462 Fmt 6652 Sfmt 6203 E:\BILLS\S1057.RS S1057

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1 mit the report to the appropriate authorizing and ap2 propriations committees of Congress and to the Sec3 retary. 

4 ‘‘(2) Beginning in the year 2006, the Secretary 

5 shall update the report required under paragraph (1) 

6 every 5 years. 

7 ‘‘(3) In preparing an updated report under 

8 paragraph (2), the Secretary shall consult with In9 dian Tribes, Tribal Organizations, and Urban Indian 

10 Organizations. The Secretary shall submit the report 

11 under paragraph (2) for inclusion in the report re12 quired to be transmitted to Congress under section 

13 801. 

14 ‘‘(4) For purposes of this subsection, the reports 

15 shall, regarding the needs of facilities operated under 

16 any contract or compact under the Indian Self-Deter17 mination and Education Assistance Act (25 U.S.C. 

18 450 et seq.), be based on the same criteria that the 

19 Secretary uses in evaluating the needs of facilities op20 erated directly by the Service. 

21 ‘‘(5) The planning, design, construction, and 

22 renovation needs of facilities operated under contracts 

23 or compacts under the Indian Self-Determination and 

24 Education Assistance Act (25 U.S.C. 450 et seq.) shall 


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1 be fully and equitably integrated into the development 

2 of the health facility priority system. 

3 ‘‘(6) Beginning in 2007 and each fiscal year 

4 thereafter, the Secretary shall provide an opportunity 

5 for nomination of planning, design, and construction 

6 projects by the Service, Indian Tribes, Tribal Organi7 zations, and Urban Indian Organizations for consid8 eration under the health care facility priority system. 

9 ‘‘(e) FUNDING CONDITION.—All funds appropriated 

10 under the Act of November 2, 1921 (25 U.S.C. 13) (com11 monly known as the ‘Snyder Act’), for the planning, design, 

12 construction, or renovation of health facilities for the benefit 

13 of 1 or more Indian Tribes shall be subject to the provisions 

14 of the Indian Self-Determination and Education Assistance 

15 Act (25 U.S.C. 450 et seq.). 

16 ‘‘(f) DEVELOPMENT OF INNOVATIVE APPROACHES.— 

17 The Secretary shall consult and cooperate with Indian 

18 Tribes, Tribal Organizations, and Urban Indian Organiza19 tions in developing innovative approaches to address all or 

20 part of the total unmet need for construction of health facili21 ties, including those provided for in other sections of this 

22 title and other approaches. 

23 ‘‘SEC. 302. SANITATION FACILITIES. 

24 ‘‘(a) FINDINGS.—Congress finds the following: 


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1 ‘‘(1) The provision of sanitation facilities is pri2 marily a health consideration and function. 

3 ‘‘(2) Indian people suffer an inordinately high 

4 incidence of disease, injury, and illness directly at5 tributable to the absence or inadequacy of sanitation 

6 facilities. 

7 ‘‘(3) The long-term cost to the United States of 

8 treating and curing such disease, injury, and illness 

9 is substantially greater than the short-term cost of 

10 providing sanitation facilities and other preventive 

11 health measures. 

12 ‘‘(4) Many Indian homes and Indian commu13 nities still lack sanitation facilities. 

14 ‘‘(5) It is in the interest of the United States, 

15 and it is the policy of the United States, that all In16 dian communities and Indian homes, new and exist17 ing, be provided with sanitation facilities. 

18 ‘‘(b) FACILITIES AND SERVICES.—In furtherance of the 

19 findings made in subsection (a), Congress reaffirms the pri20 mary responsibility and authority of the Service to provide 

21 the necessary sanitation facilities and services as provided 

22 in section 7 of the Act of August 5, 1954 (42 U.S.C. 2004a). 

23 Under such authority, the Secretary, acting through the 

24 Service, is authorized to provide the following: 


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1 ‘‘(1) Financial and technical assistance to In2 dian Tribes, Tribal Organizations, and Indian com3 munities in the establishment, training, and equip4 ping of utility organizations to operate and maintain 

5 sanitation facilities, including the provision of exist6 ing plans, standard details, and specifications avail7 able in the Department, to be used at the option of 

8 the Indian Tribe, Tribal Organization, or Indian 

9 community. 

10 ‘‘(2) Ongoing technical assistance and training 

11 to Indian Tribes, Tribal Organizations, and Indian 

12 communities in the management of utility organiza13 tions which operate and maintain sanitation facili14 ties. 

15 ‘‘(3) Priority funding for operation and mainte16 nance assistance for, and emergency repairs to, sani17 tation facilities operated by an Indian Tribe, Tribal 

18 Organization or Indian community when necessary 

19 to avoid an imminent health threat or to protect the 

20 investment in sanitation facilities and the investment 

21 in the health benefits gained through the provision of 

22 sanitation facilities. 

23 ‘‘(c) FUNDING.—Notwithstanding any other provision 

24 of law— 


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1 ‘‘(1) the Secretary of Housing and Urban Devel2 opment is authorized to transfer funds appropriated 

3 under the Native American Housing Assistance and 

4 Self-Determination Act of 1996 to the Secretary of 

5 Health and Human Services; 

6 ‘‘(2) the Secretary of Health and Human Serv7 ices is authorized to accept and use such funds for the 

8 purpose of providing sanitation facilities and services 

9 for Indians under section 7 of the Act of August 5, 

10 1954 (42 U.S.C. 2004a); 

11 ‘‘(3) unless specifically authorized when funds 

12 are appropriated, the Secretary shall not use funds 

13 appropriated under section 7 of the Act of August 5, 

14 1954 (42 U.S.C. 2004a), to provide sanitation facili15 ties to new homes constructed using funds provided by 

16 the Department of Housing and Urban Development; 

17 ‘‘(4) the Secretary of Health and Human Serv18 ices is authorized to accept from any source, includ19 ing Federal and State agencies, funds for the purpose 

20 of providing sanitation facilities and services and 

21 place these funds into contracts or compacts under the 

22 Indian Self-Determination and Education Assistance 

23 Act (25 U.S.C. 450 et seq.); 

24 ‘‘(5) except as otherwise prohibited by this sec25 tion, the Secretary may use funds appropriated under 


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1 the authority of section 7 of the Act of August 5, 1954 

2 (42 U.S.C. 2004a) to fund up to 100 percent of the 

3 amount of an Indian Tribe’s loan obtained under any 

4 Federal program for new projects to construct eligible 

5 sanitation facilities to serve Indian homes; 

6 ‘‘(6) except as otherwise prohibited by this sec7 tion, the Secretary may use funds appropriated under 

8 the authority of section 7 of the Act of August 5, 1954 

9 (42 U.S.C. 2004a) to meet matching or cost partici10 pation requirements under other Federal and non11 Federal programs for new projects to construct eligible 

12 sanitation facilities; 

13 ‘‘(7) all Federal agencies are authorized to trans14 fer to the Secretary funds identified, granted, loaned, 

15 or appropriated whereby the Department’s applicable 

16 policies, rules, and regulations shall apply in the im17 plementation of such projects; 

18 ‘‘(8) the Secretary of Health and Human Serv19 ices shall enter into interagency agreements with Fed20 eral and State agencies for the purpose of providing 

21 financial assistance for sanitation facilities and serv22 ices under this Act; and 

23 ‘‘(9) the Secretary of Health and Human Serv24 ices shall, by regulation developed through rulemaking 

25 under section 802, establish standards applicable to 


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1 the planning, design, and construction of sanitation 

2 facilities funded under this Act. 

3 ‘‘(d) CERTAIN CAPABILITIES NOT PREREQUISITE.— 

4 The financial and technical capability of an Indian Tribe, 

5 Tribal Organization, or Indian community to safely oper6 ate, manage, and maintain a sanitation facility shall not 

7 be a prerequisite to the provision or construction of sanita8 tion facilities by the Secretary. 

9 ‘‘(e) FINANCIAL ASSISTANCE.—The Secretary is au10 thorized to provide financial assistance to Indian Tribes, 

11 Tribal Organizations, and Indian communities for oper12 ation, management, and maintenance of their sanitation 

13 facilities. 

14 ‘‘(f) OPERATION, MANAGEMENT, AND MAINTENANCE OF

15 FACILITIES.—The Indian Tribe has the primary responsi16 bility to establish, collect, and use reasonable user fees, or 

17 otherwise set aside funding, for the purpose of operating, 

18 managing, and maintaining sanitation facilities. If a sani19 tation facility serving a community that is operated by an 

20 Indian Tribe or Tribal Organization is threatened with im21 minent failure and such operator lacks capacity to main22 tain the integrity or the health benefits of the sanitation 

23 facility, then the Secretary is authorized to assist the In24 dian Tribe, Tribal Organization, or Indian community in 

25 the resolution of the problem on a short-term basis through 


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1 cooperation with the emergency coordinator or by providing 

2 operation, management, and maintenance service. 

3 ‘‘(g) ISDEAA PROGRAM FUNDED ON EQUAL BASIS.— 

4 Tribal Health Programs shall be eligible (on an equal basis 

5 with programs that are administered directly by the Serv6 ice) for— 

7 ‘‘(1) any funds appropriated pursuant to this 

8 section; and 

9 ‘‘(2) any funds appropriated for the purpose of 

10 providing sanitation facilities. 

11 ‘‘(h) REPORT.— 

12 ‘‘(1) REQUIRED; CONTENTS.—The Secretary, in 

13 consultation with the Secretary of Housing and 

14 Urban Development, Indian Tribes, Tribal Organiza15 tions, and tribally designated housing entities (as de16 fined in section 4 of the Native American Housing 

17 Assistance and Self-Determination Act of 1996 (25 

18 U.S.C. 4103)) shall submit to the President, for inclu19 sion in the report required to be transmitted to Con20 gress under section 801, a report which sets forth— 

21 ‘‘(A) the current Indian sanitation facility 

22 priority system of the Service; 

23 ‘‘(B) the methodology for determining sani24 tation deficiencies and needs; 


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1 ‘‘(C) the level of initial and final sanitation 

2 deficiency for each type of sanitation facility for 

3 each project of each Indian Tribe or Indian com4 munity; 

5 ‘‘(D) the amount and most effective use of 

6 funds, derived from whatever source, necessary to 

7 accommodate the sanitation facilities needs of 

8 new homes assisted with funds under the Native 

9 American Housing Assistance and Self-Deter10 mination Act, and to reduce the identified sani11 tation deficiency levels of all Indian Tribes and 

12 Indian communities to level I sanitation defi13 ciency as defined in paragraph (4)(A); and 

14 ‘‘(E) a 10-year plan to provide sanitation 

15 facilities to serve existing Indian homes and In16 dian communities and new and renovated In17 dian homes. 

18 ‘‘(2) CRITERIA.—The criteria on which the defi19 ciencies and needs will be evaluated shall be developed 

20 through negotiated rulemaking pursuant to section 

21 802. 

22 ‘‘(3) UNIFORM METHODOLOGY.—The method23 ology used by the Secretary in determining, pre24 paring cost estimates for, and reporting sanitation 

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1 plied uniformly to all Indian Tribes and Indian com2 munities. 

3 ‘‘(4) SANITATION DEFICIENCY LEVELS.—For 

4 purposes of this subsection, the sanitation deficiency 

5 levels for an individual, Indian Tribe, or Indian com6 munity sanitation facility to serve Indian homes are 

7 determined as follows: 

8 ‘‘(A) A level I deficiency exists if a sanita9 tion facility serving an individual, Indian 

10 Tribe, or Indian community— 

11 ‘‘(i) complies with all applicable water 

12 supply, pollution control, and solid waste 

13 disposal laws; and 

14 ‘‘(ii) deficiencies relate to routine re15 placement, repair, or maintenance needs. 

16 ‘‘(B) A level II deficiency exists if a sanita17 tion facility serving an individual, Indian 

18 Tribe, or Indian community substantially or re19 cently complied with all applicable water sup20 ply, pollution control, and solid waste laws and 

21 any deficiencies relate to— 

22 ‘‘(i) small or minor capital improve23 ments needed to bring the facility back into 

24 compliance; 


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1 ‘‘(ii) capital improvements that are 

2 necessary to enlarge or improve the facili3 ties in order to meet the current needs for 

4 domestic sanitation facilities; or 

5 ‘‘(iii) the lack of equipment or training 

6 by an Indian Tribe, Tribal Organization, 

7 or an Indian community to properly oper8 ate and maintain the sanitation facilities. 

9 ‘‘(C) A level III deficiency exists if a sani10 tation facility serving an individual, Indian 

11 Tribe or Indian community meets 1 or more of 

12 the following conditions— 

13 ‘‘(i) water or sewer service in the home 

14 is provided by a haul system with holding 

15 tanks and interior plumbing; 

16 ‘‘(ii) major significant interruptions to 

17 water supply or sewage disposal occur fre18 quently, requiring major capital improve19 ments to correct the deficiencies; or 

20 ‘‘(iii) there is no access to or no ap21 proved or permitted solid waste facility 

22 available. 

23 ‘‘(D) A level IV deficiency exists— 


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1 ‘‘(i) if a sanitation facility for an in2 dividual home, an Indian Tribe, or an In3 dian community exists but— 

4 ‘‘(I) lacks— 

5 ‘‘(aa) a safe water supply 

6 system; or 

7 ‘‘(bb) a waste disposal sys8 tem; 

9 ‘‘(II) contains no piped water or 

10 sewer facilities; or 

11 ‘‘(III) has become inoperable due 

12 to a major component failure; or 

13 ‘‘(ii) if only a washeteria or central fa14 cility exists in the community. 

15 ‘‘(E) A level V deficiency exists in the ab16 sence of a sanitation facility, where individual 

17 homes do not have access to safe drinking water 

18 or adequate wastewater (including sewage) dis19 posal. 

20 ‘‘(i) DEFINITIONS.—For purposes of this section, the 

21 following terms apply: 

22 ‘‘(1) INDIAN COMMUNITY.—The term ‘Indian 

23 community’ means a geographic area, a significant 

24 proportion of whose inhabitants are Indians and 


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1 which is served by or capable of being served by a fa2 cility described in this section. 

3 ‘‘(2) SANITATION FACILITIES.—The terms ‘sani4 tation facility’ and ‘sanitation facilities’ mean safe 

5 and adequate water supply systems, sanitary sewage 

6 disposal systems, and sanitary solid waste systems 

7 (and all related equipment and support infrastruc8 ture). 

9 ‘‘SEC. 303. PREFERENCE TO INDIANS AND INDIAN FIRMS. 

10 ‘‘(a) BUY INDIAN ACT.—The Secretary, acting through 

11 the Service, may use the negotiating authority of section 

12 23 of the Act of June 25, 1910 (25 U.S.C. 47, commonly 

13 known as the ‘Buy Indian Act’), to give preference to any 

14 Indian or any enterprise, partnership, corporation, or other 

15 type of business organization owned and controlled by an 

16 Indian or Indians including former or currently federally 

17 recognized Indian Tribes in the State of New York (herein18 after referred to as an ‘Indian firm’) in the construction 

19 and renovation of Service facilities pursuant to section 301 

20 and in the construction of sanitation facilities pursuant to 

21 section 302. Such preference may be accorded by the Sec22 retary unless the Secretary finds, pursuant to regulations 

23 adopted pursuant to section 802, that the project or function 

24 to be contracted for will not be satisfactory or such project 

25 or function cannot be properly completed or maintained 


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1 under the proposed contract. The Secretary, in arriving at 

2 such a finding, shall consider whether the Indian or Indian 

3 firm will be deficient with respect to— 

4 ‘‘(1) ownership and control by Indians; 

5 ‘‘(2) equipment; 

6 ‘‘(3) bookkeeping and accounting procedures; 

7 ‘‘(4) substantive knowledge of the project or func8 tion to be contracted for; 

9 ‘‘(5) adequately trained personnel; or 

10 ‘‘(6) other necessary components of contract per11 formance. 

12 ‘‘(b) LABOR STANDARDS.— 

13 ‘‘(1) IN GENERAL.—For the purposes of imple14 menting the provisions of this title, contracts for the 

15 construction or renovation of health care facilities, 

16 staff quarters, and sanitation facilities, and related 

17 support infrastructure, funded in whole or in part 

18 with funds made available pursuant to this title, shall 

19 contain a provision requiring compliance with sub20 chapter IV of chapter 31 of title 40, United States 

21 Code (commonly known as the ‘Davis-Bacon Act’), 

22 unless such construction or renovation— 

23 ‘‘(A) is performed by a contractor pursuant 

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1 tract or compact authorized by the Indian Self2 Determination and Education Assistance Act (25 

3 U.S.C. 450 et seq.), or other statutory authority; 

4 and 

5 ‘‘(B) is subject to prevailing wage rates for 

6 similar construction or renovation in the locality 

7 as determined by the Indian Tribes or Tribal 

8 Organizations to be served by the construction or 

9 renovation. 

10 ‘‘(2) EXCEPTION.—This subsection shall not 

11 apply to construction or renovation carried out by an 

12 Indian Tribe or Tribal Organization with its own 

13 employees. 

14 ‘‘SEC. 304. EXPENDITURE OF NONSERVICE FUNDS FOR REN15 OVATION. 

16 ‘‘(a) IN GENERAL.—Notwithstanding any other provi17 sion of law, if the requirements of subsection (c) are met, 

18 the Secretary, acting through the Service, is authorized to 

19 accept any major expansion, renovation, or modernization 

20 by any Indian Tribe or Tribal Organization of any Service 

21 facility or of any other Indian health facility operated pur22 suant to a contract or compact under the Indian Self-Deter23 mination and Education Assistance Act (25 U.S.C. 450 et 

24 seq.), including— 


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1 ‘‘(1) any plans or designs for such expansion, 

2 renovation, or modernization; and 

3 ‘‘(2) any expansion, renovation, or moderniza4 tion for which funds appropriated under any Federal 

5 law were lawfully expended. 

6 ‘‘(b) PRIORITY LIST.— 

7 ‘‘(1) IN GENERAL.—The Secretary shall main8 tain a separate priority list to address the needs for 

9 increased operating expenses, personnel, or equipment 

10 for such facilities. The methodology for establishing 

11 priorities shall be developed through negotiated rule12 making under section 802. The list of priority facili13 ties will be revised annually in consultation with In14 dian Tribes and Tribal Organizations. 

15 ‘‘(2) REPORT.—The Secretary shall submit to the 

16 President, for inclusion in the report required to be 

17 transmitted to Congress under section 801, the pri18 ority list maintained pursuant to paragraph (1). 

19 ‘‘(c) REQUIREMENTS.—The requirements of this sub20 section are met with respect to any expansion, renovation, 

21 or modernization if— 

22 ‘‘(1) the Indian Tribe or Tribal Organization— 

23 ‘‘(A) provides notice to the Secretary of its 

24 intent to expand, renovate, or modernize; and 


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1 ‘‘(B) applies to the Secretary to be placed 

2 on a separate priority list to address the needs 

3 of such new facilities for increased operating ex4 penses, personnel, or equipment; and 

5 ‘‘(2) the expansion, renovation, or moderniza6 tion— 

7 ‘‘(A) is approved by the appropriate area 

8 director of the Service for Federal facilities; and 

9 ‘‘(B) is administered by the Indian Tribe or 

10 Tribal Organization in accordance with any ap11 plicable regulations prescribed by the Secretary 

12 with respect to construction or renovation of 

13 Service facilities. 

14 ‘‘(d) ADDITIONAL REQUIREMENT FOR EXPANSION.— 

15 In addition to the requirements under subsection (c), for 

16 any expansion, the Indian Tribe or Tribal Organization 

17 shall provide to the Secretary additional information devel18 oped through negotiated rulemaking under section 802, in19 cluding additional staffing, equipment, and other costs as20 sociated with the expansion. 

21 ‘‘(e) CLOSURE OR CONVERSION OF FACILITIES.—If 

22 any Service facility which has been expanded, renovated, 

23 or modernized by an Indian Tribe or Tribal Organization 

24 under this section ceases to be used as a Service facility 

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1 pansion, renovation, or modernization is completed, such 

2 Indian Tribe or Tribal Organization shall be entitled to 

3 recover from the United States an amount which bears the 

4 same ratio to the value of such facility at the time of such 

5 cessation as the value of such expansion, renovation, or 

6 modernization (less the total amount of any funds provided 

7 specifically for such facility under any Federal program 

8 that were expended for such expansion, renovation, or mod9 ernization) bore to the value of such facility at the time 

10 of the completion of such expansion, renovation, or mod11 ernization. 

12 ‘‘SEC. 305. FUNDING FOR THE CONSTRUCTION, EXPANSION, 

13 AND MODERNIZATION OF SMALL AMBULA14 TORY CARE FACILITIES. 

15 ‘‘(a) FUNDING.— 

16 ‘‘(1) IN GENERAL.—The Secretary, acting 

17 through the Service, shall make grants to Indian 

18 Tribes and Tribal Organizations for the construction, 

19 expansion, or modernization of facilities for the provi20 sion of ambulatory care services to eligible Indians 

21 (and noneligible persons pursuant to subsections 

22 (b)(2) and (c)(1)(C)). A grant made under this sec23 tion may cover up to 100 percent of the costs of such 

24 construction, expansion, or modernization. For the 


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1 purposes of this section, the term ‘construction’ in2 cludes the replacement of an existing facility. 

3 ‘‘(2) GRANT AGREEMENT REQUIRED.—A grant 

4 under paragraph (1) may only be made available to 

5 a Tribal Health Program operating an Indian health 

6 facility (other than a facility owned or constructed by 

7 the Service, including a facility originally owned or 

8 constructed by the Service and transferred to an In9 dian Tribe or Tribal Organization). 

10 ‘‘(b) USE OF GRANT FUNDS.— 

11 ‘‘(1) ALLOWABLE USES.—A grant awarded 

12 under this section may be used for the construction, 

13 expansion, or modernization (including the planning 

14 and design of such construction, expansion, or mod15 ernization) of an ambulatory care facility— 

16 ‘‘(A) located apart from a hospital; 

17 ‘‘(B) not funded under section 301 or sec18 tion 307; and 

19 ‘‘(C) which, upon completion of such con20 struction or modernization will— 

21 ‘‘(i) have a total capacity appropriate 

22 to its projected service population; 

23 ‘‘(ii) provide annually no fewer than 

24 150 patient visits by eligible Indians and 

25 other users who are eligible for services in 


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1 such facility in accordance with section 

2 807(c)(2); and 

3 ‘‘(iii) provide ambulatory care in a 

4 Service Area (specified in the contract or 

5 compact under the Indian Self-Determina6 tion and Education Assistance Act (25 

7 U.S.C. 450 et seq.)) with a population of no 

8 fewer than 1,500 eligible Indians and other 

9 users who are eligible for services in such 

10 facility in accordance with section 

11 807(c)(2). 

12 ‘‘(2) ADDITIONAL ALLOWABLE USE.—The Sec13 retary may also reserve a portion of the funding pro14 vided under this section and use those reserved funds 

15 to reduce an outstanding debt incurred by Indian 

16 Tribes or Tribal Organizations for the construction, 

17 expansion, or modernization of an ambulatory care 

18 facility that meets the requirements under paragraph 

19 (1). The provisions of this section shall apply, except 

20 that such applications for funding under this para21 graph shall be considered separately from applica22 tions for funding under paragraph (1). 

23 ‘‘(3) USE ONLY FOR CERTAIN PORTION OF

24 COSTS.—A grant provided under this section may be 

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1 tion, expansion, or modernization project that benefits 

2 the Service population identified above in subsection 

3 (b)(1)(C) (ii) and (iii). The requirements of clauses 

4 (ii) and (iii) of paragraph (1)(C) shall not apply to 

5 an Indian Tribe or Tribal Organization applying for 

6 a grant under this section for a health care facility 

7 located or to be constructed on an island or when such 

8 facility is not located on a road system providing di9 rect access to an inpatient hospital where care is 

10 available to the Service population. 

11 ‘‘(c) GRANTS.— 

12 ‘‘(1) APPLICATION.—No grant may be made 

13 under this section unless an application or proposal 

14 for the grant has been approved by the Secretary in 

15 accordance with applicable regulations and has forth 

16 reasonable assurance by the applicant that, at all 

17 times after the construction, expansion, or moderniza18 tion of a facility carried out using a grant received 

19 under this section— 

20 ‘‘(A) adequate financial support will be 

21 available for the provision of services at such fa22 cility; 

23 ‘‘(B) such facility will be available to eligi24 ble Indians without regard to ability to pay or 

25 source of payment; and 


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1 ‘‘(C) such facility will, as feasible without 

2 diminishing the quality or quantity of services 

3 provided to eligible Indians, serve noneligible 

4 persons on a cost basis. 

5 ‘‘(2) PRIORITY.—In awarding grants under this 

6 section, the Secretary shall give priority to Indian 

7 Tribes and Tribal Organizations that demonstrate— 

8 ‘‘(A) a need for increased ambulatory care 

9 services; and 

10 ‘‘(B) insufficient capacity to deliver such 

11 services. 

12 ‘‘(3) PEER REVIEW PANELS.—The Secretary may 

13 provide for the establishment of peer review panels, as 

14 necessary, to review and evaluate applications and 

15 proposals and to advise the Secretary regarding such 

16 applications using the criteria developed pursuant to 

17 subsection (a)(1). 

18 ‘‘(d) REVERSION OF FACILITIES.—If any facility (or 

19 portion thereof) with respect to which funds have been paid 

20 under this section, ceases, within 5 years after completion 

21 of the construction, expansion, or modernization carried out 

22 with such funds, to be used for the purposes of providing 

23 health care services to eligible Indians, all of the right, title, 

24 and interest in and to such facility (or portion thereof) shall 


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1 transfer to the United States unless otherwise negotiated by 

2 the Service and the Indian Tribe or Tribal Organization. 

3 ‘‘(e) FUNDING NONRECURRING.—Funding provided 

4 under this section shall be nonrecurring and shall not be 

5 available for inclusion in any individual Indian Tribe’s 

6 tribal share for an award under the Indian Self-Determina7 tion and Education Assistance Act (25 U.S.C. 450 et seq.) 

8 or for reallocation or redesign thereunder. 

9 ‘‘SEC. 306. INDIAN HEALTH CARE DELIVERY DEMONSTRA10 TION PROJECT. 

11 ‘‘(a) HEALTH CARE DEMONSTRATION PROJECTS.— 

12 The Secretary, acting through the Service, and in consulta13 tion with Indian Tribes and Tribal Organizations, is au14 thorized to enter into construction agreements under the In15 dian Self-Determination and Education Assistance Act (25 

16 U.S.C. 450 et seq.) with Indian Tribes or Tribal Organiza17 tions for the purpose of carrying out a health care delivery 

18 demonstration project to test alternative means of delivering 

19 health care and services to Indians through facilities. 

20 ‘‘(b) USE OF FUNDS.—The Secretary, in approving 

21 projects pursuant to this section, may authorize funding for 

22 the construction and renovation of hospitals, health centers, 

23 health stations, and other facilities to deliver health care 

24 services and is authorized to— 

25 ‘‘(1) waive any leasing prohibition; 


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1 ‘‘(2) permit carryover of funds appropriated for 

2 the provision of health care services; 

3 ‘‘(3) permit the use of other available funds; 

4 ‘‘(4) permit the use of funds or property donated 

5 from any source for project purposes; 

6 ‘‘(5) provide for the reversion of donated real or 

7 personal property to the donor; and 

8 ‘‘(6) permit the use of Service funds to match 

9 other funds, including Federal funds. 

10 ‘‘(c) REGULATIONS.—The Secretary shall develop and 

11 promulgate regulations not later than 1 year after the date 

12 of enactment of the Indian Health Care Improvement Act 

13 Amendments of 2005. If the Secretary has not promulgated 

14 regulations by that date, the Secretary shall develop and 

15 publish regulations, through rulemaking under section 802, 

16 for the review and approval of applications submitted 

17 under this section. 

18 ‘‘(d) CRITERIA.—The Secretary may approve projects 

19 that meet the following criteria: 

20 ‘‘(1) There is a need for a new facility or pro21 gram or the reorientation of an existing facility or 

22 program. 

23 ‘‘(2) A significant number of Indians, including 

24 those with low health status, will be served by the 

25 project. 


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1 ‘‘(3) The project has the potential to deliver serv2 ices in an efficient and effective manner. 

3 ‘‘(4) The project is economically viable. 

4 ‘‘(5) The Indian Tribe or Tribal Organization 

5 has the administrative and financial capability to 

6 administer the project. 

7 ‘‘(6) The project is integrated with providers of 

8 related health and social services and is coordinated 

9 with, and avoids duplication of, existing services. 

10 ‘‘(e) PEER REVIEW PANELS.—The Secretary may pro11 vide for the establishment of peer review panels, as nec12 essary, to review and evaluate applications using the cri13 teria developed pursuant to subsection (d). 

14 ‘‘(f) PRIORITY.—The Secretary shall give priority to 

15 applications for demonstration projects in each of the fol16 lowing Service Units to the extent that such applications 

17 are timely filed and meet the criteria specified in subsection 

18 (d): 

19 ‘‘(1) Cass Lake, Minnesota. 

20 ‘‘(2) Clinton, Oklahoma. 

21 ‘‘(3) Harlem, Montana. 

22 ‘‘(4) Mescalero, New Mexico. 

23 ‘‘(5) Owyhee, Nevada. 

24 ‘‘(6) Parker, Arizona. 

25 ‘‘(7) Schurz, Nevada. 


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1 ‘‘(8) Winnebago, Nebraska. 

2 ‘‘(9) Ft. Yuma, California. 

3 ‘‘(g) TECHNICAL ASSISTANCE.—The Secretary shall 

4 provide such technical and other assistance as may be nec5 essary to enable applicants to comply with the provisions 

6 of this section. 

7 ‘‘(h) SERVICE TO INELIGIBLE PERSONS.—Subject to 

8 section 807, the authority to provide services to persons oth9 erwise ineligible for the health care benefits of the Service 

10 and the authority to extend hospital privileges in Service 

11 facilities to non-Service health practitioners as provided in 

12 section 807 may be included, subject to the terms of such 

13 section, in any demonstration project approved pursuant 

14 to this section. 

15 ‘‘(i) EQUITABLE TREATMENT.—For purposes of sub16 section (d)(1), the Secretary shall, in evaluating facilities 

17 operated under any contract or compact under the Indian 

18 Self-Determination and Education Assistance Act (25 

19 U.S.C. 450 et seq.), use the same criteria that the Secretary 

20 uses in evaluating facilities operated directly by the Service. 

21 ‘‘(j) EQUITABLE INTEGRATION OF FACILITIES.—The 

22 Secretary shall ensure that the planning, design, construc23 tion, renovation, and expansion needs of Service and non24 Service facilities which are the subject of a contract or com25 pact under the Indian Self-Determination and Education 


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1 Assistance Act (25 U.S.C. 450 et seq.) for health services 

2 are fully and equitably integrated into the implementation 

3 of the health care delivery demonstration projects under this 

4 section. 

5 ‘‘SEC. 307. LAND TRANSFER. 

6 ‘‘Notwithstanding any other provision of law, the Bu7 reau of Indian Affairs and all other agencies and depart8 ments of the United States are authorized to transfer, at 

9 no cost, land and improvements to the Service for the provi10 sion of health care services. The Secretary is authorized to 

11 accept such land and improvements for such purposes. 

12 ‘‘SEC. 308. LEASES, CONTRACTS, AND OTHER AGREEMENTS. 

13 ‘‘The Secretary, acting through the Service, may enter 

14 into leases, contracts, and other agreements with Indian 

15 Tribes and Tribal Organizations which hold (1) title to, (2) 

16 a leasehold interest in, or (3) a beneficial interest in (when 

17 title is held by the United States in trust for the benefit 

18 of an Indian Tribe) facilities used or to be used for the ad19 ministration and delivery of health services by an Indian 

20 Health Program. Such leases, contracts, or agreements may 

21 include provisions for construction or renovation and pro22 vide for compensation to the Indian Tribe or Tribal Orga23 nization of rental and other costs consistent with section 

24 105(l) of the Indian Self-Determination and Education As25 sistance Act (25 U.S.C. 450j(l)) and regulations thereunder. 


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1 ‘‘SEC. 309. STUDY ON LOANS, LOAN GUARANTEES, AND 

2 LOAN REPAYMENT. 

3 ‘‘(a) IN GENERAL.—The Secretary, in consultation 

4 with the Secretary of the Treasury, Indian Tribes, and 

5 Tribal Organizations, shall carry out a study to determine 

6 the feasibility of establishing a loan fund to provide to In7 dian Tribes and Tribal Organizations direct loans or guar8 antees for loans for the construction of health care facilities, 

9 including— 

10 ‘‘(1) inpatient facilities; 

11 ‘‘(2) outpatient facilities; 

12 ‘‘(3) staff quarters; 

13 ‘‘(4) hostels; and 

14 ‘‘(5) specialized care facilities, such as behavioral 

15 health and elder care facilities. 

16 ‘‘(b) DETERMINATIONS.—In carrying out the study 

17 under subsection (a), the Secretary shall determine— 

18 ‘‘(1) the maximum principal amount of a loan 

19 or loan guarantee that should be offered to a recipient 

20 from the loan fund; 

21 ‘‘(2) the percentage of eligible costs, not to exceed 

22 100 percent, that may be covered by a loan or loan 

23 guarantee from the loan fund (including costs relating 

24 to planning, design, financing, site land development, 

25 construction, rehabilitation, renovation, conversion, 

26 improvements, medical equipment and furnishings, 


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1 and other facility-related costs and capital purchase 

2 (but excluding staffing)); 

3 ‘‘(3) the cumulative total of the principal of di4 rect loans and loan guarantees, respectively, that may 

5 be outstanding at any 1 time; 

6 ‘‘(4) the maximum term of a loan or loan guar7 antee that may be made for a facility from the loan 

8 fund; 

9 ‘‘(5) the maximum percentage of funds from the 

10 loan fund that should be allocated for payment of 

11 costs associated with planning and applying for a 

12 loan or loan guarantee; 

13 ‘‘(6) whether acceptance by the Secretary of an 

14 assignment of the revenue of an Indian Tribe or Trib15 al Organization as security for any direct loan or 

16 loan guarantee from the loan fund would be appro17 priate; 

18 ‘‘(7) whether, in the planning and design of 

19 health facilities under this section, users eligible 

20 under section 807(c) may be included in any projec21 tion of patient population; 

22 ‘‘(8) whether funds of the Service provided 

23 through loans or loan guarantees from the loan fund 

24 should be eligible for use in matching other Federal 

25 funds under other programs; 


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1 ‘‘(9) the appropriateness of, and best methods 

2 for, coordinating the loan fund with the health care 

3 priority system of the Service under section 301; and 

4 ‘‘(10) any legislative or regulatory changes re5 quired to implement recommendations of the Sec6 retary based on results of the study. 

7 ‘‘(c) REPORT.—Not later than September 30, 2007, the 

8 Secretary shall submit to the Committee on Indian Affairs 

9 of the Senate and the Committee on Resources and the Com10 mittee on Energy and Commerce of the House of Represent11 atives a report that describes— 

12 ‘‘(1) the manner of consultation made as re13 quired by subsection (a); and 

14 ‘‘(2) the results of the study, including any rec15 ommendations of the Secretary based on results of the 

16 study. 

17 ‘‘SEC. 310. TRIBAL LEASING. 

18 ‘‘A Tribal Health Program may lease permanent 

19 structures for the purpose of providing health care services 

20 without obtaining advance approval in appropriation Acts. 

21 ‘‘SEC. 311. INDIAN HEALTH SERVICE/TRIBAL FACILITIES 

22 JOINT VENTURE PROGRAM. 

23 ‘‘(a) IN GENERAL.—The Secretary, acting through the 

24 Service, shall make arrangements with Indian Tribes and 

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1 tion projects under which an Indian Tribe or Tribal Orga2 nization shall expend tribal, private, or other available 

3 funds, for the acquisition or construction of a health facility 

4 for a minimum of 10 years, under a no-cost lease, in ex5 change for agreement by the Service to provide the equip6 ment, supplies, and staffing for the operation and mainte7 nance of such a health facility. An Indian Tribe or Tribal 

8 Organization may use tribal funds, private sector, or other 

9 available resources, including loan guarantees, to fulfill its 

10 commitment under a joint venture entered into under this 

11 subsection. An Indian Tribe or Tribal Organization shall 

12 be eligible to establish a joint venture project if, when it 

13 submits a letter of intent, it— 

14 ‘‘(1) has begun but not completed the process of 

15 acquisition or construction of a health facility to be 

16 used in the joint venture project; or 

17 ‘‘(2) has not begun the process of acquisition or 

18 construction of a health facility for use in the joint 

19 venture project. 

20 ‘‘(b) REQUIREMENTS.—The Secretary shall make such 

21 an arrangement with an Indian Tribe or Tribal Organiza22 tion only if— 

23 ‘‘(1) the Secretary first determines that the In24 dian Tribe or Tribal Organization has the adminis25 trative and financial capabilities necessary to comVerDate Aug 31 2005 05:25 Mar 17, 2006 Jkt 049200 PO 00000 Frm 00493 Fmt 6652 Sfmt 6203 E:\BILLS\S1057.RS S1057

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1 plete the timely acquisition or construction of the rel2 evant health facility; and 

3 ‘‘(2) the Indian Tribe or Tribal Organization 

4 meets the need criteria which shall be developed 

5 through the negotiated rulemaking process provided 

6 for under section 802. 

7 ‘‘(c) CONTINUED OPERATION.—The Secretary shall ne8 gotiate an agreement with the Indian Tribe or Tribal Orga9 nization regarding the continued operation of the facility 

10 at the end of the initial 10 year no-cost lease period. 

11 ‘‘(d) BREACH OF AGREEMENT.—An Indian Tribe or 

12 Tribal Organization that has entered into a written agree13 ment with the Secretary under this section, and that 

14 breaches or terminates without cause such agreement, shall 

15 be liable to the United States for the amount that has been 

16 paid to the Indian Tribe or Tribal Organization, or paid 

17 to a third party on the Indian Tribe’s or Tribal Organiza18 tion’s behalf, under the agreement. The Secretary has the 

19 right to recover tangible property (including supplies) and 

20 equipment, less depreciation, and any funds expended for 

21 operations and maintenance under this section. The pre22 ceding sentence does not apply to any funds expended for 

23 the delivery of health care services, personnel, or staffing. 

24 ‘‘(e) RECOVERY FOR NONUSE.—An Indian Tribe or 

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1 ment with the Secretary under this subsection shall be enti2 tled to recover from the United States an amount that is 

3 proportional to the value of such facility if, at any time 

4 within the 10-year term of the agreement, the Service ceases 

5 to use the facility or otherwise breaches the agreement. 

6 ‘‘(f) DEFINITION.—For the purposes of this section, the 

7 term ‘health facility’ or ‘health facilities’ includes quarters 

8 needed to provide housing for staff of the relevant Tribal 

9 Health Program. 

10 ‘‘SEC. 312. LOCATION OF FACILITIES. 

11 ‘‘(a) IN GENERAL.—In all matters involving the reor12 ganization or development of Service facilities or in the es13 tablishment of related employment projects to address un14 employment conditions in economically depressed areas, the 

15 Bureau of Indian Affairs and the Service shall give priority 

16 to locating such facilities and projects on Indian lands, or 

17 lands in Alaska owned by any Alaska Native village, or 

18 village or regional corporation under the Alaska Native 

19 Claims Settlement Act, or any land allotted to any Alaska 

20 Native, if requested by the Indian owner and the Indian 

21 Tribe with jurisdiction over such lands or other lands 

22 owned or leased by the Indian Tribe or Tribal Organiza23 tion. Top priority shall be given to Indian land owned by 

24 1 or more Indian Tribes. 


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1 ‘‘(b) DEFINITION.—For purposes of this section, the 

2 term ‘Indian lands’ means— 

3 ‘‘(1) all lands within the exterior boundaries of 

4 any reservation; and 

5 ‘‘(2) any lands title to which is held in trust by 

6 the United States for the benefit of any Indian Tribe 

7 or individual Indian or held by any Indian Tribe or 

8 individual Indian subject to restriction by the United 

9 States against alienation. 

10 ‘‘SEC. 313. MAINTENANCE AND IMPROVEMENT OF HEALTH 

11 CARE FACILITIES. 

12 ‘‘(a) REPORT.—The Secretary shall submit to the 

13 President, for inclusion in the report required to be trans14 mitted to Congress under section 801, a report which identi15 fies the backlog of maintenance and repair work required 

16 at both Service and tribal health care facilities, including 

17 new health care facilities expected to be in operation in the 

18 next fiscal year. The report shall also identify the need for 

19 renovation and expansion of existing facilities to support 

20 the growth of health care programs. 

21 ‘‘(b) MAINTENANCE OF NEWLY CONSTRUCTED

22 SPACE.—The Secretary, acting through the Service, is au23 thorized to expend maintenance and improvement funds to 

24 support maintenance of newly constructed space only if 

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1 cation for the Indian Tribe or Tribal Organization. Sup2 portable space allocation shall be defined through the nego3 tiated rulemaking process provided for under section 802. 

4 ‘‘(c) REPLACEMENT FACILITIES.—In addition to using 

5 maintenance and improvement funds for renovation, mod6 ernization, and expansion of facilities, an Indian Tribe or 

7 Tribal Organization may use maintenance and improve8 ment funds for construction of a replacement facility if the 

9 costs of renovation of such facility would exceed a maximum 

10 renovation cost threshold. The maximum renovation cost 

11 threshold shall be determined through the negotiated rule12 making process provided for under section 802. 

13 ‘‘SEC. 314. TRIBAL MANAGEMENT OF FEDERALLY OWNED 

14 QUARTERS. 

15 ‘‘(a) RENTAL RATES.— 

16 ‘‘(1) ESTABLISHMENT.—Notwithstanding any 

17 other provision of law, a Tribal Health Program 

18 which operates a hospital or other health facility and 

19 the federally owned quarters associated therewith pur20 suant to a contract or compact under the Indian Self21 Determination and Education Assistance Act (25 

22 U.S.C. 450 et seq.) shall have the authority to estab23 lish the rental rates charged to the occupants of such 

24 quarters by providing notice to the Secretary of its 

25 election to exercise such authority. 


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1 ‘‘(2) OBJECTIVES.—In establishing rental rates 

2 pursuant to authority of this subsection, a Tribal 

3 Health Program shall endeavor to achieve the fol4 lowing objectives: 

5 ‘‘(A) To base such rental rates on the rea6 sonable value of the quarters to the occupants 

7 thereof. 

8 ‘‘(B) To generate sufficient funds to pru9 dently provide for the operation and mainte10 nance of the quarters, and subject to the discre11 tion of the Tribal Health Program, to supply re12 serve funds for capital repairs and replacement 

13 of the quarters. 

14 ‘‘(3) EQUITABLE FUNDING.—Any quarters whose 

15 rental rates are established by a Tribal Health Pro16 gram pursuant to this subsection shall remain eligible 

17 for quarters improvement and repair funds to the 

18 same extent as all federally owned quarters used to 

19 house personnel in Services-supported programs. 

20 ‘‘(4) NOTICE OF RATE CHANGE.—A Tribal 

21 Health Program which exercises the authority pro22 vided under this subsection shall provide occupants 

23 with no less than 60 days notice of any change in 

24 rental rates. 

25 ‘‘(b) DIRECT COLLECTION OF RENT.— 


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1 ‘‘(1) IN GENERAL.—Notwithstanding any other 

2 provision of law, and subject to paragraph (2), a 

3 Tribal Health Program shall have the authority to 

4 collect rents directly from Federal employees who oc5 cupy such quarters in accordance with the following: 

6 ‘‘(A) The Tribal Health Program shall no7 tify the Secretary and the subject Federal em8 ployees of its election to exercise its authority to 

9 collect rents directly from such Federal employ10 ees. 

11 ‘‘(B) Upon receipt of a notice described in 

12 subparagraph (A), the Federal employees shall 

13 pay rents for occupancy of such quarters directly 

14 to the Tribal Health Program and the Secretary 

15 shall have no further authority to collect rents 

16 from such employees through payroll deduction 

17 or otherwise. 

18 ‘‘(C) Such rent payments shall be retained 

19 by the Tribal Health Program and shall not be 

20 made payable to or otherwise be deposited with 

21 the United States. 

22 ‘‘(D) Such rent payments shall be deposited 

23 into a separate account which shall be used by 

24 the Tribal Health Program for the maintenance 

25 (including capital repairs and replacement) and 


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1 operation of the quarters and facilities as the 

2 Tribal Health Program shall determine. 

3 ‘‘(2) RETROCESSION OF AUTHORITY.—If a Trib4 al Health Program which has made an election under 

5 paragraph (1) requests retrocession of its authority to 

6 directly collect rents from Federal employees occu7 pying federally owned quarters, such retrocession 

8 shall become effective on the earlier of— 

9 ‘‘(A) the first day of the month that begins 

10 no less than 180 days after the Tribal Health 

11 Program notifies the Secretary of its desire to 

12 retrocede; or 

13 ‘‘(B) such other date as may be mutually 

14 agreed by the Secretary and the Tribal Health 

15 Program. 

16 ‘‘(c) RATES IN ALASKA.—To the extent that a Tribal 

17 Health Program, pursuant to authority granted in sub18 section (a), establishes rental rates for federally owned quar19 ters provided to a Federal employee in Alaska, such rents 

20 may be based on the cost of comparable private rental hous21 ing in the nearest established community with a year-round 

22 population of 1,500 or more individuals. 


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1 ‘‘SEC. 315. APPLICABILITY OF BUY AMERICAN ACT REQUIRE2 MENT. 

3 ‘‘(a) APPLICABILITY.—The Secretary shall ensure that 

4 the requirements of the Buy American Act apply to all pro5 curements made with funds provided pursuant to section 

6 317. Indian Tribes and Tribal Organizations shall be ex7 empt from these requirements. 

8 ‘‘(b) EFFECT OF VIOLATION.—If it has been finally de9 termined by a court or Federal agency that any person in10 tentionally affixed a label bearing a ‘Made in America’ in11 scription or any inscription with the same meaning, to any 

12 product sold in or shipped to the United States that is not 

13 made in the United States, such person shall be ineligible 

14 to receive any contract or subcontract made with funds pro15 vided pursuant to section 317, pursuant to the debarment, 

16 suspension, and ineligibility procedures described in sec17 tions 9.400 through 9.409 of title 48, Code of Federal Regu18 lations. 

19 ‘‘(c) DEFINITIONS.—For purposes of this section, the 

20 term ‘Buy American Act’ means title III of the Act entitled 

21 ‘An Act making appropriations for the Treasury and Post 

22 Office Departments for the fiscal year ending June 30, 

23 1934, and for other purposes’, approved March 3, 1933 (41 

24 U.S.C. 10a et seq.). 


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1 ‘‘SEC. 316. OTHER FUNDING FOR FACILITIES. 

2 ‘‘(a) AUTHORITY TO ACCEPT FUNDS.—The Secretary 

3 is authorized to accept from any source, including Federal 

4 and State agencies, funds that are available for the con5 struction of health care facilities and use such funds to 

6 plan, design, and construct health care facilities for Indians 

7 and to place such funds into a contract or compact under 

8 the Indian Self-Determination and Education Assistance 

9 Act (25 U.S.C. 450 et seq.). Receipt of such funds shall have 

10 no effect on the priorities established pursuant to section 

11 301. 

12 ‘‘(b) INTERAGENCY AGREEMENTS.—The Secretary is 

13 authorized to enter into interagency agreements with other 

14 Federal agencies or State agencies and other entities and 

15 to accept funds from such Federal or State agencies or other 

16 sources to provide for the planning, design, and construc17 tion of health care facilities to be administered by Indian 

18 Health Programs in order to carry out the purposes of this 

19 Act and the purposes for which the funds were appropriated 

20 or for which the funds were otherwise provided. 

21 ‘‘(c) TRANSFERRED FUNDS.—Any Federal agency to 

22 which funds for the construction of health care facilities are 

23 appropriated is authorized to transfer such funds to the Sec24 retary for the construction of health care facilities to carry 

25 out the purposes of this Act as well as the purposes for 


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1 which such funds are appropriated to such other Federal 

2 agency. 

3 ‘‘(d) ESTABLISHMENT OF STANDARDS.—The Sec4 retary, through the Service, shall establish standards by reg5 ulation, developed by rulemaking under section 802, for the 

6 planning, design, and construction of health care facilities 

7 serving Indians under this Act. 

8 ‘‘SEC. 317. AUTHORIZATION OF APPROPRIATIONS. 

9 ‘‘There are authorized to be appropriated such sums 

10 as may be necessary for each fiscal year through fiscal year 

11 2015 to carry out this title. 

12 ‘‘TITLE IV—ACCESS TO HEALTH 

13 SERVICES 

14 ‘‘SEC. 401. TREATMENT OF PAYMENTS UNDER SOCIAL SECU15 RITY ACT HEALTH CARE PROGRAMS. 

16 ‘‘(a) DISREGARD OF MEDICARE, MEDICAID, AND

17 SCHIP PAYMENTS IN DETERMINING APPROPRIATIONS.— 

18 Any payments received by an Indian Health Program or 

19 by an Urban Indian Organization made under title XVIII, 

20 XIX, or XXI of the Social Security Act for services provided 

21 to Indians eligible for benefits under such respective titles 

22 shall not be considered in determining appropriations for 

23 the provision of health care and services to Indians. 

24 ‘‘(b) NONPREFERENTIAL TREATMENT.—Nothing in 

25 this Act authorizes the Secretary to provide services to an 


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1 Indian with coverage under title XVIII, XIX, or XXI of 

2 the Social Security Act in preference to an Indian without 

3 such coverage. 

4 ‘‘(c) USE OF FUNDS.— 

5 ‘‘(1) SPECIAL FUND.—Notwithstanding any 

6 other provision of law, but subject to paragraph (2), 

7 payments to which a facility of the Service is entitled 

8 by reason of a provision of the Social Security Act 

9 shall be placed in a special fund to be held by the Sec10 retary and first used (to such extent or in such 

11 amounts as are provided in appropriation Acts) for 

12 the purpose of making any improvements in the pro13 grams of the Service which may be necessary to 

14 achieve or maintain compliance with the applicable 

15 conditions and requirements of titles XVIII, XIX, and 

16 XXI of the Social Security Act. Any amounts to be 

17 reimbursed that are in excess of the amount necessary 

18 to achieve or maintain such conditions and require19 ments shall, subject to the consultation with Indian 

20 Tribes being served by the Service Unit, be used for 

21 reducing the health resource deficiencies of the Indian 

22 Tribes. In making payments from such fund, the Sec23 retary shall ensure that each Service Unit of the Serv24 ice receives 100 percent of the amount to which the 

25 facilities of the Service, for which such Service Unit 


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1 makes collections, are entitled by reason of a provi2 sion of the Social Security Act. 

3 ‘‘(2) DIRECT PAYMENT OPTION.—Paragraph (1) 

4 shall not apply upon the election of a Tribal Health 

5 Program under subsection (d) to receive payments di6 rectly. No payment may be made out of the special 

7 fund described in such paragraph with respect to re8 imbursement made for services provided during the 

9 period of such election. 

10 ‘‘(d) DIRECT BILLING.— 

11 ‘‘(1) IN GENERAL.—A Tribal Health Program 

12 may directly bill for, and receive payment for, health 

13 care items and services provided by such Indian Tribe 

14 or Tribal Organization for which payment is made 

15 under title XVIII, XIX, or XXI of the Social Security 

16 Act or from any other third party payor. 

17 ‘‘(2) DIRECT REIMBURSEMENT.— 

18 ‘‘(A) USE OF FUNDS.—Each Tribal Health 

19 Program exercising the option described in para20 graph (1) with respect to a program under a 

21 title of the Social Security Act shall be reim22 bursed directly by that program for items and 

23 services furnished without regard to section 

24 401(c), but all amounts so reimbursed shall be 

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1 pose of making any improvements in Tribal fa2 cilities or Tribal Health Programs that may be 

3 necessary to achieve or maintain compliance 

4 with the conditions and requirements applicable 

5 generally to such items and services under the 

6 program under such title and to provide addi7 tional health care services, improvements in 

8 health care facilities and Tribal Health Pro9 grams, any health care-related purpose, or other10 wise to achieve the objectives provided in section 

11 3 of this Act. 

12 ‘‘(B) AUDITS.—The amounts paid to an In13 dian Tribe or Tribal Organization exercising the 

14 option described in paragraph (1) with respect 

15 to a program under a title of the Social Security 

16 Act shall be subject to all auditing requirements 

17 applicable to programs administered by an In18 dian Health Program. 

19 ‘‘(C) IDENTIFICATION OF SOURCE OF PAY20 MENTS.—If an Indian Tribe or Tribal Organiza21 tion receives funding from the Service under the 

22 Indian Self-Determination and Education As23 sistance Act (25 U.S.C. 450 et seq.) or an Urban 

24 Indian Organization receives funding from the 

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1 imbursements or payments under title XVIII, 

2 XIX, or XXI of the Social Security Act, such In3 dian Tribe or Tribal Organization, or Urban In4 dian Organization, shall provide to the Service 

5 a list of each provider enrollment number (or 

6 other identifier) under which it receives such re7 imbursements or payments. 

8 ‘‘(3) EXAMINATION AND IMPLEMENTATION OF

9 CHANGES.—The Secretary, acting through the Service 

10 and with the assistance of the Administrator of the 

11 Centers for Medicare & Medicaid Services, shall ex12 amine on an ongoing basis and implement any ad13 ministrative changes that may be necessary to facili14 tate direct billing and reimbursement under the pro15 gram established under this subsection, including any 

16 agreements with States that may be necessary to pro17 vide for direct billing under a program under a title 

18 of the Social Security Act. 

19 ‘‘(4) WITHDRAWAL FROM PROGRAM.—A Tribal 

20 Health Program that bills directly under the program 

21 established under this subsection may withdraw from 

22 participation in the same manner and under the 

23 same conditions that an Indian Tribe or Tribal Orga24 nization may retrocede a contracted program to the 

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1 termination and Education Assistance Act (25 U.S.C. 

2 450 et seq.). All cost accounting and billing authority 

3 under the program established under this subsection 

4 shall be returned to the Secretary upon the Sec5 retary’s acceptance of the withdrawal of participation 

6 in this program. 

7 ‘‘SEC. 402. GRANTS TO AND CONTRACTS WITH THE SERV8 ICE, INDIAN TRIBES, TRIBAL ORGANIZA9 TIONS, AND URBAN INDIAN ORGANIZATIONS. 

10 ‘‘(a) INDIAN TRIBES AND TRIBAL ORGANIZATIONS.— 

11 The Secretary, acting through the Service, shall make 

12 grants to or enter into contracts with Indian Tribes and 

13 Tribal Organizations to assist such Tribes and Tribal Orga14 nizations in establishing and administering programs on 

15 or near reservations and trust lands to assist individual 

16 Indians— 

17 ‘‘(1) to enroll for benefits under title XVIII, XIX, 

18 or XXI of the Social Security Act and other health 

19 benefits programs; and 

20 ‘‘(2) to pay premiums for coverage for such bene21 fits, which may be based on financial need (as deter22 mined by the Indian Tribe or Tribes being served 

23 based on a schedule of income levels developed or im24 plemented by such Tribe or Tribes). 


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1 ‘‘(b) CONDITIONS.—The Secretary, acting through the 

2 Service, shall place conditions as deemed necessary to effect 

3 the purpose of this section in any grant or contract which 

4 the Secretary makes with any Indian Tribe or Tribal Orga5 nization pursuant to this section. Such conditions shall in6 clude requirements that the Indian Tribe or Tribal Organi7 zation successfully undertake— 

8 ‘‘(1) to determine the population of Indians eli9 gible for the benefits described in subsection (a); 

10 ‘‘(2) to educate Indians with respect to the bene11 fits available under the respective programs; 

12 ‘‘(3) to provide transportation for such indi13 vidual Indians to the appropriate offices for enroll14 ment or applications for such benefits; and 

15 ‘‘(4) to develop and implement methods of im16 proving the participation of Indians in receiving the 

17 benefits provided under titles XVIII, XIX, and XXI of 

18 the Social Security Act. 

19 ‘‘(c) AGREEMENTS RELATING TO IMPROVING ENROLL20 MENT OF INDIANS UNDER SOCIAL SECURITY ACT PRO21 GRAMS.— 

22 ‘‘(1) AGREEMENTS WITH SECRETARY TO IM23 PROVE RECEIPT AND PROCESSING OF APPLICA24 TIONS.— 


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1 ‘‘(A) AUTHORIZATION.—The Secretary, act2 ing through the Service, may enter into an 

3 agreement with an Indian Tribe, Tribal Organi4 zation, or Urban Indian Organization which 

5 provides for the receipt and processing of appli6 cations by Indians for assistance under titles 

7 XIX and XXI of the Social Security Act, and 

8 benefits under title XVIII of such Act, by an In9 dian Health Program or Urban Indian Organi10 zation. 

11 ‘‘(B) REIMBURSEMENT OF COSTS.—Such 

12 agreements may provide for reimbursement of 

13 costs of outreach, education regarding eligibility 

14 and benefits, and translation when such services 

15 are provided. The reimbursement may, as appro16 priate, be added to the applicable rate per en17 counter or be provided as a separate fee-for-serv18 ice payment to the Indian Tribe or Tribal Orga19 nization. 

20 ‘‘(C) PROCESSING CLARIFIED.—In this 

21 paragraph, the term ‘processing’ does not include 

22 a final determination of eligibility. 

23 ‘‘(2) AGREEMENTS WITH STATES FOR OUTREACH

24 ON OR NEAR RESERVATION.— 


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1 ‘‘(A) IN GENERAL.—In order to improve the 

2 access of Indians residing on or near a reserva3 tion to obtain benefits under title XIX or XXI of 

4 the Social Security Act, the Secretary shall en5 courage the State to take steps to provide for en6 rollment on or near the reservation. Such steps 

7 may include outreach efforts such as the 

8 outstationing of eligibility workers, entering into 

9 agreements with Indian Tribes and Tribal Orga10 nizations to provide outreach, education regard11 ing eligibility and benefits, enrollment, and 

12 translation services when such services are pro13 vided. 

14 ‘‘(B) CONSTRUCTION.—Nothing in subpara15 graph (A) shall be construed as affecting ar16 rangements entered into between States and In17 dian Tribes and Tribal Organizations for such 

18 Indian Tribes and Tribal Organizations to con19 duct administrative activities under such titles. 

20 ‘‘(d) FACILITATING COOPERATION.—The Secretary, 

21 acting through the Centers for Medicare & Medicaid Serv22 ices, shall take such steps as are necessary to facilitate co23 operation with, and agreements between, States and the 

24 Service, Indian Tribes, Tribal Organizations, or Urban In25 dian Organizations. 


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1 ‘‘(e) APPLICATION TO URBAN INDIAN ORGANIZA2 TIONS.— 

3 ‘‘(1) IN GENERAL.—The provisions of subsection 

4 (a) shall apply with respect to grants and other fund5 ing to Urban Indian Organizations with respect to 

6 populations served by such organizations in the same 

7 manner they apply to grants and contracts with In8 dian Tribes and Tribal Organizations with respect to 

9 programs on or near reservations. 

10 ‘‘(2) REQUIREMENTS.—The Secretary shall in11 clude in the grants or contracts made or provided 

12 under paragraph (1) requirements that are— 

13 ‘‘(A) consistent with the requirements im14 posed by the Secretary under subsection (b); 

15 ‘‘(B) appropriate to Urban Indian Organi16 zations and Urban Indians; and 

17 ‘‘(C) necessary to effect the purposes of this 

18 section. 

19 ‘‘SEC. 403. REIMBURSEMENT FROM CERTAIN THIRD PAR20 TIES OF COSTS OF HEALTH SERVICES. 

21 ‘‘(a) RIGHT OF RECOVERY.—Except as provided in 

22 subsection (f), the United States, an Indian Tribe, or Tribal 

23 Organization shall have the right to recover from an insur24 ance company, health maintenance organization, employee 

25 benefit plan, third-party tortfeasor, or any other responsible 


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1 or liable third party (including a political subdivision or 

2 local governmental entity of a State) the reasonable charges 

3 as determined by the Secretary, and billed by the Secretary, 

4 an Indian Tribe, or Tribal Organization, in providing 

5 health services, through the Service, an Indian Tribe, or 

6 Tribal Organization to any individual to the same extent 

7 that such individual, or any nongovernmental provider of 

8 such services, would be eligible to receive damages, reim9 bursement, or indemnification for such charges or expenses 

10 if— 

11 ‘‘(1) such services had been provided by a non12 governmental provider; and 

13 ‘‘(2) such individual had been required to pay 

14 such charges or expenses and did pay such charges or 

15 expenses. 

16 ‘‘(b) LIMITATIONS ON RECOVERIES FROM STATES.— 

17 Subsection (a) shall provide a right of recovery against any 

18 State, only if the injury, illness, or disability for which 

19 health services were provided is covered under— 

20 ‘‘(1) workers’ compensation laws; or 

21 ‘‘(2) a no-fault automobile accident insurance 

22 plan or program. 

23 ‘‘(c) NONAPPLICATION OF OTHER LAWS.—No law of 

24 any State, or of any political subdivision of a State and 

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1 nance organization policy, employee benefit plan, self-in2 surance plan, managed care plan, or other health care plan 

3 or program entered into or renewed after the date of the 

4 enactment of the Indian Health Care Amendments of 1988, 

5 shall prevent or hinder the right of recovery of the United 

6 States, an Indian Tribe, or Tribal Organization under sub7 section (a). 

8 ‘‘(d) NO EFFECT ON PRIVATE RIGHTS OF ACTION.— 

9 No action taken by the United States, an Indian Tribe, or 

10 Tribal Organization to enforce the right of recovery pro11 vided under this section shall operate to deny to the injured 

12 person the recovery for that portion of the person’s damage 

13 not covered hereunder. 

14 ‘‘(e) ENFORCEMENT.— 

15 ‘‘(1) IN GENERAL.—The United States, an In16 dian Tribe, or Tribal Organization may enforce the 

17 right of recovery provided under subsection (a) by— 

18 ‘‘(A) intervening or joining in any civil ac19 tion or proceeding brought— 

20 ‘‘(i) by the individual for whom health 

21 services were provided by the Secretary, an 

22 Indian Tribe, or Tribal Organization; or 

23 ‘‘(ii) by any representative or heirs of 

24 such individual, or 


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1 ‘‘(B) instituting a civil action, including a 

2 civil action for injunctive relief and other relief 

3 and including, with respect to a political sub4 division or local governmental entity of a State, 

5 such an action against an official thereof. 

6 ‘‘(2) NOTICE.—All reasonable efforts shall be 

7 made to provide notice of action instituted under 

8 paragraph (1)(B) to the individual to whom health 

9 services were provided, either before or during the 

10 pendency of such action. 

11 ‘‘(f) LIMITATION.—Absent specific written authoriza12 tion by the governing body of an Indian Tribe for the period 

13 of such authorization (which may not be for a period of 

14 more than 1 year and which may be revoked at any time 

15 upon written notice by the governing body to the Service), 

16 the United States shall not have a right of recovery under 

17 this section if the injury, illness, or disability for which 

18 health services were provided is covered under a self-insur19 ance plan funded by an Indian Tribe, Tribal Organization, 

20 or Urban Indian Organization. Where such authorization 

21 is provided, the Service may receive and expend such 

22 amounts for the provision of additional health services con23 sistent with such authorization. 

24 ‘‘(g) COSTS AND ATTORNEYS’ FEES.—In any action 

25 brought to enforce the provisions of this section, a prevailing 


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1 plaintiff shall be awarded its reasonable attorneys’ fees and 

2 costs of litigation. 

3 ‘‘(h) NONAPPLICATION OF CLAIMS FILING REQUIRE4 MENTS.—An insurance company, health maintenance orga5 nization, self-insurance plan, managed care plan, or other 

6 health care plan or program (under the Social Security Act 

7 or otherwise) may not deny a claim for benefits submitted 

8 by the Service or by an Indian Tribe or Tribal Organiza9 tion based on the format in which the claim is submitted 

10 if such format complies with the format required for sub11 mission of claims under title XVIII of the Social Security 

12 Act or recognized under section 1175 of such Act. 

13 ‘‘(i) APPLICATION TO URBAN INDIAN ORGANIZA14 TIONS.—The previous provisions of this section shall apply 

15 to Urban Indian Organizations with respect to populations 

16 served by such Organizations in the same manner they 

17 apply to Indian Tribes and Tribal Organizations with re18 spect to populations served by such Indian Tribes and Trib19 al Organizations. 

20 ‘‘(j) STATUTE OF LIMITATIONS.—The provisions of sec21 tion 2415 of title 28, United States Code, shall apply to 

22 all actions commenced under this section, and the references 

23 therein to the United States are deemed to include Indian 

24 Tribes, Tribal Organizations, and Urban Indian Organiza25 tions. 


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1 ‘‘(k) SAVINGS.—Nothing in this section shall be con2 strued to limit any right of recovery available to the United 

3 States, an Indian Tribe, or Tribal Organization under the 

4 provisions of any applicable, Federal, State, or Tribal law, 

5 including medical lien laws and the Federal Medical Care 

6 Recovery Act (42 U.S.C. 2651 et seq.). 

7 ‘‘SEC. 404. CREDITING OF REIMBURSEMENTS. 

8 ‘‘(a) USE OF AMOUNTS.— 

9 ‘‘(1) RETENTION BY PROGRAM.—Except as pro10 vided in section 202(g) (relating to the Catastrophic 

11 Health Emergency Fund) and section 807 (relating to 

12 health services for ineligible persons), all reimburse13 ments received or recovered under any of the pro14 grams described in paragraph (2), including under 

15 section 807, by reason of the provision of health serv16 ices by the Service, by an Indian Tribe or Tribal Or17 ganization, or by an Urban Indian Organization, 

18 shall be credited to the Service, such Indian Tribe or 

19 Tribal Organization, or such Urban Indian Organi20 zation, respectively, and may be used as provided in 

21 section 401. In the case of such a service provided by 

22 or through a Service Unit, such amounts shall be 

23 credited to such unit and used for such purposes. 

24 ‘‘(2) PROGRAMS COVERED.—The programs re25 ferred to in paragraph (1) are the following: 


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1 ‘‘(A) Titles XVIII, XIX, and XXI of the So2 cial Security Act. 

3 ‘‘(B) This Act, including section 807. 

4 ‘‘(C) Public Law 87–693. 

5 ‘‘(D) Any other provision of law. 

6 ‘‘(b) NO OFFSET OF AMOUNTS.—The Service may not 

7 offset or limit any amount obligated to any Service Unit 

8 or entity receiving funding from the Service because of the 

9 receipt of reimbursements under subsection (a). 

10 ‘‘SEC. 405. PURCHASING HEALTH CARE COVERAGE. 

11 ‘‘(a) IN GENERAL.—Insofar as amounts are made 

12 available under law (including a provision of the Social 

13 Security Act, the Indian Self-Determination and Education 

14 Assistance Act (25 U.S.C. 450 et seq.), or other law, other 

15 than under section 402) to Indian Tribes, Tribal Organiza16 tions, and Urban Indian Organizations for health benefits 

17 for Service beneficiaries, Indian Tribes, Tribal Organiza18 tions, and Urban Indian Organizations may use such 

19 amounts to purchase health benefits coverage for such bene20 ficiaries in any manner, including through— 

21 ‘‘(1) a tribally owned and operated health care 

22 plan; 

23 ‘‘(2) a State or locally authorized or licensed 

24 health care plan; 


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1 ‘‘(3) a health insurance provider or managed 

2 care organization; or 

3 ‘‘(4) a self-insured plan. 

4 The purchase of such coverage by an Indian Tribe, Tribal 

5 Organization, or Urban Indian Organization may be based 

6 on the financial needs of such beneficiaries (as determined 

7 by the Indian Tribe or Tribes being served based on a sched8 ule of income levels developed or implemented by such In9 dian Tribe or Tribes). 

10 ‘‘(b) EXPENSES FOR SELF-INSURED PLAN.—In the 

11 case of a self-insured plan under subsection (a)(4), the 

12 amounts may be used for expenses of operating the plan, 

13 including administration and insurance to limit the finan14 cial risks to the entity offering the plan. 

15 ‘‘(c) CONSTRUCTION.—Nothing in this section shall be 

16 construed as affecting the use of any amounts not referred 

17 to in subsection (a). 

18 ‘‘SEC. 406. SHARING ARRANGEMENTS WITH FEDERAL AGEN19 CIES. 

20 ‘‘(a) AUTHORITY.— 

21 ‘‘(1) IN GENERAL.—The Secretary may enter 

22 into (or expand) arrangements for the sharing of 

23 medical facilities and services between the Service, In24 dian Tribes, and Tribal Organizations and the DeVerDate Aug 31 2005 05:25 Mar 17, 2006 Jkt 049200 PO 00000 Frm 00519 Fmt 6652 Sfmt 6203 E:\BILLS\S1057.RS S1057

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1 partment of Veterans Affairs and the Department of 

2 Defense. 

3 ‘‘(2) CONSULTATION BY SECRETARY RE4 QUIRED.—The Secretary may not finalize any ar5 rangement between the Service and a Department de6 scribed in paragraph (1) without first consulting with 

7 the Indian Tribes which will be significantly affected 

8 by the arrangement. 

9 ‘‘(b) LIMITATIONS.—The Secretary shall not take any 

10 action under this section or under subchapter IV of chapter 

11 81 of title 38, United States Code, which would impair— 

12 ‘‘(1) the priority access of any Indian to health 

13 care services provided through the Service and the eli14 gibility of any Indian to receive health services 

15 through the Service; 

16 ‘‘(2) the quality of health care services provided 

17 to any Indian through the Service; 

18 ‘‘(3) the priority access of any veteran to health 

19 care services provided by the Department of Veterans 

20 Affairs; 

21 ‘‘(4) the quality of health care services provided 

22 by the Department of Veterans Affairs or the Depart23 ment of Defense; or 


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1 ‘‘(5) the eligibility of any Indian who is a vet2 eran to receive health services through the Department 

3 of Veterans Affairs. 

4 ‘‘(c) REIMBURSEMENT.—The Service, Indian Tribe, or 

5 Tribal Organization shall be reimbursed by the Department 

6 of Veterans Affairs or the Department of Defense (as the 

7 case may be) where services are provided through the Serv8 ice, an Indian Tribe, or a Tribal Organization to bene9 ficiaries eligible for services from either such Department, 

10 notwithstanding any other provision of law. 

11 ‘‘(d) CONSTRUCTION.—Nothing in this section may be 

12 construed as creating any right of a non-Indian veteran 

13 to obtain health services from the Service. 

14 ‘‘SEC. 407. PAYOR OF LAST RESORT. 

15 ‘‘Indian Health Programs and health care programs 

16 operated by Urban Indian Organizations shall be the payor 

17 of last resort for services provided to persons eligible for 

18 services from Indian Health Programs and Urban Indian 

19 Organizations, notwithstanding any Federal, State, or local 

20 law to the contrary. 

21 ‘‘SEC. 408. NONDISCRIMINATION IN QUALIFICATIONS FOR 

22 REIMBURSEMENT FOR SERVICES. 

23 ‘‘For purposes of determining the eligibility of an enti24 ty that is operated by the Service, an Indian Tribe, Tribal 

25 Organization, or Urban Indian Organization to receive 


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1 payment or reimbursement from any federally funded 

2 health care program for health care services it furnishes to 

3 an Indian, such program must provide that such entity, 

4 meeting generally applicable State or other requirements 

5 applicable for participation, must be accepted as a provider 

6 on the same basis as any other qualified provider, except 

7 that any requirement that the entity be licensed or recog8 nized under State or local law to furnish such services shall 

9 be deemed to have been met if the entity meets all the appli10 cable standards for such licensure, but the entity need not 

11 obtain a license or other documentation. In determining 

12 whether the entity meets such standards, the absence of li13 censure of any staff member of the entity may not be taken 

14 into account. 

15 ‘‘SEC. 409. CONSULTATION. 

16 ‘‘(a) TRIBAL TECHNICAL ADVISORY GROUP (TTAG).— 

17 The Secretary shall maintain within the Centers for Med18 icaid & Medicare Services (CMS) a Tribal Technical Advi19 sory Group, established in accordance with requirements of 

20 the charter dated September 30, 2003, and in such group 

21 shall include a representative of the Urban Indian Organi22 zations and the Service. The representative of the Urban 

23 Indian Organization shall be deemed to be an elected officer 

24 of a tribal government for purposes of applying section 


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1 204(b) of the Unfunded Mandates Reform Act of 1995 (2 

2 U.S.C. 1534(b)). 

3 ‘‘(b) SOLICITATION OF MEDICAID ADVICE.— 

4 ‘‘(1) IN GENERAL.—As part of its plan under 

5 title XIX of the Social Security Act, a State in which 

6 the Service operates or funds health care programs, or 

7 in which 1 or more Indian Health Programs or 

8 Urban Indian Organizations provide health care in 

9 the State for which medical assistance is available 

10 under such title, may establish a process under which 

11 the State seeks advice on a regular, ongoing basis 

12 from designees of such Indian Health Programs and 

13 Urban Indian Organizations on matters relating to 

14 the application of such title to and likely to have a 

15 direct effect on such Indian Health Programs and 

16 Urban Indian Organizations. 

17 ‘‘(2) MANNER OF ADVICE.—The process described 

18 in paragraph (1) should include solicitation of advice 

19 prior to submission of any plan amendments, waiver 

20 requests, and proposals for demonstration projects 

21 likely to have a direct effect on Indians, Indian 

22 Health Programs, or Urban Indian Organizations. 

23 Such process may include appointment of an advi24 sory committee and of a designee of such Indian 

25 Health Programs and Urban Indian Organizations to 


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•S 1057 RS

1 the medical care advisory committee advising the 

2 State on its medicaid plan. 

3 ‘‘(3) PAYMENT OF EXPENSES.—The reasonable 

4 expenses of carrying out this subsection shall be eligi5 ble for reimbursement under section 1903(a) of the 

6 Social Security Act. 

7 ‘‘(c) CONSTRUCTION.—Nothing in this section shall be 

8 construed as superseding existing advisory committees, 

9 working groups, or other advisory procedures established by 

10 the Secretary or by any State. 

11 ‘‘SEC. 410. STATE CHILDREN’S HEALTH INSURANCE PRO12 GRAM (SCHIP). 

13 ‘‘(a) OPTIONAL USE OF FUNDS FOR INDIAN HEALTH

14 PROGRAM PAYMENTS.—Subject to the succeeding provisions 

15 of this section, a State may provide under its State child 

16 health plan under title XXI of the Social Security Act (re17 gardless of whether such plan is implemented under such 

18 title, title XIX of such Act, or both) for payments under 

19 this section to Indian Health Programs and Urban Indian 

20 Organizations operating in the State. Such payments shall 

21 be treated under title XXI of the Social Security Act as 

22 expenditures described in section 2105(a)(1)(A) of such Act. 

23 ‘‘(b) USE OF FUNDS.—Payments under this section 

24 may be used only for expenditures described in clauses (i) 

25 through (iii) of section 2105(a)(1)(D) of the Social Security 


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1 Act for targeted low-income children or other low-income 

2 children (as defined in 2110 of such Act) who are— 

3 ‘‘(1) Indians; or 

4 ‘‘(2) otherwise eligible for health services from the 

5 Indian Health Program involved. 

6 ‘‘(c) SPECIAL RESTRICTIONS.—The following condi7 tions apply to a State electing to provide payments under 

8 this section: 

9 ‘‘(1) NO LIMITATION ON OTHER SCHIP PARTICI10 PATION OF, OR PROVIDER PAYMENTS TO, INDIAN

11 HEALTH PROGRAMS.—The State may not exclude or 

12 limit participation of otherwise eligible Indian 

13 Health Programs in its State child health program 

14 under title XXI of the Social Security Act or its med15 icaid program under title XIX of such Act or pay 

16 such Programs less than they otherwise would as par17 ticipating providers on the basis that payments are 

18 made to such Programs under this section. 

19 ‘‘(2) NO LIMITATION ON OTHER SCHIP ELIGI20 BILITY OF INDIANS.—The State may not exclude or 

21 limit participation of otherwise eligible Indian chil22 dren in such State child health or medicaid program 

23 on the basis that payments are made for assistance 

24 for such children under this section. 


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1 ‘‘(3) LIMITATION ON ACCEPTANCE OF CONTRIBU2 TIONS.— 

3 ‘‘(A) IN GENERAL.—The State may not ac4 cept contributions or condition making of pay5 ments under this section upon contribution of 

6 funds from any Indian Health Program to meet 

7 the State’s non-Federal matching fund require8 ments under titles XIX and XXI of the Social 

9 Security Act. 

10 ‘‘(B) CONTRIBUTION DEFINED.—For pur11 poses of subparagraph (A), the term ‘contribu12 tion’ includes any tax, donation, fee, or other 

13 payment made, whether made voluntarily or in14 voluntarily. 

15 ‘‘(d) APPLICATION OF SEPARATE 10 PERCENT LIMITA16 TION.—Payment may be made under section 2105(a) of the 

17 Social Security Act to a State for a fiscal year for payments 

18 under this section up to an amount equal to 10 percent 

19 of the total amount available under title XXI of such Act 

20 (including allotments and reallotments available from pre21 vious fiscal years) to the State with respect to the fiscal 

22 year. 

23 ‘‘(e) GENERAL TERMS.—A payment under this section 

24 shall only be made upon application to the State from the 

25 Indian Health Program involved and under such terms and 


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1 conditions, and in a form and manner, as the Secretary 

2 determines appropriate. 

3 ‘‘SEC. 411. SOCIAL SECURITY ACT SANCTIONS. 

4 ‘‘(a) REQUESTS FOR WAIVER OF SANCTIONS.— 

5 ‘‘(1) IN GENERAL.—For purposes of applying 

6 any authority under a provision of title XI, XVIII, 

7 XIX, or XXI of the Social Security Act to seek a 

8 waiver of a sanction imposed against a health care 

9 provider insofar as that provider provides services to 

10 individuals through an Indian Health Program, the 

11 Indian Health Program shall request the State to seek 

12 such waiver, and if such State has not sought the 

13 waiver within 60 days of the Indian Health Program 

14 request, the Indian Health Program itself may peti15 tion the Secretary for such waiver. 

16 ‘‘(2) PROCEDURE.—In seeking a waiver under 

17 paragraph (1), the Indian Health Program must pro18 vide notice and a copy of the request, including the 

19 reasons for the waiver sought, to the State. The Sec20 retary may consider the State’s views in the deter21 mination of the waiver request, but may not withhold 

22 or delay a determination based on the lack of the 

23 State’s views. 

24 ‘‘(b) SAFE HARBOR FOR TRANSACTIONS BETWEEN

25 AND AMONG INDIAN HEALTH CARE PROGRAMS.—For purVerDate Aug 31 2005 05:25 Mar 17, 2006 Jkt 049200 PO 00000 Frm 00527 Fmt 6652 Sfmt 6203 E:\BILLS\S1057.RS S1057

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1 poses of applying section 1128B(b) of the Social Security 

2 Act, the exchange of anything of value between or among 

3 the following shall not be treated as remuneration if the 

4 exchange arises from or relates to any of the following health 

5 programs: 

6 ‘‘(1) An exchange between or among the fol7 lowing: 

8 ‘‘(A) Any Indian Health Program. 

9 ‘‘(B) Any Urban Indian Organization. 

10 ‘‘(2) An exchange between an Indian Tribe, 

11 Tribal Organization, or an Urban Indian Organiza12 tion and any patient served or eligible for service 

13 from an Indian Tribe, Tribal Organization, or Urban 

14 Indian Organization, including patients served or eli15 gible for service pursuant to section 807, but only if 

16 such exchange— 

17 ‘‘(A) is for the purpose of transporting the 

18 patient for the provision of health care items or 

19 services; 

20 ‘‘(B) is for the purpose of providing housing 

21 to the patient (including a pregnant patient) 

22 and immediate family members or an escort in23 cidental to assuring the timely provision of 

24 health care items and services to the patient; 


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1 ‘‘(C) is for the purpose of paying premiums, 

2 copayments, deductibles, or other cost-sharing on 

3 behalf of patients; or 

4 ‘‘(D) consists of an item or service of small 

5 value that is provided as a reasonable incentive 

6 to secure timely and necessary preventive and 

7 other items and services. 

8 ‘‘(3) Other exchanges involving an Indian 

9 Health Program, an Urban Indian Organization, or 

10 an Indian Tribe or Tribal Organization that meet 

11 such standards as the Secretary of Health and 

12 Human Services, in consultation with the Attorney 

13 General, determines is appropriate, taking into ac14 count the special circumstances of such Indian Health 

15 Programs, Urban Indian Organizations, Indian 

16 Tribes, and Tribal Organizations and of patients 

17 served by Indian Health Programs, Urban Indian 

18 Organizations, Indian Tribes, and Tribal Organiza19 tions. 

20 ‘‘SEC. 412. COST SHARING. 

21 ‘‘(a) COINSURANCE, COPAYMENTS, AND

22 DEDUCTIBLES.—Notwithstanding any other provision of 

23 Federal or State law— 

24 ‘‘(1) PROTECTION FOR ELIGIBLE INDIANS UNDER

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1 dian who is furnished an item or service for which 

2 payment may be made under title XIX or XXI of the 

3 Social Security Act may be charged a deductible, co4 payment, or coinsurance. 

5 ‘‘(2) PROTECTION FOR INDIANS.—No Indian who 

6 is furnished an item or service by the Service may be 

7 charged a deductible, copayment, or coinsurance. 

8 ‘‘(3) NO REDUCTION IN AMOUNT OF PAYMENT TO

9 INDIAN HEALTH PROVIDERS.—The payment or reim10 bursement due to the Service, Indian Tribe, Tribal 

11 Organization, or Urban Indian Organization under 

12 title XIX or XXI of the Social Security Act may not 

13 be reduced by the amount of the deductible, copay14 ment, or coinsurance that would be due from the In15 dian but for the operation of this section. 

16 ‘‘(b) EXEMPTION FROM MEDICAID AND SCHIP PRE17 MIUMS.—Notwithstanding any other provision of Federal 

18 or State law, no Indian who is otherwise eligible for services 

19 under title XIX of the Social Security Act (relating to the 

20 medicaid program) or title XXI of such Act (relating to 

21 the State children’s health insurance program) may be 

22 charged a premium, enrollment fee, or similar charge as 

23 a condition of receiving benefits under the program under 

24 the respective title. 


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1 ‘‘(c) TREATMENT OF CERTAIN PROPERTY FOR MED2 ICAID ELIGIBILITY.—Notwithstanding any other provision 

3 of Federal or State law, the following property may not 

4 be included when determining eligibility for services under 

5 title XIX of the Social Security Act: 

6 ‘‘(1) Property, including real property and im7 provements, located on a reservation, including any 

8 federally recognized Indian Tribe’s reservation, Pueb9 lo, or Colony, including former reservations in Okla10 homa, Alaska Native regions established by the Alaska 

11 Native Claims Settlement Act and Indian allotments 

12 on or near a reservation as designated and approved 

13 by the Bureau of Indian Affairs of the Department of 

14 the Interior. 

15 ‘‘(2) For any federally recognized Tribe not de16 scribed in paragraph (1), property located within the 

17 most recent boundaries of a prior Federal reservation. 

18 ‘‘(3) Ownership interests in rents, leases, royal19 ties, or usage rights related to natural resources (in20 cluding extraction of natural resources or harvesting 

21 of timber, other plants and plant products, animals, 

22 fish, and shellfish) resulting from the exercise of feder23 ally protected rights. 

24 ‘‘(4) Ownership interests in or usage rights to 

25 items not covered by paragraphs (1) through (3) that 


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•S 1057 RS

1 have unique religious, spiritual, traditional, or cul2 tural significance or rights that support subsistence or 

3 a traditional life style according to applicable tribal 

4 law or custom. 

5 ‘‘(d) CONTINUATION OF CURRENT LAW PROTECTIONS

6 OF CERTAIN INDIAN PROPERTY FROM MEDICAID ESTATE

7 RECOVERY.—Income, resources, and property that are ex8 empt from medicaid estate recovery under title XIX of the 

9 Social Security Act as of April 1, 2003, under manual in10 structions issued to carry out section 1917(b)(3) of such Act 

11 because of Federal responsibility for Indian Tribes and 

12 Alaska Native Villages shall remain so exempt. Nothing in 

13 this subsection shall be construed as preventing the Sec14 retary from providing additional medicaid estate recovery 

15 exemptions for Indians. 

16 ‘‘SEC. 413. TREATMENT UNDER MEDICAID MANAGED CARE. 

17 ‘‘(a) PROVISION OF SERVICES, TO ENROLLEES WITH

18 NON-INDIAN MEDICAID MANAGED CARE ENTITIES, BY IN19 DIAN HEALTH PROGRAMS AND URBAN INDIAN ORGANIZA20 TIONS.— 

21 ‘‘(1) PAYMENT RULES.— 

22 ‘‘(A) IN GENERAL.—Subject to subpara23 graph (B), in the case of an Indian who is en24 rolled with a non-Indian medicaid managed care 

25 entity (as defined in subsection (c)) and who reVerDate Aug 31 2005 05:25 Mar 17, 2006 Jkt 049200 PO 00000 Frm 00532 Fmt 6652 Sfmt 6203 E:\BILLS\S1057.RS S1057

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1 ceives covered medicaid managed care services 

2 from an Indian Health Program or an Urban 

3 Indian Organization, whether or not it is a par4 ticipating provider with respect to such entity, 

5 the following rules apply: 

6 ‘‘(i) DIRECT PAYMENT.—The entity 

7 shall make prompt payment (in accordance 

8 with rules applicable to medicaid managed 

9 care entities under title XIX of the Social 

10 Security Act) to the Indian Health Pro11 gram or Urban Indian Organization at a 

12 rate established by the entity for such serv13 ices that is equal to the rate negotiated be14 tween such entity and the Program or Or15 ganization involved or, if such a rate has 

16 not been negotiated, a rate that is not less 

17 than the level and amount of payment 

18 which the entity would make for the services 

19 if the services were furnished by a provider 

20 which is not such a Program or Organiza21 tion. 

22 ‘‘(ii) PAYMENT THROUGH STATE.—If 

23 there is no arrangement for direct payment 

24 under clause (i) or if a State provides for 

25 this clause to apply in lieu of clause (i), the 


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1 State shall provide for payment to the In2 dian Health Program or Urban Indian Or3 ganization under its State program under 

4 title XIX of such Act at the rate that would 

5 be otherwise applicable for such services 

6 under such program and shall provide for 

7 an appropriate adjustment of the capitation 

8 payment made to the entity to take into ac9 count such payment. 

10 ‘‘(B) COMPLIANCE WITH GENERALLY APPLI11 CABLE REQUIREMENTS.— 

12 ‘‘(i) IN GENERAL.—Except as otherwise 

13 provided, as a condition of payment under 

14 subparagraph (A), the Indian Health Pro15 gram or Urban Indian Organization shall 

16 comply with the generally applicable re17 quirements of title XIX of the Social Secu18 rity Act with respect to covered services. 

19 ‘‘(ii) SATISFACTION OF CLAIM RE20 QUIREMENT.—Any requirement for the sub21 mission of a claim or other documentation 

22 for services covered under subparagraph (A) 

23 by the enrollee is deemed to be satisfied 

24 through the submission of a claim or other 

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1 gram or Urban Indian Organization con2 sistent with section 403(h). 

3 ‘‘(C) CONSTRUCTION.—Nothing in this sub4 section shall be construed as waiving the appli5 cation of section 1902(a)(30)(A) of the Social Se6 curity Act (relating to application of standards 

7 to assure that payments are consistent with effi8 ciency, economy, and quality of care). 

9 ‘‘(2) ENROLLEE OPTION TO SELECT AN INDIAN

10 HEALTH PROGRAM OR URBAN INDIAN ORGANIZATION

11 AS PRIMARY CARE PROVIDER.—In the case of a non12 Indian medicaid managed care entity that— 

13 ‘‘(A) has an Indian enrolled with the entity; 

14 and 

15 ‘‘(B) has an Indian Health Program or 

16 Urban Indian Organization that is partici17 pating as a primary care provider within the 

18 network of the entity, 

19 insofar as the Indian is otherwise eligible to receive 

20 services from such Program or Organization and the 

21 Program or Organization has the capacity to provide 

22 primary care services to such Indian, the Indian shall 

23 be allowed to choose such Program or Organization as 

24 the Indian’s primary care provider under the entity. 


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•S 1057 RS

1 ‘‘(b) OFFERING OF MANAGED CARE THROUGH INDIAN

2 MEDICAID MANAGED CARE ENTITIES.—If— 

3 ‘‘(1) a State elects to provide services through 

4 medicaid managed care entities under its medicaid 

5 managed care program; and 

6 ‘‘(2) an Indian Health Program or Urban In7 dian Organization that is funded in whole or in part 

8 by the Service, or a consortium thereof, has estab9 lished an Indian medicaid managed care entity in 

10 the State that meets generally applicable standards 

11 required of such an entity under such medicaid man12 aged care program, 

13 the State shall offer to enter into an agreement with the 

14 entity to serve as a medicaid managed care entity with re15 spect to eligible Indians served by such entity under such 

16 program. 

17 ‘‘(c) SPECIAL RULES FOR INDIAN MANAGED CARE EN18 TITIES.—The following are special rules regarding the ap19 plication of a medicaid managed care program to Indian 

20 medicaid managed care entities: 

21 ‘‘(1) ENROLLMENT.— 

22 ‘‘(A) LIMITATION TO INDIANS.—An Indian 

23 medicaid managed care entity may restrict en24 rollment under such program to Indians and to 

25 members of specific Tribes in the same manner 


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•S 1057 RS

1 as Indian Health Programs may restrict the de2 livery of services to such Indians and tribal 

3 members. 

4 ‘‘(B) NO LESS CHOICE OF PLANS.—Under 

5 such program the State may not limit the choice 

6 of an Indian among medicaid managed care en7 tities only to Indian medicaid managed care en8 tities or to be more restrictive than the choice of 

9 managed care entities offered to individuals who 

10 are not Indians. 

11 ‘‘(C) DEFAULT ENROLLMENT.— 

12 ‘‘(i) IN GENERAL.—If such program of 

13 a State requires the enrollment of Indians 

14 in a medicaid managed care entity in order 

15 to receive benefits, the State shall provide 

16 for the enrollment of Indians described in 

17 clause (ii) who are not otherwise enrolled 

18 with such an entity in an Indian medicaid 

19 managed care entity described in such 

20 clause. 

21 ‘‘(ii) INDIAN DESCRIBED.—An Indian 

22 described in this clause, with respect to an 

23 Indian medicaid managed care entity, is an 

24 Indian who, based upon the service area 

25 and capacity of the entity, is eligible to be 


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1 enrolled with the entity consistent with sub2 paragraph (A). 

3 ‘‘(D) EXCEPTION TO STATE LOCK-IN.—A re4 quest by an Indian who is enrolled under such 

5 program with a non-Indian medicaid managed 

6 care entity to change enrollment with that entity 

7 to enrollment with an Indian medicaid managed 

8 care entity shall be considered cause for granting 

9 such request under procedures specified by the 

10 Secretary. 

11 ‘‘(2) FLEXIBILITY IN APPLICATION OF SOL12 VENCY.—In applying section 1903(m)(1) of the Social 

13 Security Act to an Indian medicaid managed care 

14 entity— 

15 ‘‘(A) any reference to a ‘State’ in subpara16 graph (A)(ii) of that section shall be deemed to 

17 be a reference to the ‘Secretary’; and 

18 ‘‘(B) the entity shall be deemed to be a pub19 lic entity described in subparagraph (C)(ii) of 

20 that section. 

21 ‘‘(3) EXCEPTIONS TO ADVANCE DIRECTIVES.— 

22 The Secretary may modify or waive the requirements 

23 of section 1902(w) of the Social Security Act (relating 

24 to provision of written materials on advance direc25 tives) insofar as the Secretary finds that the requireVerDate Aug 31 2005 05:25 Mar 17, 2006 Jkt 049200 PO 00000 Frm 00538 Fmt 6652 Sfmt 6203 E:\BILLS\S1057.RS S1057

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1 ments otherwise imposed are not an appropriate or 

2 effective way of communicating the information to In3 dians. 

4 ‘‘(4) FLEXIBILITY IN INFORMATION AND MAR5 KETING.— 

6 ‘‘(A) MATERIALS.—The Secretary may 

7 modify requirements under section 1932(a)(5) of 

8 the Social Security Act in a manner that im9 proves the materials to take into account the spe10 cial circumstances of such entities and their en11 rollees while maintaining and clearly commu12 nicating to potential enrollees their rights, pro13 tections, and benefits. 

14 ‘‘(B) DISTRIBUTION OF MARKETING MATE15 RIALS.—The provisions of section 1932(d)(2)(B) 

16 of the Social Security Act requiring the distribu17 tion of marketing materials to an entire service 

18 area shall be deemed satisfied in the case of an 

19 Indian medicaid managed care entity that dis20 tributes appropriate materials only to those In21 dians who are potentially eligible to enroll with 

22 the entity in the service area. 

23 ‘‘(d) MALPRACTICE INSURANCE.—Insofar as, under a 

24 medicaid managed care program, a health care provider is 

25 required to have medical malpractice insurance coverage as 


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1 a condition of contracting as a provider with a medicaid 

2 managed care entity, an Indian Health Program, or an 

3 Urban Indian Organization that is a Federally-qualified 

4 health center under title XIX of the Social Security Act, 

5 that is covered under the Federal Tort Claims Act (28 

6 U.S.C. 1346(b), 2671 et seq.) is deemed to satisfy such re7 quirement. 

8 ‘‘(e) DEFINITIONS.—For purposes of this section: 

9 ‘‘(1) MEDICAID MANAGED CARE ENTITY.—The 

10 term ‘medicaid managed care entity’ means a man11 aged care entity (whether a managed care organiza12 tion or a primary care case manager) under title XIX 

13 of the Social Security Act, whether pursuant to sec14 tion 1903(m) or section 1932 of such Act, a waiver 

15 under section 1115 or 1915(b) of such Act, or other16 wise. 

17 ‘‘(2) INDIAN MEDICAID MANAGED CARE ENTI18 TY.—The term ‘Indian medicaid managed care enti19 ty’ means a managed care entity that is controlled 

20 (within the meaning of the last sentence of section 

21 1903(m)(1)(C) of the Social Security Act) by the In22 dian Health Service, a Tribe, Tribal Organization, or 

23 Urban Indian Organization (as such terms are de24 fined in section 4), or a consortium, which may be 

25 composed of 1 or more Tribes, Tribal Organizations, 


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1 or Urban Indian Organizations, and which also may 

2 include the Service. 

3 ‘‘(3) NON-INDIAN MEDICAID MANAGED CARE EN4 TITY.—The term ‘non-Indian medicaid managed care 

5 entity’ means a medicaid managed care entity that is 

6 not an Indian medicaid managed care entity. 

7 ‘‘(4) COVERED MEDICAID MANAGED CARE SERV8 ICES.—The term ‘covered medicaid managed care 

9 services’ means, with respect to an individual enrolled 

10 with a medicaid managed care entity, items and serv11 ices that are within the scope of items and services for 

12 which benefits are available with respect to the indi13 vidual under the contract between the entity and the 

14 State involved. 

15 ‘‘(5) MEDICAID MANAGED CARE PROGRAM.—The 

16 term ‘medicaid managed care program’ means a pro17 gram under sections 1903(m) and 1932 of the Social 

18 Security Act and includes a managed care program 

19 operating under a waiver under section 1915(b) or 

20 1115 of such Act or otherwise. 

21 ‘‘SEC. 414. NAVAJO NATION MEDICAID AGENCY FEASIBILITY 

22 STUDY. 

23 ‘‘(a) STUDY.—The Secretary shall conduct a study to 

24 determine the feasibility of treating the Navajo Nation as 

25 a State for the purposes of title XIX of the Social Security 


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1 Act, to provide services to Indians living within the bound2 aries of the Navajo Nation through an entity established 

3 having the same authority and performing the same func4 tions as single-State medicaid agencies responsible for the 

5 administration of the State plan under title XIX of the So6 cial Security Act. 

7 ‘‘(b) CONSIDERATIONS.—In conducting the study, the 

8 Secretary shall consider the feasibility of— 

9 ‘‘(1) assigning and paying all expenditures for 

10 the provision of services and related administration 

11 funds, under title XIX of the Social Security Act, to 

12 Indians living within the boundaries of the Navajo 

13 Nation that are currently paid to or would otherwise 

14 be paid to the State of Arizona, New Mexico, or Utah; 

15 ‘‘(2) providing assistance to the Navajo Nation 

16 in the development and implementation of such entity 

17 for the administration, eligibility, payment, and de18 livery of medical assistance under title XIX of the So19 cial Security Act; 

20 ‘‘(3) providing an appropriate level of matching 

21 funds for Federal medical assistance with respect to 

22 amounts such entity expends for medical assistance 

23 for services and related administrative costs; and 

24 ‘‘(4) authorizing the Secretary, at the option of 

25 the Navajo Nation, to treat the Navajo Nation as a 


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1 State for the purposes of title XIX of the Social Secu2 rity Act (relating to the State children’s health insur3 ance program) under terms equivalent to those de4 scribed in paragraphs (2) through (4). 

5 ‘‘(c) REPORT.—Not later then 3 years after the date 

6 of enactment of the Indian Health Act Improvement Act 

7 Amendments of 2005, the Secretary shall submit to the 

8 Committee on Indian Affairs and Committee on Finance 

9 of the Senate and the Committee on Resources and Com10 mittee on Energy and Commerce of the House of Represent11 atives a report that includes— 

12 ‘‘(1) the results of the study under this section; 

13 ‘‘(2) a summary of any consultation that oc14 curred between the Secretary and the Navajo Nation, 

15 other Indian Tribes, the States of Arizona, New Mex16 ico, and Utah, counties which include Navajo Lands, 

17 and other interested parties, in conducting this study; 

18 ‘‘(3) projected costs or savings associated with es19 tablishment of such entity, and any estimated impact 

20 on services provided as described in this section in re21 lation to probable costs or savings; and 

22 ‘‘(4) legislative actions that would be required to 

23 authorize the establishment of such entity if such enti24 ty is determined by the Secretary to be feasible. 


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1 ‘‘SEC. 415. AUTHORIZATION OF APPROPRIATIONS. 

2 ‘‘There are authorized to be appropriated such sums 

3 as may be necessary for each fiscal year through fiscal year 

4 2015 to carry out this title. 

5 ‘‘TITLE V—HEALTH SERVICES 

6 FOR URBAN INDIANS 

7 ‘‘SEC. 501. PURPOSE. 

8 ‘‘The purpose of this title is to establish and maintain 

9 programs in Urban Centers to make health services more 

10 accessible and available to Urban Indians. 

11 ‘‘SEC. 502. CONTRACTS WITH, AND GRANTS TO, URBAN IN12 DIAN ORGANIZATIONS. 

13 ‘‘Under authority of the Act of November 2, 1921 (25 

14 U.S.C. 13) (commonly known as the ‘Snyder Act’), the Sec15 retary, acting through the Service, shall enter into contracts 

16 with, or make grants to, Urban Indian Organizations to 

17 assist such organizations in the establishment and adminis18 tration, within Urban Centers, of programs which meet the 

19 requirements set forth in this title. Subject to section 506, 

20 the Secretary, acting through the Service, shall include such 

21 conditions as the Secretary considers necessary to effect the 

22 purpose of this title in any contract into which the Sec23 retary enters with, or in any grant the Secretary makes 

24 to, any Urban Indian Organization pursuant to this title. 


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1 ‘‘SEC. 503. CONTRACTS AND GRANTS FOR THE PROVISION 

2 OF HEALTH CARE AND REFERRAL SERVICES. 

3 ‘‘(a) REQUIREMENTS FOR GRANTS AND CONTRACTS.— 

4 Under authority of the Act of November 2, 1921 (25 U.S.C. 

5 13) (commonly known as the ‘Snyder Act’), the Secretary, 

6 acting through the Service, shall enter into contracts with, 

7 and make grants to, Urban Indian Organizations for the 

8 provision of health care and referral services for Urban In9 dians. Any such contract or grant shall include require10 ments that the Urban Indian Organization successfully un11 dertake to— 

12 ‘‘(1) estimate the population of Urban Indians 

13 residing in the Urban Center or centers that the orga14 nization proposes to serve who are or could be recipi15 ents of health care or referral services; 

16 ‘‘(2) estimate the current health status of Urban 

17 Indians residing in such Urban Center or centers; 

18 ‘‘(3) estimate the current health care needs of 

19 Urban Indians residing in such Urban Center or cen20 ters; 

21 ‘‘(4) provide basic health education, including 

22 health promotion and disease prevention education, to 

23 Urban Indians; 

24 ‘‘(5) make recommendations to the Secretary and 

25 Federal, State, local, and other resource agencies on 


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1 methods of improving health service programs to meet 

2 the needs of Urban Indians; and 

3 ‘‘(6) where necessary, provide, or enter into con4 tracts for the provision of, health care services for 

5 Urban Indians. 

6 ‘‘(b) CRITERIA.—The Secretary, acting through the 

7 Service, shall, by regulation, prescribe the criteria for select8 ing Urban Indian Organizations to enter into contracts or 

9 receive grants under this section. Such criteria shall, among 

10 other factors, include— 

11 ‘‘(1) the extent of unmet health care needs of 

12 Urban Indians in the Urban Center or centers in13 volved; 

14 ‘‘(2) the size of the Urban Indian population in 

15 the Urban Center or centers involved; 

16 ‘‘(3) the extent, if any, to which the activities set 

17 forth in subsection (a) would duplicate any project 

18 funded under this title; 

19 ‘‘(4) the capability of an Urban Indian Organi20 zation to perform the activities set forth in subsection 

21 (a) and to enter into a contract with the Secretary 

22 or to meet the requirements for receiving a grant 

23 under this section; 


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1 ‘‘(5) the satisfactory performance and successful 

2 completion by an Urban Indian Organization of 

3 other contracts with the Secretary under this title; 

4 ‘‘(6) the appropriateness and likely effectiveness 

5 of conducting the activities set forth in subsection (a) 

6 in an Urban Center or centers; and 

7 ‘‘(7) the extent of existing or likely future par8 ticipation in the activities set forth in subsection (a) 

9 by appropriate health and health-related Federal, 

10 State, local, and other agencies. 

11 ‘‘(c) ACCESS TO HEALTH PROMOTION AND DISEASE

12 PREVENTION PROGRAMS.—The Secretary, acting through 

13 the Service, shall facilitate access to or provide health pro14 motion and disease prevention services for Urban Indians 

15 through grants made to Urban Indian Organizations ad16 ministering contracts entered into or receiving grants under 

17 subsection (a). 

18 ‘‘(d) IMMUNIZATION SERVICES.— 

19 ‘‘(1) ACCESS OR SERVICES PROVIDED.—The Sec20 retary, acting through the Service, shall facilitate ac21 cess to, or provide, immunization services for Urban 

22 Indians through grants made to Urban Indian Orga23 nizations administering contracts entered into or re24 ceiving grants under this section. 


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1 ‘‘(2) DEFINITION.—For purposes of this sub2 section, the term ‘immunization services’ means serv3 ices to provide without charge immunizations against 

4 vaccine-preventable diseases. 

5 ‘‘(e) BEHAVIORAL HEALTH SERVICES.— 

6 ‘‘(1) ACCESS OR SERVICES PROVIDED.—The Sec7 retary, acting through the Service, shall facilitate ac8 cess to, or provide, behavioral health services for 

9 Urban Indians through grants made to Urban Indian 

10 Organizations administering contracts entered into or 

11 receiving grants under subsection (a). 

12 ‘‘(2) ASSESSMENT REQUIRED.—Except as pro13 vided by paragraph (3)(A), a grant may not be made 

14 under this subsection to an Urban Indian Organiza15 tion until that organization has prepared, and the 

16 Service has approved, an assessment of the following: 

17 ‘‘(A) The behavioral health needs of the 

18 Urban Indian population concerned. 

19 ‘‘(B) The behavioral health services and 

20 other related resources available to that popu21 lation. 

22 ‘‘(C) The barriers to obtaining those services 

23 and resources. 

24 ‘‘(D) The needs that are unmet by such 

25 services and resources. 


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1 ‘‘(3) PURPOSES OF GRANTS.—Grants may be 

2 made under this subsection for the following: 

3 ‘‘(A) To prepare assessments required under 

4 paragraph (2). 

5 ‘‘(B) To provide outreach, educational, and 

6 referral services to Urban Indians regarding the 

7 availability of direct behavioral health services, 

8 to educate Urban Indians about behavioral 

9 health issues and services, and effect coordina10 tion with existing behavioral health providers in 

11 order to improve services to Urban Indians. 

12 ‘‘(C) To provide outpatient behavioral 

13 health services to Urban Indians, including the 

14 identification and assessment of illness, thera15 peutic treatments, case management, support 

16 groups, family treatment, and other treatment. 

17 ‘‘(D) To develop innovative behavioral 

18 health service delivery models which incorporate 

19 Indian cultural support systems and resources. 

20 ‘‘(f) PREVENTION OF CHILD ABUSE.— 

21 ‘‘(1) ACCESS OR SERVICES PROVIDED.—The Sec22 retary, acting through the Service, shall facilitate ac23 cess to or provide services for Urban Indians through 

24 grants to Urban Indian Organizations administering 

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1 section (a) to prevent and treat child abuse (including 

2 sexual abuse) among Urban Indians. 

3 ‘‘(2) EVALUATION REQUIRED.—Except as pro4 vided by paragraph (3)(A), a grant may not be made 

5 under this subsection to an Urban Indian Organiza6 tion until that organization has prepared, and the 

7 Service has approved, an assessment that documents 

8 the prevalence of child abuse in the Urban Indian 

9 population concerned and specifies the services and 

10 programs (which may not duplicate existing services 

11 and programs) for which the grant is requested. 

12 ‘‘(3) PURPOSES OF GRANTS.—Grants may be 

13 made under this subsection for the following: 

14 ‘‘(A) To prepare assessments required under 

15 paragraph (2). 

16 ‘‘(B) For the development of prevention, 

17 training, and education programs for Urban In18 dians, including child education, parent edu19 cation, provider training on identification and 

20 intervention, education on reporting require21 ments, prevention campaigns, and establishing 

22 service networks of all those involved in Indian 

23 child protection. 

24 ‘‘(C) To provide direct outpatient treatment 

25 services (including individual treatment, family 


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1 treatment, group therapy, and support groups) 

2 to Urban Indians who are child victims of abuse 

3 (including sexual abuse) or adult survivors of 

4 child sexual abuse, to the families of such child 

5 victims, and to Urban Indian perpetrators of 

6 child abuse (including sexual abuse). 

7 ‘‘(4) CONSIDERATIONS WHEN MAKING GRANTS.— 

8 In making grants to carry out this subsection, the 

9 Secretary shall take into consideration— 

10 ‘‘(A) the support for the Urban Indian Or11 ganization demonstrated by the child protection 

12 authorities in the area, including committees or 

13 other services funded under the Indian Child 

14 Welfare Act of 1978 (25 U.S.C. 1901 et seq.), if 

15 any; 

16 ‘‘(B) the capability and expertise dem17 onstrated by the Urban Indian Organization to 

18 address the complex problem of child sexual 

19 abuse in the community; and 

20 ‘‘(C) the assessment required under para21 graph (2). 

22 ‘‘(g) OTHER GRANTS.—The Secretary, acting through 

23 the Service, may enter into a contract with or make grants 

24 to an Urban Indian Organization that provides or arranges 

25 for the provision of health care services (through satellite 


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1 facilities, provider networks, or otherwise) to Urban Indi2 ans in more than 1 Urban Center. 

3 ‘‘SEC. 504. CONTRACTS AND GRANTS FOR THE DETERMINA4 TION OF UNMET HEALTH CARE NEEDS. 

5 ‘‘(a) GRANTS AND CONTRACTS AUTHORIZED.—Under 

6 authority of the Act of November 2, 1921 (25 U.S.C. 13) 

7 (commonly known as the ‘Snyder Act’), the Secretary, act8 ing through the Service, may enter into contracts with or 

9 make grants to Urban Indian Organizations situated in 

10 Urban Centers for which contracts have not been entered 

11 into or grants have not been made under section 503. 

12 ‘‘(b) PURPOSE.—The purpose of a contract or grant 

13 made under this section shall be the determination of the 

14 matters described in subsection (c)(1) in order to assist the 

15 Secretary in assessing the health status and health care 

16 needs of Urban Indians in the Urban Center involved and 

17 determining whether the Secretary should enter into a con18 tract or make a grant under section 503 with respect to 

19 the Urban Indian Organization which the Secretary has en20 tered into a contract with, or made a grant to, under this 

21 section. 

22 ‘‘(c) GRANT AND CONTRACT REQUIREMENTS.—Any 

23 contract entered into, or grant made, by the Secretary 

24 under this section shall include requirements that— 


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1 ‘‘(1) the Urban Indian Organization successfully 

2 undertakes to— 

3 ‘‘(A) document the health care status and 

4 unmet health care needs of Urban Indians in the 

5 Urban Center involved; and 

6 ‘‘(B) with respect to Urban Indians in the 

7 Urban Center involved, determine the matters 

8 described in paragraphs (2), (3), (4), and (7) of 

9 section 503(b); and 

10 ‘‘(2) the Urban Indian Organization complete 

11 performance of the contract, or carry out the require12 ments of the grant, within 1 year after the date on 

13 which the Secretary and such organization enter into 

14 such contract, or within 1 year after such organiza15 tion receives such grant, whichever is applicable. 

16 ‘‘(d) NO RENEWALS.—The Secretary may not renew 

17 any contract entered into or grant made under this section. 

18 ‘‘SEC. 505. EVALUATIONS; RENEWALS. 

19 ‘‘(a) PROCEDURES FOR EVALUATIONS.—The Sec20 retary, acting through the Service, shall develop procedures 

21 to evaluate compliance with grant requirements and com22 pliance with and performance of contracts entered into by 

23 Urban Indian Organizations under this title. Such proce24 dures shall include provisions for carrying out the require25 ments of this section. 


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1 ‘‘(b) EVALUATIONS.—The Secretary, acting through 

2 the Service, shall evaluate the compliance of each Urban 

3 Indian Organization which has entered into a contract or 

4 received a grant under section 503 with the terms of such 

5 contract or grant. For purposes of this evaluation, in deter6 mining the capacity of an Urban Indian Organization to 

7 deliver quality patient care the Secretary shall— 

8 ‘‘(1) acting through the Service, conduct an an9 nual onsite evaluation of the organization; or 

10 ‘‘(2) accept in lieu of such onsite evaluation evi11 dence of the organization’s provisional or full accredi12 tation by a private independent entity recognized by 

13 the Secretary for purposes of conducting quality re14 views of providers participating in the Medicare pro15 gram under title XVIII of the Social Security Act. 

16 ‘‘(c) NONCOMPLIANCE; UNSATISFACTORY PERFORM17 ANCE.—If, as a result of the evaluations conducted under 

18 this section, the Secretary determines that an Urban Indian 

19 Organization has not complied with the requirements of a 

20 grant or complied with or satisfactorily performed a con21 tract under section 503, the Secretary shall, prior to renew22 ing such contract or grant, attempt to resolve with the orga23 nization the areas of noncompliance or unsatisfactory per24 formance and modify the contract or grant to prevent future 

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1 ance. If the Secretary determines that the noncompliance 

2 or unsatisfactory performance cannot be resolved and pre3 vented in the future, the Secretary shall not renew the con4 tract or grant with the organization and is authorized to 

5 enter into a contract or make a grant under section 503 

6 with another Urban Indian Organization which is situated 

7 in the same Urban Center as the Urban Indian Organiza8 tion whose contract or grant is not renewed under this sec9 tion. 

10 ‘‘(d) CONSIDERATIONS FOR RENEWALS.—In deter11 mining whether to renew a contract or grant with an Urban 

12 Indian Organization under section 503 which has com13 pleted performance of a contract or grant under section 504, 

14 the Secretary shall review the records of the Urban Indian 

15 Organization, the reports submitted under section 507, and 

16 shall consider the results of the onsite evaluations or accred17 itations under subsection (b). 

18 ‘‘SEC. 506. OTHER CONTRACT AND GRANT REQUIREMENTS. 

19 ‘‘(a) PROCUREMENT.—Contracts with Urban Indian 

20 Organizations entered into pursuant to this title shall be 

21 in accordance with all Federal contracting laws and regula22 tions relating to procurement except that in the discretion 

23 of the Secretary, such contracts may be negotiated without 

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1 tions 1304 and 3131 through 3133 of title 40, United States 

2 Code. 

3 ‘‘(b) PAYMENTS UNDER CONTRACTS OR GRANTS.— 

4 Payments under any contracts or grants pursuant to this 

5 title shall, notwithstanding any term or condition of such 

6 contract or grant— 

7 ‘‘(1) be made in their entirety by the Secretary 

8 to the Urban Indian Organization by no later than 

9 the end of the first 30 days of the funding period with 

10 respect to which the payments apply, unless the Sec11 retary determines through an evaluation under sec12 tion 505 that the organization is not capable of ad13 ministering such payments in their entirety; and 

14 ‘‘(2) if any portion thereof is unexpended by the 

15 Urban Indian Organization during the funding pe16 riod with respect to which the payments initially 

17 apply, shall be carried forward for expenditure with 

18 respect to allowable or reimbursable costs incurred by 

19 the organization during 1 or more subsequent funding 

20 periods without additional justification or docu21 mentation by the organization as a condition of car22 rying forward the availability for expenditure of such 

23 funds. 

24 ‘‘(c) REVISION OR AMENDMENT OF CONTRACTS.—Not25 withstanding any provision of law to the contrary, the SecVerDate Aug 31 2005 05:25 Mar 17, 2006 Jkt 049200 PO 00000 Frm 00556 Fmt 6652 Sfmt 6203 E:\BILLS\S1057.RS S1057

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1 retary may, at the request and consent of an Urban Indian 

2 Organization, revise or amend any contract entered into 

3 by the Secretary with such organization under this title as 

4 necessary to carry out the purposes of this title. 

5 ‘‘(d) FAIR AND UNIFORM SERVICES AND ASSIST6 ANCE.—Contracts with or grants to Urban Indian Organi7 zations and regulations adopted pursuant to this title shall 

8 include provisions to assure the fair and uniform provision 

9 to Urban Indians of services and assistance under such con10 tracts or grants by such organizations. 

11 ‘‘SEC. 507. REPORTS AND RECORDS. 

12 ‘‘(a) REPORTS.—For each fiscal year during which an 

13 Urban Indian Organization receives or expends funds pur14 suant to a contract entered into or a grant received pursu15 ant to this title, such Urban Indian Organization shall sub16 mit to the Secretary not more frequently than every 6 

17 months, a report that includes the following: 

18 ‘‘(1) In the case of a contract or grant under sec19 tion 503, recommendations pursuant to section 

20 503(a)(5). 

21 ‘‘(2) Information on activities conducted by the 

22 organization pursuant to the contract or grant. 

23 ‘‘(3) An accounting of the amounts and purpose 

24 for which Federal funds were expended. 


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1 ‘‘(4) A minimum set of data, using uniformly 

2 defined elements, as specified by the Secretary after 

3 consultation with Urban Indian Organizations. 

4 ‘‘(b) AUDIT.—The reports and records of the Urban In5 dian Organization with respect to a contract or grant under 

6 this title shall be subject to audit by the Secretary and the 

7 Comptroller General of the United States. 

8 ‘‘(c) COSTS OF AUDITS.—The Secretary shall allow as 

9 a cost of any contract or grant entered into or awarded 

10 under section 502 or 503 the cost of an annual independent 

11 financial audit conducted by— 

12 ‘‘(1) a certified public accountant; or 

13 ‘‘(2) a certified public accounting firm qualified 

14 to conduct Federal compliance audits. 

15 ‘‘SEC. 508. LIMITATION ON CONTRACT AUTHORITY. 

16 ‘‘The authority of the Secretary to enter into contracts 

17 or to award grants under this title shall be to the extent, 

18 and in an amount, provided for in appropriation Acts. 

19 ‘‘SEC. 509. FACILITIES. 

20 ‘‘(a) GRANTS.—The Secretary, acting through the 

21 Service, may make grants to contractors or grant recipients 

22 under this title for the lease, purchase, renovation, construc23 tion, or expansion of facilities, including leased facilities, 

24 in order to assist such contractors or grant recipients in 


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1 complying with applicable licensure or certification re2 quirements. 

3 ‘‘(b) LOAN FUND STUDY.—The Secretary, acting 

4 through the Services, may carry out a study to determine 

5 the feasibility of establishing a loan fund to provide to 

6 Urban Indian Organizations direct loans or guarantees for 

7 loans for the construction of health care facilities in a man8 ner consistent with section 309. 

9 ‘‘SEC. 510. DIVISION OF URBAN INDIAN HEALTH. 

10 ‘‘There is established within the Service a Division of 

11 Urban Indian Health, which shall be responsible for— 

12 ‘‘(1) carrying out the provisions of this title; 

13 ‘‘(2) providing central oversight of the programs 

14 and services authorized under this title; and 

15 ‘‘(3) providing technical assistance to Urban In16 dian Organizations. 

17 ‘‘SEC. 511. GRANTS FOR ALCOHOL AND SUBSTANCE ABUSE18 RELATED SERVICES. 

19 ‘‘(a) GRANTS AUTHORIZED.—The Secretary, acting 

20 through the Service, may make grants for the provision of 

21 health-related services in prevention of, treatment of, reha22 bilitation of, or school- and community-based education re23 garding, alcohol and substance abuse in Urban Centers to 

24 those Urban Indian Organizations with which the SecVerDate Aug 31 2005 05:25 Mar 17, 2006 Jkt 049200 PO 00000 Frm 00559 Fmt 6652 Sfmt 6203 E:\BILLS\S1057.RS S1057

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1 retary has entered into a contract under this title or under 

2 section 201. 

3 ‘‘(b) GOALS.—Each grant made pursuant to subsection 

4 (a) shall set forth the goals to be accomplished pursuant 

5 to the grant. The goals shall be specific to each grant as 

6 agreed to between the Secretary and the grantee. 

7 ‘‘(c) CRITERIA.—The Secretary shall establish criteria 

8 for the grants made under subsection (a), including criteria 

9 relating to the following: 

10 ‘‘(1) The size of the Urban Indian population. 

11 ‘‘(2) Capability of the organization to adequately 

12 perform the activities required under the grant. 

13 ‘‘(3) Satisfactory performance standards for the 

14 organization in meeting the goals set forth in such 

15 grant. The standards shall be negotiated and agreed 

16 to between the Secretary and the grantee on a grant17 by-grant basis. 

18 ‘‘(4) Identification of the need for services. 

19 ‘‘(d) ALLOCATION OF GRANTS.—The Secretary shall 

20 develop a methodology for allocating grants made pursuant 

21 to this section based on the criteria established pursuant 

22 to subsection (c). 

23 ‘‘(e) GRANTS SUBJECT TO CRITERIA.—Any funds re24 ceived by an Urban Indian Organization under this Act 

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1 tion shall be subject to the criteria set forth in subsection 

2 (c). 

3 ‘‘SEC. 512. TREATMENT OF CERTAIN DEMONSTRATION 

4 PROJECTS. 

5 ‘‘Notwithstanding any other provision of law, the 

6 Tulsa Clinic and Oklahoma City Clinic demonstration 

7 projects shall— 

8 ‘‘(1) be permanent programs within the Service’s 

9 direct care program; 

10 ‘‘(2) continue to be treated as Service Units in 

11 the allocation of resources and coordination of care; 

12 and 

13 ‘‘(3) continue to meet the requirements and defi14 nitions of an Urban Indian Organization in this Act, 

15 and shall not be subject to the provisions of the In16 dian Self-Determination and Education Assistance 

17 Act (25 U.S.C. 450 et seq.). 

18 ‘‘SEC. 513. URBAN NIAAA TRANSFERRED PROGRAMS. 

19 ‘‘(a) GRANTS AND CONTRACTS.—The Secretary, 

20 through the Division of Urban Indian Health, shall make 

21 grants or enter into contracts with Urban Indian Organiza22 tions, to take effect not later than September 30, 2008, for 

23 the administration of Urban Indian alcohol programs that 

24 were originally established under the National Institute on 


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1 Alcoholism and Alcohol Abuse (hereafter in this section re2 ferred to as ‘NIAAA’) and transferred to the Service. 

3 ‘‘(b) USE OF FUNDS.—Grants provided or contracts 

4 entered into under this section shall be used to provide sup5 port for the continuation of alcohol prevention and treat6 ment services for Urban Indian populations and such other 

7 objectives as are agreed upon between the Service and a re8 cipient of a grant or contract under this section. 

9 ‘‘(c) ELIGIBILITY.—Urban Indian Organizations that 

10 operate Indian alcohol programs originally funded under 

11 the NIAAA and subsequently transferred to the Service are 

12 eligible for grants or contracts under this section. 

13 ‘‘(d) REPORT.—The Secretary shall evaluate and re14 port to Congress on the activities of programs funded under 

15 this section not less than every 5 years. 

16 ‘‘SEC. 514. CONSULTATION WITH URBAN INDIAN ORGANIZA17 TIONS. 

18 ‘‘(a) IN GENERAL.—The Secretary shall ensure that 

19 the Service consults, to the greatest extent practicable, with 

20 Urban Indian Organizations. 

21 ‘‘(b) DEFINITION OF CONSULTATION.—For purposes of 

22 subsection (a), consultation is the open and free exchange 

23 of information and opinions which leads to mutual under24 standing and comprehension and which emphasizes trust, 

25 respect, and shared responsibility. 


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1 ‘‘SEC. 515. FEDERAL TORT CLAIM ACT COVERAGE. 

2 ‘‘(a) IN GENERAL.—With respect to claims resulting 

3 from the performance of functions during fiscal year 2005 

4 and thereafter, or claims asserted after September 30, 2004, 

5 but resulting from the performance of functions prior to fis6 cal year 2005, under a contract, grant agreement, or any 

7 other agreement authorized under this title, an Urban In8 dian Organization is deemed hereafter to be part of the 

9 Service in the Department of Health and Human Services 

10 while carrying out any such contract or agreement and its 

11 employees are deemed employees of the Service while acting 

12 within the scope of their employment in carrying out the 

13 contract or agreement. After September 30, 2003, any civil 

14 action or proceeding involving such claims brought here15 after against any Urban Indian Organization or any em16 ployee of such Urban Indian Organization covered by this 

17 provision shall be deemed to be an action against the United 

18 States and will be defended by the Attorney General and 

19 be afforded the full protection and coverage of the Federal 

20 Tort Claims Act (28 U.S.C. 1346(b), 2671 et seq.). Future 

21 coverage under that Act shall be contingent on cooperation 

22 of the Urban Indian Organization with the Attorney Gen23 eral in prosecuting past claims. 

24 ‘‘(b) CLAIMS RESULTING FROM PERFORMANCE OF

25 CONTRACT OR GRANT.—Beginning for fiscal year 2005 and 

26 thereafter, the Secretary shall request through annual apVerDate Aug 31 2005 05:25 Mar 17, 2006 Jkt 049200 PO 00000 Frm 00563 Fmt 6652 Sfmt 6203 E:\BILLS\S1057.RS S1057

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1 propriations funds sufficient to reimburse the Treasury for 

2 any claims paid in the prior fiscal year pursuant to the 

3 foregoing provisions. 

4 ‘‘SEC. 516. URBAN YOUTH TREATMENT CENTER DEM5 ONSTRATION. 

6 ‘‘(a) CONSTRUCTION AND OPERATION.—The Secretary, 

7 acting through the Service, through grant or contract, is 

8 authorized to fund the construction and operation of at least 

9 2 residential treatment centers in each State described in 

10 subsection (b) to demonstrate the provision of alcohol and 

11 substance abuse treatment services to Urban Indian youth 

12 in a culturally competent residential setting. 

13 ‘‘(b) DEFINITION OF STATE.—A State described in this 

14 subsection is a State in which— 

15 ‘‘(1) there resides Urban Indian youth with need 

16 for alcohol and substance abuse treatment services in 

17 a residential setting; and 

18 ‘‘(2) there is a significant shortage of culturally 

19 competent residential treatment services for Urban 

20 Indian youth. 

21 ‘‘SEC. 517. USE OF FEDERAL GOVERNMENT FACILITIES AND 

22 SOURCES OF SUPPLY. 

23 ‘‘(a) AUTHORIZATION FOR USE.—The Secretary, act24 ing through the Service, shall allow an Urban Indian Orga25 nization that has entered into a contract or received a grant 


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1 pursuant to this title, in carrying out such contract or 

2 grant, to use existing facilities and all equipment therein 

3 or pertaining thereto and other personal property owned 

4 by the Federal Government within the Secretary’s jurisdic5 tion under such terms and conditions as may be agreed 

6 upon for their use and maintenance. 

7 ‘‘(b) DONATIONS.—Subject to subsection (d), the Sec8 retary may donate to an Urban Indian Organization that 

9 has entered into a contract or received a grant pursuant 

10 to this title any personal or real property determined to 

11 be excess to the needs of the Service or the General Services 

12 Administration for purposes of carrying out the contract 

13 or grant. 

14 ‘‘(c) ACQUISITION OF PROPERTY FOR DONATION.—The 

15 Secretary may acquire excess or surplus government per16 sonal or real property for donation (subject to subsection 

17 (d)), to an Urban Indian Organization that has entered 

18 into a contract or received a grant pursuant to this title 

19 if the Secretary determines that the property is appropriate 

20 for use by the Urban Indian Organization for a purpose 

21 for which a contract or grant is authorized under this title. 

22 ‘‘(d) PRIORITY.—In the event that the Secretary re23 ceives a request for donation of a specific item of personal 

24 or real property described in subsection (b) or (c) from both 

25 an Urban Indian Organization and from an Indian Tribe 


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1 or Tribal Organization, the Secretary shall give priority 

2 to the request for donation of the Indian Tribe or Tribal 

3 Organization if the Secretary receives the request from the 

4 Indian Tribe or Tribal Organization before the date the 

5 Secretary transfers title to the property or, if earlier, the 

6 date the Secretary transfers the property physically to the 

7 Urban Indian Organization. 

8 ‘‘(e) URBAN INDIAN ORGANIZATIONS DEEMED EXECU9 TIVE AGENCY FOR CERTAIN PURPOSES.—For purposes of 

10 section 501 of title 40, United States Code, (relating to Fed11 eral sources of supply, including lodging providers, airlines, 

12 and other transportation providers), an Urban Indian Or13 ganization that has entered into a contract or received a 

14 grant pursuant to this title shall be deemed an executive 

15 agency when carrying out such contract or grant. 

16 ‘‘SEC. 518. GRANTS FOR DIABETES PREVENTION, TREAT17 MENT, AND CONTROL. 

18 ‘‘(a) GRANTS AUTHORIZED.—The Secretary may 

19 make grants to those Urban Indian Organizations that have 

20 entered into a contract or have received a grant under this 

21 title for the provision of services for the prevention and 

22 treatment of, and control of the complications resulting 

23 from, diabetes among Urban Indians. 

24 ‘‘(b) GOALS.—Each grant made pursuant to subsection 

25 (a) shall set forth the goals to be accomplished under the 


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1 grant. The goals shall be specific to each grant as agreed 

2 to between the Secretary and the grantee. 

3 ‘‘(c) ESTABLISHMENT OF CRITERIA.—The Secretary 

4 shall establish criteria for the grants made under subsection 

5 (a) relating to— 

6 ‘‘(1) the size and location of the Urban Indian 

7 population to be served; 

8 ‘‘(2) the need for prevention of and treatment of, 

9 and control of the complications resulting from, dia10 betes among the Urban Indian population to be 

11 served; 

12 ‘‘(3) performance standards for the organization 

13 in meeting the goals set forth in such grant that are 

14 negotiated and agreed to by the Secretary and the 

15 grantee; 

16 ‘‘(4) the capability of the organization to ade17 quately perform the activities required under the 

18 grant; and 

19 ‘‘(5) the willingness of the organization to col20 laborate with the registry, if any, established by the 

21 Secretary under section 204(e) in the Area Office of 

22 the Service in which the organization is located. 

23 ‘‘(d) FUNDS SUBJECT TO CRITERIA.—Any funds re24 ceived by an Urban Indian Organization under this Act 

25 for the prevention, treatment, and control of diabetes among 


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1 Urban Indians shall be subject to the criteria developed by 

2 the Secretary under subsection (c). 

3 ‘‘SEC. 519. COMMUNITY HEALTH REPRESENTATIVES. 

4 ‘‘The Secretary, acting through the Service, may enter 

5 into contracts with, and make grants to, Urban Indian Or6 ganizations for the employment of Indians trained as health 

7 service providers through the Community Health Represent8 atives Program under section 109 in the provision of health 

9 care, health promotion, and disease prevention services to 

10 Urban Indians. 

11 ‘‘SEC. 520. EFFECTIVE DATE. 

12 ‘‘The amendments made by the Indian Health Care 

13 Improvement Act Amendments of 2005 to this title shall 

14 take effect beginning on the date of enactment of that Act, 

15 regardless of whether the Secretary has promulgated regula16 tions implementing such amendments. 

17 ‘‘SEC. 521. ELIGIBILITY FOR SERVICES. 

18 ‘‘Urban Indians shall be eligible and the ultimate bene19 ficiaries for health care or referral services provided pursu20 ant to this title. 

21 ‘‘SEC. 522. AUTHORIZATION OF APPROPRIATIONS. 

22 ‘‘There are authorized to be appropriated such sums 

23 as may be necessary for each fiscal year through fiscal year 

24 2015 to carry out this title. 


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1 ‘‘TITLE VI—ORGANIZATIONAL 

2 IMPROVEMENTS 

3 ‘‘SEC. 601. ESTABLISHMENT OF THE INDIAN HEALTH SERV4 ICE AS AN AGENCY OF THE PUBLIC HEALTH 

5 SERVICE. 

6 ‘‘(a) ESTABLISHMENT.— 

7 ‘‘(1) IN GENERAL.—In order to more effectively 

8 and efficiently carry out the responsibilities, authori9 ties, and functions of the United States to provide 

10 health care services to Indians and Indian Tribes, as 

11 are or may be hereafter provided by Federal statute 

12 or treaties, there is established within the Public 

13 Health Service of the Department the Indian Health 

14 Service. 

15 ‘‘(2) ASSISTANT SECRETARY OF INDIAN

16 HEALTH.—The Service shall be administered by an 

17 Assistant Secretary of Indian Health, who shall be 

18 appointed by the President, by and with the advice 

19 and consent of the Senate. The Assistant Secretary 

20 shall report to the Secretary. Effective with respect to 

21 an individual appointed by the President, by and 

22 with the advice and consent of the Senate, after Janu23 ary 1, 2005, the term of service of the Assistant Sec24 retary shall be 4 years. An Assistant Secretary may 

25 serve more than 1 term. 


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1 ‘‘(3) INCUMBENT.—The individual serving in the 

2 position of Director of the Indian Health Service on 

3 the day before the date of enactment of the Indian 

4 Health Care Improvement Act Amendments of 2005 

5 shall serve as Assistant Secretary. 

6 ‘‘(4) ADVOCACY AND CONSULTATION.—The posi7 tion of Assistant Secretary is established to, in a 

8 manner consistent with the government-to-government 

9 relationship between the United States and Indian 

10 Tribes— 

11 ‘‘(A) facilitate advocacy for the development 

12 of appropriate Indian health policy; and 

13 ‘‘(B) promote consultation on matters relat14 ing to Indian health. 

15 ‘‘(b) AGENCY.—The Service shall be an agency within 

16 the Public Health Service of the Department, and shall not 

17 be an office, component, or unit of any other agency of the 

18 Department. 

19 ‘‘(c) DUTIES.—The Assistant Secretary of Indian 

20 Health shall— 

21 ‘‘(1) perform all functions that were, on the day 

22 before the date of enactment of the Indian Health 

23 Care Improvement Act Amendments of 2005, carried 

24 out by or under the direction of the individual serv25 ing as Director of the Service on that day; 


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1 ‘‘(2) perform all functions of the Secretary relat2 ing to the maintenance and operation of hospital and 

3 health facilities for Indians and the planning for, and 

4 provision and utilization of, health services for Indi5 ans; 

6 ‘‘(3) administer all health programs under which 

7 health care is provided to Indians based upon their 

8 status as Indians which are administered by the Sec9 retary, including programs under— 

10 ‘‘(A) this Act; 

11 ‘‘(B) the Act of November 2, 1921 (25 

12 U.S.C. 13); 

13 ‘‘(C) the Act of August 5, 1954 (42 U.S.C. 

14 2001 et seq.); 

15 ‘‘(D) the Act of August 16, 1957 (42 U.S.C. 

16 2005 et seq.); and 

17 ‘‘(E) the Indian Self-Determination and 

18 Education Assistance Act (25 U.S.C. 450 et 

19 seq.); 

20 ‘‘(4) administer all scholarship and loan func21 tions carried out under title I; 

22 ‘‘(5) report directly to the Secretary concerning 

23 all policy- and budget-related matters affecting In24 dian health; 


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1 ‘‘(6) collaborate with the Assistant Secretary for 

2 Health concerning appropriate matters of Indian 

3 health that affect the agencies of the Public Health 

4 Service; 

5 ‘‘(7) advise each Assistant Secretary of the De6 partment concerning matters of Indian health with 

7 respect to which that Assistant Secretary has author8 ity and responsibility; 

9 ‘‘(8) advise the heads of other agencies and pro10 grams of the Department concerning matters of In11 dian health with respect to which those heads have 

12 authority and responsibility; 

13 ‘‘(9) coordinate the activities of the Department 

14 concerning matters of Indian health; and 

15 ‘‘(10) perform such other functions as the Sec16 retary may designate. 

17 ‘‘(d) AUTHORITY.— 

18 ‘‘(1) IN GENERAL.—The Secretary, acting 

19 through the Assistant Secretary, shall have the au20 thority— 

21 ‘‘(A) except to the extent provided for in 

22 paragraph (2), to appoint and compensate em23 ployees for the Service in accordance with title 

24 5, United States Code; 


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1 ‘‘(B) to enter into contracts for the procure2 ment of goods and services to carry out the func3 tions of the Service; and 

4 ‘‘(C) to manage, expend, and obligate all 

5 funds appropriated for the Service. 

6 ‘‘(2) PERSONNEL ACTIONS.—Notwithstanding 

7 any other provision of law, the provisions of section 

8 12 of the Act of June 18, 1934 (48 Stat. 986; 25 

9 U.S.C. 472), shall apply to all personnel actions 

10 taken with respect to new positions created within the 

11 Service as a result of its establishment under sub12 section (a). 

13 ‘‘(e) REFERENCES.—Any reference to the Director of 

14 the Indian Health Service in any other Federal law, Execu15 tive order, rule, regulation, or delegation of authority, or 

16 in any document of or relating to the Director of the Indian 

17 Health Service, shall be deemed to refer to the Assistant Sec18 retary. 

19 ‘‘SEC. 602. AUTOMATED MANAGEMENT INFORMATION SYS20 TEM. 

21 ‘‘(a) ESTABLISHMENT.— 

22 ‘‘(1) IN GENERAL.—The Secretary shall establish 

23 an automated management information system for 

24 the Service. 


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1 ‘‘(2) REQUIREMENTS OF SYSTEM.—The informa2 tion system established under paragraph (1) shall in3 clude— 

4 ‘‘(A) a financial management system; 

5 ‘‘(B) a patient care information system for 

6 each area served by the Service; 

7 ‘‘(C) a privacy component that protects the 

8 privacy of patient information held by, or on be9 half of, the Service; 

10 ‘‘(D) a services-based cost accounting com11 ponent that provides estimates of the costs associ12 ated with the provision of specific medical treat13 ments or services in each Area office of the Serv14 ice; 

15 ‘‘(E) an interface mechanism for patient 

16 billing and accounts receivable system; and 

17 ‘‘(F) a training component. 

18 ‘‘(b) PROVISION OF SYSTEMS TO TRIBES AND ORGANI19 ZATIONS.—The Secretary shall provide each Tribal Health 

20 Program automated management information systems 

21 which— 

22 ‘‘(1) meet the management information needs of 

23 such Tribal Health Program with respect to the treat24 ment by the Tribal Health Program of patients of the 

25 Service; and 


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1 ‘‘(2) meet the management information needs of 

2 the Service. 

3 ‘‘(c) ACCESS TO RECORDS.—Notwithstanding any 

4 other provision of law, each patient shall have reasonable 

5 access to the medical or health records of such patient which 

6 are held by, or on behalf of, the Service. 

7 ‘‘(d) AUTHORITY TO ENHANCE INFORMATION TECH8 NOLOGY.—The Secretary, acting through the Assistant Sec9 retary, shall have the authority to enter into contracts, 

10 agreements, or joint ventures with other Federal agencies, 

11 States, private and nonprofit organizations, for the purpose 

12 of enhancing information technology in Indian health pro13 grams and facilities. 

14 ‘‘SEC. 603. AUTHORIZATION OF APPROPRIATIONS. 

15 ‘‘There is authorized to be appropriated such sums as 

16 may be necessary for each fiscal year through fiscal year 

17 2015 to carry out this title. 

18 ‘‘TITLE VII—BEHAVIORAL 

19 HEALTH PROGRAMS 

20 ‘‘SEC. 701. BEHAVIORAL HEALTH PREVENTION AND TREAT21 MENT SERVICES. 

22 ‘‘(a) PURPOSES.—The purposes of this section are as 

23 follows: 

24 ‘‘(1) To authorize and direct the Secretary, act25 ing through the Service, Indian Tribes, Tribal OrgaVerDate Aug 31 2005 05:25 Mar 17, 2006 Jkt 049200 PO 00000 Frm 00575 Fmt 6652 Sfmt 6203 E:\BILLS\S1057.RS S1057

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1 nizations, and Urban Indian Organizations, to de2 velop a comprehensive behavioral health prevention 

3 and treatment program which emphasizes collabora4 tion among alcohol and substance abuse, social serv5 ices, and mental health programs. 

6 ‘‘(2) To provide information, direction, and 

7 guidance relating to mental illness and dysfunction 

8 and self-destructive behavior, including child abuse 

9 and family violence, to those Federal, tribal, State, 

10 and local agencies responsible for programs in Indian 

11 communities in areas of health care, education, social 

12 services, child and family welfare, alcohol and sub13 stance abuse, law enforcement, and judicial services. 

14 ‘‘(3) To assist Indian Tribes to identify services 

15 and resources available to address mental illness and 

16 dysfunctional and self-destructive behavior. 

17 ‘‘(4) To provide authority and opportunities for 

18 Indian Tribes and Tribal Organizations to develop, 

19 implement, and coordinate with community-based 

20 programs which include identification, prevention, 

21 education, referral, and treatment services, including 

22 through multidisciplinary resource teams. 

23 ‘‘(5) To ensure that Indians, as citizens of the 

24 United States and of the States in which they reside, 


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1 have the same access to behavioral health services to 

2 which all citizens have access. 

3 ‘‘(6) To modify or supplement existing programs 

4 and authorities in the areas identified in paragraph 

5 (2). 

6 ‘‘(b) PLANS.— 

7 ‘‘(1) DEVELOPMENT.—The Secretary, acting 

8 through the Service, Indian Tribes, Tribal Organiza9 tions, and Urban Indian Organizations, shall encour10 age Indian Tribes and Tribal Organizations to de11 velop tribal plans, and Urban Indian Organizations 

12 to develop local plans, and for all such groups to par13 ticipate in developing areawide plans for Indian Be14 havioral Health Services. The plans shall include, to 

15 the extent feasible, the following components: 

16 ‘‘(A) An assessment of the scope of alcohol 

17 or other substance abuse, mental illness, and dys18 functional and self-destructive behavior, includ19 ing suicide, child abuse, and family violence, 

20 among Indians, including— 

21 ‘‘(i) the number of Indians served who 

22 are directly or indirectly affected by such 

23 illness or behavior; or 


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1 ‘‘(ii) an estimate of the financial and 

2 human cost attributable to such illness or 

3 behavior. 

4 ‘‘(B) An assessment of the existing and ad5 ditional resources necessary for the prevention 

6 and treatment of such illness and behavior, in7 cluding an assessment of the progress toward 

8 achieving the availability of the full continuum 

9 of care described in subsection (c). 

10 ‘‘(C) An estimate of the additional funding 

11 needed by the Service, Indian Tribes, Tribal Or12 ganizations, and Urban Indian Organizations to 

13 meet their responsibilities under the plans. 

14 ‘‘(2) NATIONAL CLEARINGHOUSE.—The Sec15 retary, acting through the Service, shall establish a 

16 national clearinghouse of plans and reports on the 

17 outcomes of such plans developed by Indian Tribes, 

18 Tribal Organizations, Urban Indian Organizations, 

19 and Service Areas relating to behavioral health. The 

20 Secretary shall ensure access to these plans and out21 comes by any Indian Tribe, Tribal Organization, 

22 Urban Indian Organization, or the Service. 

23 ‘‘(3) TECHNICAL ASSISTANCE.—The Secretary 

24 shall provide technical assistance to Indian Tribes, 

25 Tribal Organizations, and Urban Indian OrganizaVerDate Aug 31 2005 05:25 Mar 17, 2006 Jkt 049200 PO 00000 Frm 00578 Fmt 6652 Sfmt 6203 E:\BILLS\S1057.RS S1057

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1 tions in preparation of plans under this section and 

2 in developing standards of care that may be used and 

3 adopted locally. 

4 ‘‘(c) PROGRAMS.—The Secretary, acting through the 

5 Service, Indian Tribes, and Tribal Organizations, shall 

6 provide, to the extent feasible and if funding is available, 

7 programs including the following: 

8 ‘‘(1) COMPREHENSIVE CARE.—A comprehensive 

9 continuum of behavioral health care which provides— 

10 ‘‘(A) community-based prevention, interven11 tion, outpatient, and behavioral health aftercare; 

12 ‘‘(B) detoxification (social and medical); 

13 ‘‘(C) acute hospitalization; 

14 ‘‘(D) intensive outpatient/day treatment; 

15 ‘‘(E) residential treatment; 

16 ‘‘(F) transitional living for those needing a 

17 temporary, stable living environment that is 

18 supportive of treatment and recovery goals; 

19 ‘‘(G) emergency shelter; 

20 ‘‘(H) intensive case management; 

21 ‘‘(I) Traditional Health Care Practices; and 

22 ‘‘(J) diagnostic services. 

23 ‘‘(2) CHILD CARE.—Behavioral health services 

24 for Indians from birth through age 17, including— 


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1 ‘‘(A) preschool and school age fetal alcohol 

2 disorder services, including assessment and be3 havioral intervention; 

4 ‘‘(B) mental health and substance abuse 

5 services (emotional, organic, alcohol, drug, inhal6 ant, and tobacco); 

7 ‘‘(C) identification and treatment of co-oc8 curring disorders and comorbidity; 

9 ‘‘(D) prevention of alcohol, drug, inhalant, 

10 and tobacco use; 

11 ‘‘(E) early intervention, treatment, and 

12 aftercare; 

13 ‘‘(F) promotion of healthy approaches to 

14 risk and safety issues; and 

15 ‘‘(G) identification and treatment of neglect 

16 and physical, mental, and sexual abuse. 

17 ‘‘(3) ADULT CARE.—Behavioral health services 

18 for Indians from age 18 through 55, including— 

19 ‘‘(A) early intervention, treatment, and 

20 aftercare; 

21 ‘‘(B) mental health and substance abuse 

22 services (emotional, alcohol, drug, inhalant, and 

23 tobacco), including sex specific services; 


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1 ‘‘(C) identification and treatment of co-oc2 curring disorders (dual diagnosis) and comor3 bidity; 

4 ‘‘(D) promotion of healthy approaches for 

5 risk-related behavior; 

6 ‘‘(E) treatment services for women at risk of 

7 giving birth to a child with a fetal alcohol dis8 order; and 

9 ‘‘(F) sex specific treatment for sexual as10 sault and domestic violence. 

11 ‘‘(4) FAMILY CARE.—Behavioral health services 

12 for families, including— 

13 ‘‘(A) early intervention, treatment, and 

14 aftercare for affected families; 

15 ‘‘(B) treatment for sexual assault and do16 mestic violence; and 

17 ‘‘(C) promotion of healthy approaches relat18 ing to parenting, domestic violence, and other 

19 abuse issues. 

20 ‘‘(5) ELDER CARE.—Behavioral health services 

21 for Indians 56 years of age and older, including— 

22 ‘‘(A) early intervention, treatment, and 

23 aftercare; 


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1 ‘‘(B) mental health and substance abuse 

2 services (emotional, alcohol, drug, inhalant, and 

3 tobacco), including sex specific services; 

4 ‘‘(C) identification and treatment of co-oc5 curring disorders (dual diagnosis) and comor6 bidity; 

7 ‘‘(D) promotion of healthy approaches to 

8 managing conditions related to aging; 

9 ‘‘(E) sex specific treatment for sexual as10 sault, domestic violence, neglect, physical and 

11 mental abuse and exploitation; and 

12 ‘‘(F) identification and treatment of demen13 tias regardless of cause. 

14 ‘‘(d) COMMUNITY BEHAVIORAL HEALTH PLAN.— 

15 ‘‘(1) ESTABLISHMENT.—The governing body of 

16 any Indian Tribe, Tribal Organization, or Urban In17 dian Organization may adopt a resolution for the es18 tablishment of a community behavioral health plan 

19 providing for the identification and coordination of 

20 available resources and programs to identify, prevent, 

21 or treat substance abuse, mental illness, or dysfunc22 tional and self-destructive behavior, including child 

23 abuse and family violence, among its members or its 

24 service population. This plan should include behavVerDate Aug 31 2005 05:25 Mar 17, 2006 Jkt 049200 PO 00000 Frm 00582 Fmt 6652 Sfmt 6203 E:\BILLS\S1057.RS S1057

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1 ioral health services, social services, intensive out2 patient services, and continuing aftercare. 

3 ‘‘(2) TECHNICAL ASSISTANCE.—At the request of 

4 an Indian Tribe, Tribal Organization, or Urban In5 dian Organization, the Bureau of Indian Affairs and 

6 the Service shall cooperate with and provide technical 

7 assistance to the Indian Tribe, Tribal Organization, 

8 or Urban Indian Organization in the development 

9 and implementation of such plan. 

10 ‘‘(3) FUNDING.—The Secretary, acting through 

11 the Service, may make funding available to Indian 

12 Tribes and Tribal Organizations which adopt a reso13 lution pursuant to paragraph (1) to obtain technical 

14 assistance for the development of a community behav15 ioral health plan and to provide administrative sup16 port in the implementation of such plan. 

17 ‘‘(e) COORDINATION FOR AVAILABILITY OF SERV18 ICES.—The Secretary, acting through the Service, Indian 

19 Tribes, Tribal Organizations, and Urban Indian Organiza20 tions, shall coordinate behavioral health planning, to the 

21 extent feasible, with other Federal agencies and with State 

22 agencies, to encourage comprehensive behavioral health serv23 ices for Indians regardless of their place of residence. 

24 ‘‘(f) MENTAL HEALTH CARE NEED ASSESSMENT.— 

25 Not later than 1 year after the date of enactment of the 


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1 Indian Health Care Improvement Act Amendments of 2005, 

2 the Secretary, acting through the Service, shall make an as3 sessment of the need for inpatient mental health care among 

4 Indians and the availability and cost of inpatient mental 

5 health facilities which can meet such need. In making such 

6 assessment, the Secretary shall consider the possible conver7 sion of existing, underused Service hospital beds into psy8 chiatric units to meet such need. 

9 ‘‘SEC. 702. MEMORANDA OF AGREEMENT WITH THE DEPART10 MENT OF THE INTERIOR. 

11 ‘‘(a) CONTENTS.—Not later than 12 months after the 

12 date of enactment of the Indian Health Care Improvement 

13 Act Amendments of 2005, the Secretary, acting through the 

14 Service, and the Secretary of the Interior shall develop and 

15 enter into a memoranda of agreement, or review and update 

16 any existing memoranda of agreement, as required by sec17 tion 4205 of the Indian Alcohol and Substance Abuse Pre18 vention and Treatment Act of 1986 (25 U.S.C. 2411) under 

19 which the Secretaries address the following: 

20 ‘‘(1) The scope and nature of mental illness and 

21 dysfunctional and self-destructive behavior, including 

22 child abuse and family violence, among Indians. 

23 ‘‘(2) The existing Federal, tribal, State, local, 

24 and private services, resources, and programs avail25 able to provide behavioral health services for Indians. 


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1 ‘‘(3) The unmet need for additional services, re2 sources, and programs necessary to meet the needs 

3 identified pursuant to paragraph (1). 

4 ‘‘(4)(A) The right of Indians, as citizens of the 

5 United States and of the States in which they reside, 

6 to have access to behavioral health services to which 

7 all citizens have access. 

8 ‘‘(B) The right of Indians to participate in, and 

9 receive the benefit of, such services. 

10 ‘‘(C) The actions necessary to protect the exercise 

11 of such right. 

12 ‘‘(5) The responsibilities of the Bureau of Indian 

13 Affairs and the Service, including mental illness iden14 tification, prevention, education, referral, and treat15 ment services (including services through multidisci16 plinary resource teams), at the central, area, and 

17 agency and Service Unit, Service Area, and head18 quarters levels to address the problems identified in 

19 paragraph (1). 

20 ‘‘(6) A strategy for the comprehensive coordina21 tion of the behavioral health services provided by the 

22 Bureau of Indian Affairs and the Service to meet the 

23 problems identified pursuant to paragraph (1), in24 cluding— 


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1 ‘‘(A) the coordination of alcohol and sub2 stance abuse programs of the Service, the Bureau 

3 of Indian Affairs, and Indian Tribes and Tribal 

4 Organizations (developed under the Indian Alco5 hol and Substance Abuse Prevention and Treat6 ment Act of 1986 (25 U.S.C. 2401 et seq.)) with 

7 behavioral health initiatives pursuant to this 

8 Act, particularly with respect to the referral and 

9 treatment of dually diagnosed individuals re10 quiring behavioral health and substance abuse 

11 treatment; and 

12 ‘‘(B) ensuring that the Bureau of Indian 

13 Affairs and Service programs and services (in14 cluding multidisciplinary resource teams) ad15 dressing child abuse and family violence are co16 ordinated with such non-Federal programs and 

17 services. 

18 ‘‘(7) Directing appropriate officials of the Bu19 reau of Indian Affairs and the Service, particularly 

20 at the agency and Service Unit levels, to cooperate 

21 fully with tribal requests made pursuant to commu22 nity behavioral health plans adopted under section 

23 701(c) and section 4206 of the Indian Alcohol and 

24 Substance Abuse Prevention and Treatment Act of 

25 1986 (25 U.S.C. 2412). 


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1 ‘‘(8) Providing for an annual review of such 

2 agreement by the Secretaries which shall be provided 

3 to Congress and Indian Tribes and Tribal Organiza4 tions. 

5 ‘‘(b) SPECIFIC PROVISIONS REQUIRED.—The memo6 randa of agreement updated or entered into pursuant to 

7 subsection (a) shall include specific provisions pursuant to 

8 which the Service shall assume responsibility for— 

9 ‘‘(1) the determination of the scope of the prob10 lem of alcohol and substance abuse among Indians, 

11 including the number of Indians within the jurisdic12 tion of the Service who are directly or indirectly af13 fected by alcohol and substance abuse and the finan14 cial and human cost; 

15 ‘‘(2) an assessment of the existing and needed re16 sources necessary for the prevention of alcohol and 

17 substance abuse and the treatment of Indians affected 

18 by alcohol and substance abuse; and 

19 ‘‘(3) an estimate of the funding necessary to ade20 quately support a program of prevention of alcohol 

21 and substance abuse and treatment of Indians affected 

22 by alcohol and substance abuse. 

23 ‘‘(c) CONSULTATION.—The Secretary, acting through 

24 the Service, and the Secretary of the Interior shall, in develVerDate Aug 31 2005 05:25 Mar 17, 2006 Jkt 049200 PO 00000 Frm 00587 Fmt 6652 Sfmt 6203 E:\BILLS\S1057.RS S1057

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1 oping the memoranda of agreement under subsection (a), 

2 consult with and solicit the comments from— 

3 ‘‘(1) Indian Tribes and Tribal Organizations; 

4 ‘‘(2) Indians; 

5 ‘‘(3) Urban Indian Organizations and other In6 dian organizations; and 

7 ‘‘(4) behavioral health service providers. 

8 ‘‘(d) PUBLICATION.—Each memorandum of agreement 

9 entered into or renewed (and amendments or modifications 

10 thereto) under subsection (a) shall be published in the Fed11 eral Register. At the same time as publication in the Fed12 eral Register, the Secretary shall provide a copy of such 

13 memoranda, amendment, or modification to each Indian 

14 Tribe, Tribal Organization, and Urban Indian Organiza15 tion. 

16 ‘‘SEC. 703. COMPREHENSIVE BEHAVIORAL HEALTH PREVEN17 TION AND TREATMENT PROGRAM. 

18 ‘‘(a) ESTABLISHMENT.— 

19 ‘‘(1) IN GENERAL.—The Secretary, acting 

20 through the Service, Indian Tribes, and Tribal Orga21 nizations, shall provide a program of comprehensive 

22 behavioral health, prevention, treatment, and 

23 aftercare, including Traditional Health Care Prac24 tices, which shall include— 


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1 ‘‘(A) prevention, through educational inter2 vention, in Indian communities; 

3 ‘‘(B) acute detoxification, psychiatric hos4 pitalization, residential, and intensive out5 patient treatment; 

6 ‘‘(C) community-based rehabilitation and 

7 aftercare; 

8 ‘‘(D) community education and involve9 ment, including extensive training of health care, 

10 educational, and community-based personnel; 

11 ‘‘(E) specialized residential treatment pro12 grams for high-risk populations, including preg13 nant and postpartum women and their children; 

14 and 

15 ‘‘(F) diagnostic services. 

16 ‘‘(2) TARGET POPULATIONS.—The target popu17 lation of such programs shall be members of Indian 

18 Tribes. Efforts to train and educate key members of 

19 the Indian community shall also target employees of 

20 health, education, judicial, law enforcement, legal, 

21 and social service programs. 

22 ‘‘(b) CONTRACT HEALTH SERVICES.— 

23 ‘‘(1) IN GENERAL.—The Secretary, acting 

24 through the Service, Indian Tribes, and Tribal Orga25 nizations, may enter into contracts with public or 


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1 private providers of behavioral health treatment serv2 ices for the purpose of carrying out the program re3 quired under subsection (a). 

4 ‘‘(2) PROVISION OF ASSISTANCE.—In carrying 

5 out this subsection, the Secretary shall provide assist6 ance to Indian Tribes and Tribal Organizations to 

7 develop criteria for the certification of behavioral 

8 health service providers and accreditation of service 

9 facilities which meet minimum standards for such 

10 services and facilities. 

11 ‘‘SEC. 704. MENTAL HEALTH TECHNICIAN PROGRAM. 

12 ‘‘(a) IN GENERAL.—Under the authority of the Act of 

13 November 2, 1921 (25 U.S.C. 13) (commonly known as the 

14 ‘Snyder Act’), the Secretary shall establish and maintain 

15 a mental health technician program within the Service 

16 which— 

17 ‘‘(1) provides for the training of Indians as men18 tal health technicians; and 

19 ‘‘(2) employs such technicians in the provision of 

20 community-based mental health care that includes 

21 identification, prevention, education, referral, and 

22 treatment services. 

23 ‘‘(b) PARAPROFESSIONAL TRAINING.—In carrying out 

24 subsection (a), the Secretary, acting through the Service, In25 dian Tribes, and Tribal Organizations, shall provide highVerDate Aug 31 2005 05:25 Mar 17, 2006 Jkt 049200 PO 00000 Frm 00590 Fmt 6652 Sfmt 6203 E:\BILLS\S1057.RS S1057

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1 standard paraprofessional training in mental health care 

2 necessary to provide quality care to the Indian communities 

3 to be served. Such training shall be based upon a cur4 riculum developed or approved by the Secretary which com5 bines education in the theory of mental health care with 

6 supervised practical experience in the provision of such 

7 care. 

8 ‘‘(c) SUPERVISION AND EVALUATION OF TECHNI9 CIANS.—The Secretary, acting through the Service, Indian 

10 Tribes, and Tribal Organizations, shall supervise and 

11 evaluate the mental health technicians in the training pro12 gram. 

13 ‘‘(d) TRADITIONAL HEALTH CARE PRACTICES.—The 

14 Secretary, acting through the Service, shall ensure that the 

15 program established pursuant to this subsection involves the 

16 use and promotion of the Traditional Health Care Practices 

17 of the Indian Tribes to be served. 

18 ‘‘SEC. 705. LICENSING REQUIREMENT FOR MENTAL HEALTH 

19 CARE WORKERS. 

20 ‘‘Subject to the provisions of section 221, any person 

21 employed as a psychologist, social worker, or marriage and 

22 family therapist for the purpose of providing mental health 

23 care services to Indians in a clinical setting under this Act 

24 is required to be licensed as a clinical psychologist, social 

25 worker, or marriage and family therapist, respectively, or 


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1 working under the direct supervision of a licensed clinical 

2 psychologist, social worker, or marriage and family thera3 pist, respectively. 

4 ‘‘SEC. 706. INDIAN WOMEN TREATMENT PROGRAMS. 

5 ‘‘(a) GRANTS.—The Secretary, consistent with section 

6 701, may make grants to Indian Tribes, Tribal Organiza7 tions, and Urban Indian Organizations to develop and im8 plement a comprehensive behavioral health program of pre9 vention, intervention, treatment, and relapse prevention 

10 services that specifically addresses the spiritual, cultural, 

11 historical, social, and child care needs of Indian women, 

12 regardless of age. 

13 ‘‘(b) USE OF GRANT FUNDS.—A grant made pursuant 

14 to this section may be used to— 

15 ‘‘(1) develop and provide community training, 

16 education, and prevention programs for Indian 

17 women relating to behavioral health issues, including 

18 fetal alcohol disorders; 

19 ‘‘(2) identify and provide psychological services, 

20 counseling, advocacy, support, and relapse prevention 

21 to Indian women and their families; and 

22 ‘‘(3) develop prevention and intervention models 

23 for Indian women which incorporate Traditional 

24 Health Care Practices, cultural values, and commu25 nity and family involvement. 


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1 ‘‘(c) CRITERIA.—The Secretary, in consultation with 

2 Indian Tribes and Tribal Organizations, shall establish cri3 teria for the review and approval of applications and pro4 posals for funding under this section. 

5 ‘‘(d) EARMARK OF CERTAIN FUNDS.—Twenty percent 

6 of the funds appropriated pursuant to this section shall be 

7 used to make grants to Urban Indian Organizations. 

8 ‘‘SEC. 707. INDIAN YOUTH PROGRAM. 

9 ‘‘(a) DETOXIFICATION AND REHABILITATION.—The 

10 Secretary, acting through the Service, consistent with sec11 tion 701, shall develop and implement a program for acute 

12 detoxification and treatment for Indian youths, including 

13 behavioral health services. The program shall include re14 gional treatment centers designed to include detoxification 

15 and rehabilitation for both sexes on a referral basis and 

16 programs developed and implemented by Indian Tribes or 

17 Tribal Organizations at the local level under the Indian 

18 Self-Determination and Education Assistance Act (25 

19 U.S.C. 450 et seq.). Regional centers shall be integrated 

20 with the intake and rehabilitation programs based in the 

21 referring Indian community. 

22 ‘‘(b) ALCOHOL AND SUBSTANCE ABUSE TREATMENT

23 CENTERS OR FACILITIES.— 

24 ‘‘(1) ESTABLISHMENT.— 


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1 ‘‘(A) IN GENERAL.—The Secretary, acting 

2 through the Service, Indian Tribes, and Tribal 

3 Organizations, shall construct, renovate, or, as 

4 necessary, purchase, and appropriately staff and 

5 operate, at least 1 youth regional treatment cen6 ter or treatment network in each area under the 

7 jurisdiction of an Area Office. 

8 ‘‘(B) AREA OFFICE IN CALIFORNIA.—For 

9 the purposes of this subsection, the Area Office in 

10 California shall be considered to be 2 Area Of11 fices, 1 office whose jurisdiction shall be consid12 ered to encompass the northern area of the State 

13 of California, and 1 office whose jurisdiction 

14 shall be considered to encompass the remainder 

15 of the State of California for the purpose of im16 plementing California treatment networks. 

17 ‘‘(2) FUNDING.—For the purpose of staffing and 

18 operating such centers or facilities, funding shall be 

19 pursuant to the Act of November 2, 1921 (25 U.S.C. 

20 13). 

21 ‘‘(3) LOCATION.—A youth treatment center con22 structed or purchased under this subsection shall be 

23 constructed or purchased at a location within the 

24 area described in paragraph (1) agreed upon (by apVerDate Aug 31 2005 05:25 Mar 17, 2006 Jkt 049200 PO 00000 Frm 00594 Fmt 6652 Sfmt 6203 E:\BILLS\S1057.RS S1057

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1 propriate tribal resolution) by a majority of the In2 dian Tribes to be served by such center. 

3 ‘‘(4) SPECIFIC PROVISION OF FUNDS.— 

4 ‘‘(A) IN GENERAL.—Notwithstanding any 

5 other provision of this title, the Secretary may, 

6 from amounts authorized to be appropriated for 

7 the purposes of carrying out this section, make 

8 funds available to— 

9 ‘‘(i) the Tanana Chiefs Conference, In10 corporated, for the purpose of leasing, con11 structing, renovating, operating, and main12 taining a residential youth treatment facil13 ity in Fairbanks, Alaska; and 

14 ‘‘(ii) the Southeast Alaska Regional 

15 Health Corporation to staff and operate a 

16 residential youth treatment facility without 

17 regard to the proviso set forth in section 4(l) 

18 of the Indian Self-Determination and Edu19 cation Assistance Act (25 U.S.C. 450b(l)). 

20 ‘‘(B) PROVISION OF SERVICES TO ELIGIBLE

21 YOUTHS.—Until additional residential youth 

22 treatment facilities are established in Alaska 

23 pursuant to this section, the facilities specified 

24 in subparagraph (A) shall make every effort to 


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1 provide services to all eligible Indian youths re2 siding in Alaska. 

3 ‘‘(c) INTERMEDIATE ADOLESCENT BEHAVIORAL

4 HEALTH SERVICES.— 

5 ‘‘(1) IN GENERAL.—The Secretary, acting 

6 through the Service, Indian Tribes, and Tribal Orga7 nizations, may provide intermediate behavioral health 

8 services, which may incorporate Traditional Health 

9 Care Practices, to Indian children and adolescents, 

10 including— 

11 ‘‘(A) pretreatment assistance; 

12 ‘‘(B) inpatient, outpatient, and aftercare 

13 services; 

14 ‘‘(C) emergency care; 

15 ‘‘(D) suicide prevention and crisis interven16 tion; and 

17 ‘‘(E) prevention and treatment of mental 

18 illness and dysfunctional and self-destructive be19 havior, including child abuse and family vio20 lence. 

21 ‘‘(2) USE OF FUNDS.—Funds provided under 

22 this subsection may be used— 

23 ‘‘(A) to construct or renovate an existing 

24 health facility to provide intermediate behavioral 

25 health services; 


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1 ‘‘(B) to hire behavioral health professionals; 

2 ‘‘(C) to staff, operate, and maintain an in3 termediate mental health facility, group home, 

4 sober housing, transitional housing or similar fa5 cilities, or youth shelter where intermediate be6 havioral health services are being provided; 

7 ‘‘(D) to make renovations and hire appro8 priate staff to convert existing hospital beds into 

9 adolescent psychiatric units; and 

10 ‘‘(E) for intensive home- and community11 based services. 

12 ‘‘(3) CRITERIA.—The Secretary, acting through 

13 the Service, shall, in consultation with Indian Tribes 

14 and Tribal Organizations, establish criteria for the 

15 review and approval of applications or proposals for 

16 funding made available pursuant to this subsection. 

17 ‘‘(d) FEDERALLY OWNED STRUCTURES.— 

18 ‘‘(1) IN GENERAL.—The Secretary, in consulta19 tion with Indian Tribes and Tribal Organizations, 

20 shall— 

21 ‘‘(A) identify and use, where appropriate, 

22 federally owned structures suitable for local resi23 dential or regional behavioral health treatment 

24 for Indian youths; and 


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1 ‘‘(B) establish guidelines, in consultation 

2 with Indian Tribes and Tribal Organizations, 

3 for determining the suitability of any such feder4 ally owned structure to be used for local residen5 tial or regional behavioral health treatment for 

6 Indian youths. 

7 ‘‘(2) TERMS AND CONDITIONS FOR USE OF

8 STRUCTURE.—Any structure described in paragraph 

9 (1) may be used under such terms and conditions as 

10 may be agreed upon by the Secretary and the agency 

11 having responsibility for the structure and any In12 dian Tribe or Tribal Organization operating the pro13 gram. 

14 ‘‘(e) REHABILITATION AND AFTERCARE SERVICES.— 

15 ‘‘(1) IN GENERAL.—The Secretary, Indian 

16 Tribes, or Tribal Organizations, in cooperation with 

17 the Secretary of the Interior, shall develop and imple18 ment within each Service Unit, community-based re19 habilitation and follow-up services for Indian youths 

20 who are having significant behavioral health prob21 lems, and require long-term treatment, community re22 integration, and monitoring to support the Indian 

23 youths after their return to their home community. 

24 ‘‘(2) ADMINISTRATION.—Services under para25 graph (1) shall be provided by trained staff within 


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1 the community who can assist the Indian youths in 

2 their continuing development of self-image, positive 

3 problem-solving skills, and nonalcohol or substance 

4 abusing behaviors. Such staff may include alcohol 

5 and substance abuse counselors, mental health profes6 sionals, and other health professionals and para7 professionals, including community health representa8 tives. 

9 ‘‘(f) INCLUSION OF FAMILY IN YOUTH TREATMENT

10 PROGRAM.—In providing the treatment and other services 

11 to Indian youths authorized by this section, the Secretary, 

12 acting through the Service, Indian Tribes, and Tribal Orga13 nizations, shall provide for the inclusion of family members 

14 of such youths in the treatment programs or other services 

15 as may be appropriate. Not less than 10 percent of the funds 

16 appropriated for the purposes of carrying out subsection (e) 

17 shall be used for outpatient care of adult family members 

18 related to the treatment of an Indian youth under that sub19 section. 

20 ‘‘(g) MULTIDRUG ABUSE PROGRAM.—The Secretary, 

21 acting through the Service, Indian Tribes, Tribal Organiza22 tions, and Urban Indian Organizations, shall provide, con23 sistent with section 701, programs and services to prevent 

24 and treat the abuse of multiple forms of substances, includ25 ing alcohol, drugs, inhalants, and tobacco, among Indian 


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1 youths residing in Indian communities, on or near reserva2 tions, and in urban areas and provide appropriate mental 

3 health services to address the incidence of mental illness 

4 among such youths. 

5 ‘‘(h) INDIAN YOUTH MENTAL HEALTH.—The Sec6 retary, acting through the Service, shall collect data for the 

7 report under section 801 with respect to— 

8 ‘‘(1) the number of Indian youth who are being 

9 provided mental health services through the Service 

10 and Tribal Health Programs; 

11 ‘‘(2) a description of, and costs associated with, 

12 the mental health services provided for Indian youth 

13 through the Service and Tribal Health Programs; 

14 ‘‘(3) the number of youth referred to the Service 

15 or Tribal Health Programs for mental health services; 

16 ‘‘(4) the number of Indian youth provided resi17 dential treatment for mental health and behavioral 

18 problems through the Service and Tribal Health Pro19 grams, reported separately for on- and off-reservation 

20 facilities; and 

21 ‘‘(5) the costs of the services described in para22 graph (4). 


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1 ‘‘SEC. 708. INDIAN YOUTH TELEMENTAL HEALTH DEM2 ONSTRATION PROJECT. 

3 ‘‘(a) PURPOSE.—The purpose of this section is to au4 thorize the Secretary to carry out a demonstration project 

5 to test the use of telemental health services in suicide pre6 vention, intervention and treatment of Indian youth, in7 cluding through— 

8 ‘‘(1) the use of psychotherapy, psychiatric assess9 ments, diagnostic interviews, therapies for mental 

10 health conditions predisposing to suicide, and alcohol 

11 and substance abuse treatment; 

12 ‘‘(2) the provision of clinical expertise to, con13 sultation services with, and medical advice and train14 ing for frontline health care providers working with 

15 Indian youth; 

16 ‘‘(3) training and related support for community 

17 leaders, family members and health and education 

18 workers who work with Indian youth; 

19 ‘‘(4) the development of culturally-relevant edu20 cational materials on suicide; and 

21 ‘‘(5) data collection and reporting. 

22 ‘‘(b) DEFINITIONS.—For the purpose of this section, 

23 the following definitions shall apply: 

24 ‘‘(1) DEMONSTRATION PROJECT.—The term 

25 ‘demonstration project’ means the Indian youth teleVerDate Aug 31 2005 05:25 Mar 17, 2006 Jkt 049200 PO 00000 Frm 00601 Fmt 6652 Sfmt 6203 E:\BILLS\S1057.RS S1057

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1 mental health demonstration project authorized under 

2 subsection (c). 

3 ‘‘(2) TELEMENTAL HEALTH.—The term ‘tele4 mental health’ means the use of electronic information 

5 and telecommunications technologies to support long 

6 distance mental health care, patient and professional7 related education, public health, and health adminis8 tration. 

9 ‘‘(c) AUTHORIZATION.— 

10 ‘‘(1) IN GENERAL.—The Secretary is authorized 

11 to award grants under the demonstration project for 

12 the provision of telemental health services to Indian 

13 youth who— 

14 ‘‘(A) have expressed suicidal ideas; 

15 ‘‘(B) have attempted suicide; or 

16 ‘‘(C) have mental health conditions that in17 crease or could increase the risk of suicide. 

18 ‘‘(2) ELIGIBILITY FOR GRANTS.—Such grants 

19 shall be awarded to Indian Tribes, Tribal Organiza20 tions, and Urban Indian Organizations that operate 

21 1 or more facilities— 

22 ‘‘(A) located in Alaska and part of the Alas23 ka Federal Health Care Access Network; 

24 ‘‘(B) reporting active clinical telehealth ca25 pabilities; or 


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1 ‘‘(C) offering school-based telemental health 

2 services relating to psychiatry to Indian youth. 

3 ‘‘(3) GRANT PERIOD.—The Secretary shall 

4 award grants under this section for a period of up to 

5 4 years. 

6 ‘‘(4) AWARDING OF GRANTS.—Not more than 5 

7 grants shall be provided under paragraph (1), with 

8 priority consideration given to Indian Tribes, Tribal 

9 Organizations, and Urban Indian Organizations 

10 that— 

11 ‘‘(A) serve a particular community or geo12 graphic area where there is a demonstrated need 

13 to address Indian youth suicide; 

14 ‘‘(B) enter in to collaborative partnerships 

15 with Indian Health Service or other Tribal 

16 Health Programs or facilities to provide services 

17 under this demonstration project; 

18 ‘‘(C) serve an isolated community or geo19 graphic area which has limited or no access to 

20 behavioral health services; or 

21 ‘‘(D) operate a detention facility at which 

22 youth are detained. 

23 ‘‘(d) USE OF FUNDS.—An Indian Tribe, Tribal Orga24 nization, or Urban Indian Organization shall use a grant 

25 received under subsection (c) for the following purposes: 


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1 ‘‘(1) To provide telemental health services to In2 dian youth, including the provision of— 

3 ‘‘(A) psychotherapy; 

4 ‘‘(B) psychiatric assessments and diagnostic 

5 interviews, therapies for mental health conditions 

6 predisposing to suicide, and treatment; and 

7 ‘‘(C) alcohol and substance abuse treatment. 

8 ‘‘(2) To provide clinician-interactive medical ad9 vice, guidance and training, assistance in diagnosis 

10 and interpretation, crisis counseling and interven11 tion, and related assistance to Service, tribal, or 

12 urban clinicians and health services providers work13 ing with youth being served under this demonstration 

14 project. 

15 ‘‘(3) To assist, educate and train community 

16 leaders, health education professionals and para17 professionals, tribal outreach workers, and family 

18 members who work with the youth receiving tele19 mental health services under this demonstration 

20 project, including with identification of suicidal ten21 dencies, crisis intervention and suicide prevention, 

22 emergency skill development, and building and ex23 panding networks among these individuals and with 

24 State and local health services providers. 


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1 ‘‘(4) To develop and distribute culturally appro2 priate community educational materials on— 

3 ‘‘(A) suicide prevention; 

4 ‘‘(B) suicide education; 

5 ‘‘(C) suicide screening; 

6 ‘‘(D) suicide intervention; and 

7 ‘‘(E) ways to mobilize communities with re8 spect to the identification of risk factors for sui9 cide. 

10 ‘‘(5) For data collection and reporting related to 

11 Indian youth suicide prevention efforts. 

12 ‘‘(e) APPLICATIONS.—To be eligible to receive a grant 

13 under subsection (c), an Indian Tribe, Tribal Organization, 

14 or Urban Indian Organization shall prepare and submit 

15 to the Secretary an application, at such time, in such man16 ner, and containing such information as the Secretary may 

17 require, including— 

18 ‘‘(1) a description of the project that the Indian 

19 Tribe, Tribal Organization, or Urban Indian Organi20 zation will carry out using the funds provided under 

21 the grant; 

22 ‘‘(2) a description of the manner in which the 

23 project funded under the grant would— 


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1 ‘‘(A) meet the telemental health care needs 

2 of the Indian youth population to be served by 

3 the project; or 

4 ‘‘(B) improve the access of the Indian youth 

5 population to be served to suicide prevention and 

6 treatment services; 

7 ‘‘(3) evidence of support for the project from the 

8 local community to be served by the project; 

9 ‘‘(4) a description of how the families and lead10 ership of the communities or populations to be served 

11 by the project would be involved in the development 

12 and ongoing operations of the project; 

13 ‘‘(5) a plan to involve the tribal community of 

14 the youth who are provided services by the project in 

15 planning and evaluating the mental health care and 

16 suicide prevention efforts provided, in order to ensure 

17 the integration of community, clinical, environ18 mental, and cultural components of the treatment; 

19 and 

20 ‘‘(6) a plan for sustaining the project after Fed21 eral assistance for the demonstration project has ter22 minated. 

23 ‘‘(f) TRADITIONAL HEALTH CARE PRACTICES.—The 

24 Secretary, acting through the Service, shall ensure that the 

25 demonstration project established pursuant to this section 


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1 involves the use and promotion of the Traditional Health 

2 Care Practices of the Indian Tribes of the youth to be served. 

3 ‘‘(g) COLLABORATION; REPORTING TO NATIONAL

4 CLEARINGHOUSE.— 

5 ‘‘(1) COLLABORATION.—The Secretary, acting 

6 through the Service, shall encourage Indian Tribes, 

7 Tribal Organizations, and Urban Indian Organiza8 tions receiving grants under this section to collaborate 

9 to enable comparisons about best practices across 

10 projects. 

11 ‘‘(2) REPORTING TO NATIONAL CLEARING12 HOUSE.—The Secretary, acting through the Service, 

13 shall also encourage Indian Tribes, Tribal Organiza14 tions, and Urban Indian Organizations receiving 

15 grants under this section to submit relevant, declas16 sified project information to the national clearing17 house authorized under section 701(b)(2) in order to 

18 better facilitate program performance and improve 

19 suicide prevention, intervention, and treatment serv20 ices. 

21 ‘‘(h) ANNUAL REPORT.—Each grant recipient shall 

22 submit to the Secretary an annual report that— 

23 ‘‘(1) describes the number of telemental health 

24 services provided; and 


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1 ‘‘(2) includes any other information that the Sec2 retary may require. 

3 ‘‘(i) REPORT TO CONGRESS.—Not later than 270 days 

4 after the termination of the demonstration project, the Sec5 retary shall submit to the Committee on Indian Affairs of 

6 the Senate and the Committee on Resources and Committee 

7 on Energy and Commerce of the House of Representatives 

8 a final report, based on the annual reports provided by 

9 grant recipients under subsection (h), that— 

10 ‘‘(1) describes the results of the projects funded 

11 by grants awarded under this section, including any 

12 data available which indicates the number of at13 tempted suicides; and 

14 ‘‘(2) evaluates the impact of the telemental health 

15 services funded by the grants in reducing the number 

16 of completed suicides among Indian youth. 

17 ‘‘(j) AUTHORIZATION OF APPROPRIATIONS.—There is 

18 authorized to be appropriated to carry out this section 

19 $1,500,000 for each of fiscal years 2006 through 2009. 

20 ‘‘SEC. 709. INPATIENT AND COMMUNITY-BASED MENTAL 

21 HEALTH FACILITIES DESIGN, CONSTRUC22 TION, AND STAFFING. 

23 ‘‘Not later than 1 year after the date of enactment of 

24 the Indian Health Care Improvement Act Amendments of 

25 2005, the Secretary, acting through the Service, Indian 


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1 Tribes, and Tribal Organizations, may provide, in each 

2 area of the Service, not less than 1 inpatient mental health 

3 care facility, or the equivalent, for Indians with behavioral 

4 health problems. For the purposes of this subsection, Cali5 fornia shall be considered to be 2 Area Offices, 1 office whose 

6 location shall be considered to encompass the northern area 

7 of the State of California and 1 office whose jurisdiction 

8 shall be considered to encompass the remainder of the State 

9 of California. The Secretary shall consider the possible con10 version of existing, underused Service hospital beds into 

11 psychiatric units to meet such need. 

12 ‘‘SEC. 710. TRAINING AND COMMUNITY EDUCATION. 

13 ‘‘(a) PROGRAM.—The Secretary, in cooperation with 

14 the Secretary of the Interior, shall develop and implement 

15 or provide funding for Indian Tribes and Tribal Organiza16 tions to develop and implement, within each Service Unit 

17 or tribal program, a program of community education and 

18 involvement which shall be designed to provide concise and 

19 timely information to the community leadership of each 

20 tribal community. Such program shall include education 

21 about behavioral health issues to political leaders, Tribal 

22 judges, law enforcement personnel, members of tribal health 

23 and education boards, health care providers including tra24 ditional practitioners, and other critical members of each 

25 tribal community. Community-based training (oriented toVerDate Aug 31 2005 05:25 Mar 17, 2006 Jkt 049200 PO 00000 Frm 00609 Fmt 6652 Sfmt 6203 E:\BILLS\S1057.RS S1057

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1 ward local capacity development) shall also include tribal 

2 community provider training (designed for adult learners 

3 from the communities receiving services for prevention, 

4 intervention, treatment, and aftercare). 

5 ‘‘(b) INSTRUCTION.—The Secretary, acting through the 

6 Service, shall, either directly or through Indian Tribes and 

7 Tribal Organizations, provide instruction in the area of be8 havioral health issues, including instruction in crisis inter9 vention and family relations in the context of alcohol and 

10 substance abuse, child sexual abuse, youth alcohol and sub11 stance abuse, and the causes and effects of fetal alcohol dis12 orders to appropriate employees of the Bureau of Indian 

13 Affairs and the Service, and to personnel in schools or pro14 grams operated under any contract with the Bureau of In15 dian Affairs or the Service, including supervisors of emer16 gency shelters and halfway houses described in section 4213 

17 of the Indian Alcohol and Substance Abuse Prevention and 

18 Treatment Act of 1986 (25 U.S.C. 2433). 

19 ‘‘(c) TRAINING MODELS.—In carrying out the edu20 cation and training programs required by this section, the 

21 Secretary, in consultation with Indian Tribes, Tribal Orga22 nizations, Indian behavioral health experts, and Indian al23 cohol and substance abuse prevention experts, shall develop 

24 and provide community-based training models. Such mod25 els shall address— 


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1 ‘‘(1) the elevated risk of alcohol and behavioral 

2 health problems faced by children of alcoholics; 

3 ‘‘(2) the cultural, spiritual, and 

4 multigenerational aspects of behavioral health prob5 lem prevention and recovery; and 

6 ‘‘(3) community-based and multidisciplinary 

7 strategies for preventing and treating behavioral 

8 health problems. 

9 ‘‘SEC. 711. BEHAVIORAL HEALTH PROGRAM. 

10 ‘‘(a) INNOVATIVE PROGRAMS.—The Secretary, acting 

11 through the Service, Indian Tribes, and Tribal Organiza12 tions, consistent with section 701, may plan, develop, im13 plement, and carry out programs to deliver innovative com14 munity-based behavioral health services to Indians. 

15 ‘‘(b) FUNDING; CRITERIA.—The Secretary may award 

16 such funding for a project under subsection (a) to an Indian 

17 Tribe or Tribal Organization and may consider the fol18 lowing criteria: 

19 ‘‘(1) The project will address significant unmet 

20 behavioral health needs among Indians. 

21 ‘‘(2) The project will serve a significant number 

22 of Indians. 

23 ‘‘(3) The project has the potential to deliver serv24 ices in an efficient and effective manner. 


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1 ‘‘(4) The Indian Tribe or Tribal Organization 

2 has the administrative and financial capability to 

3 administer the project. 

4 ‘‘(5) The project may deliver services in a man5 ner consistent with Traditional Health Care Prac6 tices. 

7 ‘‘(6) The project is coordinated with, and avoids 

8 duplication of, existing services. 

9 ‘‘(c) EQUITABLE TREATMENT.—For purposes of this 

10 subsection, the Secretary shall, in evaluating project appli11 cations or proposals, use the same criteria that the Sec12 retary uses in evaluating any other application or proposal 

13 for such funding. 

14 ‘‘SEC. 712. FETAL ALCOHOL DISORDER PROGRAMS. 

15 ‘‘(a) PROGRAMS.— 

16 ‘‘(1) ESTABLISHMENT.—The Secretary, con17 sistent with section 701, acting through the Service, 

18 Indian Tribes, and Tribal Organizations, is author19 ized to establish and operate fetal alcohol disorder 

20 programs as provided in this section for the purposes 

21 of meeting the health status objectives specified in sec22 tion 3. 

23 ‘‘(2) USE OF FUNDS.—Funding provided pursu24 ant to this section shall be used for the following: 


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1 ‘‘(A) To develop and provide for Indians 

2 community and in school training, education, 

3 and prevention programs relating to fetal alcohol 

4 disorders. 

5 ‘‘(B) To identify and provide behavioral 

6 health treatment to high-risk Indian women and 

7 high-risk women pregnant with an Indian’s 

8 child. 

9 ‘‘(C) To identify and provide appropriate 

10 psychological services, educational and voca11 tional support, counseling, advocacy, and infor12 mation to fetal alcohol disorder affected Indians 

13 and their families or caretakers. 

14 ‘‘(D) To develop and implement counseling 

15 and support programs in schools for fetal alcohol 

16 disorder affected Indian children. 

17 ‘‘(E) To develop prevention and interven18 tion models which incorporate practitioners of 

19 Traditional Health Care Practices, cultural and 

20 spiritual values, and community involvement. 

21 ‘‘(F) To develop, print, and disseminate 

22 education and prevention materials on fetal alco23 hol disorder. 

24 ‘‘(G) To develop and implement, in con25 sultation with Indian Tribes, Tribal OrganizaVerDate Aug 31 2005 05:25 Mar 17, 2006 Jkt 049200 PO 00000 Frm 00613 Fmt 6652 Sfmt 6203 E:\BILLS\S1057.RS S1057

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1 tions, and Urban Indian Organizations, cul2 turally sensitive assessment and diagnostic tools 

3 including dysmorphology clinics and multidisci4 plinary fetal alcohol disorder clinics for use in 

5 Indian communities and Urban Centers. 

6 ‘‘(H) To develop early childhood interven7 tion projects from birth on to mitigate the effects 

8 of fetal alcohol disorder among Indians. 

9 ‘‘(I) To develop— 

10 ‘‘(i) community-based support services 

11 for Indians and women pregnant with In12 dian children; and 

13 ‘‘(ii) to the extent funding is available, 

14 community-based housing for adult Indians 

15 with fetal alcohol disorder. 

16 ‘‘(3) CRITERIA FOR APPLICATIONS.—The Sec17 retary shall establish criteria for the review and ap18 proval of applications for funding under this section. 

19 ‘‘(b) SERVICES.—The Secretary, acting through the 

20 Service and Indian Tribes, Tribal Organizations, and 

21 Urban Indian Organizations, shall— 

22 ‘‘(1) develop and provide services for the preven23 tion, intervention, treatment, and aftercare for those 

24 affected by fetal alcohol disorder in Indian commu25 nities; and 


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1 ‘‘(2) provide supportive services, including serv2 ices to meet the special educational, vocational, 

3 school-to-work transition, and independent living 

4 needs of adolescent and adult Indians with fetal alco5 hol disorder. 

6 ‘‘(c) TASK FORCE.—The Secretary shall establish a 

7 task force to be known as the Fetal Alcohol Disorder Task 

8 Force to advise the Secretary in carrying out subsection (b). 

9 Such task force shall be composed of representatives from 

10 the following: 

11 ‘‘(1) The National Institute on Drug Abuse. 

12 ‘‘(2) The National Institute on Alcohol and Alco13 holism. 

14 ‘‘(3) The Office of Substance Abuse Prevention. 

15 ‘‘(4) The National Institute of Mental Health. 

16 ‘‘(5) The Service. 

17 ‘‘(6) The Office of Minority Health of the De18 partment of Health and Human Services. 

19 ‘‘(7) The Administration for Native Americans. 

20 ‘‘(8) The National Institute of Child Health and 

21 Human Development (NICHD). 

22 ‘‘(9) The Centers for Disease Control and Pre23 vention. 

24 ‘‘(10) The Bureau of Indian Affairs. 

25 ‘‘(11) Indian Tribes. 


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1 ‘‘(12) Tribal Organizations. 

2 ‘‘(13) Urban Indian Organizations. 

3 ‘‘(14) Indian fetal alcohol disorder experts. 

4 ‘‘(d) APPLIED RESEARCH PROJECTS.—The Secretary, 

5 acting through the Substance Abuse and Mental Health 

6 Services Administration, shall make grants to Indian 

7 Tribes, Tribal Organizations, and Urban Indian Organiza8 tions for applied research projects which propose to elevate 

9 the understanding of methods to prevent, intervene, treat, 

10 or provide rehabilitation and behavioral health aftercare for 

11 Indians and Urban Indians affected by fetal alcohol dis12 order. 

13 ‘‘(e) FUNDING FOR URBAN INDIAN ORGANIZATIONS.— 

14 Ten percent of the funds appropriated pursuant to this sec15 tion shall be used to make grants to Urban Indian Organi16 zations funded under title V. 

17 ‘‘SEC. 713. CHILD SEXUAL ABUSE AND PREVENTION TREAT18 MENT PROGRAMS. 

19 ‘‘(a) ESTABLISHMENT.—The Secretary, acting through 

20 the Service, and the Secretary of the Interior, Indian 

21 Tribes, and Tribal Organizations, shall establish, consistent 

22 with section 701, in every Service Area, programs involving 

23 treatment for— 

24 ‘‘(1) victims of sexual abuse who are Indian chil25 dren or children in an Indian household; and 


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1 ‘‘(2) perpetrators of child sexual abuse who are 

2 Indian or members of an Indian household. 

3 ‘‘(b) USE OF FUNDS.—Funding provided pursuant to 

4 this section shall be used for the following: 

5 ‘‘(1) To develop and provide community edu6 cation and prevention programs related to sexual 

7 abuse of Indian children or children in an Indian 

8 household. 

9 ‘‘(2) To identify and provide behavioral health 

10 treatment to victims of sexual abuse who are Indian 

11 children or children in an Indian household, and to 

12 their family members who are affected by sexual 

13 abuse. 

14 ‘‘(3) To develop prevention and intervention 

15 models which incorporate Traditional Health Care 

16 Practices, cultural and spiritual values, and commu17 nity involvement. 

18 ‘‘(4) To develop and implement, in consultation 

19 with Indian Tribes, Tribal Organizations, and Urban 

20 Indian Organizations, culturally sensitive assessment 

21 and diagnostic tools for use in Indian communities 

22 and Urban Centers. 

23 ‘‘(5) To identify and provide behavioral health 

24 treatment to Indian perpetrators and perpetrators 

25 who are members of an Indian household— 


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1 ‘‘(A) making efforts to begin offender and 

2 behavioral health treatment while the perpetrator 

3 is incarcerated or at the earliest possible date if 

4 the perpetrator is not incarcerated; and 

5 ‘‘(B) providing treatment after the perpe6 trator is released, until it is determined that the 

7 perpetrator is not a threat to children. 

8 ‘‘SEC. 714. BEHAVIORAL HEALTH RESEARCH. 

9 ‘‘The Secretary, in consultation with appropriate Fed10 eral agencies, shall make grants to, or enter into contracts 

11 with, Indian Tribes, Tribal Organizations, and Urban In12 dian Organizations or enter into contracts with, or make 

13 grants to appropriate institutions for, the conduct of re14 search on the incidence and prevalence of behavioral health 

15 problems among Indians served by the Service, Indian 

16 Tribes, or Tribal Organizations and among Indians in 

17 urban areas. Research priorities under this section shall in18 clude— 

19 ‘‘(1) the multifactorial causes of Indian youth 

20 suicide, including— 

21 ‘‘(A) protective and risk factors and sci22 entific data that identifies those factors; and 

23 ‘‘(B) the effects of loss of cultural identity 

24 and the development of scientific data on those 

25 effects; 


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1 ‘‘(2) the interrelationship and interdependence of 

2 behavioral health problems with alcoholism and other 

3 substance abuse, suicide, homicides, other injuries, 

4 and the incidence of family violence; and 

5 ‘‘(3) the development of models of prevention 

6 techniques. 

7 The effect of the interrelationships and interdependencies 

8 referred to in paragraph (2) on children, and the develop9 ment of prevention techniques under paragraph (3) appli10 cable to children, shall be emphasized. 

11 ‘‘SEC. 715. DEFINITIONS. 

12 ‘‘For the purpose of this title, the following definitions 

13 shall apply: 

14 ‘‘(1) ASSESSMENT.—The term ‘assessment’ 

15 means the systematic collection, analysis, and dis16 semination of information on health status, health 

17 needs, and health problems. 

18 ‘‘(2) ALCOHOL-RELATED NEURODEVELOPMENTAL

19 DISORDERS OR ARND.—The term ‘alcohol-related 

20 neurodevelopmental disorders’ or ‘ARND’ means, with 

21 a history of maternal alcohol consumption during 

22 pregnancy, central nervous system involvement such 

23 as developmental delay, intellectual deficit, or 

24 neurologic abnormalities. Behaviorally, there can be 

25 problems with irritability, and failure to thrive as inVerDate Aug 31 2005 05:25 Mar 17, 2006 Jkt 049200 PO 00000 Frm 00619 Fmt 6652 Sfmt 6203 E:\BILLS\S1057.RS S1057

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1 fants. As children become older there will likely be hy2 peractivity, attention deficit, language dysfunction, 

3 and perceptual and judgment problems. 

4 ‘‘(3) BEHAVIORAL HEALTH AFTERCARE.—The 

5 term ‘behavioral health aftercare’ includes those ac6 tivities and resources used to support recovery fol7 lowing inpatient, residential, intensive substance 

8 abuse, or mental health outpatient or outpatient 

9 treatment. The purpose is to help prevent or deal with 

10 relapse by ensuring that by the time a client or pa11 tient is discharged from a level of care, such as out12 patient treatment, an aftercare plan has been devel13 oped with the client. An aftercare plan may use such 

14 resources a as community-based therapeutic group, 

15 transitional living facilities, a 12-step sponsor, a 

16 local 12-step or other related support group, and other 

17 community-based providers (mental health profes18 sionals, traditional health care practitioners, commu19 nity health aides, community health representatives, 

20 mental health technicians, ministers, etc.) 

21 ‘‘(4) DUAL DIAGNOSIS.—The term ‘dual diag22 nosis’ means coexisting substance abuse and mental 

23 illness conditions or diagnosis. Such clients are some24 times referred to as mentally ill chemical abusers 

25 (MICAs). 


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1 ‘‘(5) FETAL ALCOHOL DISORDERS.—The term 

2 ‘fetal alcohol disorders’ means fetal alcohol syndrome, 

3 partial fetal alcohol syndrome and alcohol related 

4 neurodevelopmental disorder (ARND). 

5 ‘‘(6) FETAL ALCOHOL SYNDROME OR FAS.—The 

6 term ‘fetal alcohol syndrome’ or ‘FAS’ means a syn7 drome in which, with a history of maternal alcohol 

8 consumption during pregnancy, the following criteria 

9 are met: 

10 ‘‘(A) Central nervous system involvement 

11 such as developmental delay, intellectual deficit, 

12 microencephaly, or neurologic abnormalities. 

13 ‘‘(B) Craniofacial abnormalities with at 

14 least 2 of the following: microophthalmia, short 

15 palpebral fissures, poorly developed philtrum, 

16 thin upper lip, flat nasal bridge, and short 

17 upturned nose. 

18 ‘‘(C) Prenatal or postnatal growth delay. 

19 ‘‘(7) PARTIAL FAS.—The term ‘partial FAS’ 

20 means, with a history of maternal alcohol consump21 tion during pregnancy, having most of the criteria of 

22 FAS, though not meeting a minimum of at least 2 of 

23 the following: microophthalmia, short palpebral fis24 sures, poorly developed philtrum, thin upper lip, flat 

25 nasal bridge, and short upturned nose. 


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1 ‘‘(8) REHABILITATION.—The term ‘rehabilita2 tion’ means to restore the ability or capacity to en3 gage in usual and customary life activities through 

4 education and therapy. 

5 ‘‘(9) SUBSTANCE ABUSE.—The term ‘substance 

6 abuse’ includes inhalant abuse. 

7 ‘‘SEC. 716. AUTHORIZATION OF APPROPRIATIONS. 

8 ‘‘There is authorized to be appropriated such sums as 

9 may be necessary for each fiscal year through fiscal year 

10 2015 to carry out the provisions of this title. 

11 ‘‘TITLE VIII—MISCELLANEOUS 

12 ‘‘SEC. 801. REPORTS. 

13 ‘‘For each fiscal year following the date of enactment 

14 of the Indian Health Care Improvement Act Amendments 

15 of 2005, the Secretary shall transmit to Congress a report 

16 containing the following: 

17 ‘‘(1) A report on the progress made in meeting 

18 the objectives of this Act, including a review of pro19 grams established or assisted pursuant to this Act and 

20 assessments and recommendations of additional pro21 grams or additional assistance necessary to, at a 

22 minimum, provide health services to Indians and en23 sure a health status for Indians, which are at a par24 ity with the health services available to and the health 

25 status of the general population, including specific 


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1 comparisons of appropriations provided and those re2 quired for such parity. 

3 ‘‘(2) A report on whether, and to what extent, 

4 new national health care programs, benefits, initia5 tives, or financing systems have had an impact on the 

6 purposes of this Act and any steps that the Secretary 

7 may have taken to consult with Indian Tribes, Tribal 

8 Organizations, and Urban Indian Organizations to 

9 address such impact, including a report on proposed 

10 changes in allocation of funding pursuant to section 

11 808. 

12 ‘‘(3) A report on the use of health services by In13 dians— 

14 ‘‘(A) on a national and area or other rel15 evant geographical basis; 

16 ‘‘(B) by gender and age; 

17 ‘‘(C) by source of payment and type of serv18 ice; 

19 ‘‘(D) comparing such rates of use with rates 

20 of use among comparable non-Indian popu21 lations; and 

22 ‘‘(E) provided under contracts. 

23 ‘‘(4) A report of contractors to the Secretary on 

24 Health Care Educational Loan Repayments every 6 

25 months required by section 110. 


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1 ‘‘(5) A general audit report of the Secretary on 

2 the Health Care Educational Loan Repayment Pro3 gram as required by section 110(n). 

4 ‘‘(6) A report of the findings and conclusions of 

5 demonstration programs on development of edu6 cational curricula for substance abuse counseling as 

7 required in section 125(f). 

8 ‘‘(7) A separate statement which specifies the 

9 amount of funds requested to carry out the provisions 

10 of section 201. 

11 ‘‘(8) A report of the evaluations of health pro12 motion and disease prevention as required in section 

13 203(c). 

14 ‘‘(9) A biennial report to Congress on infectious 

15 diseases as required by section 212. 

16 ‘‘(10) A report on environmental and nuclear 

17 health hazards as required by section 215. 

18 ‘‘(11) An annual report on the status of all 

19 health care facilities needs as required by section 

20 301(c)(2) and 301(d). 

21 ‘‘(12) Reports on safe water and sanitary waste 

22 disposal facilities as required by section 302(h). 

23 ‘‘(13) An annual report on the expenditure of 

24 nonservice funds for renovation as required by sec25 tions 304(b)(2). 


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1 ‘‘(14) A report identifying the backlog of mainte2 nance and repair required at Service and tribal fa3 cilities required by section 313(a). 

4 ‘‘(15) A report providing an accounting of reim5 bursement funds made available to the Secretary 

6 under titles XVIII, XIX, and XXI of the Social Secu7 rity Act. 

8 ‘‘(16) A report on any arrangements for the 

9 sharing of medical facilities or services, as authorized 

10 by section 406. 

11 ‘‘(17) A report on evaluation and renewal of 

12 Urban Indian programs under section 505. 

13 ‘‘(18) A report on the evaluation of programs as 

14 required by section 513(d). 

15 ‘‘(19) A report on alcohol and substance abuse as 

16 required by section 701(f). 

17 ‘‘(20) A report on Indian youth mental health 

18 services as required by section 707(h). 

19 ‘‘SEC. 802. REGULATIONS. 

20 ‘‘(a) DEADLINES.— 

21 ‘‘(1) PROCEDURES.—Not later than 90 days 

22 after the date of enactment of the Indian Health Care 

23 Improvement Act Amendments of 2005, the Secretary 

24 shall initiate procedures under subchapter III of 

25 chapter 5 of title 5, United States Code, to negotiate 


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1 and promulgate such regulations or amendments 

2 thereto that are necessary to carry out titles I (except 

3 sections 105, 115, and 117), II, III, and VII. The Sec4 retary may promulgate regulations to carry out sec5 tions 105, 115, 117, and titles IV and V, using the 

6 procedures required by chapter V of title 5, United 

7 States Code (commonly known as the ‘Administrative 

8 Procedure Act’). The Secretary shall issue no regula9 tions to carry out titles VI and VIII. 

10 ‘‘(2) PROPOSED REGULATIONS.—Proposed regu11 lations to implement this Act shall be published in the 

12 Federal Register by the Secretary no later than 1 

13 year after the date of enactment of the Indian Health 

14 Care Improvement Act Amendments of 2005 and shall 

15 have no less than a 120-day comment period. 

16 ‘‘(3) EXPIRATION OF AUTHORITY.—Except as 

17 otherwise provided herein, the authority to promul18 gate regulations under this Act shall expire 24 months 

19 from the date of enactment of this Act. 

20 ‘‘(b) COMMITTEE.—A negotiated rulemaking com21 mittee established pursuant to section 565 of title 5, United 

22 States Code, to carry out this section shall have as its mem23 bers only representatives of the Federal Government and 

24 representatives of Indian Tribes and Tribal Organizations, 

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1 atives of Indian Tribes, Tribal Organizations, and Urban 

2 Indian Organizations from each Service Area. The rep3 resentative of the Urban Indian Organization shall be 

4 deemed to be an elected officer of a tribal government for 

5 purposes of applying section 204(b) of the Unfunded Man6 dates Reform Act of 1995 (2 U.S.C. 1534(b)). 

7 ‘‘(c) ADAPTATION OF PROCEDURES.—The Secretary 

8 shall adapt the negotiated rulemaking procedures to the 

9 unique context of self-governance and the government-to10 government relationship between the United States and In11 dian Tribes. 

12 ‘‘(d) LACK OF REGULATIONS.—The lack of promul13 gated regulations shall not limit the effect of this Act. 

14 ‘‘(e) INCONSISTENT REGULATIONS.—The provisions of 

15 this Act shall supersede any conflicting provisions of law 

16 in effect on the day before the date of enactment of the In17 dian Health Care Improvement Act Amendments of 2005, 

18 and the Secretary is authorized to repeal any regulation 

19 inconsistent with the provisions of this Act. 

20 ‘‘SEC. 803. PLAN OF IMPLEMENTATION. 

21 ‘‘Not later than 9 months after the date of enactment 

22 of the Indian Health Care Improvement Act Amendments 

23 of 2005, the Secretary in consultation with Indian Tribes, 

24 Tribal Organizations, and Urban Indian Organizations, 

25 shall submit to Congress a plan explaining the manner and 


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1 schedule (including a schedule of appropriation requests), 

2 by title and section, by which the Secretary will implement 

3 the provisions of this Act. 

4 ‘‘SEC. 804. AVAILABILITY OF FUNDS. 

5 ‘‘The funds appropriated pursuant to this Act shall re6 main available until expended. 

7 ‘‘SEC. 805. LIMITATION ON USE OF FUNDS APPROPRIATED 

8 TO THE INDIAN HEALTH SERVICE. 

9 ‘‘Any limitation on the use of funds contained in an 

10 Act providing appropriations for the Department for a pe11 riod with respect to the performance of abortions shall 

12 apply for that period with respect to the performance of 

13 abortions using funds contained in an Act providing appro14 priations for the Service. 

15 ‘‘SEC. 806. ELIGIBILITY OF CALIFORNIA INDIANS. 

16 ‘‘(a) IN GENERAL.—The following California Indians 

17 shall be eligible for health services provided by the Service: 

18 ‘‘(1) Any member of a federally recognized In19 dian Tribe. 

20 ‘‘(2) Any descendant of an Indian who was re21 siding in California on June 1, 1852, if such descend22 ant— 

23 ‘‘(A) is a member of the Indian community 

24 served by a local program of the Service; and 


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1 ‘‘(B) is regarded as an Indian by the com2 munity in which such descendant lives. 

3 ‘‘(3) Any Indian who holds trust interests in 

4 public domain, national forest, or reservation allot5 ments in California. 

6 ‘‘(4) Any Indian in California who is listed on 

7 the plans for distribution of the assets of rancherias 

8 and reservations located within the State of Cali9 fornia under the Act of August 18, 1958 (72 Stat. 

10 619), and any descendant of such an Indian. 

11 ‘‘(b) CLARIFICATION.—Nothing in this section may be 

12 construed as expanding the eligibility of California Indians 

13 for health services provided by the Service beyond the scope 

14 of eligibility for such health services that applied on May 

15 1, 1986. 

16 ‘‘SEC. 807. HEALTH SERVICES FOR INELIGIBLE PERSONS. 

17 ‘‘(a) CHILDREN.—Any individual who— 

18 ‘‘(1) has not attained 19 years of age; 

19 ‘‘(2) is the natural or adopted child, stepchild, 

20 foster child, legal ward, or orphan of an eligible In21 dian; and 

22 ‘‘(3) is not otherwise eligible for health services 

23 provided by the Service, 

24 shall be eligible for all health services provided by the Serv25 ice on the same basis and subject to the same rules that 


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1 apply to eligible Indians until such individual attains 19 

2 years of age. The existing and potential health needs of all 

3 such individuals shall be taken into consideration by the 

4 Service in determining the need for, or the allocation of, 

5 the health resources of the Service. If such an individual 

6 has been determined to be legally incompetent prior to at7 taining 19 years of age, such individual shall remain eligi8 ble for such services until 1 year after the date of a deter9 mination of competency. 

10 ‘‘(b) SPOUSES.—Any spouse of an eligible Indian who 

11 is not an Indian, or who is of Indian descent but is not 

12 otherwise eligible for the health services provided by the 

13 Service, shall be eligible for such health services if all such 

14 spouses or spouses who are married to members of each In15 dian Tribe being served are made eligible, as a class, by 

16 an appropriate resolution of the governing body of the In17 dian Tribe or Tribal Organization providing such services. 

18 The health needs of persons made eligible under this para19 graph shall not be taken into consideration by the Service 

20 in determining the need for, or allocation of, its health re21 sources. 

22 ‘‘(c) PROVISION OF SERVICES TO OTHER INDIVID23 UALS.— 

24 ‘‘(1) IN GENERAL.—The Secretary is authorized 

25 to provide health services under this subsection 


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1 through health programs operated directly by the 

2 Service to individuals who reside within the Service 

3 Unit and who are not otherwise eligible for such 

4 health services if— 

5 ‘‘(A) the Indian Tribes served by such Serv6 ice Unit request such provision of health services 

7 to such individuals; and 

8 ‘‘(B) the Secretary and the served Indian 

9 Tribes have jointly determined that— 

10 ‘‘(i) the provision of such health serv11 ices will not result in a denial or diminu12 tion of health services to eligible Indians; 

13 and 

14 ‘‘(ii) there is no reasonable alternative 

15 health facilities or services, within or with16 out the Service Unit, available to meet the 

17 health needs of such individuals. 

18 ‘‘(2) ISDEAA PROGRAMS.—In the case of health 

19 programs and facilities operated under a contract or 

20 compact entered into under the Indian Self-Deter21 mination and Education Assistance Act (25 U.S.C. 

22 450 et seq.), the governing body of the Indian Tribe 

23 or Tribal Organization providing health services 

24 under such contract or compact is authorized to deter25 mine whether health services should be provided under 


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1 such contract or compact to individuals who are not 

2 otherwise eligible for such services under any other 

3 subsection of this section or under any other provision 

4 of law. In making such determination, the governing 

5 body of the Indian Tribe or Tribal Organization shall 

6 take into account the considerations described in 

7 clauses (i) and (ii) of paragraph (1)(B). 

8 ‘‘(3) PAYMENT FOR SERVICES.— 

9 ‘‘(A) IN GENERAL.—Persons receiving 

10 health services provided by the Service under this 

11 subsection shall be liable for payment of such 

12 health services under a schedule of charges pre13 scribed by the Secretary which, in the judgment 

14 of the Secretary, results in reimbursement in an 

15 amount not less than the actual cost of providing 

16 the health services. Notwithstanding section 404 

17 of this Act or any other provision of law, 

18 amounts collected under this subsection, includ19 ing medicare, medicaid, or SCHIP reimburse20 ments under titles XVIII, XIX, and XXI of the 

21 Social Security Act, shall be credited to the ac22 count of the program providing the service and 

23 shall be used for the purposes listed in section 

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1 section shall be available for expenditure within 

2 such program. 

3 ‘‘(B) INDIGENT PEOPLE.—Health services 

4 may be provided by the Secretary through the 

5 Service under this subsection to an indigent in6 dividual who would not be otherwise eligible for 

7 such health services but for the provisions of 

8 paragraph (1) only if an agreement has been en9 tered into with a State or local government 

10 under which the State or local government agrees 

11 to reimburse the Service for the expenses in12 curred by the Service in providing such health 

13 services to such indigent individual. 

14 ‘‘(4) REVOCATION OF CONSENT FOR SERVICES.— 

15 ‘‘(A) SINGLE TRIBE SERVICE AREA.—In the 

16 case of a Service Area which serves only 1 In17 dian Tribe, the authority of the Secretary to pro18 vide health services under paragraph (1) shall 

19 terminate at the end of the fiscal year succeeding 

20 the fiscal year in which the governing body of the 

21 Indian Tribe revokes its concurrence to the pro22 vision of such health services. 

23 ‘‘(B) MULTITRIBAL SERVICE AREA.—In the 

24 case of a multitribal Service Area, the authority 

25 of the Secretary to provide health services under 


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1 paragraph (1) shall terminate at the end of the 

2 fiscal year succeeding the fiscal year in which at 

3 least 51 percent of the number of Indian Tribes 

4 in the Service Area revoke their concurrence to 

5 the provisions of such health services. 

6 ‘‘(d) OTHER SERVICES.—The Service may provide 

7 health services under this subsection to individuals who are 

8 not eligible for health services provided by the Service under 

9 any other provision of law in order to— 

10 ‘‘(1) achieve stability in a medical emergency; 

11 ‘‘(2) prevent the spread of a communicable dis12 ease or otherwise deal with a public health hazard; 

13 ‘‘(3) provide care to non-Indian women pregnant 

14 with an eligible Indian’s child for the duration of the 

15 pregnancy through postpartum; or 

16 ‘‘(4) provide care to immediate family members 

17 of an eligible individual if such care is directly re18 lated to the treatment of the eligible individual. 

19 ‘‘(e) HOSPITAL PRIVILEGES FOR PRACTITIONERS.— 

20 Hospital privileges in health facilities operated and main21 tained by the Service or operated under a contract or com22 pact pursuant to the Indian Self-Determination and Edu23 cation Assistance Act (25 U.S.C. 450 et seq.) may be ex24 tended to non-Service health care practitioners who provide 

25 services to individuals described in subsection (a), (b), (c), 


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1 or (d). Such non-Service health care practitioners may, as 

2 part of privileging process, be designated as employees of 

3 the Federal Government for purposes of section 1346(b) and 

4 chapter 171 of title 28, United States Code (relating to Fed5 eral tort claims) only with respect to acts or omissions 

6 which occur in the course of providing services to eligible 

7 individuals as a part of the conditions under which such 

8 hospital privileges are extended. 

9 ‘‘(f) ELIGIBLE INDIAN.—For purposes of this section, 

10 the term ‘eligible Indian’ means any Indian who is eligible 

11 for health services provided by the Service without regard 

12 to the provisions of this section. 

13 ‘‘SEC. 808. REALLOCATION OF BASE RESOURCES. 

14 ‘‘(a) REPORT REQUIRED.—Notwithstanding any other 

15 provision of law, any allocation of Service funds for a fiscal 

16 year that reduces by 5 percent or more from the previous 

17 fiscal year the funding for any recurring program, project, 

18 or activity of a Service Unit may be implemented only after 

19 the Secretary has submitted to the President, for inclusion 

20 in the report required to be transmitted to Congress under 

21 section 801, a report on the proposed change in allocation 

22 of funding, including the reasons for the change and its like23 ly effects. 

24 ‘‘(b) EXCEPTION.—Subsection (a) shall not apply if 

25 the total amount appropriated to the Service for a fiscal 


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1 year is at least 5 percent less than the amount appropriated 

2 to the Service for the previous fiscal year. 

3 ‘‘SEC. 809. RESULTS OF DEMONSTRATION PROJECTS. 

4 ‘‘The Secretary shall provide for the dissemination to 

5 Indian Tribes, Tribal Organizations, and Urban Indian 

6 Organizations of the findings and results of demonstration 

7 projects conducted under this Act. 

8 ‘‘SEC. 810. PROVISION OF SERVICES IN MONTANA. 

9 ‘‘(a) CONSISTENT WITH COURT DECISION.—The Sec10 retary, acting through the Service, shall provide services 

11 and benefits for Indians in Montana in a manner con12 sistent with the decision of the United States Court of Ap13 peals for the Ninth Circuit in McNabb for McNabb v. 

14 Bowen, 829 F.2d 787 (9th Cir. 1987). 

15 ‘‘(b) CLARIFICATION.—The provisions of subsection (a) 

16 shall not be construed to be an expression of the sense of 

17 Congress on the application of the decision described in sub18 section (a) with respect to the provision of services or bene19 fits for Indians living in any State other than Montana. 

20 ‘‘SEC. 811. MORATORIUM. 

21 ‘‘During the period of the moratorium imposed on im22 plementation of the final rule published in the Federal Reg23 ister on September 16, 1987, by the Health Resources and 

24 Services Administration of the Public Health Service, relat25 ing to eligibility for the health care services of the Indian 


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1 Health Service, the Indian Health Service shall provide 

2 services pursuant to the criteria for eligibility for such serv3 ices that were in effect on September 15, 1987, subject to 

4 the provisions of sections 806 and 807 until such time as 

5 new criteria governing eligibility for services are developed 

6 in accordance with section 802. 

7 ‘‘SEC. 812. TRIBAL EMPLOYMENT. 

8 ‘‘For purposes of section 2(2) of the Act of July 5, 1935 

9 (49 Stat. 450, chapter 372), an Indian Tribe or Tribal Or10 ganization carrying out a contract or compact pursuant 

11 to the Indian Self-Determination and Education Assistance 

12 Act (25 U.S.C. 450 et seq.) shall not be considered an ‘em13 ployer’. 

14 ‘‘SEC. 813. SEVERABILITY PROVISIONS. 

15 ‘‘If any provision of this Act, any amendment made 

16 by the Act, or the application of such provision or amend17 ment to any person or circumstances is held to be invalid, 

18 the remainder of this Act, the remaining amendments made 

19 by this Act, and the application of such provisions to per20 sons or circumstances other than those to which it is held 

21 invalid, shall not be affected thereby. 


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1 ‘‘SEC. 814. ESTABLISHMENT OF NATIONAL BIPARTISAN 

2 COMMISSION ON INDIAN HEALTH CARE. 

3 ‘‘(a) ESTABLISHMENT.—There is established the Na4 tional Bipartisan Indian Health Care Commission (the 

5 ‘Commission’). 

6 ‘‘(b) DUTIES OF COMMISSION.—The duties of the Com7 mission are the following: 

8 ‘‘(1) To establish a study committee composed of 

9 those members of the Commission appointed by the 

10 Director and at least 4 members of Congress from 

11 among the members of the Commission, the duties of 

12 which shall be the following: 

13 ‘‘(A) To the extent necessary to carry out its 

14 duties, collect and compile data necessary to un15 derstand the extent of Indian needs with regard 

16 to the provision of health services, regardless of 

17 the location of Indians, including holding hear18 ings and soliciting the views of Indians, Indian 

19 Tribes, Tribal Organizations, and Urban Indian 

20 Organizations, which may include authorizing 

21 and making funds available for feasibility stud22 ies of various models for providing and funding 

23 health services for all Indian beneficiaries, in24 cluding those who live outside of a reservation, 

25 temporarily or permanently. 


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1 ‘‘(B) To make legislative recommendations 

2 to the Commission regarding the delivery of Fed3 eral health care services to Indians. Such rec4 ommendations shall include those related to 

5 issues of eligibility, benefits, the range of service 

6 providers, the cost of such services, financing 

7 such services, and the optimal manner in which 

8 to provide such services. 

9 ‘‘(C) To determine the effect of the enact10 ment of such recommendations on (i) the existing 

11 system of delivery of health services for Indians, 

12 and (ii) the sovereign status of Indian Tribes. 

13 ‘‘(D) Not later than 12 months after the ap14 pointment of all members of the Commission, to 

15 submit a written report of its findings and rec16 ommendations to the full Commission. The re17 port shall include a statement of the minority 

18 and majority position of the Committee and 

19 shall be disseminated, at a minimum, to every 

20 Indian Tribe, Tribal Organization, and Urban 

21 Indian Organization for comment to the Com22 mission. 

23 ‘‘(E) To report regularly to the full Com24 mission regarding the findings and recommenda25 tions developed by the study committee in the 


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1 course of carrying out its duties under this sec2 tion. 

3 ‘‘(2) To review and analyze the recommendations 

4 of the report of the study committee. 

5 ‘‘(3) To make legislative recommendations to 

6 Congress regarding the delivery of Federal health care 

7 services to Indians. Such recommendations shall in8 clude those related to issues of eligibility, benefits, the 

9 range of service providers, the cost of such services, fi10 nancing such services, and the optimal manner in 

11 which to provide such services. 

12 ‘‘(4) Not later than 18 months following the date 

13 of appointment of all members of the Commission, 

14 submit a written report to Congress regarding the de15 livery of Federal health care services to Indians. Such 

16 recommendations shall include those related to issues 

17 of eligibility, benefits, the range of service providers, 

18 the cost of such services, financing such services, and 

19 the optimal manner in which to provide such services. 

20 ‘‘(c) MEMBERS.— 

21 ‘‘(1) APPOINTMENT.—The Commission shall be 

22 composed of 25 members, appointed as follows: 

23 ‘‘(A) Ten members of Congress, including 3 

24 from the House of Representatives and 2 from 

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1 ity leaders, and 3 from the House of Representa2 tives and 2 from the Senate, appointed by their 

3 respective minority leaders, and who shall be 

4 members of the standing committees of Congress 

5 that consider legislation affecting health care to 

6 Indians. 

7 ‘‘(B) Twelve persons chosen by the congres8 sional members of the Commission, 1 from each 

9 Service Area as currently designated by the Di10 rector to be chosen from among 3 nominees from 

11 each Service Area put forward by the Indian 

12 Tribes within the area, with due regard being 

13 given to the experience and expertise of the nomi14 nees in the provision of health care to Indians 

15 and to a reasonable representation on the com16 mission of members who are familiar with var17 ious health care delivery modes and who rep18 resent Indian Tribes of various size populations. 

19 ‘‘(C) Three persons appointed by the Direc20 tor who are knowledgeable about the provision of 

21 health care to Indians, at least 1 of whom shall 

22 be appointed from among 3 nominees put for23 ward by those programs whose funds are pro24 vided in whole or in part by the Service priVerDate Aug 31 2005 05:25 Mar 17, 2006 Jkt 049200 PO 00000 Frm 00641 Fmt 6652 Sfmt 6203 E:\BILLS\S1057.RS S1057

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1 marily or exclusively for the benefit of Urban In2 dians. 

3 ‘‘(D) All those persons chosen by the con4 gressional members of the Commission and by 

5 the Director shall be members of federally recog6 nized Indian Tribes. 

7 ‘‘(2) CHAIR; VICE CHAIR.—The Chair and Vice 

8 Chair of the Commission shall be selected by the con9 gressional members of the Commission. 

10 ‘‘(3) TERMS.—The terms of members of the Com11 mission shall be for the life of the Commission. 

12 ‘‘(4) DEADLINE FOR APPOINTMENTS.—Congres13 sional members of the Commission shall be appointed 

14 not later than 180 days after the date of enactment 

15 of the Indian Health Care Improvement Act Amend16 ments of 2005, and the remaining members of the 

17 Commission shall be appointed not later than 60 days 

18 following the appointment of the congressional mem19 bers. 

20 ‘‘(5) VACANCY.—A vacancy in the Commission 

21 shall be filled in the manner in which the original 

22 appointment was made. 

23 ‘‘(d) COMPENSATION.— 

24 ‘‘(1) CONGRESSIONAL MEMBERS.—Each congres25 sional member of the Commission shall receive no adVerDate Aug 31 2005 05:25 Mar 17, 2006 Jkt 049200 PO 00000 Frm 00642 Fmt 6652 Sfmt 6203 E:\BILLS\S1057.RS S1057

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1 ditional pay, allowances, or benefits by reason of their 

2 service on the Commission and shall receive travel ex3 penses and per diem in lieu of subsistence in accord4 ance with sections 5702 and 5703 of title 5, United 

5 States Code. 

6 ‘‘(2) OTHER MEMBERS.—Remaining members of 

7 the Commission, while serving on the business of the 

8 Commission (including travel time), shall be entitled 

9 to receive compensation at the per diem equivalent of 

10 the rate provided for level IV of the Executive Sched11 ule under section 5315 of title 5, United States Code, 

12 and while so serving away from home and the mem13 ber’s regular place of business, a member may be al14 lowed travel expenses, as authorized by the Chairman 

15 of the Commission. For purpose of pay (other than 

16 pay of members of the Commission) and employment 

17 benefits, rights, and privileges, all personnel of the 

18 Commission shall be treated as if they were employees 

19 of the United States Senate. 

20 ‘‘(e) MEETINGS.—The Commission shall meet at the 

21 call of the Chair. 

22 ‘‘(f) QUORUM.—A quorum of the Commission shall 

23 consist of not less than 15 members, provided that no less 

24 than 6 of the members of Congress who are Commission 


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1 members are present and no less than 9 of the members who 

2 are Indians are present. 

3 ‘‘(g) EXECUTIVE DIRECTOR; STAFF; FACILITIES.— 

4 ‘‘(1) APPOINTMENT; PAY.—The Commission shall 

5 appoint an executive director of the Commission. The 

6 executive director shall be paid the rate of basic pay 

7 for level V of the Executive Schedule. 

8 ‘‘(2) STAFF APPOINTMENT.—With the approval 

9 of the Commission, the executive director may ap10 point such personnel as the executive director deems 

11 appropriate. 

12 ‘‘(3) STAFF PAY.—The staff of the Commission 

13 shall be appointed without regard to the provisions of 

14 title 5, United States Code, governing appointments 

15 in the competitive service, and shall be paid without 

16 regard to the provisions of chapter 51 and subchapter 

17 III of chapter 53 of such title (relating to classifica18 tion and General Schedule pay rates). 

19 ‘‘(4) TEMPORARY SERVICES.—With the approval 

20 of the Commission, the executive director may procure 

21 temporary and intermittent services under section 

22 3109(b) of title 5, United States Code. 

23 ‘‘(5) FACILITIES.—The Administrator of General 

24 Services shall locate suitable office space for the oper25 ation of the Commission. The facilities shall serve as 


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1 the headquarters of the Commission and shall include 

2 all necessary equipment and incidentals required for 

3 the proper functioning of the Commission. 

4 ‘‘(h) HEARINGS.—(1) For the purpose of carrying out 

5 its duties, the Commission may hold such hearings and un6 dertake such other activities as the Commission determines 

7 to be necessary to carry out its duties, provided that at least 

8 6 regional hearings are held in different areas of the United 

9 States in which large numbers of Indians are present. Such 

10 hearings are to be held to solicit the views of Indians re11 garding the delivery of health care services to them. To con12 stitute a hearing under this subsection, at least 5 members 

13 of the Commission, including at least 1 member of Congress, 

14 must be present. Hearings held by the study committee es15 tablished in this section may count toward the number of 

16 regional hearings required by this subsection. 

17 ‘‘(2) Upon request of the Commission, the Comptroller 

18 General shall conduct such studies or investigations as the 

19 Commission determines to be necessary to carry out its du20 ties. 

21 ‘‘(3)(A) The Director of the Congressional Budget Of22 fice or the Chief Actuary of the Centers for Medicare & Med23 icaid Services, or both, shall provide to the Commission, 

24 upon the request of the Commission, such cost estimates as 


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1 the Commission determines to be necessary to carry out its 

2 duties. 

3 ‘‘(B) The Commission shall reimburse the Director of 

4 the Congressional Budget Office for expenses relating to the 

5 employment in the office of the Director of such additional 

6 staff as may be necessary for the Director to comply with 

7 requests by the Commission under subparagraph (A). 

8 ‘‘(4) Upon the request of the Commission, the head of 

9 any Federal agency is authorized to detail, without reim10 bursement, any of the personnel of such agency to the Com11 mission to assist the Commission in carrying out its duties. 

12 Any such detail shall not interrupt or otherwise affect the 

13 civil service status or privileges of the Federal employee. 

14 ‘‘(5) Upon the request of the Commission, the head of 

15 a Federal agency shall provide such technical assistance to 

16 the Commission as the Commission determines to be nec17 essary to carry out its duties. 

18 ‘‘(6) The Commission may use the United States mails 

19 in the same manner and under the same conditions as Fed20 eral agencies and shall, for purposes of the frank, be consid21 ered a commission of Congress as described in section 3215 

22 of title 39, United States Code. 

23 ‘‘(7) The Commission may secure directly from any 

24 Federal agency information necessary to enable it to carry 

25 out its duties, if the information may be disclosed under 


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1 section 552 of title 4, United States Code. Upon request of 

2 the Chairman of the Commission, the head of such agency 

3 shall furnish such information to the Commission. 

4 ‘‘(8) Upon the request of the Commission, the Adminis5 trator of General Services shall provide to the Commission 

6 on a reimbursable basis such administrative support serv7 ices as the Commission may request. 

8 ‘‘(9) For purposes of costs relating to printing and 

9 binding, including the cost of personnel detailed from the 

10 Government Printing Office, the Commission shall be 

11 deemed to be a committee of Congress. 

12 ‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—There is 

13 authorized to be appropriated $4,000,000 to carry out the 

14 provisions of this section, which sum shall not be deducted 

15 from or affect any other appropriation for health care for 

16 Indian persons. 

17 ‘‘(j) FACA.—The Federal Advisory Committee Act (5 

18 U.S.C. App.) shall not apply to the Commission. 

19 ‘‘SEC. 815. APPROPRIATIONS; AVAILABILITY. 

20 ‘‘Any new spending authority (described in subsection 

21 (c)(2)(A) or (B) of section 401 of the Congressional Budget 

22 Act of 1974) which is provided under this Act shall be effec23 tive for any fiscal year only to such extent or in such 

24 amounts as are provided in appropriation Acts. 


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1 ‘‘SEC. 816. AUTHORIZATION OF APPROPRIATIONS. 

2 ‘‘(a) IN GENERAL.—There are authorized to be appro3 priated such sums as may be necessary for each fiscal year 

4 through fiscal year 2015 to carry out this title.’’. 

5 (b) RATE OF PAY.— 

6 (1) POSITIONS AT LEVEL IV.—Section 5315 of 

7 title 5, United States Code, is amended by striking 

8 ‘‘Assistant Secretaries of Health and Human Services 

9 (6).’’ and inserting ‘‘Assistant Secretaries of Health 

10 and Human Services (7)’’. 

11 (2) POSITIONS AT LEVEL V.—Section 5316 of 

12 title 5, United States Code, is amended by striking 

13 ‘‘Director, Indian Health Service, Department of 

14 Health and Human Services’’. 

15 (c) AMENDMENTS TO OTHER PROVISIONS OF LAW.— 

16 (1) Section 3307(b)(1)(C) of the Children’s 

17 Health Act of 2000 (25 U.S.C. 1671 note; Public Law 

18 106–310) is amended by striking ‘‘Director of the In19 dian Health Service’’ and inserting ‘‘Assistant Sec20 retary for Indian Health’’. 

21 (2) The Indian Lands Open Dump Cleanup Act 

22 of 1994 is amended— 

23 (A) in section 3 (25 U.S.C. 3902)— 

24 (i) by striking paragraph (2); 

25 (ii) by redesignating paragraphs (1), 

26 (3), (4), (5), and (6) as paragraphs (4), (5), 


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1 (2), (6), and (1), respectively, and moving 

2 those paragraphs so as to appear in numer3 ical order; and 

4 (iii) by inserting before paragraph (4) 

5 (as redesignated by subclause (II)) the fol6 lowing: 

7 ‘‘(3) ASSISTANT SECRETARY.—The term ‘Assist8 ant Secretary’ means the Assistant Secretary for In9 dian Health.’’; 

10 (B) in section 5 (25 U.S.C. 3904), by strik11 ing the section heading and inserting the fol12 lowing: 

13 ‘‘SEC. 5. AUTHORITY OF ASSISTANT SECRETARY FOR IN14 DIAN HEALTH.’’; 

15 (C) in section 6(a) (25 U.S.C. 3905(a)), in 

16 the subsection heading, by striking ‘‘DIRECTOR’’ 

17 and inserting ‘‘ASSISTANT SECRETARY’’; 

18 (D) in section 9(a) (25 U.S.C. 3908(a)), in 

19 the subsection heading, by striking ‘‘DIRECTOR’’ 

20 and inserting ‘‘ASSISTANT SECRETARY’’; and 

21 (E) by striking ‘‘Director’’ each place it ap22 pears and inserting ‘‘Assistant Secretary’’. 

23 (3) Section 5504(d)(2) of the Augustus F. Haw24 kins-Robert T. Stafford Elementary and Secondary 

25 School Improvement Amendments of 1988 (25 U.S.C. 


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1 2001 note; Public Law 100–297) is amended by strik2 ing ‘‘Director of the Indian Health Service’’ and in3 serting ‘‘Assistant Secretary for Indian Health’’. 

4 (4) Section 203(a)(1) of the Rehabilitation Act of 

5 1973 (29 U.S.C. 763(a)(1)) is amended by striking 

6 ‘‘Director of the Indian Health Service’’ and inserting 

7 ‘‘Assistant Secretary for Indian Health’’. 

8 (5) Subsections (b) and (e) of section 518 of the 

9 Federal Water Pollution Control Act (33 U.S.C. 1377) 

10 are amended by striking ‘‘Director of the Indian 

11 Health Service’’ each place it appears and inserting 

12 ‘‘Assistant Secretary for Indian Health’’. 

13 (6) Section 317M(b) of the Public Health Service 

14 Act (42 U.S.C. 247b–14(b)) is amended— 

15 (A) by striking ‘‘Director of the Indian 

16 Health Service’’ each place it appears and in17 serting ‘‘Assistant Secretary for Indian Health’’; 

18 and 

19 (B) in paragraph (2)(A), by striking ‘‘the 

20 Directors referred to in such paragraph’’ and in21 serting ‘‘the Director of the Centers for Disease 

22 Control and Prevention and the Assistant Sec23 retary for Indian Health’’. 

24 (7) Section 417C(b) of the Public Health Service 

25 Act (42 U.S.C. 285–9(b)) is amended by striking ‘‘DiVerDate Aug 31 2005 05:25 Mar 17, 2006 Jkt 049200 PO 00000 Frm 00650 Fmt 6652 Sfmt 6203 E:\BILLS\S1057.RS S1057

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1 rector of the Indian Health Service’’ and inserting 

2 ‘‘Assistant Secretary for Indian Health’’. 

3 (8) Section 1452(i) of the Safe Drinking Water 

4 Act (42 U.S.C. 300j–12(i)) is amended by striking 

5 ‘‘Director of the Indian Health Service’’ each place it 

6 appears and inserting ‘‘Assistant Secretary for In7 dian Health’’. 

8 (9) Section 803B(d)(1) of the Native American 

9 Programs Act of 1974 (42 U.S.C. 2991b–2(d)(1)) is 

10 amended in the last sentence by striking ‘‘Director of 

11 the Indian Health Service’’ and inserting ‘‘Assistant 

12 Secretary for Indian Health’’. 

13 (10) Section 203(b) of the Michigan Indian 

14 Land Claims Settlement Act (Public Law 105–143; 

15 111 Stat. 2666) is amended by striking ‘‘Director of 

16 the Indian Health Service’’ and inserting ‘‘Assistant 

17 Secretary for Indian Health’’. 

18 SEC. 3. SOBOBA SANITATION FACILITIES. 

19 The Act of December 17, 1970 (84 Stat. 1465), is 

20 amended by adding at the end the following new section: 

21 ‘‘SEC. 9. Nothing in this Act shall preclude the Soboba 

22 Band of Mission Indians and the Soboba Indian Reserva23 tion from being provided with sanitation facilities and serv24 ices under the authority of section 7 of the Act of August 


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1 5, 1954 (68 Stat. 674), as amended by the Act of July 31, 

2 1959 (73 Stat. 267).’’. 

3 SEC. 4. AMENDMENTS TO THE MEDICAID AND STATE CHIL4 DREN’S HEALTH INSURANCE PROGRAMS. 

5 (a) EXPANSION OF MEDICAID PAYMENT FOR ALL COV6 ERED SERVICES FURNISHED BY INDIAN HEALTH PRO7 GRAMS.— 

8 (1) EXPANSION TO ALL COVERED SERVICES.— 

9 Section 1911 of the Social Security Act (42 U.S.C. 

10 1396j) is amended— 

11 (A) by amending the heading to read as fol12 lows: 

13 ‘‘SEC. 1911. INDIAN HEALTH PROGRAMS.’’; and 

14 (B) by amending subsection (a) to read as 

15 follows: 

16 ‘‘(a) ELIGIBILITY FOR REIMBURSEMENT FOR MEDICAL

17 ASSISTANCE.—The Indian Health Service and an Indian 

18 Tribe, Tribal Organization, or an Urban Indian Organiza19 tion (as such terms are defined in section 4 of the Indian 

20 Health Care Improvement Act) shall be eligible for reim21 bursement for medical assistance provided under a State 

22 plan or under waiver authority with respect to items and 

23 services furnished by the Indian Health Service, Indian 

24 Tribe, Tribal Organization, or Urban Indian Organization 

25 if the furnishing of such services meets all the conditions 


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1 and requirements which are applicable generally to the fur2 nishing of items and services under this title and under 

3 such plan or waiver authority.’’. 

4 (2) ELIMINATION OF TEMPORARY DEEMING PRO5 VISION.—Such section is amended by striking sub6 section (b). 

7 (3) REVISION OF AUTHORITY TO ENTER INTO

8 AGREEMENTS.—Subsection (c) of such section is re9 designated as subsection (b) and is amended to read 

10 as follows: 

11 ‘‘(b) AUTHORITY TO ENTER INTO AGREEMENTS.—The 

12 Secretary may enter into an agreement with a State for 

13 the purpose of reimbursing the State for medical assistance 

14 provided by the Indian Health Service, an Indian Tribe, 

15 Tribal Organizations, or an Urban Indian Organization 

16 (as so defined), directly, through referral, or under contracts 

17 or other arrangements between the Indian Health Service, 

18 an Indian Tribe, Tribal Organization, or an Urban Indian 

19 Organization and another health care provider to Indians 

20 who are eligible for medical assistance under the State plan 

21 or under waiver authority.’’. 

22 (4) REFERENCE CORRECTION.—Subsection (d) of 

23 such section is redesignated as subsection (c) and is 

24 amended— 


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1 (A) by striking ‘‘For’’ and inserting ‘‘DI2 RECT BILLING.—For’’; and 

3 (B) by striking ‘‘section 405’’ and inserting 

4 ‘‘section 401(d)’’. 

5 (b) SPECIAL RULES FOR INDIANS, INDIAN HEALTH

6 CARE PROVIDERS, AND INDIAN MANAGED CARE ENTI7 TIES.— 

8 (1) IN GENERAL.—Section 1932 of the Social Se9 curity Act (42 U.S.C. 1396u–2) is amended by add10 ing at the end the following new subsection: 

11 ‘‘(h) SPECIAL RULES FOR INDIANS, INDIAN HEALTH

12 CARE PROVIDERS, AND INDIAN MANAGED CARE ENTI13 TIES.—A State shall comply with the provisions of section 

14 413 of the Indian Health Care Improvement Act (relating 

15 to the treatment of Indians, Indian health care providers, 

16 and Indian managed care entities under a medicaid man17 aged care program).’’. 

18 (2) APPLICATION TO SCHIP.—Section 2107(e)(1) 

19 of the Social Security Act (42 U.S.C. 1397gg(1)) is 

20 amended by adding at the end the following: 

21 ‘‘(E) Subsections (a)(2)(C) and (h) of sec22 tion 1932.’’. 

23 (c) SCHIP TREATMENT OF INDIAN TRIBES, TRIBAL

24 ORGANIZATIONS, AND URBAN INDIAN ORGANIZATIONS.— 


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1 Section 2105(c) of the Social Security Act (42 U.S.C. 

2 1397ee(c)) is amended— 

3 (1) in paragraph (2), by adding at the end the 

4 following: 

5 ‘‘(C) INDIAN HEALTH PROGRAM PAY6 MENTS.—For provisions relating to authorizing 

7 use of allotments under this title for payments to 

8 Indian Health Programs and Urban Indian Or9 ganizations, see section 410 of the Indian Health 

10 Care Improvement Act.’’; and 

11 (2) in paragraph (6)(B), by inserting ‘‘or by an 

12 Indian Tribe, Tribal Organization, or Urban Indian 

13 Organization (as such terms are defined in section 4 

14 of the Indian Health Care Improvement Act)’’ after 

15 ‘‘Service’’. 

16 SEC. 5. NATIVE AMERICAN HEALTH AND WELLNESS FOUN17 DATION. 

18 (a) IN GENERAL.—The Indian Self-Determination 

19 and Education Assistance Act (25 U.S.C. 450 et seq.) is 

20 amended by adding at the end the following: 

21 ‘‘TITLE VIII—NATIVE AMERICAN 

22 HEALTH AND WELLNESS 

23 FOUNDATION 

24 ‘‘SEC. 801. DEFINITIONS. 

25 ‘‘In this title: 


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1 ‘‘(1) BOARD.—The term ‘Board’ means the 

2 Board of Directors of the Foundation. 

3 ‘‘(2) COMMITTEE.—The term ‘Committee’ means 

4 the Committee for the Establishment of Native Amer5 ican Health and Wellness Foundation established 

6 under section 802(f). 

7 ‘‘(3) FOUNDATION.—The term ‘Foundation’ 

8 means the Native American Health and Wellness 

9 Foundation established under section 802. 

10 ‘‘(4) SECRETARY.—The term ‘Secretary’ means 

11 the Secretary of Health and Human Services. 

12 ‘‘(5) SERVICE.—The term ‘Service’ means the In13 dian Health Service of the Department of Health and 

14 Human Services. 

15 ‘‘SEC. 802. NATIVE AMERICAN HEALTH AND WELLNESS 

16 FOUNDATION. 

17 ‘‘(a) ESTABLISHMENT.— 

18 ‘‘(1) IN GENERAL.—As soon as practicable after 

19 the date of enactment of this title, the Secretary shall 

20 establish, under the laws of the District of Columbia 

21 and in accordance with this title, the Native Amer22 ican Health and Wellness Foundation. 

23 ‘‘(2) FUNDING DETERMINATIONS.—No funds, 

24 gift, property, or other item of value (including any 


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1 interest accrued on such an item) acquired by the 

2 Foundation shall— 

3 ‘‘(A) be taken into consideration for pur4 poses of determining Federal appropriations re5 lating to the provision of health care and services 

6 to Indians; or 

7 ‘‘(B) otherwise limit, diminish, or affect the 

8 Federal responsibility for the provision of health 

9 care and services to Indians. 

10 ‘‘(b) PERPETUAL EXISTENCE.—The Foundation shall 

11 have perpetual existence. 

12 ‘‘(c) NATURE OF CORPORATION.—The Foundation— 

13 ‘‘(1) shall be a charitable and nonprofit federally 

14 chartered corporation; and 

15 ‘‘(2) shall not be an agency or instrumentality of 

16 the United States. 

17 ‘‘(d) PLACE OF INCORPORATION AND DOMICILE.—The 

18 Foundation shall be incorporated and domiciled in the Dis19 trict of Columbia. 

20 ‘‘(e) DUTIES.—The Foundation shall— 

21 ‘‘(1) encourage, accept, and administer private 

22 gifts of real and personal property, and any income 

23 from or interest in such gifts, for the benefit of, or in 

24 support of, the mission of the Service; 


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1 ‘‘(2) undertake and conduct such other activities 

2 as will further the health and wellness activities and 

3 opportunities of Native Americans; and 

4 ‘‘(3) participate with and assist Federal, State, 

5 and tribal governments, agencies, entities, and indi6 viduals in undertaking and conducting activities that 

7 will further the health and wellness activities and op8 portunities of Native Americans. 

9 ‘‘(f) COMMITTEE FOR THE ESTABLISHMENT OF NATIVE

10 AMERICAN HEALTH AND WELLNESS FOUNDATION.— 

11 ‘‘(1) IN GENERAL.—The Secretary shall establish 

12 the Committee for the Establishment of Native Amer13 ican Health and Wellness Foundation to assist the 

14 Secretary in establishing the Foundation. 

15 ‘‘(2) DUTIES.—Not later than 180 days after the 

16 date of enactment of this section, the Committee 

17 shall— 

18 ‘‘(A) carry out such activities as are nec19 essary to incorporate the Foundation under the 

20 laws of the District of Columbia, including act21 ing as incorporators of the Foundation; 

22 ‘‘(B) ensure that the Foundation qualifies 

23 for and maintains the status required to carry 

24 out this section, until the Board is established; 


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1 ‘‘(C) establish the constitution and initial 

2 bylaws of the Foundation; 

3 ‘‘(D) provide for the initial operation of the 

4 Foundation, including providing for temporary 

5 or interim quarters, equipment, and staff; and 

6 ‘‘(E) appoint the initial members of the 

7 Board in accordance with the constitution and 

8 initial bylaws of the Foundation. 

9 ‘‘(g) BOARD OF DIRECTORS.— 

10 ‘‘(1) IN GENERAL.—The Board of Directors shall 

11 be the governing body of the Foundation. 

12 ‘‘(2) POWERS.—The Board may exercise, or pro13 vide for the exercise of, the powers of the Foundation. 

14 ‘‘(3) SELECTION.— 

15 ‘‘(A) IN GENERAL.—Subject to subpara16 graph (B), the number of members of the Board, 

17 the manner of selection of the members (includ18 ing the filling of vacancies), and the terms of of19 fice of the members shall be as provided in the 

20 constitution and bylaws of the Foundation. 

21 ‘‘(B) REQUIREMENTS.— 

22 ‘‘(i) NUMBER OF MEMBERS.—The 

23 Board shall have at least 11 members, who 

24 shall have staggered terms. 


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1 ‘‘(ii) INITIAL VOTING MEMBERS.—The 

2 initial voting members of the Board— 

3 ‘‘(I) shall be appointed by the 

4 Committee not later than 180 days 

5 after the date on which the Foundation 

6 is established; and 

7 ‘‘(II) shall have staggered terms. 

8 ‘‘(iii) QUALIFICATION.—The members 

9 of the Board shall be United States citizens 

10 who are knowledgeable or experienced in 

11 Native American health care and related 

12 matters. 

13 ‘‘(C) COMPENSATION.—A member of the 

14 Board shall not receive compensation for service 

15 as a member, but shall be reimbursed for actual 

16 and necessary travel and subsistence expenses in17 curred in the performance of the duties of the 

18 Foundation. 

19 ‘‘(h) OFFICERS.— 

20 ‘‘(1) IN GENERAL.—The officers of the Founda21 tion shall be— 

22 ‘‘(A) a secretary, elected from among the 

23 members of the Board; and 

24 ‘‘(B) any other officers provided for in the 

25 constitution and bylaws of the Foundation. 


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1 ‘‘(2) SECRETARY.—The secretary of the Founda2 tion shall serve, at the direction of the Board, as the 

3 chief operating officer of the Foundation. 

4 ‘‘(3) ELECTION.—The manner of election, term 

5 of office, and duties of the officers of the Foundation 

6 shall be as provided in the constitution and bylaws 

7 of the Foundation. 

8 ‘‘(i) POWERS.—The Foundation— 

9 ‘‘(1) shall adopt a constitution and bylaws for 

10 the management of the property of the Foundation 

11 and the regulation of the affairs of the Foundation; 

12 ‘‘(2) may adopt and alter a corporate seal; 

13 ‘‘(3) may enter into contracts; 

14 ‘‘(4) may acquire (through a gift or otherwise), 

15 own, lease, encumber, and transfer real or personal 

16 property as necessary or convenient to carry out the 

17 purposes of the Foundation; 

18 ‘‘(5) may sue and be sued; and 

19 ‘‘(6) may perform any other act necessary and 

20 proper to carry out the purposes of the Foundation. 

21 ‘‘(j) PRINCIPAL OFFICE.— 

22 ‘‘(1) IN GENERAL.—The principal office of the 

23 Foundation shall be in the District of Columbia. 

24 ‘‘(2) ACTIVITIES; OFFICES.—The activities of the 

25 Foundation may be conducted, and offices may be 


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1 maintained, throughout the United States in accord2 ance with the constitution and bylaws of the Founda3 tion. 

4 ‘‘(k) SERVICE OF PROCESS.—The Foundation shall 

5 comply with the law on service of process of each State in 

6 which the Foundation is incorporated and of each State in 

7 which the Foundation carries on activities. 

8 ‘‘(l) LIABILITY OF OFFICERS, EMPLOYEES, AND

9 AGENTS.— 

10 ‘‘(1) IN GENERAL.—The Foundation shall be lia11 ble for the acts of the officers, employees, and agents 

12 of the Foundation acting within the scope of their au13 thority. 

14 ‘‘(2) PERSONAL LIABILITY.—A member of the 

15 Board shall be personally liable only for gross neg16 ligence in the performance of the duties of the mem17 ber. 

18 ‘‘(m) RESTRICTIONS.— 

19 ‘‘(1) LIMITATION ON SPENDING.—Beginning 

20 with the fiscal year following the first full fiscal year 

21 during which the Foundation is in operation, the ad22 ministrative costs of the Foundation shall not exceed 

23 10 percent of the sum of— 


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1 ‘‘(A) the amounts transferred to the Foun2 dation under subsection (o) during the preceding 

3 fiscal year; and 

4 ‘‘(B) donations received from private 

5 sources during the preceding fiscal year. 

6 ‘‘(2) APPOINTMENT AND HIRING.—The appoint7 ment of officers and employees of the Foundation 

8 shall be subject to the availability of funds. 

9 ‘‘(3) STATUS.—A member of the Board or officer, 

10 employee, or agent of the Foundation shall not by 

11 reason of association with the Foundation be consid12 ered to be an officer, employee, or agent of the United 

13 States. 

14 ‘‘(n) AUDITS.—The Foundation shall comply with sec15 tion 10101 of title 36, United States Code, as if the Founda16 tion were a corporation under part B of subtitle II of that 

17 title. 

18 ‘‘(o) FUNDING.— 

19 ‘‘(1) AUTHORIZATION OF APPROPRIATIONS.— 

20 There is authorized to be appropriated to carry out 

21 subsection (e)(1) $500,000 for each fiscal year, as ad22 justed to reflect changes in the Consumer Price Index 

23 for all-urban consumers published by the Department 

24 of Labor. 


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1 ‘‘(2) TRANSFER OF DONATED FUNDS.—The Sec2 retary shall transfer to the Foundation funds held by 

3 the Department of Health and Human Services under 

4 the Act of August 5, 1954 (42 U.S.C. 2001 et seq.), 

5 if the transfer or use of the funds is not prohibited 

6 by any term under which the funds were donated. 

7 ‘‘SEC. 803. ADMINISTRATIVE SERVICES AND SUPPORT. 

8 ‘‘(a) PROVISION OF SUPPORT BY SECRETARY.—Sub9 ject to subsection (b), during the 5-year period beginning 

10 on the date on which the Foundation is established, the Sec11 retary— 

12 ‘‘(1) may provide personnel, facilities, and other 

13 administrative support services to the Foundation; 

14 ‘‘(2) may provide funds for initial operating 

15 costs and to reimburse the travel expenses of the mem16 bers of the Board; and 

17 ‘‘(3) shall require and accept reimbursements 

18 from the Foundation for— 

19 ‘‘(A) services provided under paragraph (1); 

20 and 

21 ‘‘(B) funds provided under paragraph (2). 

22 ‘‘(b) REIMBURSEMENT.—Reimbursements accepted 

23 under subsection (a)(3)— 


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1 ‘‘(1) shall be deposited in the Treasury of the 

2 United States to the credit of the applicable appro3 priations account; and 

4 ‘‘(2) shall be chargeable for the cost of providing 

5 services described in subsection (a)(1) and travel ex6 penses described in subsection (a)(2). 

7 ‘‘(c) CONTINUATION OF CERTAIN SERVICES.—The Sec8 retary may continue to provide facilities and necessary sup9 port services to the Foundation after the termination of the 

10 5-year period specified in subsection (a) if the facilities and 

11 services— 

12 ‘‘(1) are available; and 

13 ‘‘(2) are provided on reimbursable cost basis.’’. 

14 (b) TECHNICAL AMENDMENTS.—The Indian Self-De15 termination and Education Assistance Act is amended— 

16 (1) by redesignating title V (25 U.S.C. 458bbb et 

17 seq.)) as title VII; 

18 (2) by redesignating sections 501, 502, and 503 

19 (25 U.S.C. 458bbb, 458bbb–1, 458bbb–2) as sections 

20 701, 702, and 703, respectively; and 

21 (3) in subsection (a)(2) of section 702 and para22 graph (2) of section 703 (as redesignated by para23 graph (2)), by striking ‘‘section 501’’ and inserting 

24 ‘‘section 701’’. 


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Calendar No. 375 

109TH CONGRESS 

2D SESSION S. 1057 

[Report No. 109

–222] 

A BILL 

To amend the Indian Health Care Improvement 

Act to revise and extend that Act. 

MARCH 16 (legislative day, MARCH 15), 2006 

Reported with an amendment 


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