II 

109TH CONGRESS 

1ST SESSION S. 1057 

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 and Mr. DORGAN) introduced the following bill; 

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

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’’. 

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 

10 as follows: 
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1 ‘‘SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

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

3 ‘Indian Health Care Improvement Act’. 

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

5 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. 

‘‘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. 
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‘‘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 

‘‘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. 
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‘‘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. 

‘‘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. 
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‘‘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 

9 is to provide the quantity and quality of health serv10 ices which will permit the health status of Indians 

11 to be raised to the highest possible level and to en-
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1 courage the maximum participation of Indians in the 

2 planning and management of those services. 

3 ‘‘(3) Federal health services to Indians have re4 sulted in a reduction in the prevalence and incidence 

5 of preventable illnesses among, and unnecessary and 

6 premature deaths of, Indians. 

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

8 needs of the American Indian people are severe and 

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

10 the general population of the United States. 

11 ‘‘SEC. 3. DECLARATION OF NATIONAL INDIAN HEALTH POL12 ICY. 

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

14 in fulfillment of its special trust responsibilities and legal 

15 obligations to Indians— 

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

17 for Indians and to provide all resources necessary to 

18 effect that policy; 

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

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

21 contained within the Healthy People 2010 or suc22 cessor objectives; 

23 ‘‘(3) to the greatest extent possible, to allow In24 dians to set their own health care priorities and es25 tablish goals that reflect their unmet needs; 
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1 ‘‘(4) to increase the proportion of all degrees in 

2 the health professions and allied and associated 

3 health professions awarded to Indians so that the 

4 proportion of Indian health professionals in each 

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

6 the general population; 

7 ‘‘(5) to require meaningful consultation with In8 dian Tribes, Tribal Organizations, and Urban Indian 

9 Organizations to implement this Act and the na10 tional policy of Indian self-determination; and 

11 ‘‘(6) to provide funding for programs and facili12 ties operated by Indian Tribes and Tribal Organiza13 tions in amounts that are not less than the amounts 

14 provided to programs and facilities operated directly 

15 by the Service. 

16 ‘‘SEC. 4. DEFINITIONS. 

17 ‘‘For purposes of this Act: 

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

19 on or near a reservation and accredited by a na20 tional or regional organization with accrediting au21 thority. 

22 ‘‘(2) The term ‘Area Office’ means an adminis23 trative entity, including a program office, within the 

24 Service through which services and funds are pro-
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1 vided to the Service Units within a defined geo2 graphic area. 

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

4 Assistant Secretary of Indian Health. 

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

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

7 tobacco) abuse and mental health prevention and 

8 treatment, for the purpose of providing comprehen9 sive services. 

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

11 joint development of substance abuse and mental 

12 health treatment planning and coordinated case 

13 management using a multidisciplinary approach. 

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

15 Indians who are eligible for health services of the 

16 Service pursuant to section 806. 

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

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

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

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

21 health services provided at the expense of the Serv22 ice or a Tribal Health Program by public or private 

23 medical providers or hospitals, other than the Serv24 ice Unit or the Tribal Health Program at whose ex25 pense the services are provided. 
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1 ‘‘(8) The term ‘Department’ means, unless oth2 erwise designated, the Department of Health and 

3 Human Services. 

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

5 reduction, limitation, and prevention of disease and 

6 its complications and reduction in the consequences 

7 of disease, including— 

8 ‘‘(A) controlling— 

9 ‘‘(i) development of diabetes; 

10 ‘‘(ii) high blood pressure; 

11 ‘‘(iii) infectious agents; 

12 ‘‘(iv) injuries; 

13 ‘‘(v) occupational hazards and disabil14 ities; 

15 ‘‘(vi) sexually transmittable diseases; 

16 and 

17 ‘‘(vii) toxic agents; and 

18 ‘‘(B) providing— 

19 ‘‘(i) fluoridation of water; and 

20 ‘‘(ii) immunizations. 

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

22 allopathic medicine, family medicine, internal medi23 cine, pediatrics, geriatric medicine, obstetrics and 

24 gynecology, podiatric medicine, nursing, public 

25 health nursing, dentistry, psychiatry, osteopathy, op-
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1 tometry, pharmacy, psychology, public health, social 

2 work, marriage and family therapy, chiropractic 

3 medicine, environmental health and engineering, al4 lied health professions, and any other health profes5 sion. 

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

7 ‘‘(A) fostering social, economic, environ8 mental, and personal factors conducive to 

9 health, including raising public awareness about 

10 health matters and enabling the people to cope 

11 with health problems by increasing their knowl12 edge and providing them with valid information; 

13 ‘‘(B) encouraging adequate and appro14 priate diet, exercise, and sleep; 

15 ‘‘(C) promoting education and work in con16 formity with physical and mental capacity; 

17 ‘‘(D) making available suitable housing, 

18 safe water, and sanitary facilities; 

19 ‘‘(E) improving the physical, economic, cul20 tural, psychological, and social environment; 

21 ‘‘(F) promoting adequate opportunity for 

22 spiritual, religious, and Traditional Health Care 

23 Practices; and 

24 ‘‘(G) providing adequate and appropriate 

25 programs, including— 
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1 ‘‘(i) abuse prevention (mental and 

2 physical); 

3 ‘‘(ii) community health; 

4 ‘‘(iii) community safety; 

5 ‘‘(iv) consumer health education; 

6 ‘‘(v) diet and nutrition; 

7 ‘‘(vi) immunization and other preven8 tion of communicable diseases, including 

9 HIV/AIDS; 

10 ‘‘(vii) environmental health; 

11 ‘‘(viii) exercise and physical fitness; 

12 ‘‘(ix) avoidance of fetal alcohol dis13 orders; 

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

15 ‘‘(xi) human growth and development; 

16 ‘‘(xii) injury prevention and personal 

17 safety; 

18 ‘‘(xiii) behavioral health; 

19 ‘‘(xiv) monitoring of disease indicators 

20 between health care provider visits, 

21 through appropriate means, including 

22 Internet-based health care management 

23 systems; 

24 ‘‘(xv) personal health and wellness 

25 practices; 
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1 ‘‘(xvi) personal capacity building; 

2 ‘‘(xvii) prenatal, pregnancy, and in3 fant care; 

4 ‘‘(xviii) psychological well-being; 

5 ‘‘(xix) reproductive health and family 

6 planning; 

7 ‘‘(xx) safe and adequate water; 

8 ‘‘(xxi) safe housing, relating to elimi9 nation, reduction, and prevention of con10 taminants that create unhealthy housing 

11 conditions; 

12 ‘‘(xxii) safe work environments; 

13 ‘‘(xxiii) stress control; 

14 ‘‘(xxiv) substance abuse; 

15 ‘‘(xxv) sanitary facilities; 

16 ‘‘(xxvi) sudden infant death syndrome 

17 prevention; 

18 ‘‘(xxvii) tobacco use cessation and re19 duction; 

20 ‘‘(xxviii) violence prevention; and 

21 ‘‘(xxix) such other activities identified 

22 by the Service, a Tribal Health Program, 

23 or an Urban Indian Organization, to pro24 mote achievement of any of the objectives 

25 described in section 3(2). 
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1 ‘‘(12) The term ‘Indian’, unless otherwise des2 ignated, means any person who is a member of an 

3 Indian tribe or is eligible for health services under 

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

5 102 and 103, the term also means any individual 

6 who— 

7 ‘‘(A)(i) irrespective of whether the indi8 vidual lives on or near a reservation, is a mem9 ber of a tribe, band, or other organized group 

10 of Indians, including those tribes, bands, or 

11 groups terminated since 1940 and those recog12 nized now or in the future by the State in 

13 which they reside; or 

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

15 degree, of any such member; 

16 ‘‘(B) is an Eskimo or Aleut or other Alas17 ka Native; 

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

19 Interior to be an Indian for any purpose; or 

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

21 regulations promulgated by the Secretary. 

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

23 means— 

24 ‘‘(A) any health program administered di25 rectly by the Service; 
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1 ‘‘(B) any Tribal Health Program; or 

2 ‘‘(C) any Indian Tribe or Tribal Organiza3 tion to which the Secretary provides funding 

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

5 1908 (25 U.S.C. 47), commonly known as the 

6 ‘Buy Indian Act’. 

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

8 given the term in the Indian Self-Determination and 

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

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

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

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

13 1058(e)). 

14 ‘‘(16) The term ‘reservation’ means any feder15 ally recognized Indian Tribe’s reservation, Pueblo, or 

16 colony, including former reservations in Oklahoma, 

17 Indian allotments, and Alaska Native Regions estab18 lished pursuant to the Alaska Native Claims Settle19 ment Act (25 U.S.C. 1601 et seq.). 

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

21 designated, means the Secretary of Health and 

22 Human Services. 

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

24 Health Service. 
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1 ‘‘(19) The term ‘Service Area’ means the geo2 graphical area served by each Area Office. 

3 ‘‘(20) The term ‘Service Unit’ means an admin4 istrative entity of the Service, or a Tribal Health 

5 Program through which services are provided, di6 rectly or by contract, to eligible Indians within a de7 fined geographic area. 

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

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

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

11 ‘‘(22) The term ‘telemedicine’ means a tele12 communications link to an end user through the use 

13 of eligible equipment that electronically links health 

14 professionals or patients and health professionals at 

15 separate sites in order to exchange health care infor16 mation in audio, video, graphic, or other format for 

17 the purpose of providing improved health care serv18 ices. 

19 ‘‘(23) The term ‘Traditional Health Care Prac20 tices’ means the application by Native healing prac21 titioners of the Native healing sciences (as opposed 

22 or in contradistinction to Western healing sciences) 

23 which embody the influences or forces of innate 

24 Tribal discovery, history, description, explanation 

25 and knowledge of the states of wellness and illness 
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1 and which call upon these influences or forces, in2 cluding physical, mental, and spiritual forces in the 

3 promotion, restoration, preservation, and mainte4 nance of health, well-being, and life’s harmony. 

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

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

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

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

9 an Indian Tribe or Tribal Organization that oper10 ates any health program, service, function, activity, 

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

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

13 with the Service under the Indian Self-Determina14 tion and Education Assistance Act (25 U.S.C. 450 

15 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 

9 tribes, bands, or groups that are recognized by 

10 the States in which they reside, or who is a de11 scendant in the first or second degree of any 

12 such member. 

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

14 or other Alaskan Native. 

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

16 Secretary of the Interior to be an Indian for 

17 any 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 situ23 ated in an Urban Center; (B) is governed by an 

24 Urban Indian-controlled board of directors; (C) pro25 vides for the participation of all interested Indian 
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1 groups and individuals; and (D) is capable of legally 

2 cooperating with other public and private entities for 

3 the purpose of performing the activities described in 

4 section 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 

12 assure an optimum supply of health professionals to the 

13 Indian 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 

18 the Service, shall make grants to public or nonprofit pri19 vate health or educational entities, Tribal Health Pro20 grams, or Urban Indian Organizations to assist such enti21 ties in meeting 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 applica20 tion has been submitted to, and approved by, the 

21 Secretary. Such application shall be in such form, 

22 submitted in such manner, and contain such infor23 mation, as the Secretary shall by regulation pre24 scribe pursuant to this Act. The Secretary shall give 
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1 a preference to applications submitted by Tribal 

2 Health Programs or Urban Indian Organizations. 

3 ‘‘(2) AMOUNT OF FUNDS; 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 

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

11 as provided in regulations issued pursuant to this 

12 Act. 

13 ‘‘SEC. 103. HEALTH PROFESSIONS PREPARATORY SCHOL14 ARSHIP PROGRAM FOR INDIANS. 

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

16 acting through the Service, shall provide scholarship 

17 grants to Indians who— 

18 ‘‘(1) have successfully completed their high 

19 school education or high school equivalency; and 

20 ‘‘(2) have demonstrated the potential to suc21 cessfully complete courses of study in the health pro22 fessions. 

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

24 this section shall be for the following purposes: 
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1 ‘‘(1) Compensatory preprofessional education of 

2 any recipient, such scholarship not to exceed 2 years 

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

4 thereof, as determined by the Secretary pursuant to 

5 regulations issued under this Act). 

6 ‘‘(2) Pregraduate education of any recipient 

7 leading to a baccalaureate degree in an approved 

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

9 health profession, such scholarship not to exceed 4 

10 years. An extension of up to 2 years (or the part11 time equivalent thereof, as determined by the Sec12 retary pursuant to regulations issued pursuant to 

13 this Act) may be approved. 

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

15 section— 

16 ‘‘(1) may cover costs of tuition, books, trans17 portation, board, and other necessary related ex18 penses of a recipient while attending school; 

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

20 the applicant’s scholastic achievement if such appli21 cant has been admitted to, or maintained good 

22 standing at, an accredited institution; and 

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

24 applicant’s eligibility for assistance or benefits under 

25 any other Federal program. 
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1 ‘‘SEC. 104. INDIAN HEALTH PROFESSIONS SCHOLARSHIPS. 

2 ‘‘(a) IN GENERAL.— 

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

4 through the Service, shall make scholarship grants 

5 to Indians who are enrolled full or part time in ac6 credited schools pursuing courses of study in the 

7 health professions. Such scholarships shall be des8 ignated Indian Health Scholarships and shall be 

9 made in accordance with section 338A of the Public 

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

11 provided in subsection (b) of this section. 

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

13 provided in paragraph (3), the funding authorized 

14 by this section shall be allocated by Service Area by 

15 a formula developed in consultation with Indian 

16 Tribes, Tribal Organizations, and Urban Indian Or17 ganizations. Such formula shall consider the human 

18 resource development needs in each Service Area. 

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

20 Paragraph (2) shall not apply with respect to indi21 vidual recipients of scholarships provided under this 

22 section (as in effect 1 day prior to the date of enact23 ment of the Indian Health Care Improvement Act 

24 Amendments of 2005) until such time as the indi25 vidual completes the course of study that is sup26 ported through such scholarship. 
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1 ‘‘(4) CERTAIN DELEGATION NOT ALLOWED.— 

2 The administration of this section shall be a respon3 sibility of the Assistant Secretary and shall not be 

4 delegated in a contract or compact under the Indian 

5 Self-Determination and Education Assistance Act 

6 (25 U.S.C. 450 et seq.). 

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

8 ‘‘(1) OBLIGATION MET.—The active duty serv9 ice obligation under a written contract with the Sec10 retary under section 338A of the Public Health 

11 Service Act (42 U.S.C. 254l) that an Indian has en12 tered into under that section shall, if that individual 

13 is a recipient of an Indian Health Scholarship, be 

14 met in full-time practice on an equivalent year-for15 year obligation, by service in one or more of the fol16 lowing: 

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

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

19 of this Act. 

20 ‘‘(C) In the private practice of the applica21 ble profession if, as determined by the Sec22 retary, in accordance with guidelines promul23 gated by the Secretary, such practice is situated 

24 in a physician or other health professional 
24 

•S 1057 IS 

1 shortage area and addresses the health care 

2 needs of a substantial number of Indians. 

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

4 of any individual who has entered into a contract re5 ferred to in paragraph (1) and who receives a degree 

6 in medicine (including osteopathic or allopathic med7 icine), dentistry, optometry, podiatry, or pharmacy, 

8 the Secretary shall defer the active duty service obli9 gation of that individual under that contract, in 

10 order that such individual may complete any intern11 ship, residency, or other advanced clinical training 

12 that is required for the practice of that health pro13 fession, for an appropriate period (in years, as deter14 mined by the Secretary), subject to the following 

15 conditions: 

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

17 other advanced clinical training shall be counted 

18 as satisfying any period of obligated service 

19 under this subsection. 

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

21 that individual shall commence not later than 

22 90 days after the completion of that advanced 

23 clinical training (or by a date specified by the 

24 Secretary). 
25 

•S 1057 IS 

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

2 be served in the health profession of that indi3 vidual in a manner consistent with paragraph 

4 (1). 

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

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

7 meet the active duty service obligation described 

8 in paragraph (1) by service in a program speci9 fied under that paragraph that— 

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

11 the Indian Tribe in which the recipient is 

12 enrolled; or 

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

14 the recipient is enrolled. 

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

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

17 assignments of Indian Health Scholarship recipients 

18 required to meet the active duty service obligation 

19 described in paragraph (1), shall give priority to as20 signing individuals to service in those programs 

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

22 health professionals to provide health care services 

23 as a result of individuals having breached contracts 

24 entered into under this section. 
26 

•S 1057 IS 

1 ‘‘(c) PART-TIME STUDENTS.—In the case of an indi2 vidual receiving a scholarship under this section who is 

3 enrolled part time in an approved course of study— 

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

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

6 years, as determined by the Area Office; 

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

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

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

10 each year for which the individual was provided 

11 a scholarship (as determined by the Area Of12 fice); or 

13 ‘‘(B) 2 years; and 

14 ‘‘(3) the amount of the monthly stipend speci15 fied in section 338A(g)(1)(B) of the Public Health 

16 Service Act (42 U.S.C. 254l(g)(1)(B)) shall be re17 duced pro rata (as determined by the Secretary) 

18 based on the number of hours such student is en19 rolled. 

20 ‘‘(d) BREACH OF CONTRACT.— 

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

22 shall be liable to the United States for the amount 

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

24 of the individual, under a contract entered into with 

25 the Secretary under this section on or after the date 
27 

•S 1057 IS 

1 of enactment of the Indian Health Care Improve2 ment Act Amendments of 2005 if that individual— 

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

4 of academic standing in the educational institu5 tion in which he or she is enrolled (such level 

6 determined by the educational institution under 

7 regulations of the Secretary); 

8 ‘‘(B) is dismissed from such educational 

9 institution for disciplinary reasons; 

10 ‘‘(C) voluntarily terminates the training in 

11 such an educational institution for which he or 

12 she is provided a scholarship under such con13 tract before the completion of such training; or 

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

15 the educational institution in which he or she is 

16 enrolled not to accept payment, in whole or in 

17 part, of a scholarship under such contract, in 

18 lieu of any service obligation arising under such 

19 contract. 

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

21 specified in paragraph (1) an individual breaches a 

22 written contract by failing either to begin such indi23 vidual’s service obligation required under such con24 tract or to complete such service obligation, the 

25 United States shall be entitled to recover from the 
28 

•S 1057 IS 

1 individual an amount determined in accordance with 

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

3 in the manner provided for in such subsection. 

4 ‘‘(3) CANCELLATION UPON DEATH OF RECIPI5 ENT.—Upon the death of an individual who receives 

6 an Indian Health Scholarship, any outstanding obli7 gation of that individual for service or payment that 

8 relates to that scholarship shall be canceled. 

9 ‘‘(4) WAIVERS AND SUSPENSIONS.—The Sec10 retary shall provide for the partial or total waiver or 

11 suspension of any obligation of service or payment of 

12 a recipient of an Indian Health Scholarship if the 

13 Secretary, in consultation with the affected Area Of14 fice, Indian Tribes, Tribal Organizations, and Urban 

15 Indian Organizations, determines that— 

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

17 meet that obligation or make that payment; 

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

19 obligation or make that payment would result 

20 in extreme hardship to the recipient; or 

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

22 meet the obligation or make the payment would 

23 be unconscionable. 

24 ‘‘(5) EXTREME HARDSHIP.—Notwithstanding 

25 any other provision of law, in any case of extreme 
29 

•S 1057 IS 

1 hardship or for other good cause shown, the Sec2 retary may waive, in whole or in part, the right of 

3 the United States to recover funds made available 

4 under this section. 

5 ‘‘(6) BANKRUPTCY.—Notwithstanding any 

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

7 an Indian Health Scholarship, no obligation for pay8 ment may be released by a discharge in bankruptcy 

9 under title 11, United States Code, unless that dis10 charge is granted after the expiration of the 5-year 

11 period beginning on the initial date on which that 

12 payment is due, and only if the bankruptcy court 

13 finds that the nondischarge of the obligation would 

14 be unconscionable. 

15 ‘‘SEC. 105. AMERICAN INDIANS INTO PSYCHOLOGY PRO16 GRAM. 

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

18 through the Service, shall make grants to at least 3 col19 leges and universities for the purpose of developing and 

20 maintaining Indian psychology career recruitment pro21 grams as a means of encouraging Indians to enter the 

22 mental health field. These programs shall be located at 

23 various locations throughout the country to maximize their 

24 availability to Indian students and new programs shall be 

25 established in different locations from time to time. 
30 

•S 1057 IS 

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

2 Secretary shall provide a grant authorized under sub3 section (a) to develop and maintain a program at the Uni4 versity of North Dakota to be known as the ‘Quentin N. 

5 Burdick American Indians Into Psychology Program’. 

6 Such program shall, to the maximum extent feasible, co7 ordinate with the Quentin N. Burdick Indian Health Pro8 grams authorized under section 117(b), the Quentin N. 

9 Burdick American Indians Into Nursing Program author10 ized under section 115(e), and existing university research 

11 and communications networks. 

12 ‘‘(c) REGULATIONS.—The Secretary shall issue regu13 lations pursuant to this Act for the competitive awarding 

14 of grants provided under this section. 

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

16 section shall agree to provide a program which, at a min17 imum— 

18 ‘‘(1) provides outreach and recruitment for 

19 health professions to Indian communities including 

20 elementary, secondary, and accredited and accessible 

21 community colleges that will be served by the pro22 gram; 

23 ‘‘(2) incorporates a program advisory board 

24 comprised of representatives from the tribes and 

25 communities that will be served by the program; 
31 

•S 1057 IS 

1 ‘‘(3) provides summer enrichment programs to 

2 expose Indian students to the various fields of psy3 chology through research, clinical, and experimental 

4 activities; 

5 ‘‘(4) provides stipends to undergraduate and 

6 graduate students to pursue a career in psychology; 

7 ‘‘(5) develops affiliation agreements with tribal 

8 colleges and universities, the Service, university af9 filiated programs, and other appropriate accredited 

10 and accessible entities to enhance the education of 

11 Indian students; 

12 ‘‘(6) to the maximum extent feasible, uses exist13 ing university tutoring, counseling, and student sup14 port services; and 

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

16 qualified Indians in the program. 

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

18 active duty service obligation prescribed under section 

19 338C of the Public Health Service Act (42 U.S.C. 254m) 

20 shall be met by each graduate who receives a stipend de21 scribed in subsection (d)(4) that is funded under this sec22 tion. Such obligation shall be met by service— 

23 ‘‘(1) in an Indian Health Program; 

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

25 Act; or 
32 

•S 1057 IS 

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

2 determined by the Secretary, in accordance with 

3 guidelines promulgated by the Secretary, such prac4 tice is situated in a physician or other health profes5 sional shortage area and addresses the health care 

6 needs of a substantial number of Indians. 

7 ‘‘SEC. 106. FUNDING FOR TRIBES FOR SCHOLARSHIP PRO8 GRAMS. 

9 ‘‘(a) IN GENERAL.— 

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

11 acting through the Service, shall make grants to 

12 Tribal Health Programs for the purpose of providing 

13 scholarships for Indians to serve as health profes14 sionals in Indian communities. 

15 ‘‘(2) AMOUNT.—Amounts available under para16 graph (1) for any fiscal year shall not exceed 5 per17 cent of the amounts available for each fiscal year for 

18 Indian Health Scholarships under section 104. 

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

20 under paragraph (1) shall be in such form and con21 tain such agreements, assurances, and information 

22 as consistent with this section. 

23 ‘‘(b) REQUIREMENTS.— 

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

25 receiving a grant under subsection (a) shall provide 
33 

•S 1057 IS 

1 scholarships to Indians in accordance with the re2 quirements of this section. 

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

4 any scholarship pursuant to subsection (a)— 

5 ‘‘(A) 80 percent of the costs of the scholar6 ship shall be paid from the funds made avail7 able pursuant to subsection (a)(1) provided to 

8 the Tribal Health Program; and 

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

10 from any other source of funds. 

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

12 shall provide scholarships under this section only to Indi13 ans enrolled or accepted for enrollment in a course of 

14 study (approved by the Secretary) in one of the health pro15 fessions contemplated by this Act. 

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

17 subsection (b), the Secretary and the Tribal Health Pro18 gram shall enter into a written contract with each recipi19 ent of such scholarship. Such contract shall— 

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

21 an Indian Health Program or Urban Indian Organi22 zation, in the same Service Area where the Tribal 

23 Health Program providing the scholarship is located, 

24 for— 
34 

•S 1057 IS 

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

2 scholarship is provided (or the part-time equiva3 lent thereof, as determined by the Secretary), 

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

5 greater; or 

6 ‘‘(B) such greater period of time as the re7 cipient and the Tribal Health Program may 

8 agree; 

9 ‘‘(2) provide that the amount of the scholar10 ship— 

11 ‘‘(A) may only be expended for— 

12 ‘‘(i) tuition expenses, other reasonable 

13 educational expenses, and reasonable living 

14 expenses incurred in attendance at the 

15 educational institution; and 

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

17 monthly stipend of not more than the 

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

19 of the Public Health Service Act (42 

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

21 to be reduced pro rata (as determined by 

22 the Secretary) based on the number of 

23 hours such student is enrolled, and not to 

24 exceed, for any year of attendance for 

25 which the scholarship is provided, the total 
35 

•S 1057 IS 

1 amount required for the year for the pur2 poses authorized in this clause; and 

3 ‘‘(B) may not exceed, for any year of at4 tendance for which the scholarship is provided, 

5 the total amount required for the year for the 

6 purposes authorized in subparagraph (A); 

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

8 maintain an acceptable level of academic standing as 

9 determined by the educational institution in accord10 ance with regulations issued pursuant to this Act; 

11 and 

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

13 meet the educational and licensure requirements ap14 propriate to each health profession. 

15 ‘‘(e) BREACH OF CONTRACT.— 

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

17 has entered into a written contract with the Sec18 retary and a Tribal Health Program under sub19 section (d) shall be liable to the United States for 

20 the Federal share of the amount which has been 

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

22 the contract if that individual— 

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

24 of academic standing in the educational institu25 tion in which he or she is enrolled (such level 
36 

•S 1057 IS 

1 as determined by the educational institution 

2 under regulations of the Secretary); 

3 ‘‘(B) is dismissed from such educational 

4 institution for disciplinary reasons; 

5 ‘‘(C) voluntarily terminates the training in 

6 such an educational institution for which he or 

7 she is provided a scholarship under such con8 tract before the completion of such training; or 

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

10 the educational institution in which he or she is 

11 enrolled not to accept payment, in whole or in 

12 part, of a scholarship under such contract, in 

13 lieu of any service obligation arising under such 

14 contract. 

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

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

17 written contract by failing to either begin such indi18 vidual’s service obligation required under such con19 tract or to complete such service obligation, the 

20 United States shall be entitled to recover from the 

21 individual an amount determined in accordance with 

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

23 in the manner provided for in such subsection. 

24 ‘‘(3) CANCELLATION UPON DEATH OF RECIPI25 ENT.—Upon the death of an individual who receives 
37 

•S 1057 IS 

1 an Indian Health Scholarship, any outstanding obli2 gation of that individual for service or payment that 

3 relates to that scholarship shall be canceled. 

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

5 out this subsection on the basis of information re6 ceived from Tribal Health Programs involved or on 

7 the basis of information collected through such other 

8 means as the Secretary deems appropriate. 

9 ‘‘(f) RELATION TO SOCIAL SECURITY ACT.—The re10 cipient of a scholarship under this section shall agree, in 

11 providing health care pursuant to the requirements here12 in— 

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

14 seeking care on the basis of the ability of the indi15 vidual to pay for such care or on the basis that pay16 ment for such care will be made pursuant to a pro17 gram established in title XVIII of the Social Secu18 rity Act or pursuant to the programs established in 

19 title XIX or title XXI of such Act; and 

20 ‘‘(2) to accept assignment under section 

21 1842(b)(3)(B)(ii) of the Social Security Act for all 

22 services for which payment may be made under part 

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

24 appropriate agreement with the State agency that 

25 administers the State plan for medical assistance 
38 

•S 1057 IS 

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

2 title XXI, of such Act to provide service to individ3 uals entitled to medical assistance or child health as4 sistance, respectively, under the plan. 

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

6 shall make payments under this section to a Tribal Health 

7 Program for any fiscal year subsequent to the first fiscal 

8 year of such payments unless the Secretary determines 

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

10 Health Program has not complied with the requirements 

11 of this section. 

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

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

14 who receives a scholarship pursuant to section 104 or 106 

15 shall be given preference for employment in the Service, 

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

17 Urban Indian Organization, or other agencies of the De18 partment as available, during any nonacademic period of 

19 the year. 

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

21 OBLIGATION.—Periods of employment pursuant to this 

22 subsection shall not be counted in determining fulfillment 

23 of the service obligation incurred as a condition of the 

24 scholarship. 
39 

•S 1057 IS 

1 ‘‘(c) TIMING; LENGTH OF EMPLOYMENT.—Any indi2 vidual enrolled in a program, including a high school pro3 gram, authorized under section 102(a) may be employed 

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

5 Indian Organization during any nonacademic period of the 

6 year. Any such employment shall not exceed 120 days dur7 ing any calendar year. 

8 ‘‘(d) NONAPPLICABILITY OF COMPETITIVE PER9 SONNEL SYSTEM.—Any employment pursuant to this sec10 tion shall be made without regard to any competitive per11 sonnel system or agency personnel limitation and to a po12 sition which will enable the individual so employed to re13 ceive practical experience in the health profession in which 

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

15 shall receive payment for his or her services comparable 

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

17 employed in the competitive system. Any individual so em18 ployed shall not be counted against any employment ceil19 ing affecting the Service or the Department. 

20 ‘‘SEC. 108. CONTINUING EDUCATION ALLOWANCES. 

21 ‘‘In order to encourage health professionals, including 

22 community health representatives and emergency medical 

23 technicians, to join or continue in an Indian Health Pro24 gram or an Urban Indian Organization and to provide 

25 their services in the rural and remote areas where a sig-
40 

•S 1057 IS 

1 nificant portion of Indians reside, the Secretary, acting 

2 through the Service, may provide allowances to health pro3 fessionals employed in an Indian Health Program or an 

4 Urban Indian Organization to enable them for a period 

5 of time each year prescribed by regulation of the Secretary 

6 to take leave of their duty stations for professional con7 sultation and refresher training courses. 

8 ‘‘SEC. 109. COMMUNITY HEALTH REPRESENTATIVE PRO9 GRAM. 

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

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

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

13 Service, shall maintain a Community Health Representa14 tive Program under which Indian Health Programs— 

15 ‘‘(1) provide for the training of Indians as com16 munity health representatives; and 

17 ‘‘(2) use such community health representatives 

18 in the provision of health care, health promotion, 

19 and disease prevention services to Indian commu20 nities. 

21 ‘‘(b) DUTIES.—The Community Health Representa22 tive Program of the Service, shall— 

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

24 community health representatives to ensure that the 

25 community health representatives provide quality 
41 

•S 1057 IS 

1 health care, health promotion, and disease preven2 tion services to the Indian communities served by 

3 the Program; 

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

5 and maintain a curriculum that— 

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

7 health care with supervised practical experience 

8 in the provision of health care; and 

9 ‘‘(B) provides instruction and practical ex10 perience in health promotion and disease pre11 vention activities, with appropriate consider12 ation given to lifestyle factors that have an im13 pact on Indian health status, such as alco14 holism, family dysfunction, and poverty; 

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

16 needs of community health representatives for con17 tinuing education in health care, health promotion, 

18 and disease prevention and develop programs that 

19 meet the needs for continuing education; 

20 ‘‘(4) maintain a system that provides close su21 pervision of Community Health Representatives; 

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

23 of Community Health Representatives is reviewed 

24 and evaluated; and 
42 

•S 1057 IS 

1 ‘‘(6) promote Traditional Health Care Practices 

2 of the Indian Tribes served consistent with the Serv3 ice standards for the provision of health care, health 

4 promotion, and disease prevention. 

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

6 PROGRAM. 

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

8 through the Service, shall establish and administer a pro9 gram to be known as the Service Loan Repayment Pro10 gram (hereinafter referred to as the ‘Loan Repayment 

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

12 trained health professionals necessary to maintain accredi13 tation of, and provide health care services to Indians 

14 through, Indian Health Programs and Urban Indian Or15 ganizations. 

16 ‘‘(b) ELIGIBLE INDIVIDUALS.—To be eligible to par17 ticipate in the Loan Repayment Program, an individual 

18 must— 

19 ‘‘(1)(A) be enrolled— 

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

21 accredited educational institution (as deter22 mined by the Secretary under section 

23 338B(b)(1)(c)(i) of the Public Health Service 

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

25 scheduled to complete such course of study in 
43 

•S 1057 IS 

1 the same year such individual applies to partici2 pate in such program; or 

3 ‘‘(ii) in an approved graduate training pro4 gram in a health profession; or 

5 ‘‘(B) have— 

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

7 ‘‘(ii) a license to practice a health profes8 sion; 

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

10 as a commissioned officer in the Regular or Reserve 

11 Corps of the Public Health Service; 

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

13 in the Regular or Reserve Corps of the Public 

14 Health Service; 

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

16 service employment in the Service; or 

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

18 or Urban Indian Organization without a service obli19 gation; and 

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

21 a contract described in subsection (e). 

22 ‘‘(c) APPLICATION.— 

23 ‘‘(1) INFORMATION TO BE INCLUDED WITH

24 FORMS.—In disseminating application forms and 

25 contract forms to individuals desiring to participate 
44 

•S 1057 IS 

1 in the Loan Repayment Program, the Secretary 

2 shall include with such forms a fair summary of the 

3 rights and liabilities of an individual whose applica4 tion is approved (and whose contract is accepted) by 

5 the Secretary, including in the summary a clear ex6 planation of the damages to which the United States 

7 is entitled under subsection (l) in the case of the in8 dividual’s breach of contract. The Secretary shall 

9 provide such individuals with sufficient information 

10 regarding the advantages and disadvantages of serv11 ice as a commissioned officer in the Regular or Re12 serve Corps of the Public Health Service or a civil13 ian employee of the Service to enable the individual 

14 to make a decision on an informed basis. 

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

16 contract form, and all other information furnished 

17 by the Secretary under this section shall be written 

18 in a manner calculated to be understood by the aver19 age individual applying to participate in the Loan 

20 Repayment Program. 

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

22 Secretary shall make such application forms, con23 tract forms, and other information available to indi24 viduals desiring to participate in the Loan Repay25 ment Program on a date sufficiently early to ensure 
45 

•S 1057 IS 

1 that such individuals have adequate time to carefully 

2 review and evaluate such forms and information. 

3 ‘‘(d) PRIORITIES.— 

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

5 Secretary shall annually— 

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

7 Health Program or Urban Indian Organization 

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

9 ‘‘(B) rank those positions in order of pri10 ority. 

11 ‘‘(2) APPROVALS.—Notwithstanding the pri12 ority determined under paragraph (1), the Secretary, 

13 in determining which applications under the Loan 

14 Repayment Program to approve (and which con15 tracts to accept), shall— 

16 ‘‘(A) give first priority to applications 

17 made by individual Indians; and 

18 ‘‘(B) after making determinations on all 

19 applications submitted by individual Indians as 

20 required under subparagraph (A), give priority 

21 to— 

22 ‘‘(i) individuals recruited through the 

23 efforts of an Indian Health Program or 

24 Urban Indian Organization; and 
46 

•S 1057 IS 

1 ‘‘(ii) other individuals based on the 

2 priority rankings under paragraph (1). 

3 ‘‘(e) RECIPIENT CONTRACTS.— 

4 ‘‘(1) CONTRACT REQUIRED.—An individual be5 comes a participant in the Loan Repayment Pro6 gram only upon the Secretary and the individual en7 tering into a written contract described in paragraph 

8 (2). 

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

10 contract referred to in this section between the Sec11 retary and an individual shall contain— 

12 ‘‘(A) an agreement under which— 

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

14 Secretary agrees— 

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

16 individual in accordance with the pro17 visions of this section; and 

18 ‘‘(II) to accept (subject to the 

19 availability of appropriated funds for 

20 carrying out this section) the indi21 vidual into the Service or place the in22 dividual with a Tribal Health Pro23 gram or Urban Indian Organization 

24 as provided in clause (ii)(III); and 
47 

•S 1057 IS 

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

2 individual agrees— 

3 ‘‘(I) to accept loan payments on 

4 behalf of the individual; 

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

6 described in subsection (b)(1)— 

7 ‘‘(aa) to maintain enrollment 

8 in a course of study or training 

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

10 until the individual completes the 

11 course of study or training; and 

12 ‘‘(bb) while enrolled in such 

13 course of study or training, to 

14 maintain an acceptable level of 

15 academic standing (as deter16 mined under regulations of the 

17 Secretary by the educational in18 stitution offering such course of 

19 study or training); and 

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

21 (hereinafter in this section referred to 

22 as the ‘period of obligated service’) 

23 equal to 2 years or such longer period 

24 as the individual may agree to serve 

25 in the full-time clinical practice of 
48 

•S 1057 IS 

1 such individual’s profession in an In2 dian Health Program or Urban In3 dian Organization to which the indi4 vidual may be assigned by the Sec5 retary; 

6 ‘‘(B) a provision permitting the Secretary 

7 to extend for such longer additional periods, as 

8 the individual may agree to, the period of obli9 gated service agreed to by the individual under 

10 subparagraph (A)(ii)(III); 

11 ‘‘(C) a provision that any financial obliga12 tion of the United States arising out of a con13 tract entered into under this section and any 

14 obligation of the individual which is conditioned 

15 thereon is contingent upon funds being appro16 priated for loan repayments under this section; 

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

18 the United States is entitled under subsection 

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

20 and 

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

22 and liabilities of the Secretary and of the indi23 vidual, not inconsistent with this section. 
49 

•S 1057 IS 

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

2 The Secretary shall provide written notice to an individual 

3 within 21 days on— 

4 ‘‘(1) the Secretary’s approving, under sub5 section (e)(1), of the individual’s participation in the 

6 Loan Repayment Program, including extensions re7 sulting in an aggregate period of obligated service in 

8 excess of 4 years; or 

9 ‘‘(2) the Secretary’s disapproving an individ10 ual’s participation in such Program. 

11 ‘‘(g) PAYMENTS.— 

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

13 for an individual under a written contract under the 

14 Loan Repayment Program shall consist of payment, 

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

16 individual of the principal, interest, and related ex17 penses on government and commercial loans received 

18 by the individual regarding the undergraduate or 

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

20 loans were made for— 

21 ‘‘(A) tuition expenses; 

22 ‘‘(B) all other reasonable educational ex23 penses, including fees, books, and laboratory ex24 penses, incurred by the individual; and 
50 

•S 1057 IS 

1 ‘‘(C) reasonable living expenses as deter2 mined by the Secretary. 

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

4 service that an individual contracts to serve under 

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

6 or an amount equal to the amount specified in sec7 tion 338B(g)(2)(A) of the Public Health Service 

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

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

10 determination of the amount to pay for a year of 

11 such service by an individual, the Secretary shall 

12 consider the extent to which each such determina13 tion— 

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

15 maximize the number of contracts that can be 

16 provided under the Loan Repayment Program 

17 from the amounts appropriated for such con18 tracts; 

19 ‘‘(B) provides an incentive to serve in In20 dian Health Programs and Urban Indian Orga21 nizations with the greatest shortages of health 

22 professionals; and 

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

24 the health professional involved remaining in an 

25 Indian Health Program or Urban Indian Orga-
51 

•S 1057 IS 

1 nization with such a health professional short2 age, and continuing to provide primary health 

3 services, after the completion of the period of 

4 obligated service under the Loan Repayment 

5 Program. 

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

7 Secretary for the making of loan repayments in ac8 cordance with this subsection shall provide that any 

9 repayments for a year of obligated service shall be 

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

11 which the individual completes such year of service. 

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

13 For the purpose of providing reimbursements for tax 

14 liability resulting from a payment under paragraph 

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

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

17 make payments to the individual in an amount 

18 equal to not less than 20 percent and not more 

19 than 39 percent of the total amount of loan re20 payments made for the taxable year involved; 

21 and 

22 ‘‘(B) may make such additional payments 

23 as the Secretary determines to be appropriate 

24 with respect to such purpose. 
52 

•S 1057 IS 

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

2 may enter into an agreement with the holder of any 

3 loan for which payments are made under the Loan 

4 Repayment Program to establish a schedule for the 

5 making of such payments. 

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

7 other provision of law, individuals who have entered into 

8 written contracts with the Secretary under this section 

9 shall not be counted against any employment ceiling af10 fecting the Department while those individuals are under11 going academic training. 

12 ‘‘(i) RECRUITMENT.—The Secretary shall conduct re13 cruiting programs for the Loan Repayment Program and 

14 other Service manpower programs of the Service at edu15 cational institutions training health professionals or spe16 cialists identified in subsection (a). 

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

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

19 to individuals during their period of obligated service 

20 under the Loan Repayment Program. 

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

22 in assigning individuals to serve in Indian Health Pro23 grams or Urban Indian Organizations pursuant to con24 tracts entered into under this section, shall— 
53 

•S 1057 IS 

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

2 Health Programs and Urban Indian Organizations 

3 receive consideration on an equal basis with pro4 grams that are administered directly by the Service; 

5 and 

6 ‘‘(2) give priority to assigning individuals to In7 dian Health Programs and Urban Indian Organiza8 tions that have a need for health professionals to 

9 provide health care services as a result of individuals 

10 having breached contracts entered into under this 

11 section. 

12 ‘‘(l) BREACH OF CONTRACT.— 

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

14 has entered into a written contract with the Sec15 retary under this section and has not received a 

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

17 of any service obligation arising under such contract, 

18 to the United States for the amount which has been 

19 paid on such individual’s behalf under the contract 

20 if that individual— 

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

22 course of study and— 

23 ‘‘(i) fails to maintain an acceptable 

24 level of academic standing in the edu25 cational institution in which he or she is 
54 

•S 1057 IS 

1 enrolled (such level determined by the edu2 cational institution under regulations of 

3 the Secretary); 

4 ‘‘(ii) voluntarily terminates such en5 rollment; or 

6 ‘‘(iii) is dismissed from such edu7 cational institution before completion of 

8 such course of study; or 

9 ‘‘(B) is enrolled in a graduate training pro10 gram and fails to complete such training pro11 gram. 

12 ‘‘(2) OTHER BREACHES; FORMULA FOR

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

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

15 written contract under this section by failing either 

16 to begin, or complete, such individual’s period of ob17 ligated service in accordance with subsection (e)(2), 

18 the United States shall be entitled to recover from 

19 such individual an amount to be determined in ac20 cordance with the following formula: A=3Z(t¥s/t) 

21 in which— 

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

23 is entitled to recover; 

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

25 under this section to, or on behalf of, the indi-
55 

•S 1057 IS 

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 

7 the individual’s period of obligated service in 

8 accordance with subsection (f); and 

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

10 period 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 sub14 ject to collection through deductions in medicare 

15 payments pursuant to section 1892 of the Social Se16 curity 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 be22 ginning on such date as shall be specified by the 

23 Secretary. 

24 ‘‘(5) RECOVERY OF DELINQUENCY.— 
56 

•S 1057 IS 

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

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

3 the Secretary shall, for the purpose of recov4 ering 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 re9 covery of such damages with collection 

10 agencies 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 

17 31, United States Code, shall apply to any such 

18 contract to the extent not inconsistent with this 

19 subsection. 

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

21 ‘‘(1) IN GENERAL.—The Secretary shall by reg22 ulation provide for the partial or total waiver or sus23 pension of any obligation of service or payment by 

24 an individual under the Loan Repayment Program 

25 whenever compliance by the individual is impossible 
57 

•S 1057 IS 

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 Pro6 gram for service or payment of damages shall be 

7 canceled 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 

20 the bankruptcy court finds that nondischarge of the 

21 obligation would be unconscionable. 

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

23 President, for inclusion in each report required to be sub24 mitted to Congress under section 801, a report concerning 
58 

•S 1057 IS 

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 

17 each 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 

22 that 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. 
59 

•S 1057 IS 

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

2 to fill the health professional positions maintained 

3 by Indian Health Programs or Urban Indian Orga4 nizations for which recruitment or retention is dif5 ficult. 

6 ‘‘SEC. 111. SCHOLARSHIP AND LOAN REPAYMENT RECOV7 ERY FUND. 

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

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

10 Indian Health Scholarship and Loan Repayment Recovery 

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

12 The LRRF shall consist of such amounts as may be col13 lected from individuals under section 104(d), section 

14 106(e), and section 110(l) for breach of contract, such 

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

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

17 appropriated, or earned relative to the LRRF shall remain 

18 available until expended. 

19 ‘‘(b) USE OF FUNDS.— 

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

21 may be expended by the Secretary, acting through 

22 the Service, to make payments to an Indian Health 

23 Program— 

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

25 section 104 and 106 or a loan repayment pro-
60 

•S 1057 IS 

1 gram participant under section 110 has been 

2 assigned to meet the obligated service require3 ments pursuant to such sections; and 

4 ‘‘(B) that has a need for a health profes5 sional to provide health care services as a result 

6 of such recipient or participant having breached 

7 the contract entered into under section 104, 

8 106, or section 110. 

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

10 Health Program receiving payments pursuant to 

11 paragraph (1) may expend the payments to provide 

12 scholarships or recruit and employ, directly or by 

13 contract, health professionals to provide health care 

14 services. 

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

16 Treasury shall invest such amounts of the LRRF as the 

17 Secretary of Health and Human Services determines are 

18 not required to meet current withdrawals from the LRRF. 

19 Such investments may be made only in interest bearing 

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

21 obligations may be acquired on original issue at the issue 

22 price, or by purchase of outstanding obligations at the 

23 market price. 
61 

•S 1057 IS 

1 ‘‘(d) SALE OF OBLIGATIONS.—Any obligation ac2 quired by the LRRF may be sold by the Secretary of the 

3 Treasury at the market price. 

4 ‘‘SEC. 112. RECRUITMENT ACTIVITIES. 

5 ‘‘(a) REIMBURSEMENT FOR TRAVEL.—The Sec6 retary, acting through the Service, may reimburse health 

7 professionals seeking positions with Indian Health Pro8 grams or Urban Indian Organizations, including individ9 uals considering entering into a contract under section 

10 110 and their spouses, for actual and reasonable expenses 

11 incurred in traveling to and from their places of residence 

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

13 of evaluating such area with respect to such assignment. 

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

15 acting through the Service, shall assign one individual in 

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

17 recruitment activities. 

18 ‘‘SEC. 113. INDIAN RECRUITMENT AND RETENTION PRO19 GRAM. 

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

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

22 demonstration projects for a period not to exceed 3 years 

23 to enable Tribal Health Programs and Urban Indian Or24 ganizations to recruit, place, and retain health profes25 sionals to meet their staffing needs. 
62 

•S 1057 IS 

1 ‘‘(b) ELIGIBLE ENTITIES; APPLICATION.—Any Trib2 al Health Program or Urban Indian Organization may 

3 submit an application for funding of a project pursuant 

4 to this section. 

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

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

7 acting through the Service, shall establish a demonstration 

8 project to enable health professionals who have worked in 

9 an Indian Health Program or Urban Indian Organization 

10 for a substantial period of time to pursue advanced train11 ing or research areas of study for which the Secretary de12 termines a need exists. 

13 ‘‘(b) SERVICE OBLIGATION.—An individual who par14 ticipates in a program under subsection (a), where the 

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

16 obligation to serve in an Indian Health Program or Urban 

17 Indian Organization for a period of obligated service equal 

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

19 participates in such program. In the event that the indi20 vidual fails to complete such obligated service, the indi21 vidual shall be liable to the United States for the period 

22 of service remaining. In such event, with respect to indi23 viduals entering the program after the date of enactment 

24 of the Indian Health Care Improvement Act Amendments 

25 of 2005, the United States shall be entitled to recover 
63 

•S 1057 IS 

1 from such individual an amount to be determined in ac2 cordance with the formula specified in subsection (l) of 

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

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

5 Health professionals from Tribal Health Programs and 

6 Urban Indian Organizations shall be given an equal oppor7 tunity to participate in the program under subsection (a). 

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

9 NURSING PROGRAM. 

10 ‘‘(a) GRANTS AUTHORIZED.—For the purpose of in11 creasing the number of nurses, nurse midwives, and nurse 

12 practitioners who deliver health care services to Indians, 

13 the Secretary, acting through the Service, shall provide 

14 grants to the following: 

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

16 ‘‘(2) Tribal colleges or universities. 

17 ‘‘(3) Nurse midwife programs and advanced 

18 practice nurse programs that are provided by any 

19 tribal college or university accredited nursing pro20 gram, or in the absence of such, any other public or 

21 private institutions. 

22 ‘‘(b) USE OF GRANTS.—Grants provided under sub23 section (a) may be used for one or more of the following: 
64 

•S 1057 IS 

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

2 train individuals to be nurses, nurse midwives, or 

3 advanced practice nurses. 

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

5 in such programs that may pay the tuition charged 

6 for such program and other expenses incurred in 

7 connection with such program, including books, fees, 

8 room and board, and stipends for living expenses. 

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

10 nurses, nurse midwives, and advanced practice 

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

12 services to Indians. 

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

14 skills of, and provides continuing education to, 

15 nurses, nurse midwives, and advanced practice 

16 nurses. 

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

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

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

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

21 Secretary may require to establish the connection between 

22 the program of the applicant and a health care facility 

23 that primarily serves Indians. 
65 

•S 1057 IS 

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

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

3 extend a preference to the following: 

4 ‘‘(1) Programs that provide a preference to In5 dians. 

6 ‘‘(2) Programs that train nurse midwives or ad7 vanced practice nurses. 

8 ‘‘(3) Programs that are interdisciplinary. 

9 ‘‘(4) Programs that are conducted in coopera10 tion with a program for gifted and talented Indian 

11 students. 

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

13 Secretary shall provide one of the grants authorized under 

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

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

16 N. Burdick American Indians Into Nursing Program’. 

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

20 N. Burdick American Indians Into Psychology Program 

21 established under section 105(b). 

22 ‘‘(f) ACTIVE DUTY SERVICE OBLIGATION.—The ac23 tive duty service obligation prescribed under section 338C 

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

25 be met by each individual who receives training or assist-
66 

•S 1057 IS 

1 ance described in paragraph (1) or (2) of subsection (b) 

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

3 Such obligation shall be met by service— 

4 ‘‘(1) in the Service; 

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

6 Organization conducted under the Indian Self-Deter7 mination and Education Assistance Act (including 

8 programs under agreements with the Bureau of In9 dian Affairs); 

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

11 Act; or 

12 ‘‘(4) in the private practice of nursing if, as de13 termined by the Secretary, in accordance with guide14 lines promulgated by the Secretary, such practice is 

15 situated in a physician or other health shortage area 

16 and addresses the health care needs of a substantial 

17 number of Indians. 

18 ‘‘SEC. 116. TRIBAL CULTURAL ORIENTATION. 

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

20 Secretary, acting through the Service, shall require that 

21 appropriate employees of the Service who serve Indian 

22 Tribes in each Service Area receive educational instruction 

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

24 relationship to the Service. 
67 

•S 1057 IS 

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 

8 universities; 

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’ (herein20 after in this section referred to as ‘INMED’) as a means 

21 of encouraging Indians to enter the health professions. 

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

23 shall provide one of the grants authorized under sub24 section (a) to maintain the INMED program at the Uni25 versity of North Dakota, to be known as the ‘Quentin N. 
68 

•S 1057 IS 

1 Burdick Indian Health Programs’, unless the Secretary 

2 makes a determination, based upon program reviews, that 

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

4 Such program shall, to the maximum extent feasible, co5 ordinate with the Quentin N. Burdick American Indians 

6 Into Psychology Program established under section 105(b) 

7 and the Quentin N. Burdick American Indians Into Nurs8 ing Program established under section 115. 

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

10 Act, shall develop regulations to govern grants pursuant 

11 to this section. 

12 ‘‘(d) REQUIREMENTS.—Applicants for grants pro13 vided under this section shall agree to provide a program 

14 which— 

15 ‘‘(1) provides outreach and recruitment for 

16 health professions to Indian communities including 

17 elementary and secondary schools and community 

18 colleges located on reservations which will be served 

19 by the program; 

20 ‘‘(2) incorporates a program advisory board 

21 comprised of representatives from the Indian Tribes 

22 and Indian communities which will be served by the 

23 program; 

24 ‘‘(3) provides summer preparatory programs for 

25 Indian students who need enrichment in the subjects 
69 

•S 1057 IS 

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 

18 a health profession for individuals who desire to 

19 practice such profession on or near a reservation or 

20 in an 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 

24 is provided to the community college shall not exceed 

25 $100,000. 
70 

•S 1057 IS 

1 ‘‘(b) GRANTS FOR MAINTENANCE AND RECRUIT2 ING.— 

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

4 through the Service, shall award grants to accredited 

5 and accessible community colleges that have estab6 lished a program described in subsection (a)(1) for 

7 the purpose of maintaining the program and recruit8 ing students for the program. 

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

10 made under this section to a community college 

11 which— 

12 ‘‘(A) is accredited; 

13 ‘‘(B) has a relationship with a hospital fa14 cility, Service facility, or hospital that could 

15 provide training of nurses or health profes16 sionals; 

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

18 an accredited college or university medical 

19 school, the terms of which— 

20 ‘‘(i) provide a program that enhances 

21 the transition and recruitment of students 

22 into advanced baccalaureate or graduate 

23 programs which train health professionals; 

24 and 
71 

•S 1057 IS 

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 

5 appropriate 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 pref10 erence for applicants for programs under this 

11 section. 

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

13 encourage community colleges described in subsection 

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

15 subsection (a)(1) by— 

16 ‘‘(1) entering into agreements with such col17 leges for the provision of qualified personnel of the 

18 Service to teach courses of study in such programs; 

19 and 

20 ‘‘(2) providing technical assistance and support 

21 to such colleges. 

22 ‘‘(d) ADVANCED TRAINING.— 

23 ‘‘(1) REQUIRED.—Any program receiving as24 sistance under this section that is conducted with re25 spect to a health profession shall also offer courses 
72 

•S 1057 IS 

1 of study which provide advanced training for any 

2 health professional who— 

3 ‘‘(A) has already received a degree or di4 ploma in such health profession; and 

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

6 reservation or for an Indian Health Program. 

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

8 Such courses of study may be offered in conjunction 

9 with the college or university with which the commu10 nity college has entered into the agreement required 

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

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

13 of subsection (b) are met, funding priority shall be pro14 vided to tribal colleges and universities in Service Areas 

15 where they exist. 

16 ‘‘SEC. 119. RETENTION BONUS. 

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

18 a retention bonus to any health professional employed by, 

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

20 or Urban Indian Organization either as a civilian employee 

21 or as a commissioned officer in the Regular or Reserve 

22 Corps of the Public Health Service who— 

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

24 for which recruitment or retention of personnel is 

25 difficult; 
73 

•S 1057 IS 

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 

6 with an Indian Health Program or Urban In7 dian Organization; 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 

17 1 year. 

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

19 the retention bonus which shall provide for a higher an20 nual rate for multiyear agreements than for single year 

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

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

23 annum. 

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

25 health professional failing to complete the agreed upon 
74 

•S 1057 IS 

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

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

3 Government the full amount of the retention bonus for the 

4 period covered by the agreement, plus interest as deter5 mined by the Secretary in accordance with section 

6 110(l)(2)(B). 

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

8 may pay a retention bonus to any health professional em9 ployed by a Tribal Health Program if such health profes10 sional is serving in a position which the Secretary deter11 mines is— 

12 ‘‘(1) a position for which recruitment or reten13 tion is difficult; and 

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

15 to Indians. 

16 ‘‘SEC. 120. NURSING RESIDENCY PROGRAM. 

17 ‘‘(a) ESTABLISHMENT OF PROGRAM.—The Sec18 retary, acting through the Service, shall establish a pro19 gram to enable Indians who are licensed practical nurses, 

20 licensed vocational nurses, and registered nurses who are 

21 working in an Indian Health Program or Urban Indian 

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

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

24 shall include a combination of education and work study 

25 in an Indian Health Program or Urban Indian Organiza-
75 

•S 1057 IS 

1 tion leading to an associate or bachelor’s degree (in the 

2 case of a licensed practical nurse or licensed vocational 

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

4 nurse), or advanced degrees or certifications in nursing 

5 and public health. 

6 ‘‘(b) SERVICE OBLIGATION.—An individual who par7 ticipates in a program under subsection (a), where the 

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

9 obligation to serve in an Indian Health Program or Urban 

10 Indian Organization for a period of obligated service equal 

11 to the amount of time during which the individual partici12 pates in such program. In the event that the individual 

13 fails to complete such obligated service, the United States 

14 shall be entitled to recover from such individual an amount 

15 determined in accordance with the formula specified in 

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

17 in such subsection. 

18 ‘‘SEC. 121. COMMUNITY HEALTH AIDE PROGRAM FOR ALAS19 KA. 

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

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

22 (commonly known as the ‘Snyder Act’), the Secretary, act23 ing through the Service, shall develop and operate a Com24 munity Health Aide Program in Alaska under which the 

25 Service— 
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1 ‘‘(1) provides for the training of Alaska Natives 

2 as health aides or community health practitioners; 

3 ‘‘(2) uses such aides or practitioners in the pro4 vision of health care, health promotion, and disease 

5 prevention services to Alaska Natives living in vil6 lages in rural Alaska; and 

7 ‘‘(3) provides for the establishment of tele8 conferencing capacity in health clinics located in or 

9 near such villages for use by community health aides 

10 or community health practitioners. 

11 ‘‘(b) SPECIFIC PROGRAM REQUIREMENTS.—The Sec12 retary, acting through the Community Health Aide Pro13 gram of the Service, shall— 

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

15 provide a high standard of training to community 

16 health aides and community health practitioners to 

17 ensure that such aides and practitioners provide 

18 quality health care, health promotion, and disease 

19 prevention services to the villages served by the Pro20 gram; 

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

22 a curriculum that— 

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

24 health care with supervised practical experience 

25 in the provision of health care; 
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1 ‘‘(B) provides instruction and practical ex2 perience in the provision of acute care, emer3 gency care, health promotion, disease preven4 tion, and the efficient and effective manage5 ment of clinic pharmacies, supplies, equipment, 

6 and facilities; and 

7 ‘‘(C) promotes the achievement of the 

8 health status objectives specified in section 

9 3(2); 

10 ‘‘(3) establish and maintain a Community 

11 Health Aide Certification Board to certify as com12 munity health aides or community health practi13 tioners individuals who have successfully completed 

14 the training described in paragraph (1) or can dem15 onstrate equivalent experience; 

16 ‘‘(4) develop and maintain a system which iden17 tifies the needs of community health aides and com18 munity health practitioners for continuing education 

19 in the provision of health care, including the areas 

20 described in paragraph (2)(B), and develop pro21 grams that meet the needs for such continuing edu22 cation; 

23 ‘‘(5) develop and maintain a system that pro24 vides close supervision of community health aides 

25 and community health practitioners; and 
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1 ‘‘(6) develop a system under which the work of 

2 community health aides and community health prac3 titioners is reviewed and evaluated to assure the pro4 vision of quality health care, health promotion, and 

5 disease prevention services. 

6 ‘‘(c) NATIONAL COMMUNITY HEALTH AIDE PRO7 GRAM.— 

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

9 through the Service, is authorized to establish a na10 tional Community Health Aide Program in accord11 ance with subsection (a), except as provided in para12 graphs (2) and (3), without reducing funds for the 

13 Community Health Aide Program for Alaska. 

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

15 dental health aide in the State of Alaska, the Sec16 retary, acting through the Community Health Aide 

17 Program of the Service, shall ensure that, for a pe18 riod of 4 years, dental health aides are certified only 

19 to provide services relating to— 

20 ‘‘(A) early childhood dental disease preven21 tion and reversible dental procedures; and 

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

23 provide those dental services. 

24 ‘‘(3) REVIEW.— 
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1 ‘‘(A) IN GENERAL.—During the 4-year pe2 riod described in paragraph (2), the Secretary, 

3 acting through the Community Health Aide 

4 Program of the Service, shall conduct a review 

5 of the dental health aide program in the State 

6 of Alaska to determine the ability of the pro7 gram to address the dental care needs of Native 

8 Alaskans, the quality of care provided (includ9 ing any training, improvement, or additional 

10 oversight needed), and whether the program is 

11 appropriate and necessary to carry out in any 

12 other Indian community. 

13 ‘‘(B) REPORT.—After conducting the re14 view under subparagraph (A), the Secretary 

15 shall submit to the Committee on Indian Af16 fairs of the Senate and the Committee on Re17 sources of the House of Representatives a re18 port describing any finding of the Secretary 

19 under the review. 

20 ‘‘(C) FUTURE AUTHORIZATION OF CER21 TIFICATIONS.—Before authorizing any dental 

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

23 the Secretary shall consult with Indian tribes, 

24 Tribal Organizations, Urban Indian Organiza25 tions, and other interested parties to ensure 
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1 that the safety and quality of care of the Com2 munity Health Aide Program are adequate and 

3 appropriate. 

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

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

6 contract or otherwise, provide training for Indians in the 

7 administration and planning of Tribal Health Programs. 

8 ‘‘SEC. 123. HEALTH PROFESSIONAL CHRONIC SHORTAGE 

9 DEMONSTRATION PROGRAMS. 

10 ‘‘(a) DEMONSTRATION PROGRAMS AUTHORIZED.— 

11 The Secretary, acting through the Service, may fund dem12 onstration programs for Tribal Health Programs to ad13 dress the chronic shortages of health professionals. 

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

15 demonstration programs funded under subsection (a) shall 

16 be— 

17 ‘‘(1) to provide direct clinical and practical ex18 perience at a Service Unit to health profession stu19 dents and residents from medical schools; 

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

21 Indians by assuring access to qualified health care 

22 professionals; and 

23 ‘‘(3) to provide academic and scholarly opportu24 nities for health professionals serving Indians by 
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1 identifying all academic and scholarly resources of 

2 the region. 

3 ‘‘(c) ADVISORY BOARD.—The demonstration pro4 grams established pursuant to subsection (a) shall incor5 porate a program advisory board composed of representa6 tives from the Indian Tribes and Indian communities in 

7 the area which will be served by the program. 

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

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

10 shall not— 

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

12 Service Corps from an Indian Health Program or 

13 Urban Indian Organization; or 

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

15 member, unless the Secretary, acting through the 

16 Service, Indian Tribes, or Tribal Organizations, has 

17 ensured that the Indians receiving services from 

18 such member will experience no reduction in serv19 ices. 

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

21 Health Service Corps scholars qualifying for the Commis22 sioned Corps in the United States Public Health Service 

23 shall be exempt from the full-time equivalent limitations 

24 of the National Health Service Corps and the Service 
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1 when serving as a commissioned corps officer in a Tribal 

2 Health Program or an Urban Indian Organization. 

3 ‘‘SEC. 125. SUBSTANCE ABUSE COUNSELOR EDUCATIONAL 

4 CURRICULA DEMONSTRATION PROGRAMS. 

5 ‘‘(a) GRANTS AND CONTRACTS.—The Secretary, act6 ing through the Service, may enter into contracts with, 

7 or make grants to, accredited tribal colleges and univer8 sities and eligible accredited and accessible community col9 leges to establish demonstration programs to develop edu10 cational curricula for substance abuse counseling. 

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

12 section shall be used only for developing and providing 

13 educational curriculum for substance abuse counseling (in14 cluding paying salaries for instructors). Such curricula 

15 may be provided through satellite campus programs. 

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

17 contract entered into or a grant provided under this sec18 tion shall be for a period of 1 year. Such contract or grant 

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

20 approval of the Secretary. 

21 ‘‘(d) CRITERIA FOR REVIEW AND APPROVAL OF AP22 PLICATIONS.—Not later than 180 days after the date of 

23 enactment of the Indian Health Care Improvement Act 

24 Amendments of 2005, the Secretary, after consultation 

25 with Indian Tribes and administrators of tribal colleges 
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1 and universities and eligible accredited and accessible com2 munity colleges, shall develop and issue criteria for the 

3 review and approval of applications for funding (including 

4 applications for renewals of funding) under this section. 

5 Such criteria shall ensure that demonstration programs 

6 established under this section promote the development of 

7 the capacity of such entities to educate substance abuse 

8 counselors. 

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

10 technical and other assistance as may be necessary to en11 able grant recipients to comply with the provisions of this 

12 section. 

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

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

15 is required to be submitted under section 801 for that fis16 cal year, a report on the findings and conclusions derived 

17 from the demonstration programs conducted under this 

18 section during that fiscal year. 

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

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

21 following: 

22 ‘‘(1) Classroom education. 

23 ‘‘(2) Clinical work experience. 

24 ‘‘(3) Continuing education workshops. 
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1 ‘‘SEC. 126. BEHAVIORAL HEALTH TRAINING AND COMMU2 NITY EDUCATION PROGRAMS. 

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

4 the Service, and the Secretary of the Interior, in consulta5 tion with Indian Tribes and Tribal Organizations, shall 

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

7 positions specified in subsection (b) whose qualifications 

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

9 prevention, education, referral, or treatment of mental ill10 ness, or dysfunctional and self destructive behavior. 

11 ‘‘(b) POSITIONS.—The positions referred to in sub12 section (a) are— 

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

14 Affairs, including existing positions, in the fields 

15 of— 

16 ‘‘(A) elementary and secondary education; 

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

18 welfare; 

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

20 and 

21 ‘‘(D) alcohol and substance abuse; 

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

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

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

25 by Indian Tribes, Tribal Organizations (without re-
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1 gard to the funding source), and Urban Indian Or2 ganizations. 

3 ‘‘(c) TRAINING CRITERIA.— 

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

5 shall provide training criteria appropriate to each 

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

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

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

9 such position. With respect to any such individual in 

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

11 the respective Secretaries shall provide appropriate 

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

13 Tribal Organization, or Urban Indian Organization 

14 for training of appropriate individuals. In the case of 

15 positions funded under a contract or compact under 

16 the Indian Self-Determination and Education Assist17 ance Act (25 U.S.C. 450 et seq.), the appropriate 

18 Secretary shall ensure that such training costs are 

19 included in the contract or compact, as the Sec20 retary determines necessary. 

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

22 Position specific training criteria shall be culturally 

23 relevant to Indians and Indian Tribes and shall en24 sure that appropriate information regarding Tradi25 tional Health Care Practices is provided. 
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1 ‘‘(d) COMMUNITY EDUCATION ON MENTAL ILL2 NESS.—The Service shall develop and implement, on re3 quest of an Indian Tribe, Tribal Organization, or Urban 

4 Indian Organization, or assist the Indian Tribe, Tribal Or5 ganization, or Urban Indian Organization to develop and 

6 implement, a program of community education on mental 

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

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

9 Urban Indian Organization, provide technical assistance 

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

11 Organization to obtain and develop community edu12 cational materials on the identification, prevention, refer13 ral, and treatment of mental illness and dysfunctional and 

14 self-destructive behavior. 

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

16 of enactment of the Indian Health Care Improvement Act 

17 Amendments of 2005, the Secretary shall develop a plan 

18 under which the Service will increase the health care staff 

19 providing behavioral health services by at least 500 posi20 tions within 5 years after the date of enactment of this 

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

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

23 under this subsection shall be implemented under the Act 

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

25 as the ‘Snyder Act’). 
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1 ‘‘SEC. 127. AUTHORIZATION OF APPROPRIATIONS. 

2 ‘‘There are authorized to be appropriated such sums 

3 as may be necessary for each fiscal year through fiscal 

4 year 2015 to carry out this title. 

5 ‘‘TITLE II—HEALTH SERVICES 

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

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

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

9 under the authority of the Indian Self-Determination and 

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

11 are appropriated under the authority of this section, for 

12 the purposes of— 

13 ‘‘(1) eliminating the deficiencies in health sta14 tus and health resources of all Indian Tribes; 

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

16 health care services to Indians; 

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

18 efficient and equitable manner, including the use of 

19 telehealth and telemedicine when appropriate; 

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

21 direct care and contract health service programs; 

22 and 

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

24 meet the following health service responsibilities with 

25 respect to those Indian Tribes with the highest levels 
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1 of health status deficiencies and resource defi2 ciencies: 

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

4 outpatient care (including audiology, clinical 

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

6 and tertiary care, and long-term care. 

7 ‘‘(B) Preventive health, including mam8 mography and other cancer screening in accord9 ance with section 207. 

10 ‘‘(C) Dental care. 

11 ‘‘(D) Mental health, including community 

12 mental health services, inpatient mental health 

13 services, dormitory mental health services, 

14 therapeutic and residential treatment centers, 

15 and training of traditional health care practi16 tioners. 

17 ‘‘(E) Emergency medical services. 

18 ‘‘(F) Treatment and control of, and reha19 bilitative care related to, alcoholism and drug 

20 abuse (including fetal alcohol syndrome) among 

21 Indians. 

22 ‘‘(G) Accident prevention programs. 

23 ‘‘(H) Home health care. 

24 ‘‘(I) Community health representatives. 

25 ‘‘(J) Maintenance and repair. 
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1 ‘‘(K) Traditional Health Care Practices. 

2 ‘‘(b) NO OFFSET OR LIMITATION.—Any funds appro3 priated under the authority of this section shall not be 

4 used to offset or limit any other appropriations made to 

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

6 (25 U.S.C. 13) (commonly known as the ‘Snyder Act’), 

7 or any other provision of law. 

8 ‘‘(c) ALLOCATION; USE.— 

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

10 the authority of this section shall be allocated to 

11 Service Units, Indian Tribes, or Tribal Organiza12 tions. The funds allocated to each Indian Tribe, 

13 Tribal Organization, or Service Unit under this 

14 paragraph shall be used by the Indian Tribe, Tribal 

15 Organization, or Service Unit under this paragraph 

16 to improve the health status and reduce the resource 

17 deficiency of each Indian Tribe served by such Serv18 ice Unit, Indian Tribe, or Tribal Organization. 

19 ‘‘(2) APPORTIONMENT OF ALLOCATED

20 FUNDS.—The apportionment of funds allocated to a 

21 Service Unit, Indian Tribe, or Tribal Organization 

22 under paragraph (1) among the health service re23 sponsibilities described in subsection (a)(5) shall be 

24 determined by the Service in consultation with, and 
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1 with the active participation of, the affected Indian 

2 Tribes and Tribal Organizations. 

3 ‘‘(d) PROVISIONS RELATING TO HEALTH STATUS

4 AND RESOURCE DEFICIENCIES.—For the purposes of this 

5 section, the following definitions apply: 

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

7 and resource deficiency’ means the extent to 

8 which— 

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

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

11 ‘‘(B) the Indian Tribe or Tribal Organiza12 tion does not have available to it the health re13 sources it needs, taking into account the actual 

14 cost of providing health care services given local 

15 geographic, climatic, rural, or other cir16 cumstances. 

17 ‘‘(2) AVAILABLE RESOURCES.—The health re18 sources available to an Indian Tribe or Tribal Orga19 nization include health resources provided by the 

20 Service as well as health resources used by the In21 dian Tribe or Tribal Organization, including services 

22 and financing systems provided by any Federal pro23 grams, private insurance, and programs of State or 

24 local governments. 
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1 ‘‘(3) PROCESS FOR REVIEW OF DETERMINA2 TIONS.—The Secretary shall establish procedures 

3 which allow any Indian Tribe or Tribal Organization 

4 to petition the Secretary for a review of any deter5 mination of the extent of the health status and re6 source deficiency of such Indian Tribe or Tribal Or7 ganization. 

8 ‘‘(e) ELIGIBILITY FOR FUNDS.—Tribal Health Pro9 grams shall be eligible for funds appropriated under the 

10 authority of this section on an equal basis with programs 

11 that are administered directly by the Service. 

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

13 years after the date of enactment of the Indian Health 

14 Care Improvement Act Amendments of 2005, the Sec15 retary shall submit to Congress the current health status 

16 and resource deficiency report of the Service for each 

17 Service Unit, including newly recognized or acknowledged 

18 Indian Tribes. Such report shall set out— 

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

20 for determining Tribal health status and resource 

21 deficiencies, as well as the most recent application of 

22 that methodology; 

23 ‘‘(2) the extent of the health status and re24 source deficiency of each Indian Tribe served by the 

25 Service or a Tribal Health Program; 
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1 ‘‘(3) the amount of funds necessary to eliminate 

2 the health status and resource deficiencies of all In3 dian Tribes served by the Service or a Tribal Health 

4 Program; and 

5 ‘‘(4) an estimate of— 

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

7 appropriated under the authority of this Act, or 

8 any other Act, including the amount of any 

9 funds transferred to the Service for the pre10 ceding fiscal year which is allocated to each 

11 Service Unit, Indian Tribe, or Tribal Organiza12 tion; 

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

14 health services in each Service Unit or Indian 

15 Tribe or Tribal Organization; and 

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

17 Service resources made available to each Service 

18 Unit, Indian Tribe or Tribal Organization, and, 

19 to the extent available, information on the wait20 ing lists and number of Indians turned away for 

21 services due to lack of resources. 

22 ‘‘(g) INCLUSION IN BASE BUDGET.—Funds appro23 priated under this section for any fiscal year shall be in24 cluded in the base budget of the Service for the purpose 
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1 of determining appropriations under this section in subse2 quent fiscal years. 

3 ‘‘(h) CLARIFICATION.—Nothing in this section is in4 tended to diminish the primary responsibility of the Serv5 ice to eliminate existing backlogs in unmet health care 

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

7 discourage the Service from undertaking additional efforts 

8 to achieve equity among Indian Tribes and Tribal Organi9 zations. 

10 ‘‘(i) FUNDING DESIGNATION.—Any funds appro11 priated under the authority of this section shall be des12 ignated as the ‘Indian Health Care Improvement Fund’. 

13 ‘‘SEC. 202. CATASTROPHIC HEALTH EMERGENCY FUND. 

14 ‘‘(a) ESTABLISHMENT.—There is established an In15 dian Catastrophic Health Emergency Fund (hereafter in 

16 this section referred to as the ‘CHEF’) consisting of— 

17 ‘‘(1) the amounts deposited under subsection 

18 (f); and 

19 ‘‘(2) the amounts appropriated to CHEF under 

20 this section. 

21 ‘‘(b) ADMINISTRATION.—CHEF shall be adminis22 tered by the Secretary, acting through the central office 

23 of the Service, solely for the purpose of meeting the ex24 traordinary medical costs associated with the treatment of 
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1 victims of disasters or catastrophic illnesses who are with2 in the responsibility of the Service. 

3 ‘‘(c) CONDITIONS ON USE OF FUND.—No part of 

4 CHEF or its administration shall be subject to contract 

5 or grant under any law, including the Indian Self-Deter6 mination and Education Assistance Act (25 U.S.C. 450 

7 et seq.), nor shall CHEF funds be allocated, apportioned, 

8 or delegated on an Area Office, Service Unit, or other 

9 similar basis. 

10 ‘‘(d) REGULATIONS.—The Secretary shall, through 

11 the negotiated rulemaking process under title VIII, pro12 mulgate regulations consistent with the provisions of this 

13 section to— 

14 ‘‘(1) establish a definition of disasters and cata15 strophic illnesses for which the cost of the treatment 

16 provided under contract would qualify for payment 

17 from CHEF; 

18 ‘‘(2) provide that a Service Unit shall not be el19 igible for reimbursement for the cost of treatment 

20 from CHEF until its cost of treating any victim of 

21 such catastrophic illness or disaster has reached a 

22 certain threshold cost which the Secretary shall es23 tablish at— 

24 ‘‘(A) the 2000 level of $19,000; and 
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1 ‘‘(B) for any subsequent year, not less 

2 than the threshold cost of the previous year in3 creased by the percentage increase in the med4 ical care expenditure category of the consumer 

5 price index for all urban consumers (United 

6 States city average) for the 12-month period 

7 ending with December of the previous year; 

8 ‘‘(3) establish a procedure for the reimburse9 ment of the portion of the costs that exceeds such 

10 threshold 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 med16 ical circumstances warrant treatment prior to the 

17 authorization 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 

21 is eligible to receive payment for the treatment from 

22 any other Federal, State, local, or private source of 

23 reimbursement 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 pro14 motion 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 In18 dians. 

19 ‘‘(b) PROVISION OF SERVICES.—The Secretary, act20 ing through the Service and Tribal Health Programs, shall 

21 provide health promotion and disease prevention services 

22 to Indians to achieve the health status objectives set forth 

23 in section 3(2). 

24 ‘‘(c) EVALUATION.—The Secretary, after obtaining 

25 input from the affected Tribal Health Programs, shall 
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1 submit to the President for inclusion in each report which 

2 is required to be submitted to Congress under section 801 

3 an evaluation of— 

4 ‘‘(1) the health promotion and disease preven5 tion needs of Indians; 

6 ‘‘(2) the health promotion and disease preven7 tion 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 

11 enable the Service and Tribal Health Programs to 

12 undertake the health promotion and disease preven13 tion activities necessary to meet such needs. 

14 ‘‘SEC. 204. DIABETES PREVENTION, TREATMENT, AND CON15 TROL. 

16 ‘‘(a) DETERMINATIONS REGARDING DIABETES.— 

17 The Secretary, acting through the Service, and in con18 sultation with Indian Tribes and Tribal Organizations, 

19 shall determine— 

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 pursu24 ant to paragraph (1), the measures (including pa25 tient education and effective ongoing monitoring of 
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1 disease indicators) each Service Unit should take to 

2 reduce the incidence of, and prevent, treat, and con3 trol the complications resulting from, diabetes 

4 among Indian Tribes within that Service Unit. 

5 ‘‘(b) DIABETES SCREENING.—To the extent medi6 cally indicated and with informed consent, the Secretary 

7 shall screen each Indian who receives services from the 

8 Service for diabetes and for conditions which indicate a 

9 high risk that the individual will become diabetic and, in 

10 consultation with Indian Tribes, Urban Indian Organiza11 tions, and appropriate health care providers, establish a 

12 cost-effective approach to ensure ongoing monitoring of 

13 disease indicators. Such screening and monitoring may be 

14 conducted by a Tribal Health Program and may be con15 ducted through appropriate Internet-based health care 

16 management programs. 

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 

20 Amendments Care Improvement Act of 2005, any such 

21 other diabetes programs operated by the Service or Tribal 

22 Health Programs, and any additional diabetes projects, 

23 such as the Medical Vanguard program provided for in 

24 title IV of Public Law 108–87, as implemented to serve 

25 Indian Tribes. Tribal Health Programs shall receive recur-
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1 ring funding for the diabetes projects that they operate 

2 pursuant to this section, both at the date of enactment 

3 of the Indian Health Care Improvement Act Amendments 

4 of 2005 and for projects which are added and funded 

5 thereafter. 

6 ‘‘(d) FUNDING FOR DIALYSIS PROGRAMS.—The Sec7 retary is authorized to provide funding through the Serv8 ice, Indian Tribes, and Tribal Organizations to establish 

9 dialysis programs, including funding to purchase dialysis 

10 equipment and provide necessary staffing. 

11 ‘‘(e) OTHER DUTIES OF THE SECRETARY.—The Sec12 retary shall, to the extent funding is available— 

13 ‘‘(1) in each Area Office, consult with Indian 

14 Tribes and Tribal Organizations regarding programs 

15 for the prevention, treatment, and control of diabe16 tes; 

17 ‘‘(2) establish in each Area Office a registry of 

18 patients with diabetes to track the incidence of dia19 betes and the complications from diabetes in that 

20 area; and 

21 ‘‘(3) ensure that data collected in each Area Of22 fice regarding diabetes and related complications 

23 among Indians are disseminated to all other Area 

24 Offices, subject to applicable patient privacy laws. 
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1 ‘‘SEC. 205. SHARED SERVICES FOR LONG-TERM CARE. 

2 ‘‘(a) LONG-TERM CARE.—Notwithstanding any other 

3 provision of law, the Secretary, acting through the Service, 

4 is authorized to provide directly, or enter into contracts 

5 or compacts under the Indian Self-Determination and 

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

7 Indian Tribes or Tribal Organizations for, the delivery of 

8 long-term care and similar services to Indians. Such agree9 ments shall provide for the sharing of staff or other serv10 ices between the Service or a Tribal Health Program and 

11 a long-term care or other similar facility owned and oper12 ated (directly or through a contract or compact under the 

13 Indian Self-Determination and Education Assistance Act 

14 (25 U.S.C. 450 et seq.)) by such Indian Tribe or Tribal 

15 Organization. 

16 ‘‘(b) CONTENTS OF AGREEMENTS.—An agreement 

17 entered into pursuant to subsection (a)— 

18 ‘‘(1) may, at the request of the Indian Tribe or 

19 Tribal Organization, delegate to such Indian Tribe 

20 or Tribal Organization such powers of supervision 

21 and control over Service employees as the Secretary 

22 deems necessary to carry out the purposes of this 

23 section; 

24 ‘‘(2) shall provide that expenses (including sala25 ries) relating to services that are shared between the 

26 Service and the Tribal Health Program be allocated 
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1 proportionately between the Service and the Indian 

2 Tribe or Tribal Organization; and 

3 ‘‘(3) may authorize such Indian Tribe or Tribal 

4 Organization to construct, renovate, or expand a 

5 long-term care or other similar facility (including the 

6 construction of a facility attached to a Service facil7 ity). 

8 ‘‘(c) MINIMUM REQUIREMENT.—Any nursing facility 

9 provided for under this section shall meet the require10 ments for nursing facilities under section 1919 of the So11 cial Security Act. 

12 ‘‘(d) OTHER ASSISTANCE.—The Secretary shall pro13 vide such technical and other assistance as may be nec14 essary to enable applicants to comply with the provisions 

15 of this section. 

16 ‘‘(e) USE OF EXISTING OR UNDERUSED FACILI17 TIES.—The Secretary shall encourage the use of existing 

18 facilities that are underused or allow the use of swing beds 

19 for long-term or similar care. 

20 ‘‘SEC. 206. HEALTH SERVICES RESEARCH. 

21 ‘‘The Secretary, acting through the Service, shall 

22 make funding available for research to further the per23 formance of the health service responsibilities of Indian 

24 Health Programs. The Secretary shall also, to the max25 imum extent practicable, coordinate departmental re-
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1 search resources and activities to address relevant Indian 

2 Health Program research needs. Tribal Health Programs 

3 shall be given an equal opportunity to compete for, and 

4 receive, research funds under this section. This funding 

5 may be used for both clinical and nonclinical research. 

6 ‘‘SEC. 207. MAMMOGRAPHY AND OTHER CANCER SCREEN7 ING. 

8 ‘‘The Secretary, acting through the Service or Tribal 

9 Health Programs, shall provide for screening as follows: 

10 ‘‘(1) Screening mammography (as defined in 

11 section 1861(jj) of the Social Security Act) for In12 dian women at a frequency appropriate to such 

13 women under accepted and appropriate national 

14 standards, and under such terms and conditions as 

15 are consistent with standards established by the Sec16 retary to ensure the safety and accuracy of screen17 ing mammography under part B of title XVIII of 

18 such Act. 

19 ‘‘(2) Other cancer screening meeting accepted 

20 and appropriate national standards. 

21 ‘‘SEC. 208. PATIENT TRAVEL COSTS. 

22 ‘‘The Secretary, acting through the Service and Trib23 al Health Programs, is authorized to provide funds for the 

24 following patient travel costs, including appropriate and 

25 necessary qualified escorts, associated with receiving 
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1 health care services provided (either through direct or con2 tract care or through a contract or compact under the In3 dian Self-Determination and Education Assistance Act 

4 (25 U.S.C. 450 et seq.)) under this Act— 

5 ‘‘(1) emergency air transportation and non6 emergency air transportation where ground trans7 portation is infeasible; 

8 ‘‘(2) transportation by private vehicle (where no 

9 other means of transportation is available), specially 

10 equipped vehicle, and ambulance; and 

11 ‘‘(3) transportation by such other means as 

12 may be available and required when air or motor ve13 hicle transportation is not available. 

14 ‘‘SEC. 209. EPIDEMIOLOGY CENTERS. 

15 ‘‘(a) ADDITIONAL CENTERS.—In addition to those 

16 epidemiology centers already established as of the date of 

17 enactment of this Act, and without reducing the funding 

18 levels for such centers, not later than 180 days after the 

19 date of enactment of the Indian Health Care Improvement 

20 Act Amendments of 2005, the Secretary, acting through 

21 the Service, shall establish and fund an epidemiology cen22 ter in each Service Area which does not yet have one to 

23 carry out the functions described in subsection (b). Any 

24 new centers so established may be operated by Tribal 

25 Health Programs, but such funding shall not be divisible. 
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1 ‘‘(b) FUNCTIONS OF CENTERS.—In consultation with 

2 and upon the request of Indian Tribes, Tribal Organiza3 tions, and Urban Indian Organizations, each Service Area 

4 epidemiology center established under this subsection 

5 shall, with respect to such Service Area— 

6 ‘‘(1) collect data relating to, and monitor 

7 progress made toward meeting, each of the health 

8 status objectives of the Service, the Indian Tribes, 

9 Tribal Organizations, and Urban Indian Organiza10 tions in the Service Area; 

11 ‘‘(2) evaluate existing delivery systems, data 

12 systems, and other systems that impact the improve13 ment of Indian health; 

14 ‘‘(3) assist Indian Tribes, Tribal Organizations, 

15 and Urban Indian Organizations in identifying their 

16 highest priority health status objectives and the 

17 services needed to achieve such objectives, based on 

18 epidemiological data; 

19 ‘‘(4) make recommendations for the targeting 

20 of services needed by the populations served; 

21 ‘‘(5) make recommendations to improve health 

22 care delivery systems for Indians and Urban Indi23 ans; 

24 ‘‘(6) provide requested technical assistance to 

25 Indian Tribes, Tribal Organizations, and Urban In-
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1 dian Organizations in the development of local 

2 health service priorities and incidence and prevalence 

3 rates of disease and other illness in the community; 

4 and 

5 ‘‘(7) provide disease surveillance and assist In6 dian Tribes, Tribal Organizations, and Urban Indian 

7 Organizations to promote public health. 

8 ‘‘(c) TECHNICAL ASSISTANCE.—The Director of the 

9 Centers for Disease Control and Prevention shall provide 

10 technical assistance to the centers in carrying out the re11 quirements of this subsection. 

12 ‘‘(d) FUNDING FOR STUDIES.—The Secretary may 

13 make funding available to Indian Tribes, Tribal Organiza14 tions, and Urban Indian Organizations to conduct epide15 miological studies of Indian communities. 

16 ‘‘SEC. 210. COMPREHENSIVE SCHOOL HEALTH EDUCATION 

17 PROGRAMS. 

18 ‘‘(a) FUNDING FOR DEVELOPMENT OF PROGRAMS.— 

19 In addition to carrying out any other program for health 

20 promotion or disease prevention, the Secretary, acting 

21 through the Service, is authorized to award grants to In22 dian Tribes, Tribal Organizations, and Urban Indian Or23 ganizations to develop comprehensive school health edu24 cation programs for children from pre-school through 
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1 grade 12 in schools for the benefit of Indian and Urban 

2 Indian children. 

3 ‘‘(b) USE OF FUNDS.—Funding provided under this 

4 section may be used for purposes which may include, but 

5 are not limited to, the following: 

6 ‘‘(1) Developing and implementing health edu7 cation curricula both for regular school programs 

8 and afterschool programs. 

9 ‘‘(2) Training teachers in comprehensive school 

10 health education curricula. 

11 ‘‘(3) Integrating school-based, community12 based, and other public and private health promotion 

13 efforts. 

14 ‘‘(4) Encouraging healthy, tobacco-free school 

15 environments. 

16 ‘‘(5) Coordinating school-based health programs 

17 with existing services and programs available in the 

18 community. 

19 ‘‘(6) Developing school programs on nutrition 

20 education, personal health, oral health, and fitness. 

21 ‘‘(7) Developing behavioral health wellness pro22 grams. 

23 ‘‘(8) Developing chronic disease prevention pro24 grams. 
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1 ‘‘(9) Developing substance abuse prevention 

2 programs. 

3 ‘‘(10) Developing injury prevention and safety 

4 education programs. 

5 ‘‘(11) Developing activities for the prevention 

6 and control of communicable diseases. 

7 ‘‘(12) Developing community and environmental 

8 health education programs that include traditional 

9 health care practitioners. 

10 ‘‘(13) Violence prevention. 

11 ‘‘(14) Such other health issues as are appro12 priate. 

13 ‘‘(c) TECHNICAL ASSISTANCE.—Upon request, the 

14 Secretary, acting through the Service, shall provide tech15 nical assistance to Indian Tribes, Tribal Organizations, 

16 and Urban Indian Organizations in the development of 

17 comprehensive health education plans and the dissemina18 tion of comprehensive health education materials and in19 formation on existing health programs and resources. 

20 ‘‘(d) CRITERIA FOR REVIEW AND APPROVAL OF AP21 PLICATIONS.—The Secretary, acting through the Service, 

22 and in consultation with Indian Tribes, Tribal Organiza23 tions, and Urban Indian Organizations, shall establish cri24 teria for the review and approval of applications for fund25 ing provided pursuant to this section. 
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1 ‘‘(e) DEVELOPMENT OF PROGRAM FOR BIA FUNDED

2 SCHOOLS.— 

3 ‘‘(1) IN GENERAL.—The Secretary of the Inte4 rior, acting through the Bureau of Indian Affairs 

5 and in cooperation with the Secretary, acting 

6 through the Service, and affected Indian Tribes and 

7 Tribal Organizations, shall develop a comprehensive 

8 school health education program for children from 

9 preschool through grade 12 in schools for which sup10 port is provided by the Bureau of Indian Affairs. 

11 ‘‘(2) REQUIREMENTS FOR PROGRAMS.—Such 

12 programs shall include— 

13 ‘‘(A) school programs on nutrition edu14 cation, personal health, oral health, and fitness; 

15 ‘‘(B) behavioral health wellness programs; 

16 ‘‘(C) chronic disease prevention programs; 

17 ‘‘(D) substance abuse prevention pro18 grams; 

19 ‘‘(E) injury prevention and safety edu20 cation programs; and 

21 ‘‘(F) activities for the prevention and con22 trol of communicable diseases. 

23 ‘‘(3) DUTIES OF THE SECRETARY.—The Sec24 retary of the Interior shall— 
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1 ‘‘(A) provide training to teachers in com2 prehensive school health education curricula; 

3 ‘‘(B) ensure the integration and coordina4 tion of school-based programs with existing 

5 services and health programs available in the 

6 community; and 

7 ‘‘(C) encourage healthy, tobacco-free school 

8 environments. 

9 ‘‘SEC. 211. INDIAN YOUTH PROGRAM. 

10 ‘‘(a) PROGRAM AUTHORIZED.—The Secretary, acting 

11 through the Service, is authorized to establish and admin12 ister a program to provide funding to Indian Tribes, Trib13 al Organizations, and Urban Indian Organizations for in14 novative mental and physical disease prevention and 

15 health promotion and treatment programs for Indian and 

16 Urban Indian preadolescent and adolescent youths. 

17 ‘‘(b) USE OF FUNDS.— 

18 ‘‘(1) ALLOWABLE USES.—Funds made available 

19 under this section may be used to— 

20 ‘‘(A) develop prevention and treatment 

21 programs for Indian youth which promote men22 tal and physical health and incorporate cultural 

23 values, community and family involvement, and 

24 traditional health care practitioners; and 
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1 ‘‘(B) develop and provide community train2 ing and education. 

3 ‘‘(2) PROHIBITED USE.—Funds made available 

4 under this section may not be used to provide serv5 ices described in section 707(c). 

6 ‘‘(c) DUTIES OF THE SECRETARY.—The Secretary 

7 shall— 

8 ‘‘(1) disseminate to Indian Tribes, Tribal Orga9 nizations, and Urban Indian Organizations informa10 tion regarding models for the delivery of comprehen11 sive health care services to Indian and Urban Indian 

12 adolescents; 

13 ‘‘(2) encourage the implementation of such 

14 models; and 

15 ‘‘(3) at the request of an Indian Tribe, Tribal 

16 Organization, or Urban Indian Organization, provide 

17 technical assistance in the implementation of such 

18 models. 

19 ‘‘(d) CRITERIA FOR REVIEW AND APPROVAL OF AP20 PLICATIONS.—The Secretary, in consultation with Indian 

21 Tribes, Tribal Organizations, and Urban Indian Organiza22 tions, shall establish criteria for the review and approval 

23 of applications or proposals under this section. 
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1 ‘‘SEC. 212. PREVENTION, CONTROL, AND ELIMINATION OF 

2 COMMUNICABLE AND INFECTIOUS DISEASES. 

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

4 through the Service, and after consultation with Indian 

5 Tribes, Tribal Organizations, Urban Indian Organiza6 tions, and the Centers for Disease Control and Prevention, 

7 may make funding available to Indian Tribes, Tribal Or8 ganizations, and Urban Indian Organizations for the fol9 lowing: 

10 ‘‘(1) Projects for the prevention, control, and 

11 elimination of communicable and infectious diseases, 

12 including tuberculosis, hepatitis, HIV, respiratory 

13 syncitial virus, hanta virus, sexually transmitted dis14 eases, and H. Pylori. 

15 ‘‘(2) Public information and education pro16 grams for the prevention, control, and elimination of 

17 communicable and infectious diseases. 

18 ‘‘(3) Education, training, and clinical skills im19 provement activities in the prevention, control, and 

20 elimination of communicable and infectious diseases 

21 for health professionals, including allied health pro22 fessionals. 

23 ‘‘(4) Demonstration projects for the screening, 

24 treatment, and prevention of hepatitis C virus 

25 (HCV). 
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1 ‘‘(b) APPLICATION REQUIRED.—The Secretary may 

2 provide funding under subsection (a) only if an application 

3 or proposal for funding is submitted to the Secretary. 

4 ‘‘(c) COORDINATION WITH HEALTH AGENCIES.—In5 dian Tribes, Tribal Organizations, and Urban Indian Or6 ganizations receiving funding under this section are en7 couraged to coordinate their activities with the Centers for 

8 Disease Control and Prevention and State and local health 

9 agencies. 

10 ‘‘(d) TECHNICAL ASSISTANCE; REPORT.—In carrying 

11 out this section, the Secretary— 

12 ‘‘(1) may, at the request of an Indian Tribe, 

13 Tribal Organization, or Urban Indian Organization, 

14 provide technical assistance; and 

15 ‘‘(2) shall prepare and submit a report to Con16 gress biennially on the use of funds under this sec17 tion and on the progress made toward the preven18 tion, control, and elimination of communicable and 

19 infectious diseases among Indians and Urban Indi20 ans. 

21 ‘‘SEC. 213. AUTHORITY FOR PROVISION OF OTHER SERV22 ICES. 

23 ‘‘(a) FUNDING AUTHORIZED.—The Secretary, acting 

24 through the Service, Indian Tribes, and Tribal Organiza25 tions, may provide funding under this Act to meet the ob-
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•S 1057 IS 

1 jectives set forth in section 3 through health care-related 

2 services and programs not otherwise described in this Act, 

3 including— 

4 ‘‘(1) hospice care; 

5 ‘‘(2) assisted living; 

6 ‘‘(3) long-term health care; 

7 ‘‘(4) home- and community-based services; and 

8 ‘‘(5) public health functions. 

9 ‘‘(b) SERVICES TO OTHERWISE INELIGIBLE PER10 SONS.—Subject to section 807, at the discretion of the 

11 Service, Indian Tribes, or Tribal Organizations, services 

12 provided for hospice care, home- and community-based 

13 care, assisted living, and long-term care may be provided 

14 (subject to reimbursement) to persons otherwise ineligible 

15 for the health care benefits of the Service. Any funds re16 ceived under this subsection shall not be used to offset 

17 or limit the funding allocated to the Service or an Indian 

18 Tribe or Tribal Organization. 

19 ‘‘(c) DEFINITIONS.—For the purposes of this section, 

20 the following definitions shall apply: 

21 ‘‘(1) The term ‘home- and community-based 

22 services’ means 1 or more of the following: 

23 ‘‘(A) Homemaker/home health aide serv24 ices. 

25 ‘‘(B) Chore services. 
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1 ‘‘(C) Personal care services. 

2 ‘‘(D) Nursing care services provided out3 side of a nursing facility by, or under the super4 vision of, a registered nurse. 

5 ‘‘(E) Respite care. 

6 ‘‘(F) Training for family members. 

7 ‘‘(G) Adult day care. 

8 ‘‘(H) Such other home- and community9 based services as the Secretary, an Indian tribe, 

10 or a Tribal Organization may approve. 

11 ‘‘(2) The term ‘hospice care’ means the items 

12 and services specified in subparagraphs (A) through 

13 (H) of section 1861(dd)(1) of the Social Security 

14 Act (42 U.S.C. 1395x(dd)(1)), and such other serv15 ices which an Indian Tribe or Tribal Organization 

16 determines are necessary and appropriate to provide 

17 in furtherance of this care. 

18 ‘‘(3) The term ‘public health functions’ means 

19 the provision of public health-related programs, 

20 functions, and services, including assessment, assur21 ance, and policy development which Indian Tribes 

22 and Tribal Organizations are authorized and encour23 aged, in those circumstances where it meets their 

24 needs, to do by forming collaborative relationships 
115 

•S 1057 IS 

1 with all levels of local, State, and Federal Govern2 ment. 

3 ‘‘SEC. 214. INDIAN WOMEN’S HEALTH CARE. 

4 ‘‘The Secretary, acting through the Service and In5 dian Tribes, Tribal Organizations, and Urban Indian Or6 ganizations, shall monitor and improve the quality of 

7 health care for Indian women of all ages through the plan8 ning and delivery of programs administered by the Service, 

9 in order to improve and enhance the treatment models of 

10 care for Indian women. 

11 ‘‘SEC. 215. ENVIRONMENTAL AND NUCLEAR HEALTH HAZ12 ARDS. 

13 ‘‘(a) STUDIES AND MONITORING.—The Secretary 

14 and the Service shall conduct, in conjunction with other 

15 appropriate Federal agencies and in consultation with con16 cerned Indian Tribes and Tribal Organizations, studies 

17 and ongoing monitoring programs to determine trends in 

18 the health hazards to Indian miners and to Indians on 

19 or near reservations and Indian communities as a result 

20 of environmental hazards which may result in chronic or 

21 life threatening health problems, such as nuclear resource 

22 development, petroleum contamination, and contamination 

23 of water source and of the food chain. Such studies shall 

24 include— 
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•S 1057 IS 

1 ‘‘(1) an evaluation of the nature and extent of 

2 health problems caused by environmental hazards 

3 currently exhibited among Indians and the causes of 

4 such health problems; 

5 ‘‘(2) an analysis of the potential effect of ongo6 ing and future environmental resource development 

7 on or near reservations and Indian communities, in8 cluding the cumulative effect over time on health; 

9 ‘‘(3) an evaluation of the types and nature of 

10 activities, practices, and conditions causing or affect11 ing such health problems, including uranium mining 

12 and milling, uranium mine tailing deposits, nuclear 

13 power plant operation and construction, and nuclear 

14 waste disposal; oil and gas production or transpor15 tation on or near reservations or Indian commu16 nities; and other development that could affect the 

17 health of Indians and their water supply and food 

18 chain; 

19 ‘‘(4) a summary of any findings and rec20 ommendations provided in Federal and State stud21 ies, reports, investigations, and inspections during 

22 the 5 years prior to the date of enactment of the In23 dian Health Care Improvement Act Amendments of 

24 2005 that directly or indirectly relate to the activi-
117 

•S 1057 IS 

1 ties, practices, and conditions affecting the health or 

2 safety of such Indians; and 

3 ‘‘(5) the efforts that have been made by Federal 

4 and State agencies and resource and economic devel5 opment companies to effectively carry out an edu6 cation program for such Indians regarding the 

7 health and safety hazards of such development. 

8 ‘‘(b) HEALTH CARE PLANS.—Upon completion of 

9 such studies, the Secretary and the Service shall take into 

10 account the results of such studies and, in consultation 

11 with Indian Tribes and Tribal Organizations, develop 

12 health care plans to address the health problems studied 

13 under subsection (a). The plans shall include— 

14 ‘‘(1) methods for diagnosing and treating Indi15 ans currently exhibiting such health problems; 

16 ‘‘(2) preventive care and testing for Indians 

17 who may be exposed to such health hazards, includ18 ing the monitoring of the health of individuals who 

19 have or may have been exposed to excessive amounts 

20 of radiation or affected by other activities that have 

21 had or could have a serious impact upon the health 

22 of such individuals; and 

23 ‘‘(3) a program of education for Indians who, 

24 by reason of their work or geographic proximity to 
118 

•S 1057 IS 

1 such nuclear or other development activities, may ex2 perience health problems. 

3 ‘‘(c) SUBMISSION OF REPORT AND PLAN TO CON4 GRESS.—The Secretary and the Service shall submit to 

5 Congress the study prepared under subsection (a) no later 

6 than 18 months after the date of enactment of the Indian 

7 Health Care Improvement Act Amendments of 2005. The 

8 health care plan prepared under subsection (b) shall be 

9 submitted in a report no later than 1 year after the study 

10 prepared under subsection (a) is submitted to Congress. 

11 Such report shall include recommended activities for the 

12 implementation of the plan, as well as an evaluation of 

13 any activities previously undertaken by the Service to ad14 dress such health problems. 

15 ‘‘(d) INTERGOVERNMENTAL TASK FORCE.— 

16 ‘‘(1) ESTABLISHMENT; MEMBERS.—There is es17 tablished an Intergovernmental Task Force to be 

18 composed of the following individuals (or their des19 ignees): 

20 ‘‘(A) The Secretary of Energy. 

21 ‘‘(B) The Secretary of the Environmental 

22 Protection Agency. 

23 ‘‘(C) The Director of the Bureau of Mines. 

24 ‘‘(D) The Assistant Secretary for Occupa25 tional Safety and Health. 
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•S 1057 IS 

1 ‘‘(E) The Secretary of the Interior. 

2 ‘‘(F) The Secretary of Health and Human 

3 Services. 

4 ‘‘(G) The Director of the Indian Health 

5 Service. 

6 ‘‘(2) DUTIES.—The Task Force shall— 

7 ‘‘(A) identify existing and potential oper8 ations related to nuclear resource development 

9 or other environmental hazards that affect or 

10 may affect the health of Indians on or near a 

11 reservation or in an Indian community; and 

12 ‘‘(B) enter into activities to correct exist13 ing health hazards and ensure that current and 

14 future health problems resulting from nuclear 

15 resource or other development activities are 

16 minimized or reduced. 

17 ‘‘(3) CHAIRMAN; MEETINGS.—The Secretary of 

18 Health and Human Services shall be the Chairman 

19 of the Task Force. The Task Force shall meet at 

20 least twice each year. 

21 ‘‘(e) HEALTH SERVICES TO CERTAIN EMPLOYEES.— 

22 In the case of any Indian who— 

23 ‘‘(1) as a result of employment in or near a 

24 uranium mine or mill or near any other environ-
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•S 1057 IS 

1 mental hazard, suffers from a work-related illness or 

2 condition; 

3 ‘‘(2) is eligible to receive diagnosis and treat4 ment services from an Indian Health Program; and 

5 ‘‘(3) by reason of such Indian’s employment, is 

6 entitled to medical care at the expense of such mine 

7 or mill operator or entity responsible for the environ8 mental hazard, the Indian Health Program shall, at 

9 the request of such Indian, render appropriate med10 ical care to such Indian for such illness or condition 

11 and may be reimbursed for any medical care so ren12 dered to which such Indian is entitled at the expense 

13 of such operator or entity from such operator or en14 tity. Nothing in this subsection shall affect the 

15 rights of such Indian to recover damages other than 

16 such amounts paid to the Indian Health Program 

17 from the employer for providing medical care for 

18 such illness or condition. 

19 ‘‘SEC. 216. ARIZONA AS A CONTRACT HEALTH SERVICE DE20 LIVERY AREA. 

21 ‘‘(a) IN GENERAL.—For fiscal years beginning with 

22 the fiscal year ending September 30, 1983, and ending 

23 with the fiscal year ending September 30, 2015, the State 

24 of Arizona shall be designated as a contract health service 

25 delivery area by the Service for the purpose of providing 
121 

•S 1057 IS 

1 contract health care services to members of federally rec2 ognized Indian Tribes of Arizona. 

3 ‘‘(b) MAINTENANCE OF SERVICES.—The Service 

4 shall not curtail any health care services provided to Indi5 ans residing on reservations in the State of Arizona if such 

6 curtailment is due to the provision of contract services in 

7 such State pursuant to the designation of such State as 

8 a contract health service delivery area pursuant to sub9 section (a). 

10 ‘‘SEC. 216A. NORTH DAKOTA AND SOUTH DAKOTA AS CON11 TRACT HEALTH SERVICE DELIVERY AREA. 

12 ‘‘(a) IN GENERAL.—Beginning in fiscal year 2003, 

13 the States of North Dakota and South Dakota shall be 

14 designated as a contract health service delivery area by 

15 the Service for the purpose of providing contract health 

16 care services to members of federally recognized Indian 

17 Tribes of North Dakota and South Dakota. 

18 ‘‘(b) LIMITATION.—The Service shall not curtail any 

19 health care services provided to Indians residing on any 

20 reservation, or in any county that has a common boundary 

21 with any reservation, in the State of North Dakota or 

22 South Dakota if such curtailment is due to the provision 

23 of contract services in such States pursuant to the des24 ignation of such States as a contract health service deliv25 ery area pursuant to subsection (a). 
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•S 1057 IS 

1 ‘‘SEC. 217. CALIFORNIA CONTRACT HEALTH SERVICES PRO2 GRAM. 

3 ‘‘(a) FUNDING AUTHORIZED.—The Secretary is au4 thorized to fund a program using the California Rural In5 dian Health Board (hereafter in this section referred to 

6 as the ‘CRIHB’) as a contract care intermediary to im7 prove the accessibility of health services to California Indi8 ans. 

9 ‘‘(b) REIMBURSEMENT CONTRACT.—The Secretary 

10 shall enter into an agreement with the CRIHB to reim11 burse the CRIHB for costs (including reasonable adminis12 trative costs) incurred pursuant to this section, in pro13 viding medical treatment under contract to California In14 dians described in section 806(a) throughout the Cali15 fornia contract health services delivery area described in 

16 section 218 with respect to high cost contract care cases. 

17 ‘‘(c) ADMINISTRATIVE EXPENSES.—Not more than 5 

18 percent of the amounts provided to the CRIHB under this 

19 section for any fiscal year may be for reimbursement for 

20 administrative expenses incurred by the CRIHB during 

21 such fiscal year. 

22 ‘‘(d) LIMITATION ON PAYMENT.—No payment may 

23 be made for treatment provided hereunder to the extent 

24 payment may be made for such treatment under the In25 dian Catastrophic Health Emergency Fund described in 

26 section 202 or from amounts appropriated or otherwise 
123 

•S 1057 IS 

1 made available to the California contract health service de2 livery area for a fiscal year. 

3 ‘‘(e) ADVISORY BOARD.—There is established an ad4 visory board which shall advise the CRIHB in carrying 

5 out this section. The advisory board shall be composed of 

6 representatives, selected by the CRIHB, from not less 

7 than 8 Tribal Health Programs serving California Indians 

8 covered under this section at least one half of whom of 

9 whom are not affiliated with the CRIHB. 

10 ‘‘SEC. 218. CALIFORNIA AS A CONTRACT HEALTH SERVICE 

11 DELIVERY AREA. 

12 ‘‘The State of California, excluding the counties of 

13 Alameda, Contra Costa, Los Angeles, Marin, Orange, Sac14 ramento, San Francisco, San Mateo, Santa Clara, Kern, 

15 Merced, Monterey, Napa, San Benito, San Joaquin, San 

16 Luis Obispo, Santa Cruz, Solano, Stanislaus, and Ven17 tura, shall be designated as a contract health service deliv18 ery area by the Service for the purpose of providing con19 tract health services to California Indians. However, any 

20 of the counties listed herein may only be included in the 

21 contract health services delivery area if funding is specifi22 cally provided by the Service for such services in those 

23 counties. 
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•S 1057 IS 

1 ‘‘SEC. 219. CONTRACT HEALTH SERVICES FOR THE TREN2 TON SERVICE AREA. 

3 ‘‘(a) AUTHORIZATION FOR SERVICES.—The Sec4 retary, acting through the Service, is directed to provide 

5 contract health services to members of the Turtle Moun6 tain Band of Chippewa Indians that reside in the Trenton 

7 Service Area of Divide, McKenzie, and Williams counties 

8 in the State of North Dakota and the adjoining counties 

9 of Richland, Roosevelt, and Sheridan in the State of Mon10 tana. 

11 ‘‘(b) NO EXPANSION OF ELIGIBILITY.—Nothing in 

12 this section may be construed as expanding the eligibility 

13 of members of the Turtle Mountain Band of Chippewa In14 dians for health services provided by the Service beyond 

15 the scope of eligibility for such health services that applied 

16 on May 1, 1986. 

17 ‘‘SEC. 220. PROGRAMS OPERATED BY INDIAN TRIBES AND 

18 TRIBAL ORGANIZATIONS. 

19 ‘‘The Service shall provide funds for health care pro20 grams and facilities operated by Tribal Health Programs 

21 on the same basis as such funds are provided to programs 

22 and facilities operated directly by the Service. 

23 ‘‘SEC. 221. LICENSING. 

24 ‘‘Health care professionals employed by a Tribal 

25 Health Program shall, if licensed in any State, be exempt 

26 from the licensing requirements of the State in which the 
125 

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1 Tribal Health Program performs the services described in 

2 its contract or compact under the Indian Self-Determina3 tion and Education Assistance Act (25 U.S.C. 450 et 

4 seq.). 

5 ‘‘SEC. 222. NOTIFICATION OF PROVISION OF EMERGENCY 

6 CONTRACT HEALTH SERVICES. 

7 ‘‘With respect to an elderly Indian or an Indian with 

8 a disability receiving emergency medical care or services 

9 from a non-Service provider or in a non-Service facility 

10 under the authority of this Act, the time limitation (as 

11 a condition of payment) for notifying the Service of such 

12 treatment or admission shall be 30 days. 

13 ‘‘SEC. 223. PROMPT ACTION ON PAYMENT OF CLAIMS. 

14 ‘‘(a) DEADLINE FOR RESPONSE.—The Service shall 

15 respond to a notification of a claim by a provider of a 

16 contract care service with either an individual purchase 

17 order or a denial of the claim within 5 working days after 

18 the receipt of such notification. 

19 ‘‘(b) EFFECT OF UNTIMELY RESPONSE.—If the 

20 Service fails to respond to a notification of a claim in ac21 cordance with subsection (a), the Service shall accept as 

22 valid the claim submitted by the provider of a contract 

23 care service. 
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1 ‘‘(c) DEADLINE FOR PAYMENT OF VALID CLAIM.— 

2 The Service shall pay a valid contract care service claim 

3 within 30 days after the completion of the claim. 

4 ‘‘SEC. 224. LIABILITY FOR PAYMENT. 

5 ‘‘(a) NO PATIENT LIABILITY.—A patient who re6 ceives contract health care services that are authorized by 

7 the Service shall not be liable for the payment of any 

8 charges or costs associated with the provision of such serv9 ices. 

10 ‘‘(b) NOTIFICATION.—The Secretary shall notify a 

11 contract care provider and any patient who receives con12 tract health care services authorized by the Service that 

13 such patient is not liable for the payment of any charges 

14 or costs associated with the provision of such services not 

15 later than 5 business days after receipt of a notification 

16 of a claim by a provider of contract care services. 

17 ‘‘(c) NO RECOURSE.—Following receipt of the notice 

18 provided under subsection (b), or, if a claim has been 

19 deemed accepted under section 223(b), the provider shall 

20 have no further recourse against the patient who received 

21 the services. 

22 ‘‘SEC. 225. AUTHORIZATION OF APPROPRIATIONS. 

23 ‘‘There are authorized to be appropriated such sums 

24 as may be necessary for each fiscal year through fiscal 

25 year 2015 to carry out this title. 
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1 ‘‘TITLE III—FACILITIES 

2 ‘‘SEC. 301. CONSULTATION: CONSTRUCTION AND RENOVA3 TION OF FACILITIES; REPORTS. 

4 ‘‘(a) PREREQUISITES FOR EXPENDITURE OF

5 FUNDS.—Prior to the expenditure of, or the making of 

6 any binding commitment to expend, any funds appro7 priated for the planning, design, construction, or renova8 tion of facilities pursuant to the Act of November 2, 1921 

9 (25 U.S.C. 13) (commonly known as the ‘Snyder Act’), 

10 the Secretary, acting through the Service, shall— 

11 ‘‘(1) consult with any Indian Tribe that would 

12 be significantly affected by such expenditure for the 

13 purpose of determining and, whenever practicable, 

14 honoring tribal preferences concerning size, location, 

15 type, and other characteristics of any facility on 

16 which such expenditure is to be made; and 

17 ‘‘(2) ensure, whenever practicable and applica18 ble, that such facility meets the construction stand19 ards of any accrediting body recognized by the Sec20 retary for the purposes of the medicare, medicaid, 

21 and SCHIP programs under titles XVIII, XIX, and 

22 XXI of the Social Security Act by not later than 1 

23 year after the date on which the construction or ren24 ovation of such facility is completed. 

25 ‘‘(b) CLOSURES.— 
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1 ‘‘(1) EVALUATION REQUIRED.—Notwith2 standing any other provision of law, no facility oper3 ated by the Service may be closed if the Secretary 

4 has not submitted to Congress at least 1 year prior 

5 to the date of the proposed closure an evaluation of 

6 the impact of the proposed closure which specifies, 

7 in addition to other considerations— 

8 ‘‘(A) the accessibility of alternative health 

9 care resources for the population served by such 

10 facility; 

11 ‘‘(B) the cost-effectiveness of such closure; 

12 ‘‘(C) the quality of health care to be pro13 vided to the population served by such facility 

14 after such closure; 

15 ‘‘(D) the availability of contract health 

16 care funds to maintain existing levels of service; 

17 ‘‘(E) the views of the Indian Tribes served 

18 by such facility concerning such closure; 

19 ‘‘(F) the level of use of such facility by all 

20 eligible Indians; and 

21 ‘‘(G) the distance between such facility and 

22 the nearest operating Service hospital. 

23 ‘‘(2) EXCEPTION FOR CERTAIN TEMPORARY

24 CLOSURES.—Paragraph (1) shall not apply to any 

25 temporary closure of a facility or any portion of a 
129 

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1 facility if such closure is necessary for medical, envi2 ronmental, or construction safety reasons. 

3 ‘‘(c) HEALTH CARE FACILITY PRIORITY SYSTEM.— 

4 ‘‘(1) IN GENERAL.— 

5 ‘‘(A) ESTABLISHMENT.—The Secretary, 

6 acting through the Service, shall establish a 

7 health care facility priority system, which 

8 shall— 

9 ‘‘(i) be developed with Indian Tribes 

10 and Tribal Organizations through nego11 tiated rulemaking under section 802; 

12 ‘‘(ii) give Indian Tribes’ needs the 

13 highest priority; and 

14 ‘‘(iii) at a minimum, include the lists 

15 required in paragraph (2)(B) and the 

16 methodology required in paragraph (2)(E). 

17 ‘‘(B) PRIORITY OF CERTAIN PROJECTS

18 PROTECTED.—The priority of any project estab19 lished under the construction priority system in 

20 effect on the date of the Indian Health Care 

21 Improvement Act Amendments of 2005 shall 

22 not be affected by any change in the construc23 tion priority system taking place thereafter if 

24 the project was identified as 1 of the 10 top25 priority inpatient projects, 1 of the 10 top-pri-
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•S 1057 IS 

1 ority outpatient projects, 1 of the 10 top-pri2 ority staff quarters developments, or 1 of the 

3 10 top-priority Youth Regional Treatment Cen4 ters in the fiscal year 2005 Indian Health Serv5 ice budget justification, or if the project had 

6 completed both Phase I and Phase II of the 

7 construction priority system in effect on the 

8 date of enactment of such Act. 

9 ‘‘(2) REPORT; CONTENTS.—The Secretary shall 

10 submit to the President, for inclusion in each report 

11 required to be transmitted to Congress under section 

12 801, a report which sets forth the following: 

13 ‘‘(A) A description of the health care facil14 ity priority system of the Service, established 

15 under paragraph (1). 

16 ‘‘(B) Health care facilities lists, includ17 ing— 

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 

24 care and alcohol and drug abuse treat25 ment); 
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1 ‘‘(iv) the 10 top-priority staff quarters 

2 developments associated with health care 

3 facilities; and 

4 ‘‘(v) the 10 top-priority hostels associ5 ated with health care facilities. 

6 ‘‘(C) The justification for such order of 

7 priority. 

8 ‘‘(D) The projected cost of such projects. 

9 ‘‘(E) The methodology adopted by the 

10 Service in establishing priorities under its 

11 health 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 

15 Secretary 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 

21 Indian 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 

15 (25 U.S.C. 450 et seq.) are fully and equitably inte16 grated 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 facilities listed 

23 under subsection (c)(2)(B), including the needs for 

24 renovation and expansion of existing facilities. The 

25 Government Accountability Office shall submit the 
133 

•S 1057 IS 

1 report to the appropriate authorizing and appropria2 tions committees of Congress and to the Secretary. 

3 ‘‘(2) Beginning in the year 2006, the Secretary 

4 shall update the report required under paragraph 

5 (1) every 5 years. 

6 ‘‘(3) The Comptroller General and the Sec7 retary shall consult with Indian Tribes, Tribal Orga8 nizations, and Urban Indian Organizations. The 

9 Secretary shall submit the reports required by para10 graphs (1) and (2), to the President for inclusion in 

11 the report required to be transmitted to Congress 

12 under section 801. 

13 ‘‘(4) For purposes of this subsection, the re14 ports shall, regarding the needs of facilities operated 

15 under any contract or compact under the Indian 

16 Self-Determination and Education Assistance Act 

17 (25 U.S.C. 450 et seq.), be based on the same cri18 teria that the Secretary uses in evaluating the needs 

19 of facilities operated directly by the Service. 

20 ‘‘(5) The planning, design, construction, and 

21 renovation needs of facilities operated under con22 tracts or compacts under the Indian Self-Determina23 tion and Education Assistance Act (25 U.S.C. 450 

24 et seq.) shall be fully and equitably integrated into 
134 

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1 the development of the health facility priority sys2 tem. 

3 ‘‘(6) Beginning in 2007 and each fiscal year 

4 thereafter, the Secretary shall provide an oppor5 tunity for nomination of planning, design, and con6 struction projects by the Service, Indian Tribes, 

7 Tribal Organizations, and Urban Indian Organiza8 tions for consideration under the health care facility 

9 priority system. 

10 ‘‘(e) FUNDING CONDITION.—All funds appropriated 

11 under the Act of November 2, 1921 (25 U.S.C. 13) (com12 monly known as the ‘Snyder Act’), for the planning, de13 sign, construction, or renovation of health facilities for the 

14 benefit of 1 or more Indian Tribes shall be subject to the 

15 provisions of the Indian Self-Determination and Edu16 cation Assistance Act (25 U.S.C. 450 et seq.). 

17 ‘‘(f) DEVELOPMENT OF INNOVATIVE APPROACHES.— 

18 The Secretary shall consult and cooperate with Indian 

19 Tribes, Tribal Organizations, and Urban Indian Organiza20 tions in developing innovative approaches to address all 

21 or part of the total unmet need for construction of health 

22 facilities, including those provided for in other sections of 

23 this title and other approaches. 

24 ‘‘SEC. 302. SANITATION FACILITIES. 

25 ‘‘(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 

19 the findings made in subsection (a), Congress reaffirms 

20 the primary responsibility and authority of the Service to 

21 provide the necessary sanitation facilities and services as 

22 provided in section 7 of the Act of August 5, 1954 (42 

23 U.S.C. 2004a). Under such authority, the Secretary, act24 ing through the Service, is authorized to provide the fol25 lowing: 
136 

•S 1057 IS 

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 

22 of sanitation facilities. 

23 ‘‘(c) FUNDING.—Notwithstanding any other provi24 sion of law— 
137 

•S 1057 IS 

1 ‘‘(1) the Secretary of Housing and Urban De2 velopment is authorized to transfer funds appro3 priated under the Native American Housing Assist4 ance and Self-Determination Act of 1996 to the Sec5 retary of Health and Human Services; 

6 ‘‘(2) the Secretary of Health and Human Serv7 ices is authorized to accept and use such funds for 

8 the purpose of providing sanitation facilities and 

9 services for Indians under section 7 of the Act of 

10 August 5, 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 

14 5, 1954 (42 U.S.C. 2004a), to provide sanitation fa15 cilities to new homes constructed using funds pro16 vided by the Department of Housing and Urban De17 velopment; 

18 ‘‘(4) the Secretary of Health and Human Serv19 ices is authorized to accept from any source, includ20 ing Federal and State agencies, funds for the pur21 pose of providing sanitation facilities and services 

22 and place these funds into contracts or compacts 

23 under the Indian Self-Determination and Education 

24 Assistance Act (25 U.S.C. 450 et seq.); 
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•S 1057 IS 

1 ‘‘(5) except as otherwise prohibited by this sec2 tion, the Secretary may use funds appropriated 

3 under the authority of section 7 of the Act of Au4 gust 5, 1954 (42 U.S.C. 2004a) to fund up to 100 

5 percent of the amount of an Indian Tribe’s loan ob6 tained under any Federal program for new projects 

7 to construct eligible sanitation facilities to serve In8 dian homes; 

9 ‘‘(6) except as otherwise prohibited by this sec10 tion, the Secretary may use funds appropriated 

11 under the authority of section 7 of the Act of Au12 gust 5, 1954 (42 U.S.C. 2004a) to meet matching 

13 or cost participation requirements under other Fed14 eral and non-Federal programs for new projects to 

15 construct eligible sanitation facilities; 

16 ‘‘(7) all Federal agencies are authorized to 

17 transfer to the Secretary funds identified, granted, 

18 loaned, or appropriated whereby the Department’s 

19 applicable policies, rules, and regulations shall apply 

20 in the implementation of such projects; 

21 ‘‘(8) the Secretary of Health and Human Serv22 ices shall enter into interagency agreements with 

23 Federal and State agencies for the purpose of pro24 viding financial assistance for sanitation facilities 

25 and services under this Act; and 
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•S 1057 IS 

1 ‘‘(9) the Secretary of Health and Human Serv2 ices shall, by regulation developed through rule3 making under section 802, establish standards appli4 cable to the planning, design, and construction of 

5 sanitation facilities funded under this Act. 

6 ‘‘(d) CERTAIN CAPABILITIES NOT PREREQUISITE.— 

7 The financial and technical capability of an Indian Tribe, 

8 Tribal Organization, or Indian community to safely oper9 ate, manage, and maintain a sanitation facility shall not 

10 be a prerequisite to the provision or construction of sanita11 tion facilities by the Secretary. 

12 ‘‘(e) FINANCIAL ASSISTANCE.—The Secretary is au13 thorized to provide financial assistance to Indian Tribes, 

14 Tribal Organizations, and Indian communities for oper15 ation, management, and maintenance of their sanitation 

16 facilities. 

17 ‘‘(f) OPERATION, MANAGEMENT, AND MAINTENANCE

18 OF FACILITIES.—The Indian Tribe has the primary re19 sponsibility to establish, collect, and use reasonable user 

20 fees, or otherwise set aside funding, for the purpose of 

21 operating, managing, and maintaining sanitation facilities. 

22 If a sanitation facility serving a community that is oper23 ated by an Indian Tribe or Tribal Organization is threat24 ened with imminent failure and such operator lacks capac25 ity to maintain the integrity or the health benefits of the 
140 

•S 1057 IS 

1 sanitation facility, then the Secretary is authorized to as2 sist the Indian Tribe, Tribal Organization, or Indian com3 munity in the resolution of the problem on a short-term 

4 basis through cooperation with the emergency coordinator 

5 or by providing operation, management, and maintenance 

6 service. 

7 ‘‘(g) ISDEAA PROGRAM FUNDED ON EQUAL

8 BASIS.—Tribal Health Programs shall be eligible (on an 

9 equal basis with programs that are administered directly 

10 by the Service) for— 

11 ‘‘(1) any funds appropriated pursuant to this 

12 section; and 

13 ‘‘(2) any funds appropriated for the purpose of 

14 providing sanitation facilities. 

15 ‘‘(h) REPORT.— 

16 ‘‘(1) REQUIRED; CONTENTS.—The Secretary, in 

17 consultation with the Secretary of Housing and 

18 Urban Development, Indian Tribes, Tribal Organiza19 tions, and tribally designated housing entities (as de20 fined in section 4 of the Native American Housing 

21 Assistance and Self-Determination Act of 1996 (25 

22 U.S.C. 4103)) shall submit to the President, for in23 clusion in each report required to be transmitted to 

24 Congress under section 801, a report which sets 

25 forth— 
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1 ‘‘(A) the current Indian sanitation facility 

2 priority system of the Service; 

3 ‘‘(B) the methodology for determining 

4 sanitation deficiencies and needs; 

5 ‘‘(C) the level of initial and final sanitation 

6 deficiency for each type of sanitation facility for 

7 each project of each Indian Tribe or Indian 

8 community; 

9 ‘‘(D) the amount and most effective use of 

10 funds, derived from whatever source, necessary 

11 to accommodate the sanitation facilities needs 

12 of new homes assisted with funds under the 

13 Native American Housing Assistance and Self14 Determination Act, and to reduce the identified 

15 sanitation deficiency levels of all Indian Tribes 

16 and Indian communities to level I sanitation de17 ficiency as defined in paragraph (4)(A); and 

18 ‘‘(E) a 10-year plan to provide sanitation 

19 facilities to serve existing Indian homes and In20 dian communities and new and renovated In21 dian homes. 

22 ‘‘(2) CRITERIA.—The criteria on which the defi23 ciencies and needs will be evaluated shall be devel24 oped through negotiated rulemaking pursuant to 

25 section 802. 
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•S 1057 IS 

1 ‘‘(3) UNIFORM METHODOLOGY.—The method2 ology used by the Secretary in determining, pre3 paring cost estimates for, and reporting sanitation 

4 deficiencies for purposes of paragraph (1) shall be 

5 applied uniformly to all Indian Tribes and Indian 

6 communities. 

7 ‘‘(4) SANITATION DEFICIENCY LEVELS.—For 

8 purposes of this subsection, the sanitation deficiency 

9 levels for an individual, Indian Tribe, or Indian com10 munity sanitation facility to serve Indian homes are 

11 determined as follows: 

12 ‘‘(A) A level I deficiency exists if a sanita13 tion facility serving an individual, Indian Tribe, 

14 or Indian community— 

15 ‘‘(i) complies with all applicable water 

16 supply, pollution control, and solid waste 

17 disposal laws; and 

18 ‘‘(ii) deficiencies relate to routine re19 placement, repair, or maintenance needs. 

20 ‘‘(B) A level II deficiency exists if a sanita21 tion facility serving an individual, Indian Tribe, 

22 or Indian community substantially or recently 

23 complied with all applicable water supply, pollu24 tion control, and solid waste laws and any defi25 ciencies relate to— 
143 

•S 1057 IS 

1 ‘‘(i) small or minor capital improve2 ments needed to bring the facility back 

3 into compliance; 

4 ‘‘(ii) capital improvements that are 

5 necessary to enlarge or improve the facili6 ties in order to meet the current needs for 

7 domestic sanitation facilities; or 

8 ‘‘(iii) the lack of equipment or train9 ing by an Indian Tribe, Tribal Organiza10 tion, or an Indian community to properly 

11 operate and maintain the sanitation facili12 ties. 

13 ‘‘(C) A level III deficiency exists if a sani14 tation facility serving an individual, Indian 

15 Tribe or Indian community meets one or more 

16 of the following conditions— 

17 ‘‘(i) water or sewer service in the 

18 home is provided by a haul system with 

19 holding tanks and interior plumbing; 

20 ‘‘(ii) major significant interruptions to 

21 water supply or sewage disposal occur fre22 quently, requiring major capital improve23 ments to correct the deficiencies; or 
144 

•S 1057 IS 

1 ‘‘(iii) there is no access to or no ap2 proved or permitted solid waste facility 

3 available. 

4 ‘‘(D) A level IV deficiency exists if— 

5 ‘‘(i) a sanitation facility of an indi6 vidual, Indian Tribe, Tribal Organization, 

7 or Indian community has no piped water 

8 or sewer facilities in the home or the facil9 ity has become inoperable due to major 

10 component failure; or 

11 ‘‘(ii) where only a washeteria or cen12 tral facility exists in the community. 

13 ‘‘(E) A level V deficiency exists in the ab14 sence of a sanitation facility, where individual 

15 homes do not have access to safe drinking 

16 water or adequate wastewater (including sew17 age) disposal. 

18 ‘‘(i) DEFINITIONS.—For purposes of this section, the 

19 following terms apply: 

20 ‘‘(1) INDIAN COMMUNITY.—The term ‘Indian 

21 community’ means a geographic area, a significant 

22 proportion of whose inhabitants are Indians and 

23 which is served by or capable of being served by a 

24 facility described in this section. 
145 

•S 1057 IS 

1 ‘‘(2) SANITATION FACILITIES.—The terms 

2 ‘sanitation facility’ and ‘sanitation facilities’ mean 

3 safe and adequate water supply systems, sanitary 

4 sewage disposal systems, and sanitary solid waste 

5 systems (and all related equipment and support in6 frastructure). 

7 ‘‘SEC. 303. PREFERENCE TO INDIANS AND INDIAN FIRMS. 

8 ‘‘(a) BUY INDIAN ACT.—The Secretary, acting 

9 through the Service, may use the negotiating authority of 

10 section 23 of the Act of June 25, 1910 (25 U.S.C. 47, 

11 commonly known as the ‘Buy Indian Act’), to give pref12 erence to any Indian or any enterprise, partnership, cor13 poration, or other type of business organization owned and 

14 controlled by an Indian or Indians including former or 

15 currently federally recognized Indian Tribes in the State 

16 of New York (hereinafter referred to as an ‘Indian firm’) 

17 in the construction and renovation of Service facilities pur18 suant to section 301 and in the construction of sanitation 

19 facilities pursuant to section 302. Such preference may be 

20 accorded by the Secretary unless the Secretary finds, pur21 suant to regulations adopted pursuant to section 802, that 

22 the project or function to be contracted for will not be 

23 satisfactory or such project or function cannot be properly 

24 completed or maintained under the proposed contract. The 

25 Secretary, in arriving at such a finding, shall consider 
146 

•S 1057 IS 

1 whether the Indian or Indian firm will be deficient with 

2 respect to— 

3 ‘‘(1) ownership and control by Indians; 

4 ‘‘(2) equipment; 

5 ‘‘(3) bookkeeping and accounting procedures; 

6 ‘‘(4) substantive knowledge of the project or 

7 function to be contracted for; 

8 ‘‘(5) adequately trained personnel; or 

9 ‘‘(6) other necessary components of contract 

10 performance. 

11 ‘‘(b) LABOR STANDARDS.— 

12 ‘‘(1) IN GENERAL.—For the purposes of imple13 menting the provisions of this title, contracts for the 

14 construction or renovation of health care facilities, 

15 staff quarters, and sanitation facilities, and related 

16 support infrastructure, funded in whole or in part 

17 with funds made available pursuant to this title, 

18 shall contain a provision requiring compliance with 

19 subchapter IV of chapter 31 of title 40, United 

20 States Code (commonly known as the ‘Davis-Bacon 

21 Act’), unless such construction or renovation— 

22 ‘‘(A) is performed by a contractor pursu23 ant to a contract with an Indian Tribe or Trib24 al Organization with funds supplied through a 

25 contract or compact authorized by the Indian 
147 

•S 1057 IS 

1 Self-Determination and Education Assistance 

2 Act, or other statutory authority; and 

3 ‘‘(B) is subject to prevailing wage rates for 

4 similar construction or renovation in the locality 

5 as determined by the Indian Tribes or Tribal 

6 Organizations to be served by the construction 

7 or renovation. 

8 ‘‘(2) EXCEPTION.—This subsection shall not 

9 apply to construction or renovation carried out by an 

10 Indian Tribe or Tribal Organization with its own 

11 employees. 

12 ‘‘SEC. 304. EXPENDITURE OF NONSERVICE FUNDS FOR REN13 OVATION. 

14 ‘‘(a) IN GENERAL.—Notwithstanding any other pro15 vision of law, if the requirements of subsection (c) are met, 

16 the Secretary, acting through the Service, is authorized 

17 to accept any major expansion, renovation, or moderniza18 tion by any Indian Tribe or Tribal Organization of any 

19 Service facility or of any other Indian health facility oper20 ated pursuant to a contract or compact under the Indian 

21 Self-Determination and Education Assistance Act (25 

22 U.S.C. 450 et seq.), including— 

23 ‘‘(1) any plans or designs for such expansion, 

24 renovation, or modernization; and 
148 

•S 1057 IS 

1 ‘‘(2) any expansion, renovation, or moderniza2 tion for which funds appropriated under any Federal 

3 law were lawfully expended. 

4 ‘‘(b) PRIORITY LIST.— 

5 ‘‘(1) IN GENERAL.—The Secretary shall main6 tain a separate priority list to address the needs for 

7 increased operating expenses, personnel, or equip8 ment for such facilities. The methodology for estab9 lishing priorities shall be developed through nego10 tiated rulemaking under section 802. The list of pri11 ority facilities will be revised annually in consulta12 tion with Indian Tribes and Tribal Organizations. 

13 ‘‘(2) REPORT.—The Secretary shall submit to 

14 the President, for inclusion in each report required 

15 to be transmitted to Congress under section 801, the 

16 priority list maintained pursuant to paragraph (1). 

17 ‘‘(c) REQUIREMENTS.—The requirements of this sub18 section are met with respect to any expansion, renovation, 

19 or modernization if— 

20 ‘‘(1) the Indian Tribe or Tribal Organization— 

21 ‘‘(A) provides notice to the Secretary of its 

22 intent to expand, renovate, or modernize; and 

23 ‘‘(B) applies to the Secretary to be placed 

24 on a separate priority list to address the needs 
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•S 1057 IS 

1 of such new facilities for increased operating ex2 penses, personnel, or equipment; and 

3 ‘‘(2) the expansion, renovation, or moderniza4 tion— 

5 ‘‘(A) is approved by the appropriate area 

6 director of the Service for Federal facilities; and 

7 ‘‘(B) is administered by the Indian Tribe 

8 or Tribal Organization in accordance with any 

9 applicable regulations prescribed by the Sec10 retary with respect to construction or renova11 tion of Service facilities. 

12 ‘‘(d) ADDITIONAL REQUIREMENT FOR EXPANSION.— 

13 In addition to the requirements under subsection (c), for 

14 any expansion, the Indian Tribe or Tribal Organization 

15 shall provide to the Secretary additional information devel16 oped through negotiated rulemaking under section 802, 

17 including additional staffing, equipment, and other costs 

18 associated with the expansion. 

19 ‘‘(e) CLOSURE OR CONVERSION OF FACILITIES.—If 

20 any Service facility which has been expanded, renovated, 

21 or modernized by an Indian Tribe or Tribal Organization 

22 under this section ceases to be used as a Service facility 

23 during the 20-year period beginning on the date such ex24 pansion, renovation, or modernization is completed, such 

25 Indian Tribe or Tribal Organization shall be entitled to 
150 

•S 1057 IS 

1 recover from the United States an amount which bears 

2 the same ratio to the value of such facility at the time 

3 of such cessation as the value of such expansion, renova4 tion, or modernization (less the total amount of any funds 

5 provided specifically for such facility under any Federal 

6 program that were expended for such expansion, renova7 tion, or modernization) bore to the value of such facility 

8 at the time of the completion of such expansion, renova9 tion, or modernization. 

10 ‘‘SEC. 305. FUNDING FOR THE CONSTRUCTION, EXPANSION, 

11 AND MODERNIZATION OF SMALL AMBULA12 TORY CARE FACILITIES. 

13 ‘‘(a) FUNDING.— 

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

15 through the Service, in consultation with Indian 

16 Tribes and Tribal Organizations, shall make grants 

17 to Indian Tribes and Tribal Organizations for the 

18 construction, expansion, or modernization of facili19 ties for the provision of ambulatory care services to 

20 eligible Indians (and noneligible persons pursuant to 

21 subsections (b)(2) and (c)(1)(C)). Funding made 

22 under this section may cover up to 100 percent of 

23 the costs of such construction, expansion, or mod24 ernization. For the purposes of this section, the term 
151 

•S 1057 IS 

1 ‘construction’ includes the replacement of an exist2 ing facility. 

3 ‘‘(2) AGREEMENT REQUIRED.—Funding under 

4 paragraph (1) may only be made available to a Trib5 al Health Program operating an Indian health facil6 ity (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 FUNDS.— 

11 ‘‘(1) ALLOWABLE USES.—Funding provided 

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 
152 

•S 1057 IS 

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 

8 no fewer than 1,500 eligible Indians and 

9 other users who are eligible for services in 

10 such 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 

15 funds to reduce an outstanding debt incurred by In16 dian Tribes or Tribal Organizations for the con17 struction, expansion, or modernization of an ambula18 tory care facility that meets the requirements under 

19 paragraph (1). The provisions of this section shall 

20 apply, except that such applications for funding 

21 under this paragraph shall be considered separately 

22 from applications for funding under paragraph (1). 

23 ‘‘(3) USE ONLY FOR CERTAIN PORTION OF

24 COSTS.—Funding provided under this section may 

25 be used only for the cost of that portion of a con-
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1 struction, expansion, or modernization project that 

2 benefits the Service population identified above in 

3 subsection (b)(1)(C) (ii) and (iii). The requirements 

4 of clauses (ii) and (iii) of paragraph (1)(C) shall not 

5 apply to an Indian Tribe or Tribal Organization ap6 plying for funding under this section for a health 

7 care facility located or to be constructed on an is8 land or when such facility is not located on a road 

9 system providing direct access to an inpatient hos10 pital where care is available to the Service popu11 lation. 

12 ‘‘(c) FUNDING.— 

13 ‘‘(1) APPLICATION.—No funding may be made 

14 available under this section unless an application or 

15 proposal for such funding has been approved by the 

16 Secretary in accordance with applicable regulations 

17 and has forth reasonable assurance by the applicant 

18 that, at all times after the construction, expansion, 

19 or modernization of a facility carried out pursuant 

20 to funding received under this section— 

21 ‘‘(A) adequate financial support will be 

22 available for the provision of services at such 

23 facility; 
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1 ‘‘(B) such facility will be available to eligi2 ble Indians without regard to ability to pay or 

3 source of payment; and 

4 ‘‘(C) such facility will, as feasible without 

5 diminishing the quality or quantity of services 

6 provided to eligible Indians, serve noneligible 

7 persons on a cost basis. 

8 ‘‘(2) PRIORITY.—In awarding funding under 

9 this section, the Secretary shall give priority to In10 dian Tribes and Tribal Organizations that dem11 onstrate— 

12 ‘‘(A) a need for increased ambulatory care 

13 services; and 

14 ‘‘(B) insufficient capacity to deliver such 

15 services. 

16 ‘‘(3) PEER REVIEW PANELS.—The Secretary 

17 may provide for the establishment of peer review 

18 panels, as necessary, to review and evaluate applica19 tions and proposals and to advise the Secretary re20 garding such applications using the criteria devel21 oped during consultations pursuant to subsection 

22 (a)(1). 

23 ‘‘(d) REVERSION OF FACILITIES.—If any facility (or 

24 portion thereof) with respect to which funds have been 

25 paid under this section, ceases, within 5 years after com-
155 

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1 pletion of the construction, expansion, or modernization 

2 carried out with such funds, to be used for the purposes 

3 of providing health care services to eligible Indians, all of 

4 the right, title, and interest in and to such facility (or por5 tion thereof) shall transfer to the United States unless 

6 otherwise negotiated by the Service and the Indian Tribe 

7 or Tribal Organization. 

8 ‘‘(e) FUNDING NONRECURRING.—Funding provided 

9 under this section shall be nonrecurring and shall not be 

10 available for inclusion in any individual Indian Tribe’s 

11 tribal share for an award under the Indian Self-Deter12 mination and Education Assistance Act or for reallocation 

13 or redesign thereunder. 

14 ‘‘SEC. 306. INDIAN HEALTH CARE DELIVERY DEMONSTRA15 TION PROJECT. 

16 ‘‘(a) HEALTH CARE DEMONSTRATION PROJECTS.— 

17 The Secretary, acting through the Service, and in con18 sultation with Indian Tribes and Tribal Organizations, is 

19 authorized to enter into construction agreements under 

20 the Indian Self-Determination and Education Assistance 

21 Act (25 U.S.C. 450 et seq.) with Indian Tribes or Tribal 

22 Organizations for the purpose of carrying out a health 

23 care delivery demonstration project to test alternative 

24 means of delivering health care and services to Indians 

25 through facilities. 
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1 ‘‘(b) USE OF FUNDS.—The Secretary, in approving 

2 projects pursuant to this section, may authorize funding 

3 for the construction and renovation of hospitals, health 

4 centers, health stations, and other facilities to deliver 

5 health care services and is authorized to— 

6 ‘‘(1) waive any leasing prohibition; 

7 ‘‘(2) permit carryover of funds appropriated for 

8 the provision of health care services; 

9 ‘‘(3) permit the use of other available funds; 

10 ‘‘(4) permit the use of funds or property do11 nated from any source for project purposes; 

12 ‘‘(5) provide for the reversion of donated real or 

13 personal property to the donor; and 

14 ‘‘(6) permit the use of Service funds to match 

15 other funds, including Federal funds. 

16 ‘‘(c) REGULATIONS.—The Secretary shall develop 

17 and promulgate regulations not later than 1 year after the 

18 date of enactment of the Indian Health Care Improvement 

19 Act Amendments of 2005. If the Secretary has not pro20 mulgated regulations by that date, the Secretary shall de21 velop and publish regulations, through rulemaking under 

22 section 802, for the review and approval of applications 

23 submitted under this section. 

24 ‘‘(d) CRITERIA.—The Secretary may approve projects 

25 that meet the following criteria: 
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1 ‘‘(1) There is a need for a new facility or pro2 gram or the reorientation of an existing facility or 

3 program. 

4 ‘‘(2) A significant number of Indians, including 

5 those with low health status, will be served by the 

6 project. 

7 ‘‘(3) The project has the potential to deliver 

8 services in an efficient and effective manner. 

9 ‘‘(4) The project is economically viable. 

10 ‘‘(5) The Indian Tribe or Tribal Organization 

11 has the administrative and financial capability to ad12 minister the project. 

13 ‘‘(6) The project is integrated with providers of 

14 related health and social services and is coordinated 

15 with, and avoids duplication of, existing services. 

16 ‘‘(e) PEER REVIEW PANELS.—The Secretary may 

17 provide for the establishment of peer review panels, as nec18 essary, to review and evaluate applications using the cri19 teria developed pursuant to subsection (d). 

20 ‘‘(f) PRIORITY.—The Secretary shall give priority to 

21 applications for demonstration projects in each of the fol22 lowing Service Units to the extent that such applications 

23 are timely filed and meet the criteria specified in sub24 section (d): 

25 ‘‘(1) Cass Lake, Minnesota. 
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1 ‘‘(2) Clinton, Oklahoma. 

2 ‘‘(3) Harlem, Montana. 

3 ‘‘(4) Mescalero, New Mexico. 

4 ‘‘(5) Owyhee, Nevada. 

5 ‘‘(6) Parker, Arizona. 

6 ‘‘(7) Schurz, Nevada. 

7 ‘‘(8) Winnebago, Nebraska. 

8 ‘‘(9) Ft. Yuma, California. 

9 ‘‘(g) TECHNICAL ASSISTANCE.—The Secretary shall 

10 provide such technical and other assistance as may be nec11 essary to enable applicants to comply with the provisions 

12 of this section. 

13 ‘‘(h) SERVICE TO INELIGIBLE PERSONS.—Subject to 

14 section 807, the authority to provide services to persons 

15 otherwise ineligible for the health care benefits of the 

16 Service and the authority to extend hospital privileges in 

17 Service facilities to non-Service health practitioners as 

18 provided in section 807 may be included, subject to the 

19 terms of such section, in any demonstration project ap20 proved pursuant to this section. 

21 ‘‘(i) EQUITABLE TREATMENT.—For purposes of sub22 section (d)(1), the Secretary shall, in evaluating facilities 

23 operated under any contract or compact under the Indian 

24 Self-Determination and Education Assistance Act (25 

25 U.S.C. 450 et seq.), use the same criteria that the Sec-
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•S 1057 IS 

1 retary uses in evaluating facilities operated directly by the 

2 Service. 

3 ‘‘(j) EQUITABLE INTEGRATION OF FACILITIES.—The 

4 Secretary shall ensure that the planning, design, construc5 tion, renovation, and expansion needs of Service and non6 Service facilities which are the subject of a contract or 

7 compact under the Indian Self-Determination and Edu8 cation Assistance Act (25 U.S.C. 450 et seq.) for health 

9 services are fully and equitably integrated into the imple10 mentation of the health care delivery demonstration 

11 projects under this section. 

12 ‘‘SEC. 307. LAND TRANSFER. 

13 ‘‘Notwithstanding any other provision of law, the Bu14 reau of Indian Affairs and all other agencies and depart15 ments of the United States are authorized to transfer, at 

16 no cost, land and improvements to the Service for the pro17 vision of health care services. The Secretary is authorized 

18 to accept such land and improvements for such purposes. 

19 ‘‘SEC. 308. LEASES, CONTRACTS, AND OTHER AGREEMENTS. 

20 ‘‘The Secretary, acting through the Service, may 

21 enter into leases, contracts, and other agreements with In22 dian Tribes and Tribal Organizations which hold (1) title 

23 to, (2) a leasehold interest in, or (3) a beneficial interest 

24 in (when title is held by the United States in trust for 

25 the benefit of an Indian Tribe) facilities used or to be used 
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1 for the administration and delivery of health services by 

2 an Indian Health Program. Such leases, contracts, or 

3 agreements may include provisions for construction or ren4 ovation and provide for compensation to the Indian Tribe 

5 or Tribal Organization of rental and other costs consistent 

6 with section 105(l) of the Indian Self-Determination and 

7 Education Assistance Act and regulations thereunder. 

8 ‘‘SEC. 309. STUDY ON LOANS, LOAN GUARANTEES, AND 

9 LOAN REPAYMENT. 

10 ‘‘(a) IN GENERAL.—The Secretary, in consultation 

11 with the Secretary of the Treasury, Indian Tribes, and 

12 Tribal Organizations, shall carry out a study to determine 

13 the feasibility of establishing a loan fund to provide to In14 dian Tribes and Tribal Organizations direct loans or guar15 antees for loans for the construction of health care facili16 ties, including— 

17 ‘‘(1) inpatient facilities; 

18 ‘‘(2) outpatient facilities; 

19 ‘‘(3) staff quarters; 

20 ‘‘(4) hostels; and 

21 ‘‘(5) specialized care facilities, such as behav22 ioral health and elder care facilities. 

23 ‘‘(b) DETERMINATIONS.—In carrying out the study 

24 under subsection (a), the Secretary shall determine— 
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1 ‘‘(1) the maximum principal amount of a loan 

2 or loan guarantee that should be offered to a recipi3 ent from the loan fund; 

4 ‘‘(2) the percentage of eligible costs, not to ex5 ceed 100 percent, that may be covered by a loan or 

6 loan guarantee from the loan fund (including costs 

7 relating to planning, design, financing, site land de8 velopment, construction, rehabilitation, renovation, 

9 conversion, improvements, medical equipment and 

10 furnishings, and other facility-related costs and cap11 ital purchase (but excluding staffing)); 

12 ‘‘(3) the cumulative total of the principal of di13 rect loans and loan guarantees, respectively, that 

14 may be outstanding at any 1 time; 

15 ‘‘(4) the maximum term of a loan or loan guar16 antee that may be made for a facility from the loan 

17 fund; 

18 ‘‘(5) the maximum percentage of funds from 

19 the loan fund that should be allocated for payment 

20 of costs associated with planning and applying for a 

21 loan or loan guarantee; 

22 ‘‘(6) whether acceptance by the Secretary of an 

23 assignment of the revenue of an Indian Tribe or 

24 Tribal Organization as security for any direct loan 
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•S 1057 IS 

1 or loan guarantee from the loan fund would be ap2 propriate; 

3 ‘‘(7) whether, in the planning and design of 

4 health facilities under this section, users eligible 

5 under section 807(c) may be included in any projec6 tion of patient population; 

7 ‘‘(8) whether funds of the Service provided 

8 through loans or loan guarantees from the loan fund 

9 should be eligible for use in matching other Federal 

10 funds under other programs; 

11 ‘‘(9) the appropriateness of, and best methods 

12 for, coordinating the loan fund with the health care 

13 priority system of the Service under section 301; and 

14 ‘‘(10) any legislative or regulatory changes re15 quired to implement recommendations of the Sec16 retary based on results of the study. 

17 ‘‘(c) REPORT.—Not later than September 30, 2007, 

18 the Secretary shall submit to the Committee on Indian Af19 fairs of the Senate and the Committee on Resources and 

20 the Committee on Energy and Commerce of the House 

21 of Representatives a report that describes— 

22 ‘‘(1) the manner of consultation made as re23 quired by subsection (a); and 
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1 ‘‘(2) the results of the study, including any rec2 ommendations of the Secretary based on results of 

3 the study. 

4 ‘‘SEC. 310. TRIBAL LEASING. 

5 ‘‘A Tribal Health Program may lease permanent 

6 structures for the purpose of providing health care services 

7 without obtaining advance approval in appropriation Acts. 

8 ‘‘SEC. 311. INDIAN HEALTH SERVICE/TRIBAL FACILITIES 

9 JOINT VENTURE PROGRAM. 

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

11 the Service, shall make arrangements with Indian Tribes 

12 and Tribal Organizations to establish joint venture dem13 onstration projects under which an Indian Tribe or Tribal 

14 Organization shall expend tribal, private, or other avail15 able funds, for the acquisition or construction of a health 

16 facility for a minimum of 10 years, under a no-cost lease, 

17 in exchange for agreement by the Service to provide the 

18 equipment, supplies, and staffing for the operation and 

19 maintenance of such a health facility. An Indian Tribe or 

20 Tribal Organization may use tribal funds, private sector, 

21 or other available resources, including loan guarantees, to 

22 fulfill its commitment under a joint venture entered into 

23 under this subsection. An Indian Tribe or Tribal Organi24 zation shall be eligible to establish a joint venture project 

25 if, when it submits a letter of intent, it— 
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1 ‘‘(1) has begun but not completed the process 

2 of acquisition or construction of a health facility to 

3 be used in the joint venture project; or 

4 ‘‘(2) has not begun the process of acquisition or 

5 construction of a health facility for use in the joint 

6 venture project. 

7 ‘‘(b) REQUIREMENTS.—The Secretary shall make 

8 such an arrangement with an Indian Tribe or Tribal Orga9 nization only if— 

10 ‘‘(1) the Secretary first determines that the In11 dian Tribe or Tribal Organization has the adminis12 trative and financial capabilities necessary to com13 plete the timely acquisition or construction of the 

14 relevant health facility; and 

15 ‘‘(2) the Indian Tribe or Tribal Organization 

16 meets the need criteria which shall be developed 

17 through the negotiated rulemaking process provided 

18 for under section 802. 

19 ‘‘(c) CONTINUED OPERATION.—The Secretary shall 

20 negotiate an agreement with the Indian Tribe or Tribal 

21 Organization regarding the continued operation of the fa22 cility at the end of the initial 10 year no-cost lease period. 

23 ‘‘(d) BREACH OF AGREEMENT.—An Indian Tribe or 

24 Tribal Organization that has entered into a written agree25 ment with the Secretary under this section, and that 
165 

•S 1057 IS 

1 breaches or terminates without cause such agreement, 

2 shall be liable to the United States for the amount that 

3 has been paid to the Indian Tribe or Tribal Organization, 

4 or paid to a third party on the Indian Tribe’s or Tribal 

5 Organization’s behalf, under the agreement. The Sec6 retary has the right to recover tangible property (including 

7 supplies) and equipment, less depreciation, and any funds 

8 expended for operations and maintenance under this sec9 tion. The preceding sentence does not apply to any funds 

10 expended for the delivery of health care services, per11 sonnel, or staffing. 

12 ‘‘(e) RECOVERY FOR NONUSE.—An Indian Tribe or 

13 Tribal Organization that has entered into a written agree14 ment with the Secretary under this subsection shall be en15 titled to recover from the United States an amount that 

16 is proportional to the value of such facility if, at any time 

17 within the 10-year term of the agreement, the Service 

18 ceases to use the facility or otherwise breaches the agree19 ment. 

20 ‘‘(f) DEFINITION.—For the purposes of this section, 

21 the term ‘health facility’ or ‘health facilities’ includes 

22 quarters needed to provide housing for staff of the rel23 evant Tribal Health Program. 
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1 ‘‘SEC. 312. LOCATION OF FACILITIES. 

2 ‘‘(a) IN GENERAL.—In all matters involving the reor3 ganization or development of Service facilities or in the 

4 establishment of related employment projects to address 

5 unemployment conditions in economically depressed areas, 

6 the Bureau of Indian Affairs and the Service shall give 

7 priority to locating such facilities and projects on Indian 

8 lands, or lands in Alaska owned by any Alaska Native vil9 lage, or village or regional corporation under the Alaska 

10 Native Claims Settlement Act, or any land allotted to any 

11 Alaska Native, if requested by the Indian owner and the 

12 Indian Tribe with jurisdiction over such lands or other 

13 lands owned or leased by the Indian Tribe or Tribal Orga14 nization. Top priority shall be given to Indian land owned 

15 by 1 or more Indian Tribes. 

16 ‘‘(b) DEFINITION.—For purposes of this section, the 

17 term ‘Indian lands’ means— 

18 ‘‘(1) all lands within the exterior boundaries of 

19 any reservation; and 

20 ‘‘(2) any lands title to which is held in trust by 

21 the United States for the benefit of any Indian 

22 Tribe or individual Indian or held by any Indian 

23 Tribe or individual Indian subject to restriction by 

24 the United States against alienation. 
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•S 1057 IS 

1 ‘‘SEC. 313. MAINTENANCE AND IMPROVEMENT OF HEALTH 

2 CARE FACILITIES. 

3 ‘‘(a) REPORT.—The Secretary shall submit to the 

4 President, for inclusion in the report required to be trans5 mitted to Congress under section 801, a report which iden6 tifies the backlog of maintenance and repair work required 

7 at both Service and tribal health care facilities, including 

8 new health care facilities expected to be in operation in 

9 the next fiscal year. The report shall also identify the need 

10 for renovation and expansion of existing facilities to sup11 port the growth of health care programs. 

12 ‘‘(b) MAINTENANCE OF NEWLY CONSTRUCTED

13 SPACE.—The Secretary, acting through the Service, is au14 thorized to expend maintenance and improvement funds 

15 to support maintenance of newly constructed space only 

16 if such space falls within the approved supportable space 

17 allocation for the Indian Tribe or Tribal Organization. 

18 Supportable space allocation shall be defined through the 

19 negotiated rulemaking process provided for under section 

20 802. 

21 ‘‘(c) REPLACEMENT FACILITIES.—In addition to 

22 using maintenance and improvement funds for renovation, 

23 modernization, and expansion of facilities, an Indian Tribe 

24 or Tribal Organization may use maintenance and improve25 ment funds for construction of a replacement facility if 

26 the costs of renovation of such facility would exceed a 
168 

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1 maximum renovation cost threshold. The maximum ren2 ovation cost threshold shall be determined through the ne3 gotiated rulemaking process provided for under section 

4 802. 

5 ‘‘SEC. 314. TRIBAL MANAGEMENT OF FEDERALLY OWNED 

6 QUARTERS. 

7 ‘‘(a) RENTAL RATES.— 

8 ‘‘(1) ESTABLISHMENT.—Notwithstanding any 

9 other provision of law, a Tribal Health Program 

10 which operates a hospital or other health facility and 

11 the federally owned quarters associated therewith 

12 pursuant to a contract or compact under the Indian 

13 Self-Determination and Education Assistance Act 

14 (25 U.S.C. 450 et seq.) shall have the authority to 

15 establish the rental rates charged to the occupants 

16 of such quarters by providing notice to the Secretary 

17 of its election to exercise such authority. 

18 ‘‘(2) OBJECTIVES.—In establishing rental rates 

19 pursuant to authority of this subsection, a Tribal 

20 Health Program shall endeavor to achieve the fol21 lowing objectives: 

22 ‘‘(A) To base such rental rates on the rea23 sonable value of the quarters to the occupants 

24 thereof. 
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1 ‘‘(B) To generate sufficient funds to pru2 dently provide for the operation and mainte3 nance of the quarters, and subject to the discre4 tion of the Tribal Health Program, to supply 

5 reserve funds for capital repairs and replace6 ment of the quarters. 

7 ‘‘(3) EQUITABLE FUNDING.—Any quarters 

8 whose rental rates are established by a Tribal 

9 Health Program pursuant to this subsection shall 

10 remain eligible for quarters improvement and repair 

11 funds to the same extent as all federally owned 

12 quarters used to house personnel in Services-sup13 ported programs. 

14 ‘‘(4) NOTICE OF RATE CHANGE.—A Tribal 

15 Health Program which exercises the authority pro16 vided under this subsection shall provide occupants 

17 with no less than 60 days notice of any change in 

18 rental rates. 

19 ‘‘(b) DIRECT COLLECTION OF RENT.— 

20 ‘‘(1) IN GENERAL.—Notwithstanding any other 

21 provision of law, and subject to paragraph (2), a 

22 Tribal Health Program shall have the authority to 

23 collect rents directly from Federal employees who oc24 cupy such quarters in accordance with the following: 
170 

•S 1057 IS 

1 ‘‘(A) The Tribal Health Program shall no2 tify the Secretary and the subject Federal em3 ployees of its election to exercise its authority 

4 to collect rents directly from such Federal em5 ployees. 

6 ‘‘(B) Upon receipt of a notice described in 

7 subparagraph (A), the Federal employees shall 

8 pay rents for occupancy of such quarters di9 rectly to the Tribal Health Program and the 

10 Secretary shall have no further authority to col11 lect rents from such employees through payroll 

12 deduction or otherwise. 

13 ‘‘(C) Such rent payments shall be retained 

14 by the Tribal Health Program and shall not be 

15 made payable to or otherwise be deposited with 

16 the United States. 

17 ‘‘(D) Such rent payments shall be depos18 ited into a separate account which shall be used 

19 by the Tribal Health Program for the mainte20 nance (including capital repairs and replace21 ment) and operation of the quarters and facili22 ties as the Tribal Health Program shall deter23 mine. 

24 ‘‘(2) RETROCESSION OF AUTHORITY.—If a 

25 Tribal Health Program which has made an election 
171 

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1 under paragraph (1) requests retrocession of its au2 thority to directly collect rents from Federal employ3 ees occupying federally owned quarters, such ret4 rocession shall become effective on the earlier of— 

5 ‘‘(A) the first day of the month that begins 

6 no less than 180 days after the Tribal Health 

7 Program notifies the Secretary of its desire to 

8 retrocede; or 

9 ‘‘(B) such other date as may be mutually 

10 agreed by the Secretary and the Tribal Health 

11 Program. 

12 ‘‘(c) RATES IN ALASKA.—To the extent that a Tribal 

13 Health Program, pursuant to authority granted in sub14 section (a), establishes rental rates for federally owned 

15 quarters provided to a Federal employee in Alaska, such 

16 rents may be based on the cost of comparable private rent17 al housing in the nearest established community with a 

18 year-round population of 1,500 or more individuals. 

19 ‘‘SEC. 315. APPLICABILITY OF BUY AMERICAN ACT RE20 QUIREMENT. 

21 ‘‘(a) APPLICABILITY.—The Secretary shall ensure 

22 that the requirements of the Buy American Act apply to 

23 all procurements made with funds provided pursuant to 

24 section 317. Indian Tribes and Tribal Organizations shall 

25 be exempt from these requirements. 
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1 ‘‘(b) EFFECT OF VIOLATION.—If it has been finally 

2 determined by a court or Federal agency that any person 

3 intentionally affixed a label bearing a ‘Made in America’ 

4 inscription or any inscription with the same meaning, to 

5 any product sold in or shipped to the United States that 

6 is not made in the United States, such person shall be 

7 ineligible to receive any contract or subcontract made with 

8 funds provided pursuant to section 317, pursuant to the 

9 debarment, suspension, and ineligibility procedures de10 scribed in sections 9.400 through 9.409 of title 48, Code 

11 of Federal Regulations. 

12 ‘‘(c) DEFINITIONS.—For purposes of this section, the 

13 term ‘Buy American Act’ means title III of the Act enti14 tled ‘An Act making appropriations for the Treasury and 

15 Post Office Departments for the fiscal year ending June 

16 30, 1934, and for other purposes’, approved March 3, 

17 1933 (41 U.S.C. 10a et seq.). 

18 ‘‘SEC. 316. OTHER FUNDING FOR FACILITIES. 

19 ‘‘(a) AUTHORITY TO ACCEPT FUNDS.—The Sec20 retary is authorized to accept from any source, including 

21 Federal and State agencies, funds that are available for 

22 the construction of health care facilities and use such 

23 funds to plan, design, and construct health care facilities 

24 for Indians and to place such funds into 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.). Receipt of such 

2 funds shall have no effect on the priorities established pur3 suant to section 301. 

4 ‘‘(b) INTERAGENCY AGREEMENTS.—The Secretary is 

5 authorized to enter into interagency agreements with 

6 other Federal agencies or State agencies and other entities 

7 and to accept funds from such Federal or State agencies 

8 or other sources to provide for the planning, design, and 

9 construction of health care facilities to be administered by 

10 Indian Health Programs in order to carry out the pur11 poses of this Act and the purposes for which the funds 

12 were appropriated or for which the funds were otherwise 

13 provided. 

14 ‘‘(c) TRANSFERRED FUNDS.—Any Federal agency to 

15 which funds for the construction of health care facilities 

16 are appropriated is authorized to transfer such funds to 

17 the Secretary for the construction of health care facilities 

18 to carry out the purposes of this Act as well as the pur19 poses for which such funds are appropriated to such other 

20 Federal agency. 

21 ‘‘(d) ESTABLISHMENT OF STANDARDS.—The Sec22 retary, through the Service, shall establish standards by 

23 regulation, developed by rulemaking under section 802, for 

24 the planning, design, and construction of health care fa25 cilities serving Indians under this Act. 
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1 ‘‘SEC. 317. AUTHORIZATION OF APPROPRIATIONS. 

2 ‘‘There are authorized to be appropriated such sums 

3 as may be necessary for each fiscal year through fiscal 

4 year 2015 to carry out this title. 

5 ‘‘TITLE IV—ACCESS TO HEALTH 

6 SERVICES 

7 ‘‘SEC. 401. TREATMENT OF PAYMENTS UNDER SOCIAL SE8 CURITY ACT HEALTH CARE PROGRAMS. 

9 ‘‘(a) DISREGARD OF MEDICARE, MEDICAID, AND

10 SCHIP PAYMENTS IN DETERMINING APPROPRIATIONS.— 

11 Any payments received by an Indian Health Program or 

12 by an Urban Indian Organization made under title XVIII, 

13 XIX, or XXI of the Social Security Act for services pro14 vided to Indians eligible for benefits under such respective 

15 titles shall not be considered in determining appropria16 tions for the provision of health care and services to Indi17 ans. 

18 ‘‘(b) NONPREFERENTIAL TREATMENT.—Nothing in 

19 this Act authorizes the Secretary to provide services to an 

20 Indian with coverage under title XVIII, XIX, or XXI of 

21 the Social Security Act in preference to an Indian without 

22 such coverage. 

23 ‘‘(c) USE OF FUNDS.— 

24 ‘‘(1) SPECIAL FUND.—Notwithstanding any 

25 other provision of law, but subject to paragraph (2), 

26 payments to which a facility of the Service is enti-
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1 tled by reason of a provision of the Social Security 

2 Act shall be placed in a special fund to be held by 

3 the Secretary and first used (to such extent or in 

4 such amounts as are provided in appropriation Acts) 

5 for the purpose of making any improvements in the 

6 programs of the Service which may be necessary to 

7 achieve or maintain compliance with the applicable 

8 conditions and requirements of titles XVIII, XIX, 

9 and XXI of the Social Security Act. Any amounts to 

10 be reimbursed that are in excess of the amount nec11 essary to achieve or maintain such conditions and 

12 requirements shall, subject to the consultation with 

13 Indian Tribes being served by the Service Unit, be 

14 used for reducing the health resource deficiencies of 

15 the Indian Tribes. In making payments from such 

16 fund, the Secretary shall ensure that each Service 

17 Unit of the Service receives 100 percent of the 

18 amount to which the facilities of the Service, for 

19 which such Service Unit makes collections, are enti20 tled by reason of a provision of the Social Security 

21 Act. 

22 ‘‘(2) DIRECT PAYMENT OPTION.—Paragraph 

23 (1) shall not apply upon the election of a Tribal 

24 Health Program under subsection (d) to receive pay25 ments directly. No payment may be made out of the 
176 

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1 special fund described in such paragraph with re2 spect to reimbursement made for services provided 

3 during the period of such election. 

4 ‘‘(d) DIRECT BILLING.— 

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

6 may directly bill for, and receive payment for, health 

7 care items and services provided by such Indian 

8 Tribe or Tribal organization for which payment is 

9 made under title XVIII, XIX, or XXI of the Social 

10 Security Act or from any other third party payor. 

11 ‘‘(2) DIRECT REIMBURSEMENT.— 

12 ‘‘(A) USE OF FUNDS.—Each Tribal Health 

13 Program exercising the option described in 

14 paragraph (1) with respect to a program under 

15 a title of the Social Security Act shall be reim16 bursed directly by that program for items and 

17 services furnished without regard to section 

18 401(c), but all amounts so reimbursed shall be 

19 used by the Tribal Health Program for the pur20 pose of making any improvements in Tribal fa21 cilities or Tribal Health Programs that may be 

22 necessary to achieve or maintain compliance 

23 with the conditions and requirements applicable 

24 generally to such items and services under the 

25 program under such title and to provide addi-
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1 tional health care services, improvements in 

2 health care facilities and Tribal Health Pro3 grams, any health care-related purpose, or oth4 erwise to achieve the objectives provided in sec5 tion 3 of this Act. 

6 ‘‘(B) AUDITS.—The amounts paid to an 

7 Indian Tribe or Tribal Organization exercising 

8 the option described in paragraph (1) with re9 spect to a program under a title of the Social 

10 Security Act shall be subject to all auditing re11 quirements applicable to programs administered 

12 by an Indian Health Program. 

13 ‘‘(C) IDENTIFICATION OF SOURCE OF PAY14 MENTS.—If an Indian Tribe or Tribal Organi15 zation receives funding from the Service under 

16 the Indian Self-Determination and Education 

17 Assistance Act or an Urban Indian Organiza18 tion receives funding from the Service under 

19 title V of this Act and receives reimbursements 

20 or payments under title XVIII, XIX, or XXI of 

21 the Social Security Act, such Indian Tribe or 

22 Tribal Organization, or Urban Indian Organiza23 tion, shall provide to the Service a list of each 

24 provider enrollment number (or other identifier) 
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1 under which it receives such reimbursements or 

2 payments. 

3 ‘‘(3) EXAMINATION AND IMPLEMENTATION OF

4 CHANGES.—The Secretary, acting through the Serv5 ice and with the assistance of the Administrator of 

6 the Centers for Medicare & Medicaid Services, shall 

7 examine on an ongoing basis and implement any ad8 ministrative changes that may be necessary to facili9 tate direct billing and reimbursement under the pro10 gram established under this subsection, including 

11 any agreements with States that may be necessary 

12 to provide for direct billing under a program under 

13 a title of the Social Security Act. 

14 ‘‘(4) WITHDRAWAL FROM PROGRAM.—A Tribal 

15 Health Program that bills directly under the pro16 gram established under this subsection may with17 draw from participation in the same manner and 

18 under the same conditions that an Indian Tribe or 

19 Tribal Organization may retrocede a contracted pro20 gram to the Secretary under the authority of the In21 dian Self-Determination and Education Assistance 

22 Act (25 U.S.C. 450 et seq.). All cost accounting and 

23 billing authority under the program established 

24 under this subsection shall be returned to the Sec-
179 

•S 1057 IS 

1 retary upon the Secretary’s acceptance of the with2 drawal of participation in this program. 

3 ‘‘SEC. 402. GRANTS TO AND CONTRACTS WITH THE SERV4 ICE, INDIAN TRIBES, TRIBAL ORGANIZA5 TIONS, AND URBAN INDIAN ORGANIZATIONS. 

6 ‘‘(a) INDIAN TRIBES AND TRIBAL ORGANIZA7 TIONS.—The Secretary, acting through the Service, shall 

8 make grants to or enter into contracts with Indian Tribes 

9 and Tribal Organizations to assist such Tribes and Tribal 

10 Organizations in establishing and administering programs 

11 on or near reservations and trust lands to assist individual 

12 Indians— 

13 ‘‘(1) to enroll for benefits under title XVIII, 

14 XIX, or XXI of the Social Security Act and other 

15 health benefits programs; and 

16 ‘‘(2) to pay premiums for coverage for such 

17 benefits, which may be based on financial need (as 

18 determined by the Indian Tribe or Tribes being 

19 served based on a schedule of income levels devel20 oped or implemented by such Tribe or Tribes). 

21 ‘‘(b) CONDITIONS.—The Secretary, acting through 

22 the Service, shall place conditions as deemed necessary to 

23 effect the purpose of this section in any grant or contract 

24 which the Secretary makes with any Indian Tribe or Trib25 al Organization pursuant to this section. Such conditions 
180 

•S 1057 IS 

1 shall include requirements that the Indian Tribe or Tribal 

2 Organization successfully undertake— 

3 ‘‘(1) to determine the population of Indians eli4 gible for the benefits described in subsection (a); 

5 ‘‘(2) to educate Indians with respect to the ben6 efits available under the respective programs; 

7 ‘‘(3) to provide transportation for such indi8 vidual Indians to the appropriate offices for enroll9 ment or applications for such benefits; and 

10 ‘‘(4) to develop and implement methods of im11 proving the participation of Indians in receiving the 

12 benefits provided under titles XVIII, XIX, and XXI 

13 of the Social Security Act. 

14 ‘‘(c) AGREEMENTS RELATING TO IMPROVING EN15 ROLLMENT OF INDIANS UNDER SOCIAL SECURITY ACT

16 PROGRAMS.— 

17 ‘‘(1) AGREEMENTS WITH SECRETARY TO IM18 PROVE RECEIPT AND PROCESSING OF APPLICA19 TIONS.— 

20 ‘‘(A) AUTHORIZATION.—The Secretary, 

21 acting through the Service, may enter into an 

22 agreement with an Indian Tribe, Tribal Organi23 zation, or Urban Indian Organization which 

24 provides for the receipt and processing of appli25 cations by Indians for assistance under titles 
181 

•S 1057 IS 

1 XIX and XXI of the Social Security Act, and 

2 benefits under title XVIII of such Act, by an 

3 Indian Health Program or Urban Indian Orga4 nization. 

5 ‘‘(B) REIMBURSEMENT OF COSTS.—Such 

6 agreements may provide for reimbursement of 

7 costs of outreach, education regarding eligibility 

8 and benefits, and translation when such services 

9 are provided. The reimbursement may, as ap10 propriate, be added to the applicable rate per 

11 encounter or be provided as a separate fee-for12 service payment to the Indian Tribe or Tribal 

13 Organization. 

14 ‘‘(C) PROCESSING CLARIFIED.—In this 

15 paragraph, the term ‘processing’ does not in16 clude a final determination of eligibility. 

17 ‘‘(2) AGREEMENTS WITH STATES FOR OUT18 REACH ON OR NEAR RESERVATION.— 

19 ‘‘(A) IN GENERAL.—In order to improve 

20 the access of Indians residing on or near a res21 ervation to obtain benefits under title XIX or 

22 XXI of the Social Security Act, the Secretary 

23 shall encourage the State to take steps to pro24 vide for enrollment on or near the reservation. 

25 Such steps may include outreach efforts such as 
182 

•S 1057 IS 

1 the outstationing of eligibility workers, entering 

2 into agreements with Indian Tribes and Tribal 

3 Organizations to provide outreach, education re4 garding eligibility and benefits, enrollment, and 

5 translation services when such services are pro6 vided. 

7 ‘‘(B) CONSTRUCTION.—Nothing in sub8 paragraph (A) shall be construed as affecting 

9 arrangements entered into between States and 

10 Indian Tribes and Tribal Organizations for 

11 such Indian Tribes and Tribal Organizations to 

12 conduct administrative activities under such ti13 tles. 

14 ‘‘(d) FACILITATING COOPERATION.—The Secretary, 

15 acting through the Centers for Medicare & Medicaid Serv16 ices, shall take such steps as are necessary to facilitate 

17 cooperation with, and agreements between, States and the 

18 Service, Indian Tribes, Tribal Organizations, or Urban In19 dian Organizations. 

20 ‘‘(e) APPLICATION TO URBAN INDIAN ORGANIZA21 TIONS.— 

22 ‘‘(1) IN GENERAL.—The provisions of sub23 section (a) shall apply with respect to grants and 

24 other funding to Urban Indian Organizations with 

25 respect to populations served by such organizations 
183 

•S 1057 IS 

1 in the same manner they apply to grants and con2 tracts with Indian Tribes and Tribal Organizations 

3 with respect to programs on or near reservations. 

4 ‘‘(2) REQUIREMENTS.—The Secretary shall in5 clude in the grants or contracts made or provided 

6 under paragraph (1) requirements that are— 

7 ‘‘(A) consistent with the requirements im8 posed by the Secretary under subsection (b); 

9 ‘‘(B) appropriate to Urban Indian Organi10 zations and Urban Indians; and 

11 ‘‘(C) necessary to effect the purposes of 

12 this section. 

13 ‘‘SEC. 403. REIMBURSEMENT FROM CERTAIN THIRD PAR14 TIES OF COSTS OF HEALTH SERVICES. 

15 ‘‘(a) RIGHT OF RECOVERY.—Except as provided in 

16 subsection (f), the United States, an Indian Tribe, or 

17 Tribal Organization shall have the right to recover from 

18 an insurance company, health maintenance organization, 

19 employee benefit plan, third-party tortfeasor, or any other 

20 responsible or liable third party (including a political sub21 division or local governmental entity of a State) the rea22 sonable charges as determined by the Secretary, and billed 

23 by the Secretary, an Indian Tribe, or Tribal Organization, 

24 in providing health services, through the Service, an In25 dian Tribe, or Tribal Organization to any individual to the 
184 

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1 same extent that such individual, or any nongovernmental 

2 provider of such services, would be eligible to receive dam3 ages, reimbursement, or indemnification for such charges 

4 or expenses if— 

5 ‘‘(1) such services had been provided by a non6 governmental provider; and 

7 ‘‘(2) such individual had been required to pay 

8 such charges or expenses and did pay such charges 

9 or expenses. 

10 ‘‘(b) LIMITATIONS ON RECOVERIES FROM STATES.— 

11 Subsection (a) shall provide a right of recovery against 

12 any State, only if the injury, illness, or disability for which 

13 health services were provided is covered under— 

14 ‘‘(1) workers’ compensation laws; or 

15 ‘‘(2) a no-fault automobile accident insurance 

16 plan or program. 

17 ‘‘(c) NONAPPLICATION OF OTHER LAWS.—No law of 

18 any State, or of any political subdivision of a State and 

19 no provision of any contract, insurance or health mainte20 nance organization policy, employee benefit plan, self-in21 surance plan, managed care plan, or other health care plan 

22 or program entered into or renewed after the date of the 

23 enactment of the Indian Health Care Amendments of 

24 1988, shall prevent or hinder the right of recovery of the 
185 

•S 1057 IS 

1 United States, an Indian Tribe, or Tribal Organization 

2 under subsection (a). 

3 ‘‘(d) NO EFFECT ON PRIVATE RIGHTS OF ACTION.— 

4 No action taken by the United States, an Indian Tribe, 

5 or Tribal Organization to enforce the right of recovery 

6 provided under this section shall operate to deny to the 

7 injured person the recovery for that portion of the person’s 

8 damage not covered hereunder. 

9 ‘‘(e) ENFORCEMENT.— 

10 ‘‘(1) IN GENERAL.—The United States, an In11 dian Tribe, or Tribal Organization may enforce the 

12 right of recovery provided under subsection (a) by— 

13 ‘‘(A) intervening or joining in any civil ac14 tion or proceeding brought— 

15 ‘‘(i) by the individual for whom health 

16 services were provided by the Secretary, an 

17 Indian Tribe, or Tribal Organization; or 

18 ‘‘(ii) by any representative or heirs of 

19 such individual, or 

20 ‘‘(B) instituting a civil action, including a 

21 civil action for injunctive relief and other relief 

22 and including, with respect to a political sub23 division or local governmental entity of a State, 

24 such an action against an official thereof. 
186 

•S 1057 IS 

1 ‘‘(2) NOTICE.—All reasonable efforts shall be 

2 made to provide notice of action instituted under 

3 paragraph (1)(B) to the individual to whom health 

4 services were provided, either before or during the 

5 pendency of such action. 

6 ‘‘(f) LIMITATION.—Absent specific written authoriza7 tion by the governing body of an Indian Tribe for the pe8 riod of such authorization (which may not be for a period 

9 of more than 1 year and which may be revoked at any 

10 time upon written notice by the governing body to the 

11 Service), the United States shall not have a right of recov12 ery under this section if the injury, illness, or disability 

13 for which health services were provided is covered under 

14 a self-insurance plan funded by an Indian Tribe, Tribal 

15 Organization, or Urban Indian Organization. Where such 

16 authorization is provided, the Service may receive and ex17 pend such amounts for the provision of additional health 

18 services consistent with such authorization. 

19 ‘‘(g) COSTS AND ATTORNEYS’ FEES.—In any action 

20 brought to enforce the provisions of this section, a pre21 vailing plaintiff shall be awarded its reasonable attorneys’ 

22 fees and costs of litigation. 

23 ‘‘(h) NONAPPLICATION OF CLAIMS FILING REQUIRE24 MENTS.—An insurance company, health maintenance or25 ganization, self-insurance plan, managed care plan, or 
187 

•S 1057 IS 

1 other health care plan or program (under the Social Secu2 rity Act or otherwise) may not deny a claim for benefits 

3 submitted by the Service or by an Indian Tribe or Tribal 

4 Organization based on the format in which the claim is 

5 submitted if such format complies with the format re6 quired for submission of claims under title XVIII of the 

7 Social Security Act or recognized under section 1175 of 

8 such Act. 

9 ‘‘(i) APPLICATION TO URBAN INDIAN ORGANIZA10 TIONS.—The previous provisions of this section shall apply 

11 to Urban Indian Organizations with respect to populations 

12 served by such Organizations in the same manner they 

13 apply to Indian Tribes and Tribal Organizations with re14 spect to populations served by such Indian Tribes and 

15 Tribal Organizations. 

16 ‘‘(j) STATUTE OF LIMITATIONS.—The provisions of 

17 section 2415 of title 28, United States Code, shall apply 

18 to all actions commenced under this section, and the ref19 erences therein to the United States are deemed to include 

20 Indian Tribes, Tribal Organizations, and Urban Indian 

21 Organizations. 

22 ‘‘(k) SAVINGS.—Nothing in this section shall be con23 strued to limit any right of recovery available to the 

24 United States, an Indian Tribe, or Tribal Organization 

25 under the provisions of any applicable, Federal, State, or 
188 

•S 1057 IS 

1 Tribal law, including medical lien laws and the Federal 

2 Medical Care Recovery Act (42 U.S.C. 2651 et seq.). 

3 ‘‘SEC. 404. CREDITING OF REIMBURSEMENTS. 

4 ‘‘(a) USE OF AMOUNTS.— 

5 ‘‘(1) RETENTION BY PROGRAM.—Except as pro6 vided in section 202(g) (relating to the Catastrophic 

7 Health Emergency Fund) and section 807 (relating 

8 to health services for ineligible persons), all reim9 bursements received or recovered under any of the 

10 programs described in paragraph (2), including 

11 under section 807, by reason of the provision of 

12 health services by the Service, by an Indian Tribe or 

13 Tribal Organization, or by an Urban Indian Organi14 zation, shall be credited to the Service, such Indian 

15 Tribe or Tribal Organization, or such Urban Indian 

16 Organization, respectively, and may be used as pro17 vided in section 401. In the case of such a service 

18 provided by or through a Service Unit, such 

19 amounts shall be credited to such unit and used for 

20 such purposes. 

21 ‘‘(2) PROGRAMS COVERED.—The programs re22 ferred to in paragraph (1) are the following: 

23 ‘‘(A) Titles XVIII, XIX, and XXI of the 

24 Social Security Act. 

25 ‘‘(B) This Act, including section 807. 
189 

•S 1057 IS 

1 ‘‘(C) Public Law 87–693. 

2 ‘‘(D) Any other provision of law. 

3 ‘‘(b) NO OFFSET OF AMOUNTS.—The Service may 

4 not offset or limit any amount obligated to any Service 

5 Unit or entity receiving funding from the Service because 

6 of the receipt of reimbursements under subsection (a). 

7 ‘‘SEC. 405. PURCHASING HEALTH CARE COVERAGE. 

8 ‘‘(a) IN GENERAL.—Insofar as amounts are made 

9 available under law (including a provision of the Social 

10 Security Act, the Indian Self-Determination and Edu11 cation Assistance Act, or other law, other than under sec12 tion 402) to Indian Tribes, Tribal Organizations, and 

13 Urban Indian Organizations for health benefits for Service 

14 beneficiaries, Indian Tribes, Tribal Organizations, and 

15 Urban Indian Organizations may use such amounts to 

16 purchase health benefits coverage for such beneficiaries in 

17 any manner, including through— 

18 ‘‘(1) a tribally owned and operated health care 

19 plan; 

20 ‘‘(2) a State or locally authorized or licensed 

21 health care plan; 

22 ‘‘(3) a health insurance provider or managed 

23 care organization; or 

24 ‘‘(4) a self-insured plan. 
190 

•S 1057 IS 

1 The purchase of such coverage by an Indian Tribe, Tribal 

2 Organization, or Urban Indian Organization may be based 

3 on the financial needs of such beneficiaries (as determined 

4 by the Indian Tribe or Tribes being served based on a 

5 schedule of income levels developed or implemented by 

6 such Indian Tribe or Tribes). 

7 ‘‘(b) EXPENSES FOR SELF-INSURED PLAN.—In the 

8 case of a self-insured plan under subsection (a)(4), the 

9 amounts may be used for expenses of operating the plan, 

10 including administration and insurance to limit the finan11 cial risks to the entity offering the plan. 

12 ‘‘(c) CONSTRUCTION.—Nothing in this section shall 

13 be construed as affecting the use of any amounts not re14 ferred to in subsection (a). 

15 ‘‘SEC. 406. SHARING ARRANGEMENTS WITH FEDERAL AGEN16 CIES. 

17 ‘‘(a) AUTHORITY.— 

18 ‘‘(1) IN GENERAL.—The Secretary may enter 

19 into (or expand) arrangements for the sharing of 

20 medical facilities and services between the Service, 

21 Indian Tribes, and Tribal Organizations and the De22 partment of Veterans Affairs and the Department of 

23 Defense. 

24 ‘‘(2) CONSULTATION BY SECRETARY RE25 QUIRED.—The Secretary may not finalize any ar-
191 

•S 1057 IS 

1 rangement between the Service and a Department 

2 described in paragraph (1) without first consulting 

3 with the Indian Tribes which will be significantly af4 fected by the arrangement. 

5 ‘‘(b) LIMITATIONS.—The Secretary shall not take 

6 any action under this section or under subchapter IV of 

7 chapter 81 of title 38, United States Code, which would 

8 impair— 

9 ‘‘(1) the priority access of any Indian to health 

10 care services provided through the Service and the 

11 eligibility of any Indian to receive health services 

12 through the Service; 

13 ‘‘(2) the quality of health care services provided 

14 to any Indian through the Service; 

15 ‘‘(3) the priority access of any veteran to health 

16 care services provided by the Department of Vet17 erans Affairs; 

18 ‘‘(4) the quality of health care services provided 

19 by the Department of Veterans Affairs or the De20 partment of Defense; or 

21 ‘‘(5) the eligibility of any Indian who is a vet22 eran to receive health services through the Depart23 ment of Veterans Affairs. 

24 ‘‘(c) REIMBURSEMENT.—The Service, Indian Tribe, 

25 or Tribal Organization shall be reimbursed by the Depart-
192 

•S 1057 IS 

1 ment of Veterans Affairs or the Department of Defense 

2 (as the case may be) where services are provided through 

3 the Service, an Indian Tribe, or a Tribal Organization to 

4 beneficiaries eligible for services from either such Depart5 ment, notwithstanding any other provision of law. 

6 ‘‘(d) CONSTRUCTION.—Nothing in this section may 

7 be construed as creating any right of a non-Indian veteran 

8 to obtain health services from the Service. 

9 ‘‘SEC. 407. PAYOR OF LAST RESORT. 

10 ‘‘Indian Health Programs and health care programs 

11 operated by Urban Indian Organizations shall be the 

12 payor of last resort for services provided to persons eligible 

13 for services from Indian Health Programs and Urban In14 dian Organizations, notwithstanding any Federal, State, 

15 or local law to the contrary. 

16 ‘‘SEC. 408. NONDISCRIMINATION IN QUALIFICATIONS FOR 

17 REIMBURSEMENT FOR SERVICES. 

18 ‘‘For purposes of determining the eligibility of an en19 tity that is operated by the Service, an Indian Tribe, Trib20 al Organization, or Urban Indian Organization to receive 

21 payment or reimbursement from any federally funded 

22 health care program for health care services it furnishes 

23 to an Indian. Such program must provide that such entity, 

24 meeting generally applicable State or other requirements 

25 applicable for participation, must be accepted as a pro-
193 

•S 1057 IS 

1 vider on the same basis as any other qualified provider, 

2 except that any requirement that the entity be licensed 

3 or recognized under State or local law to furnish such 

4 services shall be deemed to have been met if the entity 

5 meets all the applicable standards for such licensure, but 

6 the entity need not obtain a license or other documenta7 tion. In determining whether the entity meets such stand8 ards, the absence of licensure of any staff member of the 

9 entity may not be taken into account. 

10 ‘‘SEC. 409. CONSULTATION. 

11 ‘‘(a) TRIBAL TECHNICAL ADVISORY GROUP

12 (TTAG).—The Secretary shall maintain within the Cen13 ters for Medicaid & Medicare Services (CMS) a Tribal 

14 Technical Advisory Group, established in accordance with 

15 requirements of the charter dated September 30, 2003, 

16 and in such group shall include a representative of the 

17 Urban Indian Organizations and the Service. The rep18 resentative of the Urban Indian Organization shall be 

19 deemed to be an elected officer of a tribal government for 

20 purposes of applying section 204(b) of the Unfunded Man21 dates Reform Act of 1995 (2 U.S.C. 1534(b)). 

22 ‘‘(b) SOLICITATION OF MEDICAID ADVICE.— 

23 ‘‘(1) IN GENERAL.—As part of its plan under 

24 title XIX of the Social Security Act, a State in 

25 which the Service operates or funds health care pro-
194 

•S 1057 IS 

1 grams, or in which 1 or more Indian Health Pro2 grams or Urban Indian Organizations provide health 

3 care in the State for which medical assistance is 

4 available under such title, may establish a process 

5 under which the State seeks advice on a regular, on6 going basis from designees of such Indian Health 

7 Programs and Urban Indian Organizations on mat8 ters relating to the application of such title to and 

9 likely to have a direct effect on such Indian Health 

10 Programs and Urban Indian Organizations. 

11 ‘‘(2) MANNER OF ADVICE.—The process de12 scribed in paragraph (1) should include solicitation 

13 of advice prior to submission of any plan amend14 ments, waiver requests, and proposals for dem15 onstration projects likely to have a direct effect on 

16 Indians, Indian Health Programs, or Urban Indian 

17 Organizations. Such process may include appoint18 ment of an advisory committee and of a designee of 

19 such Indian Health Programs and Urban Indian Or20 ganizations to the medical care advisory committee 

21 advising the State on its medicaid plan. 

22 ‘‘(3) PAYMENT OF EXPENSES.—The reasonable 

23 expenses of carrying out this subsection shall be eli24 gible for reimbursement under section 1903(a) of 

25 the Social Security Act. 
195 

•S 1057 IS 

1 ‘‘(c) CONSTRUCTION.—Nothing in this section shall 

2 be construed as superseding existing advisory committees, 

3 working groups, or other advisory procedures established 

4 by the Secretary or by any State. 

5 ‘‘SEC. 410. STATE CHILDREN’S HEALTH INSURANCE PRO6 GRAM (SCHIP). 

7 ‘‘(a) OPTIONAL USE OF FUNDS FOR INDIAN HEALTH

8 PROGRAM PAYMENTS.—Subject to the succeeding provi9 sions of this section, a State may provide under its State 

10 child health plan under title XXI of the Social Security 

11 Act (regardless of whether such plan is implemented under 

12 such title, title XIX of such Act, or both) for payments 

13 under this section to Indian Health Programs and Urban 

14 Indian Organizations operating in the State. Such pay15 ments shall be treated under title XXI of the Social Secu16 rity Act as expenditures described in section 

17 2105(a)(1)(A) of such Act. 

18 ‘‘(b) USE OF FUNDS.—Payments under this section 

19 may be used only for expenditures described in clauses (i) 

20 through (iii) of section 2105(a)(1)(D) of the Social Secu21 rity Act for targeted low-income children or other low-in22 come children (as defined in 2110 of such Act) who are— 

23 ‘‘(1) Indians; or 

24 ‘‘(2) otherwise eligible for health services from 

25 the Indian Health Program involved. 
196 

•S 1057 IS 

1 ‘‘(c) SPECIAL RESTRICTIONS.—The following condi2 tions apply to a State electing to provide payments under 

3 this section: 

4 ‘‘(1) NO LIMITATION ON OTHER SCHIP PARTICI5 PATION OF, OR PROVIDER PAYMENTS TO, INDIAN

6 HEALTH PROGRAMS.—The State may not exclude or 

7 limit participation of otherwise eligible Indian 

8 Health Programs in its State child health program 

9 under title XXI of the Social Security Act or its 

10 medicaid program under title XIX of such Act or 

11 pay such Programs less than they otherwise would 

12 as participating providers on the basis that pay13 ments are made to such Programs under this sec14 tion. 

15 ‘‘(2) NO LIMITATION ON OTHER SCHIP ELIGI16 BILITY OF INDIANS.—The State may not exclude or 

17 limit participation of otherwise eligible Indian chil18 dren in such State child health or medicaid program 

19 on the basis that payments are made for assistance 

20 for such children under this section. 

21 ‘‘(3) LIMITATION ON ACCEPTANCE OF CON22 TRIBUTIONS.— 

23 ‘‘(A) IN GENERAL.—The State may not ac24 cept contributions or condition making of pay25 ments under this section upon contribution of 
197 

•S 1057 IS 

1 funds from any Indian Health Program to meet 

2 the State’s non-Federal matching fund require3 ments under titles XIX and XXI of the Social 

4 Security Act. 

5 ‘‘(B) CONTRIBUTION DEFINED.—For pur6 poses of subparagraph (A), the term ‘contribu7 tion’ includes any tax, donation, fee, or other 

8 payment made, whether made voluntarily or in9 voluntarily. 

10 ‘‘(d) APPLICATION OF SEPARATE 10 PERCENT LIMI11 TATION.—Payment may be made under section 2105(a) 

12 of the Social Security Act to a State for a fiscal year for 

13 payments under this section up to an amount equal to 10 

14 percent of the total amount available under title XXI of 

15 such Act (including allotments and reallotments available 

16 from previous fiscal years) to the State with respect to 

17 the fiscal year. 

18 ‘‘(e) GENERAL TERMS.—A payment under this sec19 tion shall only be made upon application to the State from 

20 the Indian Health Program involved and under such terms 

21 and conditions, and in a form and manner, as the Sec22 retary determines appropriate. 

23 ‘‘SEC. 411. SOCIAL SECURITY ACT SANCTIONS. 

24 ‘‘(a) REQUESTS FOR WAIVER OF SANCTIONS.— 
198 

•S 1057 IS 

1 ‘‘(1) IN GENERAL.—For purposes of applying 

2 any authority under a provision of title XI, XVIII, 

3 XIX, or XXI of the Social Security Act to seek a 

4 waiver of a sanction imposed against a health care 

5 provider insofar as that provider provides services to 

6 individuals through an Indian Health Program, the 

7 Indian Health Program shall request the State to 

8 seek such waiver, and if such State has not sought 

9 the waiver within 60 days of the Indian Health Pro10 gram request, the Indian Health Program itself may 

11 petition the Secretary for such waiver. 

12 ‘‘(2) PROCEDURE.—In seeking a waiver under 

13 paragraph (1), the Indian Health Program must 

14 provide notice and a copy of the request, including 

15 the reasons for the waiver sought, to the State. The 

16 Secretary may consider the State’s views in the de17 termination of the waiver request, but may not with18 hold or delay a determination based on the lack of 

19 the State’s views. 

20 ‘‘(b) SAFE HARBOR FOR TRANSACTIONS BETWEEN

21 AND AMONG INDIAN HEALTH CARE PROGRAMS.—For 

22 purposes of applying section 1128B(b) of the Social Secu23 rity Act, the exchange of anything of value between or 

24 among the following shall not be treated as remuneration 
199 

•S 1057 IS 

1 if the exchange arises from or relates to any of the fol2 lowing health programs: 

3 ‘‘(1) An exchange between or among the fol4 lowing: 

5 ‘‘(A) Any Indian Health Program. 

6 ‘‘(B) Any Urban Indian Organization. 

7 ‘‘(2) An exchange between an Indian Tribe, 

8 Tribal Organization, or an Urban Indian Organiza9 tion and any patient served or eligible for service 

10 from an Indian Tribe, Tribal Organization, or 

11 Urban Indian Organization, including patients 

12 served or eligible for service pursuant to section 807, 

13 but only if such exchange— 

14 ‘‘(A) is for the purpose of transporting the 

15 patient for the provision of health care items or 

16 services; 

17 ‘‘(B) is for the purpose of providing hous18 ing to the patient (including a pregnant pa19 tient) and immediate family members or an es20 cort incidental to assuring the timely provision 

21 of health care items and services to the patient; 

22 ‘‘(C) is for the purpose of paying pre23 miums, copayments, deductibles, or other cost24 sharing on behalf of patients; or 
200 

•S 1057 IS 

1 ‘‘(D) consists of an item or service of small 

2 value that is provided as a reasonable incentive 

3 to secure timely and necessary preventive and 

4 other items and services. 

5 ‘‘(3) Other exchanges involving an Indian 

6 Health Program, an Urban Indian Organization, or 

7 an Indian Tribe or Tribal Organization that meet 

8 such standards as the Secretary of Health and 

9 Human Services, in consultation with the Attorney 

10 General, determines is appropriate, taking into ac11 count the special circumstances of such Indian 

12 Health Programs, Urban Indian Organizations, In13 dian Tribes, and Tribal Organizations and of pa14 tients served by Indian Health Programs, Urban In15 dian Organizations, Indian Tribes, and Tribal Orga16 nizations. 

17 ‘‘SEC. 412. COST SHARING. 

18 ‘‘(a) COINSURANCE, COPAYMENTS, AND

19 DEDUCTIBLES.—Notwithstanding any other provision of 

20 Federal or State law— 

21 ‘‘(1) PROTECTION FOR ELIGIBLE INDIANS

22 UNDER SOCIAL SECURITY ACT HEALTH PRO23 GRAMS.—No Indian who is furnished an item or 

24 service for which payment may be made under title 
201 

•S 1057 IS 

1 XIX or XXI of the Social Security Act may be 

2 charged a deductible, copayment, or coinsurance. 

3 ‘‘(2) PROTECTION FOR INDIANS.—No Indian 

4 who is furnished an item or service by the Service 

5 may be charged a deductible, copayment, or coinsur6 ance. 

7 ‘‘(3) NO REDUCTION IN AMOUNT OF PAYMENT

8 TO INDIAN HEALTH PROVIDERS.—The payment or 

9 reimbursement due to the Service, Indian Tribe, 

10 Tribal Organization, or Urban Indian Organization 

11 under title XIX or XXI of the Social Security Act 

12 may not be reduced by the amount of the deductible, 

13 copayment, or coinsurance that would be due from 

14 the Indian but for the operation of this section. 

15 ‘‘(b) EXEMPTION FROM MEDICAID AND SCHIP PRE16 MIUMS.—Notwithstanding any other provision of Federal 

17 or State law, no Indian who is otherwise eligible for serv18 ices under title XIX of the Social Security Act (relating 

19 to the medicaid program) or title XXI of such Act (relat20 ing to the State children’s health insurance program) may 

21 be charged a premium, enrollment fee, or similar charge 

22 as a condition of receiving benefits under the program 

23 under the respective title. 

24 ‘‘(c) TREATMENT OF CERTAIN PROPERTY FOR MED25 ICAID ELIGIBILITY.—Notwithstanding any other provision 
202 

•S 1057 IS 

1 of Federal or State law, the following property may not 

2 be included when determining eligibility for services under 

3 title XIX of the Social Security Act: 

4 ‘‘(1) Property, including real property and im5 provements, located on a reservation, including any 

6 federally recognized Indian Tribe’s reservation, 

7 Pueblo, or Colony, including former reservations in 

8 Oklahoma, Alaska Native regions established by the 

9 Alaska Native Claims Settlement Act and Indian al10 lotments on or near a reservation as designated and 

11 approved by the Bureau of Indian Affairs of the De12 partment of the Interior. 

13 ‘‘(2) For any federally recognized Tribe not de14 scribed in paragraph (1), property located within the 

15 most recent boundaries of a prior Federal reserva16 tion. 

17 ‘‘(3) Ownership interests in rents, leases, royal18 ties, or usage rights related to natural resources (in19 cluding extraction of natural resources or harvesting 

20 of timber, other plants and plant products, animals, 

21 fish, and shellfish) resulting from the exercise of fed22 erally protected rights. 

23 ‘‘(4) Ownership interests in or usage rights to 

24 items not covered by paragraphs (1) through (3) 

25 that have unique religious, spiritual, traditional, or 
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1 cultural significance or rights that support subsist2 ence or a traditional life style according to applicable 

3 tribal law or custom. 

4 ‘‘(d) CONTINUATION OF CURRENT LAW PROTEC5 TIONS OF CERTAIN INDIAN PROPERTY FROM MEDICAID

6 ESTATE RECOVERY.—Income, resources, and property 

7 that are exempt from medicaid estate recovery under title 

8 XIX of the Social Security Act as of April 1, 2003, under 

9 manual instructions issued to carry out section 1917(b)(3) 

10 of such Act because of Federal responsibility for Indian 

11 Tribes and Alaska Native Villages shall remain so exempt. 

12 Nothing in this subsection shall be construed as pre13 venting the Secretary from providing additional medicaid 

14 estate recovery exemptions for Indians. 

15 ‘‘SEC. 413. TREATMENT UNDER MEDICAID MANAGED CARE. 

16 ‘‘(a) PROVISION OF SERVICES, TO ENROLLEES WITH

17 NON-INDIAN MEDICAID MANAGED CARE ENTITIES, BY

18 INDIAN HEALTH PROGRAMS AND URBAN INDIAN ORGANI19 ZATIONS.— 

20 ‘‘(1) PAYMENT RULES.— 

21 ‘‘(A) IN GENERAL.—Subject to subpara22 graph (B), in the case of an Indian who is en23 rolled with a non-Indian medicaid managed care 

24 entity (as defined in subsection (c)) and who re25 ceives covered medicaid managed care services 
204 

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1 from an Indian Health Program or an Urban 

2 Indian Organization, whether or not it is a par3 ticipating provider with respect to such entity, 

4 the following rules apply: 

5 ‘‘(i) DIRECT PAYMENT.—The entity 

6 shall make prompt payment (in accordance 

7 with rules applicable to medicaid managed 

8 care entities under title XIX of the Social 

9 Security Act) to the Indian Health Pro10 gram or Urban Indian Organization at a 

11 rate established by the entity for such serv12 ices that is equal to the rate negotiated be13 tween such entity and the Program or Or14 ganization involved or, if such a rate has 

15 not been negotiated, a rate that is not less 

16 than the level and amount of payment 

17 which the entity would make for the serv18 ices if the services were furnished by a pro19 vider which is not such a Program or Or20 ganization. 

21 ‘‘(ii) PAYMENT THROUGH STATE.—If 

22 there is no arrangement for direct payment 

23 under clause (i) or if a State provides for 

24 this clause to apply in lieu of clause (i), 

25 the State shall provide for payment to the 
205 

•S 1057 IS 

1 Indian Health Program or Urban Indian 

2 Organization under its State program 

3 under title XIX of such Act at the rate 

4 that would be otherwise applicable for such 

5 services under such program and shall pro6 vide for an appropriate adjustment of the 

7 capitation payment made to the entity to 

8 take into account such payment. 

9 ‘‘(B) COMPLIANCE WITH GENERALLY AP10 PLICABLE REQUIREMENTS.— 

11 ‘‘(i) IN GENERAL.—Except as other12 wise provided, as a condition of payment 

13 under subparagraph (A), the Indian 

14 Health Program or Urban Indian Organi15 zation shall comply with the generally ap16 plicable requirements of title XIX of the 

17 Social Security Act with respect to covered 

18 services. 

19 ‘‘(ii) SATISFACTION OF CLAIM RE20 QUIREMENT.—Any requirement for the 

21 submission of a claim or other documenta22 tion for services covered under subpara23 graph (A) by the enrollee is deemed to be 

24 satisfied through the submission of a claim 

25 or other documentation by the Indian 
206 

•S 1057 IS 

1 Health Program or Urban Indian Organi2 zation consistent with section 403(h). 

3 ‘‘(C) CONSTRUCTION.—Nothing in this 

4 subsection shall be construed as waiving the ap5 plication of section 1902(a)(30)(A) of the Social 

6 Security Act (relating to application of stand7 ards to assure that payments are consistent 

8 with efficiency, 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 enti14 ty; and 

15 ‘‘(B) has an Indian Health Program or 

16 Urban Indian Organization that is participating 

17 as a primary care provider within the network 

18 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 

23 shall be allowed to choose such Program or Organi24 zation as the Indian’s primary care provider under 

25 the entity. 
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•S 1057 IS 

1 ‘‘(b) OFFERING OF MANAGED CARE THROUGH IN2 DIAN 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 

15 respect to eligible Indians served by such entity under 

16 such program. 

17 ‘‘(c) SPECIAL RULES FOR INDIAN MANAGED CARE

18 ENTITIES.—The following are special rules regarding the 

19 application 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 
208 

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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 

6 choice of an Indian among medicaid managed 

7 care entities only to Indian medicaid managed 

8 care entities or to be more restrictive than the 

9 choice of managed care entities offered to indi10 viduals who are not Indians. 

11 ‘‘(C) DEFAULT ENROLLMENT.— 

12 ‘‘(i) IN GENERAL.—If such program 

13 of a State requires the enrollment of Indi14 ans in a medicaid managed care entity in 

15 order to receive benefits, the State shall 

16 provide for the enrollment of Indians de17 scribed in clause (ii) who are not otherwise 

18 enrolled with such an entity in an Indian 

19 medicaid managed care entity described in 

20 such 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 
209 

•S 1057 IS 

1 enrolled with the entity consistent with 

2 subparagraph (A). 

3 ‘‘(D) EXCEPTION TO STATE LOCK-IN.—A 

4 request by an Indian who is enrolled under such 

5 program with a non-Indian medicaid managed 

6 care entity to change enrollment with that enti7 ty to enrollment with an Indian medicaid man8 aged care entity shall be considered cause for 

9 granting such request under procedures speci10 fied by the Secretary. 

11 ‘‘(2) FLEXIBILITY IN APPLICATION OF SOL12 VENCY.—In applying section 1903(m)(1) of the So13 cial Security Act to an Indian medicaid managed 

14 care 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 

19 public entity described in subparagraph (C)(ii) 

20 of that section. 

21 ‘‘(3) EXCEPTIONS TO ADVANCE DIRECTIVES.— 

22 The Secretary may modify or waive the require23 ments of section 1902(w) of the Social Security Act 

24 (relating to provision of written materials on ad25 vance directives) insofar as the Secretary finds that 
210 

•S 1057 IS 

1 the requirements otherwise imposed are not an ap2 propriate or effective way of communicating the in3 formation to Indians. 

4 ‘‘(4) FLEXIBILITY IN INFORMATION AND MAR5 KETING.— 

6 ‘‘(A) MATERIALS.—The Secretary may 

7 modify requirements under section 1932(a)(5) 

8 of the Social Security Act in a manner that im9 proves the materials to take into account the 

10 special circumstances of such entities and their 

11 enrollees 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 

16 1932(d)(2)(B) of the Social Security Act re17 quiring the distribution of marketing materials 

18 to an entire service area shall be deemed satis19 fied in the case of an Indian medicaid managed 

20 care entity that distributes appropriate mate21 rials only to those Indians who are potentially 

22 eligible to enroll with the entity in the service 

23 area. 

24 ‘‘(d) MALPRACTICE INSURANCE.—Insofar as, under 

25 a medicaid managed care program, a health care provider 
211 

•S 1057 IS 

1 is required to have medical malpractice insurance coverage 

2 as a condition of contracting as a provider with a medicaid 

3 managed care entity, an Indian Health Program, or an 

4 Urban Indian Organization that is a Federally-qualified 

5 health center under title XIX of the Social Security Act, 

6 that is covered under the Federal Tort Claims Act (28 

7 U.S.C. 1346(b), 2671 et seq.) is deemed to satisfy such 

8 requirement. 

9 ‘‘(e) DEFINITIONS.—For purposes of this section: 

10 ‘‘(1) MEDICAID MANAGED CARE ENTITY.—The 

11 term ‘medicaid managed care entity’ means a man12 aged care entity (whether a managed care organiza13 tion or a primary care case manager) under title 

14 XIX of the Social Security Act, whether pursuant to 

15 section 1903(m) or section 1932 of such Act, a waiv16 er under section 1115 or 1915(b) of such Act, or 

17 otherwise. 

18 ‘‘(2) INDIAN MEDICAID MANAGED CARE ENTI19 TY.—The term ‘Indian medicaid managed care enti20 ty’ means a managed care entity that is controlled 

21 (within the meaning of the last sentence of section 

22 1903(m)(1)(C) of the Social Security Act) by the In23 dian Health Service, a Tribe, Tribal Organization, or 

24 Urban Indian Organization (as such terms are de25 fined in section 4), or a consortium, which may be 
212 

•S 1057 IS 

1 composed of 1 or more Tribes, Tribal Organizations, 

2 or Urban Indian Organizations, and which also may 

3 include the Service. 

4 ‘‘(3) NON-INDIAN MEDICAID MANAGED CARE

5 ENTITY.—The term ‘non-Indian medicaid managed 

6 care entity’ means a medicaid managed care entity 

7 that is not an Indian medicaid managed care entity. 

8 ‘‘(4) COVERED MEDICAID MANAGED CARE

9 SERVICES.—The term ‘covered medicaid managed 

10 care services’ means, with respect to an individual 

11 enrolled with a medicaid managed care entity, items 

12 and services that are within the scope of items and 

13 services for which benefits are available with respect 

14 to the individual under the contract between the en15 tity and the State involved. 

16 ‘‘(5) MEDICAID MANAGED CARE PROGRAM.— 

17 The term ‘medicaid managed care program’ means 

18 a program under sections 1903(m) and 1932 of the 

19 Social Security Act and includes a managed care 

20 program operating under a waiver under section 

21 1915(b) or 1115 of such Act or otherwise. 

22 ‘‘SEC. 414. NAVAJO NATION MEDICAID AGENCY FEASI23 BILITY STUDY. 

24 ‘‘(a) STUDY.—The Secretary shall conduct a study 

25 to determine the feasibility of treating the Navajo Nation 
213 

•S 1057 IS 

1 as a State for the purposes of title XIX of the Social Secu2 rity Act, to provide services to Indians living within the 

3 boundaries of the Navajo Nation through an entity estab4 lished having the same authority and performing the same 

5 functions as single-State medicaid agencies responsible for 

6 the administration of the State plan under title XIX of 

7 the Social Security Act. 

8 ‘‘(b) CONSIDERATIONS.—In conducting the study, 

9 the Secretary shall consider the feasibility of— 

10 ‘‘(1) assigning and paying all expenditures for 

11 the provision of services and related administration 

12 funds, under title XIX of the Social Security Act, to 

13 Indians living within the boundaries of the Navajo 

14 Nation that are currently paid to or would otherwise 

15 be paid to the State of Arizona, New Mexico, or 

16 Utah; 

17 ‘‘(2) providing assistance to the Navajo Nation 

18 in the development and implementation of such enti19 ty for the administration, eligibility, payment, and 

20 delivery of medical assistance under title XIX of the 

21 Social Security Act; 

22 ‘‘(3) providing an appropriate level of matching 

23 funds for Federal medical assistance with respect to 

24 amounts such entity expends for medical assistance 

25 for services and related administrative costs; and 
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•S 1057 IS 

1 ‘‘(4) authorizing the Secretary, at the option of 

2 the Navajo Nation, to treat the Navajo Nation as a 

3 State for the purposes of title XIX of the Social Se4 curity Act (relating to the State children’s health in5 surance program) under terms equivalent to those 

6 described in paragraphs (2) through (4). 

7 ‘‘(c) REPORT.—Not later then 3 years after the date 

8 of enactment of the Indian Health Act Improvement Act 

9 Amendments of 2005, the Secretary shall submit to the 

10 Committee of Indian Affairs and Committee on Finance 

11 of the Senate and the Committee on Resources and Com12 mittee on Ways and Means of the House of Representa13 tives a report that includes— 

14 ‘‘(1) the results of the study under this section; 

15 ‘‘(2) a summary of any consultation that oc16 curred between the Secretary and the Navajo Na17 tion, other Indian Tribes, the States of Arizona, 

18 New Mexico, and Utah, counties which include Nav19 ajo Lands, and other interested parties, in con20 ducting this study; 

21 ‘‘(3) projected costs or savings associated with 

22 establishment of such entity, and any estimated im23 pact on services provided as described in this section 

24 in relation to probable costs or savings; and 
215 

•S 1057 IS 

1 ‘‘(4) legislative actions that would be required 

2 to authorize the establishment of such entity if such 

3 entity is determined by the Secretary to be feasible. 

4 ‘‘SEC. 415. AUTHORIZATION OF APPROPRIATIONS. 

5 ‘‘There are authorized to be appropriated such sums 

6 as may be necessary for each fiscal year through fiscal 

7 year 2015 to carry out this title. 

8 ‘‘TITLE V—HEALTH SERVICES 

9 FOR URBAN INDIANS 

10 ‘‘SEC. 501. PURPOSE. 

11 ‘‘The purpose of this title is to establish and maintain 

12 programs in Urban Centers to make health services more 

13 accessible and available to Urban Indians. 

14 ‘‘SEC. 502. CONTRACTS WITH, AND GRANTS TO, URBAN IN15 DIAN ORGANIZATIONS. 

16 ‘‘Under authority of the Act of November 2, 1921 

17 (25 U.S.C. 13) (commonly known as the ‘Snyder Act’), 

18 the Secretary, acting through the Service, shall enter into 

19 contracts with, or make grants to, Urban Indian Organi20 zations to assist such organizations in the establishment 

21 and administration, within Urban Centers, of programs 

22 which meet the requirements set forth in this title. Subject 

23 to section 506, the Secretary, acting through the Service, 

24 shall include such conditions as the Secretary considers 

25 necessary to effect the purpose of this title in any contract 
216 

•S 1057 IS 

1 into which the Secretary enters with, or in any grant the 

2 Secretary makes to, any Urban Indian Organization pur3 suant to this title. 

4 ‘‘SEC. 503. CONTRACTS AND GRANTS FOR THE PROVISION 

5 OF HEALTH CARE AND REFERRAL SERVICES. 

6 ‘‘(a) REQUIREMENTS FOR GRANTS AND CON7 TRACTS.—Under authority of the Act of November 2, 

8 1921 (25 U.S.C. 13) (commonly known as the ‘Snyder 

9 Act’), the Secretary, acting through the Service, shall 

10 enter into contracts with, and make grants to, Urban In11 dian Organizations for the provision of health care and 

12 referral services for Urban Indians. Any such contract or 

13 grant shall include requirements that the Urban Indian 

14 Organization successfully undertake to— 

15 ‘‘(1) estimate the population of Urban Indians 

16 residing in the Urban Center or centers that the or17 ganization proposes to serve who are or could be re18 cipients of health care or referral services; 

19 ‘‘(2) estimate the current health status of 

20 Urban Indians residing in such Urban Center or 

21 centers; 

22 ‘‘(3) estimate the current health care needs of 

23 Urban Indians residing in such Urban Center or 

24 centers; 
217 

•S 1057 IS 

1 ‘‘(4) provide basic health education, including 

2 health promotion and disease prevention education, 

3 to Urban Indians; 

4 ‘‘(5) make recommendations to the Secretary 

5 and Federal, State, local, and other resource agen6 cies on methods of improving health service pro7 grams to meet the needs of Urban Indians; and 

8 ‘‘(6) where necessary, provide, or enter into 

9 contracts for the provision of, health care services 

10 for Urban Indians. 

11 ‘‘(b) CRITERIA.—The Secretary, acting through the 

12 Service, shall by regulation adopted pursuant to section 

13 520 prescribe the criteria for selecting Urban Indian Or14 ganizations to enter into contracts or receive grants under 

15 this section. Such criteria shall, among other factors, in16 clude— 

17 ‘‘(1) the extent of unmet health care needs of 

18 Urban Indians in the Urban Center or centers in19 volved; 

20 ‘‘(2) the size of the Urban Indian population in 

21 the Urban Center or centers involved; 

22 ‘‘(3) the extent, if any, to which the activities 

23 set forth in subsection (a) would duplicate any 

24 project funded under this title; 
218 

•S 1057 IS 

1 ‘‘(4) the capability of an Urban Indian Organi2 zation to perform the activities set forth in sub3 section (a) and to enter into a contract with the Sec4 retary or to meet the requirements for receiving a 

5 grant under this section; 

6 ‘‘(5) the satisfactory performance and success7 ful completion by an Urban Indian Organization of 

8 other contracts with the Secretary under this title; 

9 ‘‘(6) the appropriateness and likely effectiveness 

10 of conducting the activities set forth in subsection 

11 (a) in an Urban Center or centers; and 

12 ‘‘(7) the extent of existing or likely future par13 ticipation in the activities set forth in subsection (a) 

14 by appropriate health and health-related Federal, 

15 State, local, and other agencies. 

16 ‘‘(c) ACCESS TO HEALTH PROMOTION AND DISEASE

17 PREVENTION PROGRAMS.—The Secretary, acting through 

18 the Service, shall facilitate access to or provide health pro19 motion and disease prevention services for Urban Indians 

20 through grants made to Urban Indian Organizations ad21 ministering contracts entered into or receiving grants 

22 under subsection (a). 

23 ‘‘(d) IMMUNIZATION SERVICES.— 

24 ‘‘(1) ACCESS OR SERVICES PROVIDED.—The 

25 Secretary, acting through the Service, shall facilitate 
219 

•S 1057 IS 

1 access to, or provide, immunization services for 

2 Urban Indians through grants made to Urban In3 dian Organizations administering contracts entered 

4 into or receiving grants under this section. 

5 ‘‘(2) DEFINITION.—For purposes of this sub6 section, the term ‘immunization services’ means 

7 services to provide without charge immunizations 

8 against vaccine-preventable diseases. 

9 ‘‘(e) BEHAVIORAL HEALTH SERVICES.— 

10 ‘‘(1) ACCESS OR SERVICES PROVIDED.—The 

11 Secretary, acting through the Service, shall facilitate 

12 access to, or provide, behavioral health services for 

13 Urban Indians through grants made to Urban In14 dian Organizations administering contracts entered 

15 into or receiving grants under subsection (a). 

16 ‘‘(2) ASSESSMENT REQUIRED.—Except as pro17 vided by paragraph (3)(A), a grant may not be made 

18 under this subsection to an Urban Indian Organiza19 tion until that organization has prepared, and the 

20 Service has approved, an assessment of the fol21 lowing: 

22 ‘‘(A) The behavioral health needs of the 

23 Urban Indian population concerned. 
220 

•S 1057 IS 

1 ‘‘(B) The behavioral health services and 

2 other related resources available to that popu3 lation. 

4 ‘‘(C) The barriers to obtaining those serv5 ices and resources. 

6 ‘‘(D) The needs that are unmet by such 

7 services and resources. 

8 ‘‘(3) PURPOSES OF GRANTS.—Grants may be 

9 made under this subsection for the following: 

10 ‘‘(A) To prepare assessments required 

11 under paragraph (2). 

12 ‘‘(B) To provide outreach, educational, and 

13 referral services to Urban Indians regarding the 

14 availability of direct behavioral health services, 

15 to educate Urban Indians about behavioral 

16 health issues and services, and effect coordina17 tion with existing behavioral health providers in 

18 order to improve services to Urban Indians. 

19 ‘‘(C) To provide outpatient behavioral 

20 health services to Urban Indians, including the 

21 identification and assessment of illness, thera22 peutic treatments, case management, support 

23 groups, family treatment, and other treatment. 
221 

•S 1057 IS 

1 ‘‘(D) To develop innovative behavioral 

2 health service delivery models which incorporate 

3 Indian cultural support systems and resources. 

4 ‘‘(f) PREVENTION OF CHILD ABUSE.— 

5 ‘‘(1) ACCESS OR SERVICES PROVIDED.—The 

6 Secretary, acting through the Service, shall facilitate 

7 access to or provide services for Urban Indians 

8 through grants to Urban Indian Organizations ad9 ministering contracts entered into or receiving 

10 grants under subsection (a) to prevent and treat 

11 child abuse (including sexual abuse) among Urban 

12 Indians. 

13 ‘‘(2) EVALUATION REQUIRED.—Except as pro14 vided by paragraph (3)(A), a grant may not be made 

15 under this subsection to an Urban Indian Organiza16 tion until that organization has prepared, and the 

17 Service has approved, an assessment that documents 

18 the prevalence of child abuse in the Urban Indian 

19 population concerned and specifies the services and 

20 programs (which may not duplicate existing services 

21 and programs) for which the grant is requested. 

22 ‘‘(3) PURPOSES OF GRANTS.—Grants may be 

23 made under this subsection for the following: 

24 ‘‘(A) To prepare assessments required 

25 under paragraph (2). 
222 

•S 1057 IS 

1 ‘‘(B) For the development of prevention, 

2 training, and education programs for Urban In3 dians, including child education, parent edu4 cation, provider training on identification and 

5 intervention, education on reporting require6 ments, prevention campaigns, and establishing 

7 service networks of all those involved in Indian 

8 child protection. 

9 ‘‘(C) To provide direct outpatient treat10 ment services (including individual treatment, 

11 family treatment, group therapy, and support 

12 groups) to Urban Indians who are child victims 

13 of abuse (including sexual abuse) or adult sur14 vivors of child sexual abuse, to the families of 

15 such child victims, and to Urban Indian per16 petrators of child abuse (including sexual 

17 abuse). 

18 ‘‘(4) CONSIDERATIONS WHEN MAKING

19 GRANTS.—In making grants to carry out this sub20 section, the Secretary shall take into consideration— 

21 ‘‘(A) the support for the Urban Indian Or22 ganization demonstrated by the child protection 

23 authorities in the area, including committees or 

24 other services funded under the Indian Child 
223 

•S 1057 IS 

1 Welfare Act of 1978 (25 U.S.C. 1901 et seq.), 

2 if any; 

3 ‘‘(B) the capability and expertise dem4 onstrated by the Urban Indian Organization to 

5 address the complex problem of child sexual 

6 abuse in the community; and 

7 ‘‘(C) the assessment required under para8 graph (2). 

9 ‘‘(g) OTHER GRANTS.—The Secretary, acting 

10 through the Service, may enter into a contract with or 

11 make grants to an Urban Indian Organization that pro12 vides or arranges for the provision of health care services 

13 (through satellite facilities, provider networks, or other14 wise) to Urban Indians in more than 1 Urban Center. 

15 ‘‘SEC. 504. CONTRACTS AND GRANTS FOR THE DETERMINA16 TION OF UNMET HEALTH CARE NEEDS. 

17 ‘‘(a) GRANTS AND CONTRACTS AUTHORIZED.— 

18 Under authority of the Act of November 2, 1921 (25 

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

20 Secretary, acting through the Service, may enter into con21 tracts with or make grants to Urban Indian Organizations 

22 situated in Urban Centers for which contracts have not 

23 been entered into or grants have not been made under sec24 tion 503. 
224 

•S 1057 IS 

1 ‘‘(b) PURPOSE.—The purpose of a contract or grant 

2 made under this section shall be the determination of the 

3 matters described in subsection (c)(1) in order to assist 

4 the Secretary in assessing the health status and health 

5 care needs of Urban Indians in the Urban Center involved 

6 and determining whether the Secretary should enter into 

7 a contract or make a grant under section 503 with respect 

8 to the Urban Indian Organization which the Secretary has 

9 entered into a contract with, or made a grant to, under 

10 this section. 

11 ‘‘(c) GRANT AND CONTRACT REQUIREMENTS.—Any 

12 contract entered into, or grant made, by the Secretary 

13 under this section shall include requirements that— 

14 ‘‘(1) the Urban Indian Organization success15 fully undertakes to— 

16 ‘‘(A) document the health care status and 

17 unmet health care needs of Urban Indians in 

18 the Urban Center involved; and 

19 ‘‘(B) with respect to Urban Indians in the 

20 Urban Center involved, determine the matters 

21 described in paragraphs (2), (3), (4), and (7) of 

22 section 503(b); and 

23 ‘‘(2) the Urban Indian Organization complete 

24 performance of the contract, or carry out the re25 quirements of the grant, within 1 year after the date 
225 

•S 1057 IS 

1 on which the Secretary and such organization enter 

2 into such contract, or within 1 year after such orga3 nization receives such grant, whichever is applicable. 

4 ‘‘(d) NO RENEWALS.—The Secretary may not renew 

5 any contract entered into or grant made under this sec6 tion. 

7 ‘‘SEC. 505. EVALUATIONS; RENEWALS. 

8 ‘‘(a) PROCEDURES FOR EVALUATIONS.—The Sec9 retary, acting through the Service, shall develop proce10 dures to evaluate compliance with grant requirements and 

11 compliance with and performance of contracts entered into 

12 by Urban Indian Organizations under this title. Such pro13 cedures shall include provisions for carrying out the re14 quirements of this section. 

15 ‘‘(b) EVALUATIONS.—The Secretary, acting through 

16 the Service, shall evaluate the compliance of each Urban 

17 Indian Organization which has entered into a contract or 

18 received a grant under section 503 with the terms of such 

19 contract or grant. For purposes of this evaluation, in de20 termining the capacity of an Urban Indian Organization 

21 to deliver quality patient care the Secretary shall, at the 

22 option of the organization— 

23 ‘‘(1) acting through the Service, conduct an an24 nual onsite evaluation of the organization; or 
226 

•S 1057 IS 

1 ‘‘(2) accept in lieu of such onsite evaluation evi2 dence of the organization’s provisional or full accred3 itation by a private independent entity recognized by 

4 the Secretary for purposes of conducting quality re5 views of providers participating in the Medicare pro6 gram under title XVIII of the Social Security Act. 

7 ‘‘(c) NONCOMPLIANCE; UNSATISFACTORY PERFORM8 ANCE.—If, as a result of the evaluations conducted under 

9 this section, the Secretary determines that an Urban In10 dian Organization has not complied with the requirements 

11 of a grant or complied with or satisfactorily performed a 

12 contract under section 503, the Secretary shall, prior to 

13 renewing such contract or grant, attempt to resolve with 

14 the organization the areas of noncompliance or unsatisfac15 tory performance and modify the contract or grant to pre16 vent future occurrences of noncompliance or unsatisfac17 tory performance. If the Secretary determines that the 

18 noncompliance or unsatisfactory performance cannot be 

19 resolved and prevented in the future, the Secretary shall 

20 not renew the contract or grant with the organization and 

21 is authorized to enter into a contract or make a grant 

22 under section 503 with another Urban Indian Organiza23 tion which is situated in the same Urban Center as the 

24 Urban Indian Organization whose contract or grant is not 

25 renewed under this section. 
227 

•S 1057 IS 

1 ‘‘(d) CONSIDERATIONS FOR RENEWALS.—In deter2 mining whether to renew a contract or grant with an 

3 Urban Indian Organization under section 503 which has 

4 completed performance of a contract or grant under sec5 tion 504, the Secretary shall review the records of the 

6 Urban Indian Organization, the reports submitted under 

7 section 507, and shall consider the results of the onsite 

8 evaluations or accreditations under subsection (b). 

9 ‘‘SEC. 506. OTHER CONTRACT AND GRANT REQUIREMENTS. 

10 ‘‘(a) PROCUREMENT.—Contracts with Urban Indian 

11 Organizations entered into pursuant to this title shall be 

12 in accordance with all Federal contracting laws and regu13 lations relating to procurement except that in the discre14 tion of the Secretary, such contracts may be negotiated 

15 without advertising and need not conform to the provisions 

16 of sections 1304 and 3131 through 3133 of title 40, 

17 United States Code. 

18 ‘‘(b) PAYMENTS UNDER CONTRACTS OR GRANTS.— 

19 Payments under any contracts or grants pursuant to this 

20 title shall, notwithstanding any term or condition of such 

21 contract or grant— 

22 ‘‘(1) be made in their entirety by the Secretary 

23 to the Urban Indian Organization by no later than 

24 the end of the first 30 days of the funding period 

25 with respect to which the payments apply, unless the 
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1 Secretary determines through an evaluation under 

2 section 505 that the organization is not capable of 

3 administering such payments in their entirety; and 

4 ‘‘(2) if any portion thereof is unexpended by the 

5 Urban Indian Organization during the funding pe6 riod with respect to which the payments initially 

7 apply, shall be carried forward for expenditure with 

8 respect to allowable or reimbursable costs incurred 

9 by the organization during 1 or more subsequent 

10 funding periods without additional justification or 

11 documentation by the organization as a condition of 

12 carrying forward the availability for expenditure of 

13 such funds. 

14 ‘‘(c) REVISION OR AMENDMENT OF CONTRACTS.— 

15 Notwithstanding any provision of law to the contrary, the 

16 Secretary may, at the request and consent of an Urban 

17 Indian Organization, revise or amend any contract entered 

18 into by the Secretary with such organization under this 

19 title as necessary to carry out the purposes of this title. 

20 ‘‘(d) FAIR AND UNIFORM SERVICES AND ASSIST21 ANCE.—Contracts with or grants to Urban Indian Organi22 zations and regulations adopted pursuant to this title shall 

23 include provisions to assure the fair and uniform provision 

24 to Urban Indians of services and assistance under such 

25 contracts or grants by such organizations. 
229 

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1 ‘‘SEC. 507. REPORTS AND RECORDS. 

2 ‘‘(a) REPORTS.—For each fiscal year during which 

3 an Urban Indian Organization receives or expends funds 

4 pursuant to a contract entered into or a grant received 

5 pursuant to this title, such Urban Indian Organization 

6 shall submit to the Secretary not more frequently than 

7 every 6 months, a report that includes the following: 

8 ‘‘(1) In the case of a contract or grant under 

9 section 503, recommendations pursuant to section 

10 503(a)(5). 

11 ‘‘(2) Information on activities conducted by the 

12 organization pursuant to the contract or grant. 

13 ‘‘(3) An accounting of the amounts and purpose 

14 for which Federal funds were expended. 

15 ‘‘(4) A minimum set of data, using uniformly 

16 defined elements, as specified by the Secretary after 

17 consultation with Urban Indian Organizations. 

18 ‘‘(b) AUDIT.—The reports and records of the Urban 

19 Indian Organization with respect to a contract or grant 

20 under this title shall be subject to audit by the Secretary 

21 and the Comptroller General of the United States. 

22 ‘‘(c) COSTS OF AUDITS.—The Secretary shall allow 

23 as a cost of any contract or grant entered into or awarded 

24 under section 502 or 503 the cost of an annual inde25 pendent financial audit conducted by— 

26 ‘‘(1) a certified public accountant; or 
230 

•S 1057 IS 

1 ‘‘(2) a certified public accounting firm qualified 

2 to conduct Federal compliance audits. 

3 ‘‘SEC. 508. LIMITATION ON CONTRACT AUTHORITY. 

4 ‘‘The authority of the Secretary to enter into con5 tracts or to award grants under this title shall be to the 

6 extent, and in an amount, provided for in appropriation 

7 Acts. 

8 ‘‘SEC. 509. FACILITIES. 

9 ‘‘(a) GRANTS.—The Secretary, acting through the 

10 Service, may make grants to contractors or grant recipi11 ents under this title for the lease, purchase, renovation, 

12 construction, or expansion of facilities, including leased fa13 cilities, in order to assist such contractors or grant recipi14 ents in complying with applicable licensure or certification 

15 requirements. 

16 ‘‘(b) LOAN FUND STUDY.—The Secretary, acting 

17 through the Services, may carry out a study to determine 

18 the feasibility of establishing a loan fund to provide to 

19 Urban Indian Organizations direct loans or guarantees for 

20 loans for the construction of health care facilities in a 

21 manner consistent with section 309. 

22 ‘‘SEC. 510. OFFICE OF URBAN INDIAN HEALTH. 

23 ‘‘There is established within the Service an Office of 

24 Urban Indian Health, which shall be responsible for— 

25 ‘‘(1) carrying out the provisions of this title; 
231 

•S 1057 IS 

1 ‘‘(2) providing central oversight of the pro2 grams and services authorized under this title; and 

3 ‘‘(3) providing technical assistance to Urban In4 dian Organizations. 

5 ‘‘SEC. 511. GRANTS FOR ALCOHOL AND SUBSTANCE ABUSE6 RELATED SERVICES. 

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

8 through the Service, may make grants for the provision 

9 of health-related services in prevention of, treatment of, 

10 rehabilitation of, or school- and community-based edu11 cation regarding, alcohol and substance abuse in Urban 

12 Centers to those Urban Indian Organizations with which 

13 the Secretary has entered into a contract under this title 

14 or under section 201. 

15 ‘‘(b) GOALS.—Each grant made pursuant to sub16 section (a) shall set forth the goals to be accomplished 

17 pursuant to the grant. The goals shall be specific to each 

18 grant as agreed to between the Secretary and the grantee. 

19 ‘‘(c) CRITERIA.—The Secretary shall establish cri20 teria for the grants made under subsection (a), including 

21 criteria relating to the following: 

22 ‘‘(1) The size of the Urban Indian population. 

23 ‘‘(2) Capability of the organization to ade24 quately perform the activities required under the 

25 grant. 
232 

•S 1057 IS 

1 ‘‘(3) Satisfactory performance standards for the 

2 organization in meeting the goals set forth in such 

3 grant. The standards shall be negotiated and agreed 

4 to between the Secretary and the grantee on a 

5 grant-by-grant basis. 

6 ‘‘(4) Identification of the need for services. 

7 ‘‘(d) ALLOCATION OF GRANTS.—The Secretary shall 

8 develop a methodology for allocating grants made pursu9 ant to this section based on the criteria established pursu10 ant to subsection (c). 

11 ‘‘(e) GRANTS SUBJECT TO CRITERIA.—Any funds re12 ceived by an Urban Indian Organization under this Act 

13 for substance abuse prevention, treatment, and rehabilita14 tion shall be subject to the criteria set forth in subsection 

15 (c). 

16 ‘‘SEC. 512. TREATMENT OF CERTAIN DEMONSTRATION 

17 PROJECTS. 

18 ‘‘Notwithstanding any other provision of law, the 

19 Tulsa Clinic and Oklahoma City Clinic demonstration 

20 projects shall— 

21 ‘‘(1) be permanent programs within the Serv22 ice’s direct care program; 

23 ‘‘(2) continue to be treated as Service Units in 

24 the allocation of resources and coordination of care; 

25 and 
233 

•S 1057 IS 

1 ‘‘(3) continue to meet the requirements and 

2 definitions of an urban Indian organization in this 

3 Act, and shall not be subject to the provisions of the 

4 Indian Self-Determination and Education Assistance 

5 Act. 

6 ‘‘SEC. 513. URBAN NIAAA TRANSFERRED PROGRAMS. 

7 ‘‘(a) GRANTS AND CONTRACTS.—The Secretary, 

8 through the Office of Urban Indian Health, shall make 

9 grants or enter into contracts with Urban Indian Organi10 zations for the administration of Urban Indian alcohol 

11 programs that were originally established under the Na12 tional Institute on Alcoholism and Alcohol Abuse (here13 after in this section referred to as ‘NIAAA’) and trans14 ferred to the Service. Such grants and contracts shall be15 come effective no later than September 30, 2008. 

16 ‘‘(b) USE OF FUNDS.—Grants provided or contracts 

17 entered into under this section shall be used to provide 

18 support for the continuation of alcohol prevention and 

19 treatment services for Urban Indian populations and such 

20 other objectives as are agreed upon between the Service 

21 and a recipient of a grant or contract under this section. 

22 ‘‘(c) ELIGIBILITY.—Urban Indian Organizations that 

23 operate Indian alcohol programs originally funded under 

24 the NIAAA and subsequently transferred to the Service 

25 are eligible for grants or contracts under this section. 
234 

•S 1057 IS 

1 ‘‘(d) REPORT.—The Secretary shall evaluate and re2 port to Congress on the activities of programs funded 

3 under this section not less than every 5 years. 

4 ‘‘SEC. 514. CONSULTATION WITH URBAN INDIAN ORGANIZA5 TIONS. 

6 ‘‘(a) IN GENERAL.—The Secretary shall ensure that 

7 the Service consults, to the greatest extent practicable, 

8 with Urban Indian Organizations. 

9 ‘‘(b) DEFINITION OF CONSULTATION.—For purposes 

10 of subsection (a), consultation is the open and free ex11 change of information and opinions which leads to mutual 

12 understanding and comprehension and which emphasizes 

13 trust, respect, and shared responsibility. 

14 ‘‘SEC. 515. FEDERAL TORT CLAIM ACT COVERAGE. 

15 ‘‘(a) IN GENERAL.—With respect to claims resulting 

16 from the performance of functions during fiscal year 2005 

17 and thereafter, or claims asserted after September 30, 

18 2004, but resulting from the performance of functions 

19 prior to fiscal year 2005, under a contract, grant agree20 ment, or any other agreement authorized under this title, 

21 an Urban Indian Organization is deemed hereafter to be 

22 part of the Service in the Department of Health and 

23 Human Services while carrying out any such contract or 

24 agreement and its employees are deemed employees of the 

25 Service while acting within the scope of their employment 
235 

•S 1057 IS 

1 in carrying out the contract or agreement. After Sep2 tember 30, 2003, any civil action or proceeding involving 

3 such claims brought hereafter against any Urban Indian 

4 Organization or any employee of such Urban Indian Orga5 nization covered by this provision shall be deemed to be 

6 an action against the United States and will be defended 

7 by the Attorney General and be afforded the full protec8 tion and coverage of the Federal Tort Claims Act (28 

9 U.S.C. 1346(b), 2671 et seq.). Future coverage under that 

10 Act shall be contingent on cooperation of the Urban In11 dian Organization with the Attorney General in pros12 ecuting past claims. 

13 ‘‘(b) CLAIMS RESULTING FROM PERFORMANCE OF

14 CONTRACT OR GRANT.—Beginning for fiscal year 2005 

15 and thereafter, the Secretary shall request through annual 

16 appropriations funds sufficient to reimburse the Treasury 

17 for any claims paid in the prior fiscal year pursuant to 

18 the foregoing provisions. 

19 ‘‘SEC. 516. URBAN YOUTH TREATMENT CENTER DEM20 ONSTRATION. 

21 ‘‘(a) CONSTRUCTION AND OPERATION.—The Sec22 retary, acting through the Service, through grant or con23 tract, is authorized to fund the construction and operation 

24 of at least 2 residential treatment centers in each State 

25 described in subsection (b) to demonstrate the provision 
236 

•S 1057 IS 

1 of alcohol and substance abuse treatment services to 

2 Urban Indian youth in a culturally competent residential 

3 setting. 

4 ‘‘(b) DEFINITION OF STATE.—A State described in 

5 this subsection is a State in which— 

6 ‘‘(1) there resides Urban Indian youth with 

7 need for alcohol and substance abuse treatment serv8 ices in a residential setting; and 

9 ‘‘(2) there is a significant shortage of culturally 

10 competent residential treatment services for Urban 

11 Indian youth. 

12 ‘‘SEC. 517. USE OF FEDERAL GOVERNMENT FACILITIES AND 

13 SOURCES OF SUPPLY. 

14 ‘‘(a) AUTHORIZATION FOR USE.—The Secretary, act15 ing through the Service, shall allow an Urban Indian Or16 ganization that has entered into a contract or received a 

17 grant pursuant to this title, in carrying out such contract 

18 or grant, to use existing facilities and all equipment there19 in or pertaining thereto and other personal property 

20 owned by the Federal Government within the Secretary’s 

21 jurisdiction under such terms and conditions as may be 

22 agreed upon for their use and maintenance. 

23 ‘‘(b) DONATIONS.—Subject to subsection (d), the 

24 Secretary may donate to an Urban Indian Organization 

25 that has entered into a contract or received a grant pursu-
237 

•S 1057 IS 

1 ant to this title any personal or real property determined 

2 to be excess to the needs of the Service or the General 

3 Services Administration for purposes of carrying out the 

4 contract or grant. 

5 ‘‘(c) ACQUISITION OF PROPERTY FOR DONATION.— 

6 The Secretary may acquire excess or surplus government 

7 personal or real property for donation (subject to sub8 section (d)), to an Urban Indian Organization that has 

9 entered into a contract or received a grant pursuant to 

10 this title if the Secretary determines that the property is 

11 appropriate for use by the Urban Indian Organization for 

12 a purpose for which a contract or grant is authorized 

13 under this title. 

14 ‘‘(d) PRIORITY.—In the event that the Secretary re15 ceives a request for donation of a specific item of personal 

16 or real property described in subsection (b) or (c) from 

17 both an Urban Indian Organization and from an Indian 

18 Tribe or Tribal Organization, the Secretary shall give pri19 ority to the request for donation of the Indian Tribe or 

20 Tribal Organization if the Secretary receives the request 

21 from the Indian Tribe or Tribal Organization before the 

22 date the Secretary transfers title to the property or, if ear23 lier, the date the Secretary transfers the property phys24 ically to the Urban Indian Organization. 
238 

•S 1057 IS 

1 ‘‘(e) URBAN INDIAN ORGANIZATIONS DEEMED EX2 ECUTIVE AGENCY FOR CERTAIN PURPOSES.—For pur3 poses of section 501 of title 40, United States Code, (relat4 ing to Federal sources of supply, including lodging pro5 viders, airlines, and other transportation providers), an 

6 Urban Indian Organization that has entered into a con7 tract or received a grant pursuant to this title shall be 

8 deemed an executive agency when carrying out such con9 tract or grant. 

10 ‘‘SEC. 518. GRANTS FOR DIABETES PREVENTION, TREAT11 MENT, AND CONTROL. 

12 ‘‘(a) GRANTS AUTHORIZED.—The Secretary may 

13 make grants to those Urban Indian Organizations that 

14 have entered into a contract or have received a grant 

15 under this title for the provision of services for the preven16 tion and treatment of, and control of the complications 

17 resulting from, diabetes among Urban Indians. 

18 ‘‘(b) GOALS.—Each grant made pursuant to sub19 section (a) shall set forth the goals to be accomplished 

20 under the grant. The goals shall be specific to each grant 

21 as agreed to between the Secretary and the grantee. 

22 ‘‘(c) ESTABLISHMENT OF CRITERIA.—The Secretary 

23 shall establish criteria for the grants made under sub24 section (a) relating to— 
239 

•S 1057 IS 

1 ‘‘(1) the size and location of the Urban Indian 

2 population to be served; 

3 ‘‘(2) the need for prevention of and treatment 

4 of, and control of the complications resulting from, 

5 diabetes among the Urban Indian population to be 

6 served; 

7 ‘‘(3) performance standards for the organiza8 tion in meeting the goals set forth in such grant 

9 that are negotiated and agreed to by the Secretary 

10 and the grantee; 

11 ‘‘(4) the capability of the organization to ade12 quately perform the activities required under the 

13 grant; and 

14 ‘‘(5) the willingness of the organization to col15 laborate with the registry, if any, established by the 

16 Secretary under section 204(e) in the Area Office of 

17 the Service in which the organization is located. 

18 ‘‘(d) FUNDS SUBJECT TO CRITERIA.—Any funds re19 ceived by an Urban Indian Organization under this Act 

20 for the prevention, treatment, and control of diabetes 

21 among Urban Indians shall be subject to the criteria devel22 oped by the Secretary under subsection (c). 

23 ‘‘SEC. 519. COMMUNITY HEALTH REPRESENTATIVES. 

24 ‘‘The Secretary, acting through the Service, may 

25 enter into contracts with, and make grants to, Urban In-
240 

•S 1057 IS 

1 dian Organizations for the employment of Indians trained 

2 as health service providers through the Community Health 

3 Representatives Program under section 109 in the provi4 sion of health care, health promotion, and disease preven5 tion services to Urban Indians. 

6 ‘‘SEC. 520. REGULATIONS. 

7 ‘‘(a) REQUIREMENTS FOR REGULATIONS.—The Sec8 retary may promulgate regulations to implement the provi9 sions of this title in accordance with the following: 

10 ‘‘(1) Proposed regulations to implement this 

11 Act shall be published in the Federal Register by the 

12 Secretary no later than 9 months after the date of 

13 enactment of this Act and shall have no less than a 

14 4-month comment period. 

15 ‘‘(2) The authority to promulgate regulations 

16 under this Act shall expire 18 months from the date 

17 of enactment of this Act. 

18 ‘‘(b) EFFECTIVE DATE OF TITLE.—The amendments 

19 to this title made by the Indian Health Care Improvement 

20 Act Amendments of 2005 shall be effective on the date 

21 of enactment of such amendments, regardless of whether 

22 the Secretary has promulgated regulations implementing 

23 such amendments have been promulgated. 
241 

•S 1057 IS 

1 ‘‘SEC. 521. ELIGIBILITY FOR SERVICES. 

2 ‘‘Urban Indians shall be eligible and the ultimate 

3 beneficiaries for health care or referral services provided 

4 pursuant to this title. 

5 ‘‘SEC. 522. AUTHORIZATION OF APPROPRIATIONS. 

6 ‘‘There are authorized to be appropriated such sums 

7 as may be necessary for each fiscal year through fiscal 

8 year 2015 to carry out this title. 

9 ‘‘TITLE VI—ORGANIZATIONAL 

10 IMPROVEMENTS 

11 ‘‘SEC. 601. ESTABLISHMENT OF THE INDIAN HEALTH SERV12 ICE AS AN AGENCY OF THE PUBLIC HEALTH 

13 SERVICE. 

14 ‘‘(a) ESTABLISHMENT.— 

15 ‘‘(1) IN GENERAL.—In order to more effectively 

16 and efficiently carry out the responsibilities, authori17 ties, and functions of the United States to provide 

18 health care services to Indians and Indian Tribes, as 

19 are or may be hereafter provided by Federal statute 

20 or treaties, there is established within the Public 

21 Health Service of the Department the Indian Health 

22 Service. 

23 ‘‘(2) ASSISTANT SECRETARY OF INDIAN

24 HEALTH.—The Service shall be administered by an 

25 Assistant Secretary of Indian Health, who shall be 

26 appointed by the President, by and with the advice 
242 

•S 1057 IS 

1 and consent of the Senate. The Assistant Secretary 

2 shall report to the Secretary. Effective with respect 

3 to an individual appointed by the President, by and 

4 with the advice and consent of the Senate, after 

5 January 1, 2005, the term of service of the Assist6 ant Secretary shall be 4 years. An Assistant Sec7 retary may serve more than 1 term. 

8 ‘‘(3) INCUMBENT.—The individual serving in 

9 the position of Director of the Indian Health Service 

10 on the day before the date of enactment of the In11 dian Health Care Improvement Act Amendments of 

12 2005 shall serve as Assistant Secretary. 

13 ‘‘(4) ADVOCACY AND CONSULTATION.—The po14 sition of Assistant Secretary is established to, in a 

15 manner consistent with the government-to-govern16 ment relationship between the United States and In17 dian Tribes— 

18 ‘‘(A) facilitate advocacy for the develop19 ment of appropriate Indian health policy; and 

20 ‘‘(B) promote consultation on matters re21 lating to Indian health. 

22 ‘‘(b) AGENCY.—The Service shall be an agency within 

23 the Public Health Service of the Department, and shall 

24 not be an office, component, or unit of any other agency 

25 of the Department. 
243 

•S 1057 IS 

1 ‘‘(c) DUTIES.—The Assistant Secretary of Indian 

2 Health shall— 

3 ‘‘(1) perform all functions that were, on the day 

4 before the date of enactment of the Indian Health 

5 Care Improvement Act Amendments of 2005, car6 ried out by or under the direction of the individual 

7 serving as Director of the Service on that day; 

8 ‘‘(2) perform all functions of the Secretary re9 lating to the maintenance and operation of hospital 

10 and health facilities for Indians and the planning 

11 for, and provision and utilization of, health services 

12 for Indians; 

13 ‘‘(3) administer all health programs under 

14 which health care is provided to Indians based upon 

15 their status as Indians which are administered by 

16 the Secretary, including programs under— 

17 ‘‘(A) this Act; 

18 ‘‘(B) the Act of November 2, 1921 (25 

19 U.S.C. 13); 

20 ‘‘(C) the Act of August 5, 1954 (42 U.S.C. 

21 2001 et seq.); 

22 ‘‘(D) the Act of August 16, 1957 (42 

23 U.S.C. 2005 et seq.); and 
244 

•S 1057 IS 

1 ‘‘(E) the Indian Self-Determination and 

2 Education Assistance Act (25 U.S.C. 450 et 

3 seq.); 

4 ‘‘(4) administer all scholarship and loan func5 tions carried out under title I; 

6 ‘‘(5) report directly to the Secretary concerning 

7 all policy- and budget-related matters affecting In8 dian health; 

9 ‘‘(6) collaborate with the Assistant Secretary 

10 for Health concerning appropriate matters of Indian 

11 health that affect the agencies of the Public Health 

12 Service; 

13 ‘‘(7) advise each Assistant Secretary of the De14 partment concerning matters of Indian health with 

15 respect to which that Assistant Secretary has au16 thority and responsibility; 

17 ‘‘(8) advise the heads of other agencies and pro18 grams of the Department concerning matters of In19 dian health with respect to which those heads have 

20 authority and responsibility; 

21 ‘‘(9) coordinate the activities of the Department 

22 concerning matters of Indian health; and 

23 ‘‘(10) perform such other functions as the Sec24 retary may designate. 

25 ‘‘(d) AUTHORITY.— 
245 

•S 1057 IS 

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

2 through the Assistant Secretary, shall have the au3 thority— 

4 ‘‘(A) except to the extent provided for in 

5 paragraph (2), to appoint and compensate em6 ployees for the Service in accordance with title 

7 5, United States Code; 

8 ‘‘(B) to enter into contracts for the pro9 curement of goods and services to carry out the 

10 functions of the Service; and 

11 ‘‘(C) to manage, expend, and obligate all 

12 funds appropriated for the Service. 

13 ‘‘(2) PERSONNEL ACTIONS.—Notwithstanding 

14 any other provision of law, the provisions of section 

15 12 of the Act of June 18, 1934 (48 Stat. 986; 25 

16 U.S.C. 472), shall apply to all personnel actions 

17 taken with respect to new positions created within 

18 the Service as a result of its establishment under 

19 subsection (a). 

20 ‘‘(e) REFERENCES.—Any reference to the Director of 

21 the Indian Health Service in any other Federal law, Exec22 utive order, rule, regulation, or delegation of authority, or 

23 in any document of or relating to the Director of the In24 dian Health Service, shall be deemed to refer to the Assist25 ant Secretary. 
246 

•S 1057 IS 

1 ‘‘SEC. 602. AUTOMATED MANAGEMENT INFORMATION SYS2 TEM. 

3 ‘‘(a) ESTABLISHMENT.— 

4 ‘‘(1) IN GENERAL.—The Secretary shall estab5 lish an automated management information system 

6 for the Service. 

7 ‘‘(2) REQUIREMENTS OF SYSTEM.—The infor8 mation system established under paragraph (1) shall 

9 include— 

10 ‘‘(A) a financial management system; 

11 ‘‘(B) a patient care information system for 

12 each area served by the Service; 

13 ‘‘(C) a privacy component that protects the 

14 privacy of patient information held by, or on be15 half of, the Service; 

16 ‘‘(D) a services-based cost accounting com17 ponent that provides estimates of the costs as18 sociated with the provision of specific medical 

19 treatments or services in each Area office of the 

20 Service; 

21 ‘‘(E) an interface mechanism for patient 

22 billing and accounts receivable system; and 

23 ‘‘(F) a training component. 

24 ‘‘(b) PROVISION OF SYSTEMS TO TRIBES AND ORGA25 NIZATIONS.—The Secretary shall provide each Tribal 
247 

•S 1057 IS 

1 Health Program automated management information sys2 tems which— 

3 ‘‘(1) meet the management information needs 

4 of such Tribal Health Program with respect to the 

5 treatment by the Tribal Health Program of patients 

6 of the Service; and 

7 ‘‘(2) meet the management information needs 

8 of the Service. 

9 ‘‘(c) ACCESS TO RECORDS.—Notwithstanding any 

10 other provision of law, each patient shall have reasonable 

11 access to the medical or health records of such patient 

12 which are held by, or on behalf of, the Service. 

13 ‘‘(d) AUTHORITY TO ENHANCE INFORMATION TECH14 NOLOGY.—The Secretary, acting through the Assistant 

15 Secretary, shall have the authority to enter into contracts, 

16 agreements, or joint ventures with other Federal agencies, 

17 States, private and nonprofit organizations, for the pur18 pose of enhancing information technology in Indian health 

19 programs and facilities. 

20 ‘‘SEC. 603. AUTHORIZATION OF APPROPRIATIONS. 

21 ‘‘There is authorized to be appropriated such sums 

22 as may be necessary for each fiscal year through fiscal 

23 year 2015 to carry out this title. 
248 

•S 1057 IS 

1 ‘‘TITLE VII—BEHAVIORAL 

2 HEALTH PROGRAMS 

3 ‘‘SEC. 701. BEHAVIORAL HEALTH PREVENTION AND TREAT4 MENT SERVICES. 

5 ‘‘(a) PURPOSES.—The purposes of this section are as 

6 follows: 

7 ‘‘(1) To authorize and direct the Secretary, act8 ing through the Service, Indian Tribes, Tribal Orga9 nizations, and Urban Indian Organizations, to de10 velop a comprehensive behavioral health prevention 

11 and treatment program which emphasizes collabora12 tion among alcohol and substance abuse, social serv13 ices, and mental health programs. 

14 ‘‘(2) To provide information, direction, and 

15 guidance relating to mental illness and dysfunction 

16 and self-destructive behavior, including child abuse 

17 and family violence, to those Federal, tribal, State, 

18 and local agencies responsible for programs in In19 dian communities in areas of health care, education, 

20 social services, child and family welfare, alcohol and 

21 substance abuse, law enforcement, and judicial serv22 ices. 

23 ‘‘(3) To assist Indian Tribes to identify services 

24 and resources available to address mental illness and 

25 dysfunctional and self-destructive behavior. 
249 

•S 1057 IS 

1 ‘‘(4) To provide authority and opportunities for 

2 Indian Tribes and Tribal Organizations to develop, 

3 implement, and coordinate with community-based 

4 programs which include identification, prevention, 

5 education, referral, and treatment services, including 

6 through multidisciplinary resource teams. 

7 ‘‘(5) To ensure that Indians, as citizens of the 

8 United States and of the States in which they re9 side, have the same access to behavioral health serv10 ices to which all citizens have access. 

11 ‘‘(6) To modify or supplement existing pro12 grams and authorities in the areas identified in 

13 paragraph (2). 

14 ‘‘(b) PLANS.— 

15 ‘‘(1) DEVELOPMENT.—The Secretary, acting 

16 through the Service, Indian Tribes, Tribal Organiza17 tions, and Urban Indian Organizations, shall encour18 age Indian Tribes and Tribal Organizations to de19 velop tribal plans, and Urban Indian Organizations 

20 to develop local plans, and for all such groups to 

21 participate in developing areawide plans for Indian 

22 Behavioral Health Services. The plans shall include, 

23 to the extent feasible, the following components: 

24 ‘‘(A) An assessment of the scope of alcohol 

25 or other substance abuse, mental illness, and 
250 

•S 1057 IS 

1 dysfunctional and self-destructive behavior, in2 cluding suicide, child abuse, and family vio3 lence, among Indians, including— 

4 ‘‘(i) the number of Indians served who 

5 are directly or indirectly affected by such 

6 illness or behavior; or 

7 ‘‘(ii) an estimate of the financial and 

8 human cost attributable to such illness or 

9 behavior. 

10 ‘‘(B) An assessment of the existing and 

11 additional resources necessary for the preven12 tion and treatment of such illness and behavior, 

13 including an assessment of the progress toward 

14 achieving the availability of the full continuum 

15 of care described in subsection (c). 

16 ‘‘(C) An estimate of the additional funding 

17 needed by the Service, Indian Tribes, Tribal 

18 Organizations, and Urban Indian Organizations 

19 to meet their responsibilities under the plans. 

20 ‘‘(2) NATIONAL CLEARINGHOUSE.—The Sec21 retary, acting through the Service, shall establish a 

22 national clearinghouse of plans and reports on the 

23 outcomes of such plans developed by Indian Tribes, 

24 Tribal Organizations, Urban Indian Organizations, 

25 and Service Areas relating to behavioral health. The 
251 

•S 1057 IS 

1 Secretary shall ensure access to these plans and out2 comes by any Indian Tribe, Tribal Organization, 

3 Urban Indian Organization, or the Service. 

4 ‘‘(3) TECHNICAL ASSISTANCE.—The Secretary 

5 shall provide technical assistance to Indian Tribes, 

6 Tribal Organizations, and Urban Indian Organiza7 tions in preparation of plans under this section and 

8 in developing standards of care that may be used 

9 and adopted locally. 

10 ‘‘(c) PROGRAMS.—The Secretary, acting through the 

11 Service, Indian Tribes, and Tribal Organizations, shall 

12 provide, to the extent feasible and if funding is available, 

13 programs including the following: 

14 ‘‘(1) COMPREHENSIVE CARE.—A comprehensive 

15 continuum of behavioral health care which pro16 vides— 

17 ‘‘(A) community-based prevention, inter18 vention, outpatient, and behavioral health 

19 aftercare; 

20 ‘‘(B) detoxification (social and medical); 

21 ‘‘(C) acute hospitalization; 

22 ‘‘(D) intensive outpatient/day treatment; 

23 ‘‘(E) residential treatment; 
252 

•S 1057 IS 

1 ‘‘(F) transitional living for those needing a 

2 temporary, stable living environment that is 

3 supportive of treatment and recovery goals; 

4 ‘‘(G) emergency shelter; 

5 ‘‘(H) intensive case management; 

6 ‘‘(I) Traditional Health Care Practices; 

7 and 

8 ‘‘(J) diagnostic services. 

9 ‘‘(2) CHILD CARE.—Behavioral health services 

10 for Indians from birth through age 17, including— 

11 ‘‘(A) preschool and school age fetal alcohol 

12 disorder services, including assessment and be13 havioral intervention; 

14 ‘‘(B) mental health and substance abuse 

15 services (emotional, organic, alcohol, drug, in16 halant, and tobacco); 

17 ‘‘(C) identification and treatment of co-oc18 curring disorders and comorbidity; 

19 ‘‘(D) prevention of alcohol, drug, inhalant, 

20 and tobacco use; 

21 ‘‘(E) early intervention, treatment, and 

22 aftercare; 

23 ‘‘(F) promotion of healthy approaches to 

24 risk and safety issues; and 
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•S 1057 IS 

1 ‘‘(G) identification and treatment of ne2 glect and physical, mental, and sexual abuse. 

3 ‘‘(3) ADULT CARE.—Behavioral health services 

4 for Indians from age 18 through 55, including— 

5 ‘‘(A) early intervention, treatment, and 

6 aftercare; 

7 ‘‘(B) mental health and substance abuse 

8 services (emotional, alcohol, drug, inhalant, and 

9 tobacco), including sex specific services; 

10 ‘‘(C) identification and treatment of co-oc11 curring disorders (dual diagnosis) and comor12 bidity; 

13 ‘‘(D) promotion of healthy approaches for 

14 risk-related behavior; 

15 ‘‘(E) treatment services for women at risk 

16 of giving birth to a child with a fetal alcohol 

17 disorder; and 

18 ‘‘(F) sex specific treatment for sexual as19 sault and domestic violence. 

20 ‘‘(4) FAMILY CARE.—Behavioral health services 

21 for families, including— 

22 ‘‘(A) early intervention, treatment, and 

23 aftercare for affected families; 

24 ‘‘(B) treatment for sexual assault and do25 mestic violence; and 
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1 ‘‘(C) promotion of healthy approaches re2 lating to parenting, domestic violence, and other 

3 abuse issues. 

4 ‘‘(5) ELDER CARE.—Behavioral health services 

5 for Indians 56 years of age and older, including— 

6 ‘‘(A) early intervention, treatment, and 

7 aftercare; 

8 ‘‘(B) mental health and substance abuse 

9 services (emotional, alcohol, drug, inhalant, and 

10 tobacco), including sex specific services; 

11 ‘‘(C) identification and treatment of co-oc12 curring disorders (dual diagnosis) and comor13 bidity; 

14 ‘‘(D) promotion of healthy approaches to 

15 managing conditions related to aging; 

16 ‘‘(E) sex specific treatment for sexual as17 sault, domestic violence, neglect, physical and 

18 mental abuse and exploitation; and 

19 ‘‘(F) identification and treatment of de20 mentias regardless of cause. 

21 ‘‘(d) COMMUNITY BEHAVIORAL HEALTH PLAN.— 

22 ‘‘(1) ESTABLISHMENT.—The governing body of 

23 any Indian Tribe, Tribal Organization, or Urban In24 dian Organization may adopt a resolution for the es25 tablishment of a community behavioral health plan 
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1 providing for the identification and coordination of 

2 available resources and programs to identify, pre3 vent, or treat substance abuse, mental illness, or 

4 dysfunctional and self-destructive behavior, including 

5 child abuse and family violence, among its members 

6 or its service population. This plan should include 

7 behavioral health services, social services, intensive 

8 outpatient services, and continuing aftercare. 

9 ‘‘(2) TECHNICAL ASSISTANCE.—At the request 

10 of an Indian Tribe, Tribal Organization, or Urban 

11 Indian Organization, the Bureau of Indian Affairs 

12 and the Service shall cooperate with and provide 

13 technical assistance to the Indian Tribe, Tribal Or14 ganization, or Urban Indian Organization in the de15 velopment and implementation of such plan. 

16 ‘‘(3) FUNDING.—The Secretary, acting through 

17 the Service, may make funding available to Indian 

18 Tribes and Tribal Organizations which adopt a reso19 lution pursuant to paragraph (1) to obtain technical 

20 assistance for the development of a community be21 havioral health plan and to provide administrative 

22 support in the implementation of such plan. 

23 ‘‘(e) COORDINATION FOR AVAILABILITY OF SERV24 ICES.—The Secretary, acting through the Service, Indian 

25 Tribes, Tribal Organizations, and Urban Indian Organiza-
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1 tions, shall coordinate behavioral health planning, to the 

2 extent feasible, with other Federal agencies and with State 

3 agencies, to encourage comprehensive behavioral health 

4 services for Indians regardless of their place of residence. 

5 ‘‘(f) MENTAL HEALTH CARE NEED ASSESSMENT.— 

6 Not later than 1 year after the date of enactment of the 

7 Indian Health Care Improvement Act Amendments of 

8 2005, the Secretary, acting through the Service, shall 

9 make an assessment of the need for inpatient mental 

10 health care among Indians and the availability and cost 

11 of inpatient mental health facilities which can meet such 

12 need. In making such assessment, the Secretary shall con13 sider the possible conversion of existing, underused Service 

14 hospital beds into psychiatric units to meet such need. 

15 ‘‘SEC. 702. MEMORANDA OF AGREEMENT WITH THE DE16 PARTMENT OF THE INTERIOR. 

17 ‘‘(a) CONTENTS.—Not later than 12 months after the 

18 date of enactment of the Indian Health Care Improvement 

19 Act Amendments of 2005, the Secretary, acting through 

20 the Service, and the Secretary of the Interior shall develop 

21 and enter into a memoranda of agreement, or review and 

22 update any existing memoranda of agreement, as required 

23 by section 4205 of the Indian Alcohol and Substance 

24 Abuse Prevention and Treatment Act of 1986 (25 U.S.C. 

25 2411) under which the Secretaries address the following: 
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1 ‘‘(1) The scope and nature of mental illness and 

2 dysfunctional and self-destructive behavior, including 

3 child abuse and family violence, among Indians. 

4 ‘‘(2) The existing Federal, tribal, State, local, 

5 and private services, resources, and programs avail6 able to provide behavioral health services for Indi7 ans. 

8 ‘‘(3) The unmet need for additional services, re9 sources, and programs necessary to meet the needs 

10 identified pursuant to paragraph (1). 

11 ‘‘(4)(A) The right of Indians, as citizens of the 

12 United States and of the States in which they re13 side, to have access to behavioral health services to 

14 which all citizens have access. 

15 ‘‘(B) The right of Indians to participate in, and 

16 receive the benefit of, such services. 

17 ‘‘(C) The actions necessary to protect the exer18 cise of such right. 

19 ‘‘(5) The responsibilities of the Bureau of In20 dian Affairs and the Service, including mental illness 

21 identification, prevention, education, referral, and 

22 treatment services (including services through multi23 disciplinary resource teams), at the central, area, 

24 and agency and Service Unit, Service Area, and 
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1 headquarters levels to address the problems identi2 fied in paragraph (1). 

3 ‘‘(6) A strategy for the comprehensive coordina4 tion of the behavioral health services provided by the 

5 Bureau of Indian Affairs and the Service to meet 

6 the problems identified pursuant to paragraph (1), 

7 including— 

8 ‘‘(A) the coordination of alcohol and sub9 stance abuse programs of the Service, the Bu10 reau of Indian Affairs, and Indian Tribes and 

11 Tribal Organizations (developed under the In12 dian Alcohol and Substance Abuse Prevention 

13 and Treatment Act of 1986) with behavioral 

14 health initiatives pursuant to this Act, particu15 larly with respect to the referral and treatment 

16 of dually diagnosed individuals requiring behav17 ioral health and substance abuse treatment; and 

18 ‘‘(B) ensuring that the Bureau of Indian 

19 Affairs and Service programs and services (in20 cluding multidisciplinary resource teams) ad21 dressing child abuse and family violence are co22 ordinated with such non-Federal programs and 

23 services. 

24 ‘‘(7) Directing appropriate officials of the Bu25 reau of Indian Affairs and the Service, particularly 
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1 at the agency and Service Unit levels, to cooperate 

2 fully with tribal requests made pursuant to commu3 nity behavioral health plans adopted under section 

4 701(c) and section 4206 of the Indian Alcohol and 

5 Substance Abuse Prevention and Treatment Act of 

6 1986 (25 U.S.C. 2412). 

7 ‘‘(8) Providing for an annual review of such 

8 agreement by the Secretaries which shall be provided 

9 to Congress and Indian Tribes and Tribal Organiza10 tions. 

11 ‘‘(b) SPECIFIC PROVISIONS REQUIRED.—The memo12 randa of agreement updated or entered into pursuant to 

13 subsection (a) shall include specific provisions pursuant to 

14 which the Service shall assume responsibility for— 

15 ‘‘(1) the determination of the scope of the prob16 lem of alcohol and substance abuse among Indians, 

17 including the number of Indians within the jurisdic18 tion of the Service who are directly or indirectly af19 fected by alcohol and substance abuse and the finan20 cial and human cost; 

21 ‘‘(2) an assessment of the existing and needed 

22 resources necessary for the prevention of alcohol and 

23 substance abuse and the treatment of Indians af24 fected by alcohol and substance abuse; and 
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1 ‘‘(3) an estimate of the funding necessary to 

2 adequately support a program of prevention of alco3 hol and substance abuse and treatment of Indians 

4 affected by alcohol and substance abuse. 

5 ‘‘(c) CONSULTATION.—The Secretary, acting through 

6 the Service, and the Secretary of the Interior shall, in de7 veloping the memoranda of agreement under subsection 

8 (a), consult with and solicit the comments from— 

9 ‘‘(1) Indian Tribes and Tribal Organizations; 

10 ‘‘(2) Indians; 

11 ‘‘(3) Urban Indian Organizations and other In12 dian organizations; and 

13 ‘‘(4) behavioral health service providers. 

14 ‘‘(d) PUBLICATION.—Each memorandum of agree15 ment entered into or renewed (and amendments or modi16 fications thereto) under subsection (a) shall be published 

17 in the Federal Register. At the same time as publication 

18 in the Federal Register, the Secretary shall provide a copy 

19 of such memoranda, amendment, or modification to each 

20 Indian Tribe, Tribal Organization, and Urban Indian Or21 ganization. 

22 ‘‘SEC. 703. COMPREHENSIVE BEHAVIORAL HEALTH PRE23 VENTION AND TREATMENT PROGRAM. 

24 ‘‘(a) ESTABLISHMENT.— 
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1 ‘‘(1) IN GENERAL.—The Secretary, acting 

2 through the Service, Indian Tribes, and Tribal Orga3 nizations, shall provide a program of comprehensive 

4 behavioral health, prevention, treatment, and 

5 aftercare, including Traditional Health Care Prac6 tices, which shall include— 

7 ‘‘(A) prevention, through educational inter8 vention, in Indian communities; 

9 ‘‘(B) acute detoxification, psychiatric hos10 pitalization, residential, and intensive outpatient 

11 treatment; 

12 ‘‘(C) community-based rehabilitation and 

13 aftercare; 

14 ‘‘(D) community education and involve15 ment, including extensive training of health 

16 care, educational, and community-based per17 sonnel; 

18 ‘‘(E) specialized residential treatment pro19 grams for high-risk populations, including preg20 nant and postpartum women and their children; 

21 and 

22 ‘‘(F) diagnostic services. 

23 ‘‘(2) TARGET POPULATIONS.—The target popu24 lation of such programs shall be members of Indian 

25 Tribes. Efforts to train and educate key members of 
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1 the Indian community shall also target employees of 

2 health, education, judicial, law enforcement, legal, 

3 and social service programs. 

4 ‘‘(b) CONTRACT HEALTH SERVICES.— 

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

6 through the Service, Indian Tribes, and Tribal Orga7 nizations, may enter into contracts with public or 

8 private providers of behavioral health treatment 

9 services for the purpose of carrying out the program 

10 required under subsection (a). 

11 ‘‘(2) PROVISION OF ASSISTANCE.—In carrying 

12 out this subsection, the Secretary shall provide as13 sistance to Indian Tribes and Tribal Organizations 

14 to develop criteria for the certification of behavioral 

15 health service providers and accreditation of service 

16 facilities which meet minimum standards for such 

17 services and facilities. 

18 ‘‘SEC. 704. MENTAL HEALTH TECHNICIAN PROGRAM. 

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

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

21 as the ‘Snyder Act’), the Secretary shall establish and 

22 maintain a mental health technician program within the 

23 Service which— 

24 ‘‘(1) provides for the training of Indians as 

25 mental health technicians; and 
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1 ‘‘(2) employs such technicians in the provision 

2 of community-based mental health care that includes 

3 identification, prevention, education, referral, and 

4 treatment services. 

5 ‘‘(b) PARAPROFESSIONAL TRAINING.—In carrying 

6 out subsection (a), the Secretary, acting through the Serv7 ice, Indian Tribes, and Tribal Organizations, shall provide 

8 high-standard paraprofessional training in mental health 

9 care necessary to provide quality care to the Indian com10 munities to be served. Such training shall be based upon 

11 a curriculum developed or approved by the Secretary 

12 which combines education in the theory of mental health 

13 care with supervised practical experience in the provision 

14 of such care. 

15 ‘‘(c) SUPERVISION AND EVALUATION OF TECHNI16 CIANS.—The Secretary, acting through the Service, Indian 

17 Tribes, and Tribal Organizations, shall supervise and 

18 evaluate the mental health technicians in the training pro19 gram. 

20 ‘‘(d) TRADITIONAL HEALTH CARE PRACTICES.—The 

21 Secretary, acting through the Service, shall ensure that 

22 the program established pursuant to this subsection in23 volves the use and promotion of the Traditional Health 

24 Care Practices of the Indian Tribes to be served. 
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1 ‘‘SEC. 705. LICENSING REQUIREMENT FOR MENTAL 

2 HEALTH CARE WORKERS. 

3 ‘‘Subject to the provisions of section 221, any person 

4 employed as a psychologist, social worker, or marriage and 

5 family therapist for the purpose of providing mental health 

6 care services to Indians in a clinical setting under this Act 

7 is required to be licensed as a clinical psychologist, social 

8 worker, or marriage and family therapist, respectively, or 

9 working under the direct supervision of a licensed clinical 

10 psychologist, social worker, or marriage and family thera11 pist, respectively. 

12 ‘‘SEC. 706. INDIAN WOMEN TREATMENT PROGRAMS. 

13 ‘‘(a) FUNDING.—The Secretary, consistent with sec14 tion 701, shall make funds available to Indian Tribes, 

15 Tribal Organizations, and Urban Indian Organizations to 

16 develop and implement a comprehensive behavioral health 

17 program of prevention, intervention, treatment, and re18 lapse prevention services that specifically addresses the 

19 spiritual, cultural, historical, social, and child care needs 

20 of Indian women, regardless of age. 

21 ‘‘(b) USE OF FUNDS.—Funds made available pursu22 ant to this section may be used to— 

23 ‘‘(1) develop and provide community training, 

24 education, and prevention programs for Indian 

25 women relating to behavioral health issues, including 

26 fetal alcohol disorders; 
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1 ‘‘(2) identify and provide psychological services, 

2 counseling, advocacy, support, and relapse preven3 tion to Indian women and their families; and 

4 ‘‘(3) develop prevention and intervention models 

5 for Indian women which incorporate Traditional 

6 Health Care Practices, cultural values, and commu7 nity and family involvement. 

8 ‘‘(c) CRITERIA.—The Secretary, in consultation with 

9 Indian Tribes and Tribal Organizations, shall establish 

10 criteria for the review and approval of applications and 

11 proposals for funding under this section. 

12 ‘‘(d) EARMARK OF CERTAIN FUNDS.—Twenty per13 cent of the funds appropriated pursuant to this section 

14 shall be used to make grants to Urban Indian Organiza15 tions. 

16 ‘‘SEC. 707. INDIAN YOUTH PROGRAM. 

17 ‘‘(a) DETOXIFICATION AND REHABILITATION.—The 

18 Secretary, acting through the Service, consistent with sec19 tion 701, shall develop and implement a program for acute 

20 detoxification and treatment for Indian youths, including 

21 behavioral health services. The program shall include re22 gional treatment centers designed to include detoxification 

23 and rehabilitation for both sexes on a referral basis and 

24 programs developed and implemented by Indian Tribes or 

25 Tribal Organizations at the local level under the Indian 
266 

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1 Self-Determination and Education Assistance Act. Re2 gional centers shall be integrated with the intake and re3 habilitation programs based in the referring Indian com4 munity. 

5 ‘‘(b) ALCOHOL AND SUBSTANCE ABUSE TREATMENT

6 CENTERS OR FACILITIES.— 

7 ‘‘(1) ESTABLISHMENT.— 

8 ‘‘(A) IN GENERAL.—The Secretary, acting 

9 through the Service, Indian Tribes, and Tribal 

10 Organizations, shall construct, renovate, or, as 

11 necessary, purchase, and appropriately staff 

12 and operate, at least 1 youth regional treatment 

13 center or treatment network in each area under 

14 the jurisdiction of an Area Office. 

15 ‘‘(B) AREA OFFICE IN CALIFORNIA.—For 

16 the purposes of this subsection, the Area Office 

17 in California shall be considered to be 2 Area 

18 Offices, 1 office whose jurisdiction shall be con19 sidered to encompass the northern area of the 

20 State of California, and 1 office whose jurisdic21 tion shall be considered to encompass the re22 mainder of the State of California for the pur23 pose of implementing California treatment net24 works. 
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1 ‘‘(2) FUNDING.—For the purpose of staffing 

2 and operating such centers or facilities, funding 

3 shall be pursuant to the Act of November 2, 1921 

4 (25 U.S.C. 13). 

5 ‘‘(3) LOCATION.—A youth treatment center 

6 constructed or purchased under this subsection shall 

7 be constructed or purchased at a location within the 

8 area described in paragraph (1) agreed upon (by ap9 propriate tribal resolution) by a majority of the In10 dian Tribes to be served by such center. 

11 ‘‘(4) SPECIFIC PROVISION OF FUNDS.— 

12 ‘‘(A) IN GENERAL.—Notwithstanding any 

13 other provision of this title, the Secretary may, 

14 from amounts authorized to be appropriated for 

15 the purposes of carrying out this section, make 

16 funds available to— 

17 ‘‘(i) the Tanana Chiefs Conference, 

18 Incorporated, for the purpose of leasing, 

19 constructing, renovating, operating, and 

20 maintaining a residential youth treatment 

21 facility in Fairbanks, Alaska; and 

22 ‘‘(ii) the Southeast Alaska Regional 

23 Health Corporation to staff and operate a 

24 residential youth treatment facility without 

25 regard to the proviso set forth in section 
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1 4(l) of the Indian Self-Determination and 

2 Education Assistance Act (25 U.S.C. 

3 450b(l)). 

4 ‘‘(B) PROVISION OF SERVICES TO ELIGI5 BLE YOUTHS.—Until additional residential 

6 youth treatment facilities are established in 

7 Alaska pursuant to this section, the facilities 

8 specified in subparagraph (A) shall make every 

9 effort to provide services to all eligible Indian 

10 youths residing in Alaska. 

11 ‘‘(c) INTERMEDIATE ADOLESCENT BEHAVIORAL

12 HEALTH SERVICES.— 

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

14 through the Service, Indian Tribes, and Tribal Orga15 nizations, may provide intermediate behavioral 

16 health services, which may incorporate Traditional 

17 Health Care Practices, to Indian children and ado18 lescents, including— 

19 ‘‘(A) pretreatment assistance; 

20 ‘‘(B) inpatient, outpatient, and aftercare 

21 services; 

22 ‘‘(C) emergency care; 

23 ‘‘(D) suicide prevention and crisis interven24 tion; and 
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1 ‘‘(E) prevention and treatment of mental 

2 illness and dysfunctional and self-destructive 

3 behavior, including child abuse and family vio4 lence. 

5 ‘‘(2) USE OF FUNDS.—Funds provided under 

6 this subsection may be used— 

7 ‘‘(A) to construct or renovate an existing 

8 health facility to provide intermediate behav9 ioral health services; 

10 ‘‘(B) to hire behavioral health profes11 sionals; 

12 ‘‘(C) to staff, operate, and maintain an in13 termediate mental health facility, group home, 

14 sober housing, transitional housing or similar 

15 facilities, or youth shelter where intermediate 

16 behavioral health services are being provided; 

17 ‘‘(D) to make renovations and hire appro18 priate staff to convert existing hospital beds 

19 into adolescent psychiatric units; and 

20 ‘‘(E) for intensive home- and community21 based services. 

22 ‘‘(3) CRITERIA.—The Secretary, acting through 

23 the Service, shall, in consultation with Indian Tribes 

24 and Tribal Organizations, establish criteria for the 
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1 review and approval of applications or proposals for 

2 funding made available pursuant to this subsection. 

3 ‘‘(d) FEDERALLY OWNED STRUCTURES.— 

4 ‘‘(1) IN GENERAL.—The Secretary, in consulta5 tion with Indian Tribes and Tribal Organizations, 

6 shall— 

7 ‘‘(A) identify and use, where appropriate, 

8 federally owned structures suitable for local res9 idential or regional behavioral health treatment 

10 for Indian youths; and 

11 ‘‘(B) establish guidelines, in consultation 

12 with Indian Tribes and Tribal Organizations, 

13 for determining the suitability of any such fed14 erally owned structure to be used for local resi15 dential or regional behavioral health treatment 

16 for Indian youths. 

17 ‘‘(2) TERMS AND CONDITIONS FOR USE OF

18 STRUCTURE.—Any structure described in paragraph 

19 (1) may be used under such terms and conditions as 

20 may be agreed upon by the Secretary and the agency 

21 having responsibility for the structure and any In22 dian Tribe or Tribal Organization operating the pro23 gram. 

24 ‘‘(e) REHABILITATION AND AFTERCARE SERVICES.— 
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1 ‘‘(1) IN GENERAL.—The Secretary, Indian 

2 Tribes, or Tribal Organizations, in cooperation with 

3 the Secretary of the Interior, shall develop and im4 plement within each Service Unit, community-based 

5 rehabilitation and follow-up services for Indian 

6 youths who are having significant behavioral health 

7 problems, and require long-term treatment, commu8 nity reintegration, and monitoring to support the In9 dian youths after their return to their home commu10 nity. 

11 ‘‘(2) ADMINISTRATION.—Services under para12 graph (1) shall be provided by trained staff within 

13 the community who can assist the Indian youths in 

14 their continuing development of self-image, positive 

15 problem-solving skills, and nonalcohol or substance 

16 abusing behaviors. Such staff may include alcohol 

17 and substance abuse counselors, mental health pro18 fessionals, and other health professionals and para19 professionals, including community health represent20 atives. 

21 ‘‘(f) INCLUSION OF FAMILY IN YOUTH TREATMENT

22 PROGRAM.—In providing the treatment and other services 

23 to Indian youths authorized by this section, the Secretary, 

24 acting through the Service, Indian Tribes, and Tribal Or25 ganizations, shall provide for the inclusion of family mem-
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1 bers of such youths in the treatment programs or other 

2 services as may be appropriate. Not less than 10 percent 

3 of the funds appropriated for the purposes of carrying out 

4 subsection (e) shall be used for outpatient care of adult 

5 family members related to the treatment of an Indian 

6 youth under that subsection. 

7 ‘‘(g) MULTIDRUG ABUSE PROGRAM.—The Secretary, 

8 acting through the Service, Indian Tribes, Tribal Organi9 zations, and Urban Indian Organizations, shall provide, 

10 consistent with section 701, programs and services to pre11 vent and treat the abuse of multiple forms of substances, 

12 including alcohol, drugs, inhalants, and tobacco, among 

13 Indian youths residing in Indian communities, on or near 

14 reservations, and in urban areas and provide appropriate 

15 mental health services to address the incidence of mental 

16 illness among such youths. 

17 ‘‘SEC. 708. INPATIENT AND COMMUNITY-BASED MENTAL 

18 HEALTH FACILITIES DESIGN, CONSTRUC19 TION, AND STAFFING. 

20 ‘‘Not later than 1 year after the date of enactment 

21 of the Indian Health Care Improvement Act Amendments 

22 of 2005, the Secretary, acting through the Service, Indian 

23 Tribes, and Tribal Organizations, may provide, in each 

24 area of the Service, not less than 1 inpatient mental health 

25 care facility, or the equivalent, for Indians with behavioral 
273 

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1 health problems. For the purposes of this subsection, Cali2 fornia shall be considered to be 2 Area Offices, 1 office 

3 whose location shall be considered to encompass the north4 ern area of the State of California and 1 office whose ju5 risdiction shall be considered to encompass the remainder 

6 of the State of California. The Secretary shall consider 

7 the possible conversion of existing, underused Service hos8 pital beds into psychiatric units to meet such need. 

9 ‘‘SEC. 709. TRAINING AND COMMUNITY EDUCATION. 

10 ‘‘(a) PROGRAM.—The Secretary, in cooperation with 

11 the Secretary of the Interior, shall develop and implement 

12 or provide funding for Indian Tribes and Tribal Organiza13 tions to develop and implement, within each Service Unit 

14 or tribal program, a program of community education and 

15 involvement which shall be designed to provide concise and 

16 timely information to the community leadership of each 

17 tribal community. Such program shall include education 

18 about behavioral health issues to political leaders, Tribal 

19 judges, law enforcement personnel, members of tribal 

20 health and education boards, health care providers includ21 ing traditional practitioners, and other critical members 

22 of each tribal community. Community-based training (ori23 ented toward local capacity development) shall also include 

24 tribal community provider training (designed for adult 
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1 learners from the communities receiving services for pre2 vention, intervention, treatment, and aftercare). 

3 ‘‘(b) INSTRUCTION.—The Secretary, acting through 

4 the Service, shall, either directly or through Indian Tribes 

5 and Tribal Organizations, provide instruction in the area 

6 of behavioral health issues, including instruction in crisis 

7 intervention and family relations in the context of alcohol 

8 and substance abuse, child sexual abuse, youth alcohol and 

9 substance abuse, and the causes and effects of fetal alco10 hol disorders to appropriate employees of the Bureau of 

11 Indian Affairs and the Service, and to personnel in schools 

12 or programs operated under any contract with the Bureau 

13 of Indian Affairs or the Service, including supervisors of 

14 emergency shelters and halfway houses described in sec15 tion 4213 of the Indian Alcohol and Substance Abuse Pre16 vention and Treatment Act of 1986 (25 U.S.C. 2433). 

17 ‘‘(c) TRAINING MODELS.—In carrying out the edu18 cation and training programs required by this section, the 

19 Secretary, in consultation with Indian Tribes, Tribal Or20 ganizations, Indian behavioral health experts, and Indian 

21 alcohol and substance abuse prevention experts, shall de22 velop and provide community-based training models. Such 

23 models shall address— 

24 ‘‘(1) the elevated risk of alcohol and behavioral 

25 health problems faced by children of alcoholics; 
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•S 1057 IS 

1 ‘‘(2) the cultural, spiritual, and 

2 multigenerational aspects of behavioral health prob3 lem prevention and recovery; and 

4 ‘‘(3) community-based and multidisciplinary 

5 strategies for preventing and treating behavioral 

6 health problems. 

7 ‘‘SEC. 710. BEHAVIORAL HEALTH PROGRAM. 

8 ‘‘(a) INNOVATIVE PROGRAMS.—The Secretary, acting 

9 through the Service, Indian Tribes, and Tribal Organiza10 tions, consistent with section 701, may plan, develop, im11 plement, and carry out programs to deliver innovative 

12 community-based behavioral health services to Indians. 

13 ‘‘(b) FUNDING; CRITERIA.—The Secretary may 

14 award such funding for a project under subsection (a) to 

15 an Indian Tribe or Tribal Organization and may consider 

16 the following criteria: 

17 ‘‘(1) The project will address significant unmet 

18 behavioral health needs among Indians. 

19 ‘‘(2) The project will serve a significant number 

20 of Indians. 

21 ‘‘(3) The project has the potential to deliver 

22 services in an efficient and effective manner. 

23 ‘‘(4) The Indian Tribe or Tribal Organization 

24 has the administrative and financial capability to ad25 minister the project. 
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1 ‘‘(5) The project may deliver services in a man2 ner consistent with Traditional Health Care Prac3 tices. 

4 ‘‘(6) The project is coordinated with, and avoids 

5 duplication of, existing services. 

6 ‘‘(c) EQUITABLE TREATMENT.—For purposes of this 

7 subsection, the Secretary shall, in evaluating project appli8 cations or proposals, use the same criteria that the Sec9 retary uses in evaluating any other application or proposal 

10 for such funding. 

11 ‘‘SEC. 711. FETAL ALCOHOL DISORDER FUNDING. 

12 ‘‘(a) PROGRAMS.— 

13 ‘‘(1) ESTABLISHMENT.—The Secretary, con14 sistent with section 701, acting through the Service, 

15 Indian Tribes, and Tribal Organizations, is author16 ized to establish and operate fetal alcohol disorder 

17 programs as provided in this section for the pur18 poses of meeting the health status objectives speci19 fied in section 3. 

20 ‘‘(2) USE OF FUNDS.—Funding provided pursu21 ant to this section shall be used for the following: 

22 ‘‘(A) To develop and provide for Indians 

23 community and in school training, education, 

24 and prevention programs relating to fetal alco25 hol disorders. 
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1 ‘‘(B) To identify and provide behavioral 

2 health treatment to high-risk Indian women 

3 and high-risk women pregnant with an Indian’s 

4 child. 

5 ‘‘(C) To identify and provide appropriate 

6 psychological services, educational and voca7 tional support, counseling, advocacy, and infor8 mation to fetal alcohol disorder affected Indians 

9 and their families or caretakers. 

10 ‘‘(D) To develop and implement counseling 

11 and support programs in schools for fetal alco12 hol disorder affected Indian children. 

13 ‘‘(E) To develop prevention and interven14 tion models which incorporate practitioners of 

15 Traditional Health Care Practices, cultural and 

16 spiritual values, and community involvement. 

17 ‘‘(F) To develop, print, and disseminate 

18 education and prevention materials on fetal al19 cohol disorder. 

20 ‘‘(G) To develop and implement, through 

21 the tribal consultation process, culturally sen22 sitive assessment and diagnostic tools including 

23 dysmorphology clinics and multidisciplinary 

24 fetal alcohol disorder clinics for use in Indian 

25 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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•S 1057 IS 

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 
290 

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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 
291 

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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 indi-
294 

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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— 
295 

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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 deter-
296 

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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 
297 

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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 
298 

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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 

25 may, as part of privileging process, be designated as em-
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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 
301 

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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 

25 issues of eligibility, benefits, the range of serv-
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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 
305 

•S 1057 IS 

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. 
306 

•S 1057 IS 

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 
307 

•S 1057 IS 

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.— 
308 

•S 1057 IS 

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 
309 

•S 1057 IS 

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 esti-
310 

•S 1057 IS 

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. 
311 

•S 1057 IS 

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 
312 

•S 1057 IS 

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)— 
313 

•S 1057 IS 

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 
314 

•S 1057 IS 

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 
315 

•S 1057 IS 

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’’. 
316 

•S 1057 IS 

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 Soboba Indian 

6 Reservation from being provided with sanitation facilities 

7 and services under the authority of section 7 of the Act 

8 of August 5, 1954 (68 Stat. 674), as amended by the Act 

9 of July 31, 1959 (73 Stat. 267).’’. 

10 SEC. 4. AMENDMENTS TO THE MEDICAID AND STATE CHIL11 DREN’S HEALTH INSURANCE PROGRAMS. 

12 (a) EXPANSION OF MEDICAID PAYMENT FOR ALL

13 COVERED SERVICES FURNISHED BY INDIAN HEALTH

14 PROGRAMS.— 

15 (1) EXPANSION TO ALL COVERED SERVICES.— 

16 Section 1911 of the Social Security Act (42 U.S.C. 

17 1396j) is amended— 

18 (A) by amending the heading to read as 

19 follows: 

20 ‘‘INDIAN HEALTH PROGRAMS’’; and 

21 (B) by amending subsection (a) to read as 

22 follows: 

23 ‘‘(a) ELIGIBILITY FOR REIMBURSEMENT FOR MED24 ICAL ASSISTANCE.—The Indian Health Service and an In25 dian Tribe, Tribal Organization, or an urban Indian Orga26 nization (as such terms are defined in section 4 of the 
317 

•S 1057 IS 

1 Indian Health Care Improvement Act) shall be eligible for 

2 reimbursement for medical assistance provided under a 

3 State plan or under waiver authority with respect to items 

4 and services furnished by the Indian Health Service, In5 dian Tribe, Tribal Organization, or Urban Indian Organi6 zation if the furnishing of such services meets all the con7 ditions and requirements which are applicable generally to 

8 the furnishing of items and services under this title and 

9 under such plan or waiver authority.’’. 

10 (2) ELIMINATION OF TEMPORARY DEEMING

11 PROVISION.—Such section is amended by striking 

12 subsection (b). 

13 (3) REVISION OF AUTHORITY TO ENTER INTO

14 AGREEMENTS.—Subsection (c) of such section is re15 designated as subsection (b) and is amended to read 

16 as follows: 

17 ‘‘(b) AUTHORITY TO ENTER INTO AGREEMENTS.— 

18 The Secretary may enter into an agreement with a State 

19 for the purpose of reimbursing the State for medical as20 sistance provided by the Indian Health Service, an Indian 

21 Tribe, Tribal Organizations, or an Urban Indian Organi22 zation (as so defined), directly, through referral, or under 

23 contracts or other arrangements between the Indian 

24 Health Service, an Indian Tribe, Tribal Organization, or 

25 an Urban Indian Organization and another health care 
318 

•S 1057 IS 

1 provider to Indians who are eligible for medical assistance 

2 under the State plan or under waiver authority.’’. 

3 (4) REFERENCE CORRECTION.—Subsection (d) 

4 of such section is redesignated as subsection (c) and 

5 is amended— 

6 (A) by striking ‘‘For’’ and inserting ‘‘DI7 RECT BILLING.—For’’; and 

8 (B) by striking ‘‘section 405’’ and insert9 ing ‘‘section 401(d)’’. 

10 (b) SPECIAL RULES FOR INDIANS, INDIAN HEALTH

11 CARE PROVIDERS, AND INDIAN MANAGED CARE ENTI12 TIES.— 

13 (1) IN GENERAL.—Section 1932 of the Social 

14 Security Act (42 U.S.C. 1396u–2) is amended by 

15 adding at the end the following new subsection: 

16 ‘‘(h) SPECIAL RULES FOR INDIANS, INDIAN HEALTH

17 CARE PROVIDERS, AND INDIAN MANAGED CARE ENTI18 TIES.—A State shall comply with the provisions of section 

19 413 of the Indian Health Care Improvement Act (relating 

20 to the treatment of Indians, Indian health care providers, 

21 and Indian managed care entities under a medicaid man22 aged care program).’’. 

23 (2) APPLICATION TO SCHIP.—Section 

24 2107(e)(1) of the Social Security Act (42 U.S.C. 
319 

•S 1057 IS 

1 1397gg(1)) is amended by adding at the end the fol2 lowing: 

3 ‘‘(E) Subsections (a)(2)(C) and (h) of sec4 tion 1932.’’. 

5 (c) SCHIP TREATMENT OF INDIAN TRIBES, TRIBAL

6 ORGANIZATIONS, AND URBAN INDIAN ORGANIZATIONS.— 

7 Section 2105(c) of the Social Security Act (42 U.S.C. 

8 1397ee(c)) is amended— 

9 (1) in paragraph (2), by adding at the end the 

10 following: 

11 ‘‘(C) INDIAN HEALTH PROGRAM PAY12 MENTS.—For provisions relating to authorizing 

13 use of allotments under this title for payments 

14 to Indian Health Programs and Urban Indian 

15 Organizations, see section 410 of the Indian 

16 Health Care Improvement Act.’’; and 

17 (2) in paragraph (6)(B), by inserting ‘‘or by an 

18 Indian Tribe, Tribal Organization, or Urban Indian 

19 Organization (as such terms are defined in section 

20 4 of the Indian Health Care Improvement Act)’’ 

21 after ‘‘Service’’. 
320 

•S 1057 IS 

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. 
321 

•S 1057 IS 

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 
322 

•S 1057 IS 

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; 
323 

•S 1057 IS 

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. 
324 

•S 1057 IS 

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. 
325 

•S 1057 IS 

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 
326 

•S 1057 IS 

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— 
327 

•S 1057 IS 

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. 
328 

•S 1057 IS 

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)— 
329 

•S 1057 IS 

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 
330 

•S 1057 IS 

1 paragraph (2)), by striking ‘‘section 501’’ and in2 serting ‘‘section 701’’. 

Æ