Page 445 TITLE 25—INDIANS § 1621d

(2) based on paragraph (1), the measures (including patient education) each Service unit

should take to reduce the incidence of, and

prevent, treat, and control the complications

resulting from, diabetes among tribes within

that Service unit.

(b) Screening

The Secretary shall screen each Indian who receives services from the Service for diabetes and

for conditions which indicate a high risk that

the individual will become diabetic. Such

screening may be done by a tribe or tribal organization operating health care programs or facilities with funds from the Service under the

Indian Self-Determination Act [25 U.S.C. 450f et

seq.].

(c) Model diabetes projects

(1) The Secretary shall continue to maintain

through fiscal year 2000 each model diabetes

project in existence on October 29, 1992, and located—

(A) at the Claremore Indian Hospital in

Oklahoma;

(B) at the Fort Totten Health Center in

North Dakota;

(C) at the Sacaton Indian Hospital in Arizona;

(D) at the Winnebago Indian Hospital in Nebraska;

(E) at the Albuquerque Indian Hospital in

New Mexico;

(F) at the Perry, Princeton, and Old Town

Health Centers in Maine;

(G) at the Bellingham Health Center in

Washington;

(H) at the Fort Berthold Reservation;

(I) at the Navajo Reservation;

(J) at the Papago Reservation;

(K) at the Zuni Reservation; or

(L) in the States of Alaska, California, Minnesota, Montana, Oregon, or Utah.

(2) The Secretary may establish new model diabetes projects under this section taking into

consideration applications received under this

section from all service areas, except that the

Secretary may not establish a greater number of

such projects in one service area than in any

other service area until there is an equal number of such projects established with respect to

all service areas from which the Secretary receives qualified applications during the application period (as determined by the Secretary).

(d) Control officer; registry of patients

The Secretary shall—

(1) employ in each area office of the Service

at least one diabetes control officer who shall

coordinate and manage on a full-time basis activities within that area office for the prevention, treatment, and control of diabetes;

(2) establish in each area office of the Service a registry of patients with diabetes to

track the incidence of diabetes and the complications from diabetes in that area;

(3) ensure that data collected in each area

office regarding diabetes and related complications among Indians is disseminated to all

other area offices; and

(4) evaluate the effectiveness of services provided through model diabetes projects established under this section.

(e) Authorization of appropriations

Funds appropriated under this section in any

fiscal year shall be in addition to base resources

appropriated to the Service for that year.

(Pub. L. 94–437, title II, §204, as added Pub. L.

100–713, title II, §203(c), Nov. 23, 1988, 102 Stat.

4806; amended Pub. L. 102–573, title II, §§204,

217(b)(3), title IX, §901(2), Oct. 29, 1992, 106 Stat.

4546, 4559, 4590.)

REFERENCES IN TEXT

The Indian Self-Determination Act, referred to in

subsec. (b), is title I of Pub. L. 93–638, Jan. 4, 1975, 88

Stat. 2206, as amended, which is classified principally

to part A (§450f et seq.) of subchapter II of chapter 14

of this title. For complete classification of this Act to

the Code, see Short Title note set out under section 450

of this title and Tables.

AMENDMENTS

1992—Subsec. (a). Pub. L. 102–573, §901(2), redesignated

par. (1) as entire subsec., redesignated subpars. (A) and

(B) as pars. (1) and (2), respectively, substituted ‘‘paragraph (1)’’ for ‘‘subparagraph (A)’’ in par. (2), and

struck out former par. (2) which read as follows: ‘‘Within 18 months after November 23, 1988, the Secretary

shall prepare and transmit to the President and the

Congress a report describing the determinations made

and measures taken under paragraph (1) and making

recommendations for additional funding to prevent,

treat, and control diabetes among Indians.’’

Subsec. (c). Pub. L. 102–573, §204(1), amended subsec.

(c) generally. Prior to amendment, subsec. (c) read as

follows:

‘‘(1) The Secretary shall continue to maintain during

fiscal years 1988 through 1991 each of the following

model diabetes projects which are in existence on November 23, 1988:

‘‘(A) Claremore Indian Hospital in Oklahoma;

‘‘(B) Fort Totten Health Center in North Dakota;

‘‘(C) Sacaton Indian Hospital in Arizona;

‘‘(D) Winnebago Indian Hospital in Nebraska;

‘‘(E) Albuquerque Indian Hospital in New Mexico;

‘‘(F) Perry, Princeton, and Old Town Health Centers in Maine; and

‘‘(G) Bellingham Health Center in Washington.

‘‘(2) The Secretary shall establish in fiscal year 1989,

and maintain during fiscal years 1989 through 1991, a

model diabetes project in each of the following locations:

‘‘(A) Fort Berthold Reservation;

‘‘(B) the Navajo Reservation;

‘‘(C) the Papago Reservation;

‘‘(D) the Zuni Reservation; and

‘‘(E) the States of Alaska, California, Minnesota,

Montana, Oregon, and Utah.’’

Subsec. (d)(4). Pub. L. 102–573, §204(2), added par. (4).

Subsec. (e). Pub. L. 102–573, §217(b)(3), substituted

‘‘this section’’ for ‘‘subsection (c) of this section’’ and

struck out at beginning ‘‘There are authorized to be appropriated such sums as may be necessary to carry out

the provisions of this section.’’

§ 1621d. Hospice care feasibility study

(a) Duty of Secretary

The Secretary, acting through the Service and

in consultation with representatives of Indian

tribes, tribal organizations, Indian Health Service personnel, and hospice providers, shall conduct a study—

(1) to assess the feasibility and desirability

of furnishing hospice care to terminally ill Indians; and

(2) to determine the most efficient and effective means of furnishing such care.
§ 1621e TITLE 25—INDIANS Page 446

(b) Functions of study

Such study shall—

(1) assess the impact of Indian culture and

beliefs concerning death and dying on the provision of hospice care to Indians;

(2) estimate the number of Indians for whom

hospice care may be appropriate and determine the geographic distribution of such individuals;

(3) determine the most appropriate means to

facilitate the participation of Indian tribes

and tribal organizations in providing hospice

care;

(4) identify and evaluate various means for

providing hospice care, including—

(A) the provision of such care by the personnel of a Service hospital pursuant to a

hospice program established by the Secretary at such hospital; and

(B) the provision of such care by a community-based hospice program under contract

to the Service; and

(5) identify and assess any difficulties in furnishing such care and the actions needed to resolve such difficulties.

(c) Report to Congress

Not later than the date which is 12 months

after October 29, 1992, the Secretary shall transmit to the Congress a report containing—

(1) a detailed description of the study conducted pursuant to this section; and

(2) a discussion of the findings and conclusions of such study.

(d) Definitions

For the purposes of this section—

(1) the term ‘‘terminally ill’’ means any Indian who has a medical prognosis (as certified

by a physician) of a life expectancy of six

months or less; and

(2) the term ‘‘hospice program’’ means any

program which satisfies the requirements of

section 1395x(dd)((2) of title 42; and

(3) the term ‘‘hospice care’’ means the items

and services specified in subparagraphs (A)

through (H) of section 1395x(dd)(1) of title 42.

(Pub. L. 94–437, title II, §205, as added Pub. L.

102–573, title II, §206(a), Oct. 29, 1992, 106 Stat.

4548.)

PRIOR PROVISIONS

A prior section 1621d, Pub. L. 94–437, title II, §205, as

added Pub. L. 100–713, title II, §203(c), Nov. 23, 1988, 102

Stat. 4807, related to Native Hawaiian health promotion and disease prevention, prior to repeal by Pub.

L. 100–579, §14, formerly §10, Oct. 31, 1988, 102 Stat. 2923;

Pub. L. 100–690, title II, §2310, Nov. 18, 1988, 102 Stat.

4229; renumbered §14, Pub. L. 102–396, title IX, §9168,

Oct. 6, 1992, 106 Stat. 1948. See section 11701 et seq. of

Title 42, The Public Health and Welfare.

§ 1621e. Reimbursement from certain third parties of costs of health services

(a) Right of recovery

Except as provided in subsection (f) of this section, the United States, an Indian tribe, or a

tribal organization shall have the right to recover the reasonable expenses incurred by the

Secretary, an Indian tribe, or a tribal organization in providing health services, through the

Service, an Indian tribe, or a tribal organization, to any individual to the same extent that

such individual, or any nongovernmental provider of such services, would be eligible to receive reimbursement or indemnification for

such expenses if—

(1) such services had been provided by a nongovernmental provider, and

(2) such individual had been required to pay

such expenses and did pay such expenses.

(b) Recovery against State with workers’ compensation laws or no-fault automobile accident insurance program

Subsection (a) of this section shall provide a

right of recovery against any State only if the

injury, illness, or disability for which health

services were provided is covered under—

(1) workers’ compensation laws, or

(2) a no-fault automobile accident insurance

plan or program.

(c) Prohibition of State law or contract provision

impeding right of recovery

No law of any State, or of any political subdivision of a State, and no provision of any contract entered into or renewed after November 23,

1988, shall prevent or hinder the right of recovery of the United States, an Indian tribe, or a

tribal organization under subsection (a) of this

section.

(d) Right to damages

No action taken by the United States, an Indian tribe, or a tribal organization to enforce

the right of recovery provided under subsection

(a) of this section shall affect the right of any

person to any damages (other than damages for

the cost of health services provided by the Secretary through the Service).

(e) Intervention or separate civil action

The United States, an Indian tribe, or a tribal

organization may enforce the right of recovery

provided under subsection (a) of this section

by—

(1) intervening or joining in any civil action

or proceeding brought—

(A) by the individual for whom health

services were provided by the Secretary, an

Indian tribe, or a tribal organization, or

(B) by any representative or heirs of such

individual, or

(2) instituting a separate civil action, after

providing to such individual, or to the representative or heirs of such individual, notice

of the intention of the United States, an Indian tribe, or a tribal organization to institute

a separate civil action.

(f) Right of recovery for services when self-insurance plan provides coverage

The United States shall not have a right of recovery under this section if the injury, illness,

or disability for which health services were provided is covered under a self-insurance plan

funded by an Indian tribe or tribal organization.

(Pub. L. 94–437, title II, §206, as added Pub. L.

100–713, title II, §204, Nov. 23, 1988, 102 Stat. 4811;

amended Pub. L. 102–573, title II, §209, Oct. 29,

1992, 106 Stat. 4551.)