Page 443 TITLE 25—INDIANS § 1621a

deficiency of’’ for ‘‘the level of health resources deficiency for’’.

Subsec. (e)(3). Pub. L. 102–573, §201(a)(5)(D), substituted ‘‘eliminate the health status and resource deficiencies of all Indian tribes served by the Service; and’’

for ‘‘raise all Indian tribes served by the Service below

health resources deficiency level II to health resources

deficiency level II;’’.

Subsec. (e)(4) to (6). Pub. L. 102–573, §201(a)(5)(E), redesignated par. (6) as (4) and struck out former pars. (4)

and (5) which read as follows:

‘‘(4) the amount of funds necessary to raise all tribes

served by the Service below health resources deficiency

level I to health resources deficiency level I;

‘‘(5) the amount of funds necessary to raise all tribes

served by the Service to zero health resources deficiency; and’’.

Subsec. (f). Pub. L. 102–573, §201(a)(6), redesignated

par. (2) as entire subsec. and struck out former par. (1)

which read as follows: ‘‘The President shall include

with the budget submitted to the Congress under section 1105 of title 31 for each fiscal year a separate statement which specifies the amount of funds requested to

carry out the provisions of this section for such fiscal

year.’’

Subsec. (h). Pub. L. 102–573, §217(b)(1), substituted

‘‘this section’’ for ‘‘this subsection’’ and struck out

former first sentence which authorized appropriations

for fiscal years 1990 to 1992.

1988—Pub. L. 100–713 amended section generally, substituting subsecs. (a) to (h) relating to improvement of

Indian health status for former subsecs. (a) to (e) relating to direct patient care program.

1980—Subsec. (c)(1). Pub. L. 96–537, §4(a)(1), inserted

provisions authorizing appropriation of specific

amounts for fiscal years ending Sept. 30, 1981, Sept. 30,

1982, Sept. 30, 1983, and Sept. 30, 1984, and further authorizing additional positions as may be necessary for

each such fiscal year.

Subsec. (c)(2). Pub. L. 96–537, §4(a)(2), inserted provisions authorizing appropriation of specific amounts for

fiscal years ending Sept. 30, 1981, Sept. 30, 1982, Sept. 30,

1983, and Sept. 30, 1984, and further authorizing additional positions as may be necessary for each such fiscal year.

Subsec. (c)(3). Pub. L. 96–537, §4(a)(3), inserted provisions authorizing appropriation of specific amounts for

fiscal years ending Sept. 30, 1981, Sept. 30, 1982, Sept. 30,

1983, and Sept. 30, 1984, and further authorizing additional positions as may be necessary for each such fiscal year.

Subsec. (c)(4)(A). Pub. L. 96–537, §4(b)(1), inserted provisions authorizing appropriation of specific amounts

for fiscal years ending Sept. 30, 1981, Sept. 30, 1982, Sept.

30, 1983, and Sept. 30, 1984, and further authorizing additional positions as may be necessary for each such fiscal year.

Subsec. (c)(4)(B). Pub. L. 96–537, §4(b)(2), inserted provisions authorizing appropriation of specific amounts

for fiscal years ending Sept. 30, 1981, Sept. 30, 1982, Sept.

30, 1983, and Sept. 30, 1984, and further authorizing additional positions as may be necessary for each such fiscal year.

Subsec. (c)(4)(C). Pub. L. 96–537, §4(b)(3), inserted provisions authorizing appropriation of specific amounts

for fiscal years ending Sept. 30, 1981, Sept. 30, 1982, Sept.

30, 1983, and Sept. 30, 1984, and further authorizing additional positions as may be necessary for each such fiscal year.

Subsec. (c)(4)(D). Pub. L. 96–537, §4(b)(4), inserted provisions authorizing appropriation of specific amounts

for fiscal years ending Sept. 30, 1981, Sept. 30, 1982, Sept.

30, 1983, and Sept. 30, 1984, and further authorizing additional positions as may be necessary for each such fiscal year.

Subsec. (c)(4)(E). Pub. L. 96–537, §4(b)(5), inserted provisions authorizing appropriation of specific amounts

for fiscal years ending Sept. 30, 1981, Sept. 30, 1982, Sept.

30, 1983, and Sept. 30, 1984.

Subsec. (c)(5). Pub. L. 96–537, §4(c)(1), inserted provisions authorizing appropriation of specific amounts for

fiscal years ending Sept. 30, 1981, Sept. 30, 1982, Sept. 30,

1983, and Sept. 30, 1984.

Subsec. (c)(6). Pub. L. 96–537, §4(c)(2), inserted provisions authorizing appropriation of specific amounts for

fiscal years ending Sept. 30, 1981, Sept. 30, 1982, Sept. 30,

1983, and Sept. 30, 1984, and further authorizing additional positions as may be necessary for each such fiscal year.

Subsec. (c)(7). Pub. L. 96–537, §4(c)(3), struck out par.

(7) which authorized appropriation for the items referred to in subsecs. (c)(1) to (c)(6) of such sums as may

be specifically authorized by an act enacted after Sept.

30, 1976, for fiscal years 1981, 1982, 1983, and 1984, and

which further authorized positions for items referred to

in subsecs. (c)(1) to (c)(6) other than subsecs. (c)(4)(E)

and (c)(5), as may be specified in an act enacted after

Sept. 30, 1976.

EFFECTIVE DATE OF 1992 AMENDMENTS

Section 201(b) of Pub. L. 102–573 provided that: ‘‘Except with respect to the amendments made by subsection (a)(5) [amending this section], the amendments

made by subsection (a) [amending this section] shall

take effect three years after the date of the enactment

of this Act [Oct. 29, 1992]. The amendments made by

subsection (a)(5) shall take effect upon the date of the

enactment of this Act.’’

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in sections 1660a, 1671 of

this title.

§ 1621a. Catastrophic Health Emergency Fund

(a) Establishment; administration; purpose

(1) There is hereby established an Indian Catastrophic Health Emergency Fund (hereafter in

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

(A) the amounts deposited under subsection

(d) of this section, and

(B) the amounts appropriated to the Fund

under this section.

(2) The Fund shall be administered by the Secretary, acting through the central office of the

Service, solely for the purpose of meeting the

extraordinary medical costs associated with the

treatment of victims of disasters or catastrophic

illnesses who are within the responsibility of the

Service.

(3) The Fund shall not be allocated, apportioned, or delegated on a service unit, area office, or any other basis.

(4) No part of the Fund or its administration

shall be subject to contract or grant under any

law, including the Indian Self-Determination

Act [25 U.S.C. 450f et seq.].

(b) Regulations; procedures for payment

The Secretary shall, through the promulgation of regulations consistent with the provisions of this section—

(1) establish a definition of disasters and catastrophic illnesses for which the cost of treatment provided under contract would qualify

for payment from the Fund;

(2) provide that a service unit shall not be

eligible for reimbursement for the cost of

treatment from the Fund until its cost of

treating any victim of such catastrophic illness or disaster has reached a certain threshold cost which the Secretary shall establish

at—

(A) for 1993, not less than $15,000 or not

more than $25,000; and
§ 1621b TITLE 25—INDIANS Page 444

(B) for any subsequent year, not less than

the threshold cost of the previous year increased by the percentage increase in the

medical care expenditure category of the

consumer price index for all urban consumers (United States city average) for the 12-

month period ending with December of the

previous year;

(3) establish a procedure for the reimbursement of the portion of the costs incurred by—

(A) service units or facilities of the Service, or

(B) whenever otherwise authorized by the

Service, non-Service facilities or providers,

in rendering treatment that exceeds such

threshold cost;

(4) establish a procedure for payment from

the Fund in cases in which the exigencies of

the medical circumstances warrant treatment

prior to the authorization of such treatment

by the Service; and

(5) establish a procedure that will ensure

that no payment shall be made from the Fund

to any provider of treatment to the extent

that such provider is eligible to receive payment for the treatment from any other Federal, State, local, or private source of reimbursement for which the patient is eligible.

(c) Effect on other appropriations

Amounts appropriated to the Fund under this

section shall not be used to offset or limit appropriations made to the Service under authority of section 13 of this title or any other law.

(d) Reimbursements to Fund

There shall be deposited into the Fund all reimbursements to which the Service is entitled

from any Federal, State, local, or private source

(including third party insurance) by reason of

treatment rendered to any victim of a disaster

or catastrophic illness the cost of which was

paid from the Fund.

(Pub. L. 94–437, title II, §202, as added Pub. L.

100–713, title II, §202, Nov. 23, 1988, 102 Stat. 4803;

amended Pub. L. 102–573, title II, §§202(a),

217(b)(2), Oct. 29, 1992, 106 Stat. 4546, 4559.)

REFERENCES IN TEXT

The Indian Self-Determination Act, referred to in

subsec. (a)(4), 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)(1)(B). Pub. L. 102–573, §202(a)(1), substituted ‘‘to the Fund under this section’’ for ‘‘under

subsection (e) of this section’’.

Subsec. (b)(2). Pub. L. 102–573, §202(a)(2), substituted

‘‘shall establish at—’’ and subpars. (A) and (B) for

‘‘shall establish at not less than $10,000 or not more

than $20,000;’’.

Subsec. (c). Pub. L. 102–573, §202(a)(3), substituted

‘‘Amounts appropriated to the Fund under this section’’ for ‘‘Funds appropriated under subsection (e) of

this section’’.

Subsec. (e). Pub. L. 102–573, §217(b)(2), struck out subsec. (e) which authorized appropriations for fiscal years

1989 to 1992.

EFFECTIVE DATE OF 1992 AMENDMENT

Section 202(b) of Pub. L. 102–573 provided that: ‘‘The

amendment made by subsection (a)(2) [amending this

section] shall take effect January 1, 1993.’’

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in sections 1621f, 1621j of

this title.

§ 1621b. Health promotion and disease prevention services

(a) Authorization

The Secretary, acting through the Service,

shall provide health promotion and disease prevention services to Indians so as to achieve the

health status objectives set forth in section

1602(b) of this title.

(b) Evaluation statement for Presidential budget

The Secretary shall submit to the President

for inclusion in each statement which is required to be submitted to the Congress under

section 1671 of this title an evaluation of—

(1) the health promotion and disease prevention needs of Indians,

(2) the health promotion and disease prevention activities which would best meet such

needs,

(3) the internal capacity of the Service to

meet such needs, and

(4) the resources which would be required to

enable the Service to undertake the health

promotion and disease prevention activities

necessary to meet such needs.

(Pub. L. 94–437, title II, §203, as added Pub. L.

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

4805; amended Pub. L. 102–573, title II, §203, Oct.

29, 1992, 106 Stat. 4546.)

AMENDMENTS

1992—Subsec. (a). Pub. L. 102–573, §203(1), inserted before period at end ‘‘so as to achieve the health status

objectives set forth in section 1602(b) of this title’’.

Subsec. (b). Pub. L. 102–573, §203(2), in introductory

provisions, substituted ‘‘section 1671’’ for ‘‘section

1621(f)’’.

Subsec. (c). Pub. L. 102–573, §203(3), struck out subsec.

(c) which directed establishment of between 1 and 4

health-related demonstration projects to terminate 30

months after Nov. 23, 1988.

CONGRESSIONAL FINDINGS ON HEALTH PROMOTION AND

DISEASE PREVENTION

Section 203(a) of Pub. L. 100–713 provided that: ‘‘The

Congress finds that health promotion and disease prevention activities will—

‘‘(1) improve the health and well being of Indians,

and

‘‘(2) reduce the expenses for medical care of Indians.’’

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in section 1671 of this title.

§ 1621c. Diabetes prevention, treatment, and control

(a) Incidence and complications

The Secretary, in consultation with the tribes,

shall determine—

(1) by tribe and by Service unit of the Service, the incidence of, and the types of complications resulting from, diabetes among Indians; and