H. R. 3378

One Hundred Fourth Congress

of the

United States of America

AT THE SECOND SESSION

Begun and held at the City of Washington on Wednesday,

the third day of January, one thousand nine hundred and ninety-six

An Act

To amend the Indian Health Care Improvement Act to extend the demonstration

program for direct billing of Medicare, Medicaid, and other third party payors.

Be it enacted by the Senate and House of Representatives of

the United States of America in Congress assembled,

SECTION 1. SHORT TITLE; REFERENCE.

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

Care Improvement Technical Corrections Act of 1996’’.

(b) REFERENCES.—Whenever in this Act an amendment or

repeal is expressed in terms of an amendment to or repeal of

a section or other provision, the reference shall be considered to

be made to a section or other provision of the Indian Health Care

Improvement Act.

SEC. 2. TECHNICAL CORRECTIONS IN THE INDIAN HEALTH CARE

IMPROVEMENT ACT.

(a) DEFINITION OF HEALTH PROFESSION.—Section 4(n) (25

U.S.C. 1603(n)) is amended—

(1) by inserting ‘‘allopathic medicine,’’ before ‘‘family

medicine’’; and

(2) by striking ‘‘and allied health professions’’ and inserting

‘‘an allied health profession, or any other health profession’’.

(b) INDIAN HEALTH PROFESSIONS SCHOLARSHIPS.—Section

104(b) of the Indian Health Care Improvement Act (25 U.S.C.

1613a(b)) is amended—

(1) in paragraph (3)—

(A) in subparagraph (A)—

(i) by striking the matter preceding clause (i) and

inserting the following:

‘‘(3)(A) The active duty service obligation under a written contract with the Secretary under section 338A of the Public Health

Service Act (42 U.S.C. 254l) that an individual has entered into

under that section shall, if that individual is a recipient of an

Indian Health Scholarship, be met in full-time practice, by

service—’’;

(ii) by striking ‘‘or’’ at the end of clause (iii); and

(iii) by striking the period at the end of clause

(iv) and inserting ‘‘; or’’;

(B) by redesignating subparagraphs (B) and (C) as

subparagraphs (C) and (D), respectively;

(C) by inserting after subparagraph (A) the following

new subparagraph:

‘‘(B) At the request of any individual who has entered into

a contract referred to in subparagraph (A) and who receives a
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degree in medicine (including osteopathic or allopathic medicine),

dentistry, optometry, podiatry, or pharmacy, the Secretary shall

defer the active duty service obligation of that individual under

that contract, in order that such individual may complete any

internship, residency, or other advanced clinical training that is

required for the practice of that health profession, for an appropriate

period (in years, as determined by the Secretary), subject to the

following conditions:

‘‘(i) No period of internship, residency, or other advanced

clinical training shall be counted as satisfying any period of

obligated service that is required under this section.

‘‘(ii) The active duty service obligation of that individual

shall commence not later than 90 days after the completion

of that advanced clinical training (or by a date specified by

the Secretary).

‘‘(iii) The active duty service obligation will be served in

the health profession of that individual, in a manner consistent

with clauses (i) through (v) of subparagraph (A).’’;

(D) in subparagraph (C), as so redesignated, by striking

‘‘prescribed under section 338C of the Public Health Service

Act (42 U.S.C. 254m) by service in a program specified

in subparagraph (A)’’ and inserting ‘‘described in subparagraph (A) by service in a program specified in that subparagraph’’; and

(E) in subparagraph (D), as so redesignated—

(i) by striking ‘‘Subject to subparagraph (B),’’ and

inserting ‘‘Subject to subparagraph (C),’’; and

(ii) by striking ‘‘prescribed under section 338C of

the Public Health Service Act (42 U.S.C. 254m)’’ and

inserting ‘‘described in subparagraph (A)’’;

(2) in paragraph (4)—

(A) in subparagraph (B), by striking the matter preceding clause (i) and inserting the following:

‘‘(B) the period of obligated service described in paragraph

(3)(A) shall be equal to the greater of—’’; and

(B) in subparagraph (C), by striking ‘‘(42 U.S.C.

254m(g)(1)(B))’’ and inserting ‘‘(42 U.S.C. 254l(g)(1)(B))’’;

and

(3) in paragraph (5), by adding at the end the following

new subparagraphs:

‘‘(C) Upon the death of an individual who receives an Indian

Health Scholarship, any obligation of that individual for service

or payment that relates to that scholarship shall be canceled.

‘‘(D) The Secretary shall provide for the partial or total waiver

or suspension of any obligation of service or payment of a recipient

of an Indian Health Scholarship if the Secretary determines that—

‘‘(i) it is not possible for the recipient to meet that obligation

or make that payment;

‘‘(ii) requiring that recipient to meet that obligation or

make that payment would result in extreme hardship to the

recipient; or

‘‘(iii) the enforcement of the requirement to meet the obligation or make the payment would be unconscionable.

‘‘(E) Notwithstanding any other provision of law, in any case

of extreme hardship or for other good cause shown, the Secretary

may waive, in whole or in part, the right of the United States

to recover funds made available under this section.
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‘‘(F) Notwithstanding any other provision of law, with respect

to a recipient of an Indian Health Scholarship, no obligation for

payment may be released by a discharge in bankruptcy under

title 11, United States Code, unless that discharge is granted after

the expiration of the 5-year period beginning on the initial date

on which that payment is due, and only if the bankruptcy court

finds that the nondischarge of the obligation would be unconscionable.’’.

(c) CALIFORNIA CONTRACT HEALTH SERVICES DEMONSTRATION

PROGRAM.—Section 211(g) (25 U.S.C. 1621j(g)) is amended by striking ‘‘1993, 1994, 1995, 1996, and 1997’’ and inserting ‘‘1996 through

2000’’.

(d) EXTENSION OF CERTAIN DEMONSTRATION PROGRAM.—Section

405(c)(2) (25 U.S.C. 1645(c)(2)) is amended by striking ‘‘September

30, 1996’’ and inserting ‘‘September 30, 1998’’.

(e) GALLUP ALCOHOL AND SUBSTANCE ABUSE TREATMENT

CENTER.—Section 706(d) (25 U.S.C. 1665e(d)) is amended to read

as follows:

‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There are authorized

to be appropriated, for each of fiscal years 1996 through 2000,

such sums as may be necessary to carry out subsection (b).’’.

(f) SUBSTANCE ABUSE COUNSELOR EDUCATION DEMONSTRATION

PROGRAM.—Section 711(h) (25 U.S.C. 1665j(h)) is amended by striking ‘‘1993, 1994, 1995, 1996, and 1997’’ and inserting ‘‘1996 through

2000’’.

(g) HOME AND COMMUNITY-BASED CARE DEMONSTRATION

PROGRAM.—Section 821(i) (25 U.S.C. 1680k(i)) is amended by striking ‘‘1993, 1994, 1995, 1996, and 1997’’ and inserting ‘‘1996 through

2000’’.

Speaker of the House of Representatives.

Vice President of the United States and

President of the Senate.