In the Senate of the United States,

September 19, 1996.

Resolved, That the bill from the House of Representatives (H.R. 3378) entitled ‘‘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.’’, do pass with the following

AMENDMENT:

Strike out all after the enacting clause and insert:

1 SECTION 1. SHORT TITLE; REFERENCES.

2 (a) SHORT TITLE.—This Act may be cited as the ‘‘In3 dian Health Care Improvement Technical Corrections Act

4 of 1996’’.

5 (b) REFERENCES.—Whenever in this Act an amend6 ment or repeal is expressed in terms of an amendment to

7 or repeal of a section or other provision, the reference shall

8 be considered to be made to a section or other provision

9 of the Indian Health Care Improvement Act.
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1 SEC. 2. TECHNICAL CORRECTIONS IN THE INDIAN HEALTH

2 CARE IMPROVEMENT ACT.

3 (a) DEFINITION OF HEALTH PROFESSION.—Section

4 4(n) (25 U.S.C. 1603(n)) is amended—

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

6 ‘‘family medicine’’; and

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

8 and inserting ‘‘an allied health profession, or any

9 other health profession’’.

10 (b) INDIAN HEALTH PROFESSIONS SCHOLARSHIPS.—

11 Section 104(b) of the Indian Health Care Improvement Act

12 (25 U.S.C. 1613a(b)) is amended—

13 (1) in paragraph (3)—

14 (A) in subparagraph (A)—

15 (i) by striking the matter preceding

16 clause (i) and inserting the following:

17 ‘‘(3)(A) The active duty service obligation under a

18 written contract with the Secretary under section 338A of

19 the Public Health Service Act (42 U.S.C. 254l) that an in20 dividual has entered into under that section shall, if that

21 individual is a recipient of an Indian Health Scholarship,

22 be met in full-time practice, by service—’’;

23 (ii) by striking ‘‘or’’ at the end of

24 clause (iii);

25 (iii) by striking the period at the end

26 of clause (iv) and inserting ‘‘; or’’; and
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1 (iv) by adding at the end the following

2 new clause:

3 ‘‘(v) in an academic setting (including a pro4 gram that receives funding under section 102, 112, or

5 114, or any other academic setting that the Secretary,

6 acting through the Service, determines to be appro7 priate for the purposes of this clause) in which the

8 major duties and responsibilities of the recipient are

9 the recruitment and training of Indian health profes10 sionals in the discipline of that recipient in a manner

11 consistent with the purpose of this title, as specified

12 in section 101.’’;

13 (B) by redesignating subparagraphs (B)

14 and (C) as subparagraphs (C) and (D), respec15 tively;

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

17 following new subparagraph:

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

19 into a contract referred to in subparagraph (A) and who

20 receives a degree in medicine (including osteopathic or

21 allopathic medicine), dentistry, optometry, podiatry, or

22 pharmacy, the Secretary shall defer the active duty service

23 obligation of that individual under that contract, in order

24 that such individual may complete any internship, resi25 dency, or other advanced clinical training that is required
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1 for the practice of that health profession, for an appropriate

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

3 to the following conditions:

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

5 advanced clinical training shall be counted as satisfy6 ing any period of obligated service that is required

7 under this section.

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

9 individual shall commence not later than 90 days

10 after the completion of that advanced clinical train11 ing (or by a date specified by the Secretary).

12 ‘‘(iii) The active duty service obligation will be

13 served in the health profession of that individual, in

14 a manner consistent with clauses (i) through (v) of

15 subparagraph (A).’’;

16 (D) in subparagraph (C), as so redesig17 nated, by striking ‘‘prescribed under section

18 338C of the Public Health Service Act (42

19 U.S.C. 254m) by service in a program specified

20 in subparagraph (A)’’ and inserting ‘‘described

21 in subparagraph (A) by service in a program

22 specified in that subparagraph’’; and

23 (E) in subparagraph (D), as so redesig24 nated—
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1 (i) by striking ‘‘Subject to subpara2 graph (B),’’ and inserting ‘‘Subject to sub3 paragraph (C),’’; and

4 (ii) by striking ‘‘prescribed under sec5 tion 338C of the Public Health Service Act

6 (42 U.S.C. 254m)’’ and inserting ‘‘described

7 in subparagraph (A)’’;

8 (2) in paragraph (4)—

9 (A) in subparagraph (B), by striking the

10 matter preceding clause (i) and inserting the fol11 lowing:

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

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

14 and

15 (B) in subparagraph (C), by striking ‘‘(42

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

17 U.S.C. 254l(g)(1)(B))’’; and

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

19 following new subparagraphs:

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

21 Indian Health Scholarship, any obligation of that individ22 ual for service or payment that relates to that scholarship

23 shall be canceled.

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

25 total waiver or suspension of any obligation of service or
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1 payment of a recipient of an Indian Health Scholarship

2 if the Secretary determines that—

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

4 that obligation or make that payment;

5 ‘‘(ii) requiring that recipient to meet that obliga6 tion or make that payment would result in extreme

7 hardship to the recipient; or

8 ‘‘(iii) the enforcement of the requirement to meet

9 the obligation or make the payment would be uncon10 scionable.

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

12 any case of extreme hardship or for other good cause shown,

13 the Secretary may waive, in whole or in part, the right

14 of the United States to recover funds made available under

15 this section.

16 ‘‘(F) Notwithstanding any other provision of law, with

17 respect to a recipient of an Indian Health Scholarship, no

18 obligation for payment may be released by a discharge in

19 bankruptcy under title 11, United States Code, unless that

20 discharge is granted after the expiration of the 5-year pe21 riod beginning on the initial date on which that payment

22 is due, and only if the bankruptcy court finds that the non23 discharge of the obligation would be unconscionable.’’.

24 (c) CALIFORNIA CONTRACT HEALTH SERVICES DEM25 ONSTRATION PROGRAM.—Section 211(g) (25 U.S.C.
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1 1621j(g)) is amended by striking ‘‘1993, 1994, 1995, 1996,

2 and 1997’’ and inserting ‘‘1996 through 2000’’.

3 (d) EXTENSION OF CERTAIN DEMONSTRATION PRO4 GRAM.—Section 405(c)(2) (25 U.S.C. 1645(c)(2)) is amend5 ed by striking ‘‘September 30, 1996’’ and inserting ‘‘Sep6 tember 30, 1998’’.

7 (e) GALLUP ALCOHOL AND SUBSTANCE ABUSE TREAT8 MENT CENTER.—Section 706(d) (25 U.S.C. 1665e(d)) is

9 amended to read as follows:

10 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There

11 are authorized to be appropriated, for each of fiscal years

12 1996 through 2000, such sums as may be necessary to carry

13 out subsection (b).’’.

14 (f) SUBSTANCE ABUSE COUNSELOR EDUCATION DEM15 ONSTRATION PROGRAM.—Section 711(h) (25 U.S.C.

16 1665j(h)) is amended by striking ‘‘1993, 1994, 1995, 1996,

17 and 1997’’ and inserting ‘‘1996 through 2000’’.

18 (g) HOME AND COMMUNITY-BASED CARE DEMONSTRA19 TION PROGRAM.—Section 821(i) (25 U.S.C. 1680k(i)) is

20 amended by striking ‘‘1993, 1994, 1995, 1996, and 1997’’

21 and inserting ‘‘1996 through 2000’’.

Attest:

Secretary.
104TH CONGRESS

2D SESSION H. R. 3378

AMENDMENT
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