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[House Report 110-564]
[From the U.S. Government Publishing Office]

110th Congress                                            Rept. 110-564
                        HOUSE OF REPRESENTATIVES
 2d Session                                                      Part 1

======================================================================

 
         INDIAN HEALTH CARE IMPROVEMENT ACT AMENDMENTS OF 2007

                                _______
                                

                 April 4, 2008.--Ordered to be printed

                                _______
                                

  Mr. Rahall, from the Committee on Natural Resources, submitted the 
                               following

                              R E P O R T

                        [To accompany H.R. 1328]

      [Including cost estimate of the Congressional Budget Office]

  The Committee on Natural Resources, to whom was referred the 
bill (H.R. 1328) to amend the Indian Health Care Improvement 
Act to revise and extend that Act, having considered the same, 
report favorably thereon with an amendment and recommend that 
the bill as amended do pass.
  The amendment is as follows:
  Strike all after the enacting clause and insert the 
following:

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

  (a) Short Title.--This Act may be cited as the ``Indian Health Care 
Improvement Act Amendments of 2007''.
  (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.

                   TITLE I--AMENDMENTS TO INDIAN LAWS

Sec. 101. Indian Health Care Improvement Act amended.
Sec. 102. Soboba sanitation facilities.
Sec. 103. Native American Health and Wellness Foundation.

 TITLE II--IMPROVEMENT OF INDIAN HEALTH CARE PROVIDED UNDER THE SOCIAL 
                              SECURITY ACT

Sec. 201. Expansion of payments under Medicare, Medicaid, and SCHIP for 
all covered services furnished by Indian Health Programs.
Sec. 202. Increased outreach to Indians under Medicaid and SCHIP and 
improved cooperation in the provision of items and services to Indians 
under Social Security Act health benefit programs.
Sec. 203. Additional provisions to increase outreach to, and enrollment 
of, Indians in SCHIP and Medicaid.
Sec. 204. Premiums and cost sharing protections under Medicaid, 
eligibility determinations under Medicaid and SCHIP, and protection of 
certain Indian property from Medicaid estate recovery.
Sec. 205. Nondiscrimination in qualifications for payment for services 
under Federal health care programs.
Sec. 206. Consultation on Medicaid, SCHIP, and other health care 
programs funded under the Social Security Act involving Indian Health 
Programs and Urban Indian Organizations.
Sec. 207. Exclusion waiver authority for affected Indian Health 
Programs and safe harbor transactions under the Social Security Act.
Sec. 208. Rules applicable under Medicaid and SCHIP to managed care 
entities with respect to Indian enrollees and Indian health care 
providers and Indian managed care entities.
Sec. 209. Annual report on Indians served by Social Security Act health 
benefit programs.

SEC. 2. REPORT ON THIRD-PARTY PAYMENT COLLECTIONS.

  (a) Study.--The Secretary of Health and Human Services shall conduct 
a thorough study of the system of third-party payment collections for 
items and services furnished through the Indian Health Service.
  (b) Report.--Not later than 6 months after the date of the enactment 
of this Act, the Secretary shall submit to each House of Congress a 
report on such study. Such report shall include such recommendations on 
how to improve such third-party payment collections as the Secretary 
determines appropriate.

                   TITLE I--AMENDMENTS TO INDIAN LAWS

SEC. 101. INDIAN HEALTH CARE IMPROVEMENT ACT AMENDED.

  (a) In General.--The Indian Health Care Improvement Act (25 U.S.C. 
1601 et seq.) is amended to read as follows:

``SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

  ``(a) Short Title.--This Act may be cited as the `Indian Health Care 
Improvement Act'.
  ``(b) Table of Contents.--The table of contents 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. Scholarship programs for Indian Tribes.
``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.
``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.
``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. 217. North Dakota and South Dakota as contract health service 
delivery area.
``Sec. 218. California contract health services program.
``Sec. 219. California as a contract health service delivery area.
``Sec. 220. Contract health services for the Trenton Service Area.
``Sec. 221. Programs operated by Indian Tribes and Tribal 
Organizations.
``Sec. 222. Licensing.
``Sec. 223. Notification of provision of emergency contract health 
services.
``Sec. 224. Prompt action on payment of claims.
``Sec. 225. Liability for payment.
``Sec. 226. Office of Indian Men's Health.
``Sec. 227. 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 non-Service 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. Study on 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 
benefits programs.
``Sec. 402. Grants to and contracts with the Service, Indian Tribes, 
Tribal Organizations, and Urban Indian Organizations to facilitate 
outreach, enrollment, and coverage of Indians under Social Security Act 
health benefit programs and other health benefits programs.
``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.
``Sec. 407. Payor of last resort.
``Sec. 408. Nondiscrimination under Federal health care programs in 
qualifications for reimbursement for services.
``Sec. 409. Consultation.
``Sec. 410. State Children's Health Insurance Program (SCHIP).
``Sec. 411. Exclusion waiver authority for affected Indian Health 
Programs and safe harbor transactions under the Social Security Act.
``Sec. 412. Premium and cost sharing protections and eligibility 
determinations under Medicaid and SCHIP and protection of certain 
Indian property from Medicaid estate recovery.
``Sec. 413. Treatment under Medicaid and SCHIP managed care.
``Sec. 414. Navajo Nation Medicaid Agency feasibility study.
``Sec. 415. General exceptions.
``Sec. 416. 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. Division 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. Urban youth treatment center demonstration.
``Sec. 516. Grants for diabetes prevention, treatment, and control.
``Sec. 517. Community health representatives.
``Sec. 518. Effective date.
``Sec. 519. Eligibility for services.
``Sec. 520. 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.
``Sec. 708. Indian youth telemental health demonstration project.
``Sec. 709. Inpatient and community-based mental health facilities 
design, construction, and staffing.
``Sec. 710. Training and community education.
``Sec. 711. Behavioral health program.
``Sec. 712. Fetal alcohol disorder programs.
``Sec. 713. Child sexual abuse and prevention treatment programs.
``Sec. 714. Behavioral health research.
``Sec. 715. Definitions.
``Sec. 716. 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 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. Severability provisions.
``Sec. 813. Establishment of National Bipartisan Commission on Indian 
Health Care.
``Sec. 814. Confidentiality of medical quality assurance records; 
qualified immunity for participants.
``Sec. 815. Appropriations; availability.
``Sec. 816. Authorization of appropriations.

``SEC. 2. FINDINGS.

  ``Congress makes the following findings:
          ``(1) Federal health services to maintain and improve the 
        health of the Indians are consonant with and required by the 
        Federal Government's historical and unique legal relationship 
        with, and resulting responsibility to, the American Indian 
        people.
          ``(2) A major national goal of the United States is to 
        provide the quantity and quality of health services which will 
        permit the health status of Indians to be raised to the highest 
        possible level and to encourage the maximum participation of 
        Indians in the planning and management of those services.
          ``(3) Federal health services to Indians have resulted in a 
        reduction in the prevalence and incidence of preventable 
        illnesses among, and unnecessary and premature deaths of, 
        Indians.
          ``(4) Despite such services, the unmet health needs of the 
        American Indian people are severe and the health status of the 
        Indians is far below that of the general population of the 
        United States.

``SEC. 3. DECLARATION OF NATIONAL INDIAN HEALTH POLICY.

  ``Congress declares that it is the policy of this Nation, in 
fulfillment of its special trust responsibilities and legal obligations 
to Indians--
          ``(1) to assure the highest possible health status for 
        Indians and Urban Indians and to provide all resources 
        necessary to effect that policy;
          ``(2) to raise the health status of Indians and Urban Indians 
        to at least the levels set forth in the goals contained within 
        the Healthy People 2010 or successor objectives;
          ``(3) to the greatest extent possible, to allow Indians to 
        set their own health care priorities and establish goals that 
        reflect their unmet needs;
          ``(4) to increase the proportion of all degrees in the health 
        professions and allied and associated health professions 
        awarded to Indians so that the proportion of Indian health 
        professionals in each Service Area is raised to at least the 
        level of that of the general population;
          ``(5) to require meaningful consultation with Indian Tribes, 
        Tribal Organizations, and Urban Indian Organizations to 
        implement this Act and the national policy of Indian self-
        determination; and
          ``(6) to provide funding for programs and facilities operated 
        by Indian Tribes and Tribal Organizations in amounts that are 
        not less than the amounts provided to programs and facilities 
        operated directly by the Service.

``SEC. 4. DEFINITIONS.

  ``For purposes of this Act:
          ``(1) The term `accredited and accessible' means on or near a 
        reservation and accredited by a national or regional 
        organization with accrediting authority.
          ``(2) The term `Area Office' means an administrative entity, 
        including a program office, within the Service through which 
        services and funds are provided to the Service Units within a 
        defined geographic area.
          ``(3) The term `Assistant Secretary' means the Assistant 
        Secretary of Indian Health.
          ``(4)(A) The term `behavioral health' means the blending of 
        substance (alcohol, drugs, inhalants, and tobacco) abuse and 
        mental health prevention and treatment, for the purpose of 
        providing comprehensive services.
          ``(B) The term `behavioral health' includes the joint 
        development of substance abuse and mental health treatment 
        planning and coordinated case management using a 
        multidisciplinary approach.
          ``(5) The term `California Indians' means those Indians who 
        are eligible for health services of the Service pursuant to 
        section 806.
          ``(6) The term `community college' means--
                  ``(A) a tribal college or university, or
                  ``(B) a junior or community college.
          ``(7) The term `contract health service' means health 
        services provided at the expense of the Service or a Tribal 
        Health Program by public or private medical providers or 
        hospitals, other than the Service Unit or the Tribal Health 
        Program at whose expense the services are provided.
          ``(8) The term `Department' means, unless otherwise 
        designated, the Department of Health and Human Services.
          ``(9) The term `disease prevention' means the reduction, 
        limitation, and prevention of disease and its complications and 
        reduction in the consequences of disease, including--
                  ``(A) controlling--
                          ``(i) the development of diabetes;
                          ``(ii) high blood pressure;
                          ``(iii) infectious agents;
                          ``(iv) injuries;
                          ``(v) occupational hazards and disabilities;
                          ``(vi) sexually transmittable diseases; and
                          ``(vii) toxic agents; and
                  ``(B) providing--
                          ``(i) fluoridation of water; and
                          ``(ii) immunizations.
          ``(10) The term `health profession' means allopathic 
        medicine, family medicine, internal medicine, pediatrics, 
        geriatric medicine, obstetrics and gynecology, podiatric 
        medicine, nursing, public health nursing, dentistry, 
        psychiatry, osteopathy, optometry, pharmacy, psychology, public 
        health, social work, marriage and family therapy, chiropractic 
        medicine, environmental health and engineering, allied health 
        professions, naturopathic medicine, and any other health 
        profession.
          ``(11) The term `health promotion' means--
                  ``(A) fostering social, economic, environmental, and 
                personal factors conducive to health, including raising 
                public awareness about health matters and enabling the 
                people to cope with health problems by increasing their 
                knowledge and providing them with valid information;
                  ``(B) encouraging adequate and appropriate diet, 
                exercise, and sleep;
                  ``(C) promoting education and work in conformity with 
                physical and mental capacity;
                  ``(D) making available safe water and sanitary 
                facilities;
                  ``(E) improving the physical, economic, cultural, 
                psychological, and social environment;
                  ``(F) promoting culturally competent care; and
                  ``(G) providing adequate and appropriate programs, 
                which may include--
                          ``(i) abuse prevention (mental and physical);
                          ``(ii) community health;
                          ``(iii) community safety;
                          ``(iv) consumer health education;
                          ``(v) diet and nutrition;
                          ``(vi) immunization and other prevention of 
                        communicable diseases, including HIV/AIDS;
                          ``(vii) environmental health;
                          ``(viii) exercise and physical fitness;
                          ``(ix) avoidance of fetal alcohol disorders;
                          ``(x) first aid and CPR education;
                          ``(xi) human growth and development;
                          ``(xii) injury prevention and personal 
                        safety;
                          ``(xiii) behavioral health;
                          ``(xiv) monitoring of disease indicators 
                        between health care provider visits, through 
                        appropriate means, including Internet-based 
                        health care management systems;
                          ``(xv) personal health and wellness 
                        practices;
                          ``(xvi) personal capacity building;
                          ``(xvii) prenatal, pregnancy, and infant 
                        care;
                          ``(xviii) psychological well-being;
                          ``(xix) reproductive health and family 
                        planning;
                          ``(xx) safe and adequate water;
                          ``(xxi) healthy work environments;
                          ``(xxii) elimination, reduction, and 
                        prevention of contaminants that create 
                        unhealthy household conditions (including mold 
                        and other allergens);
                          ``(xxiii) stress control;
                          ``(xxiv) substance abuse;
                          ``(xxv) sanitary facilities;
                          ``(xxvi) sudden infant death syndrome 
                        prevention;
                          ``(xxvii) tobacco use cessation and 
                        reduction;
                          ``(xxviii) violence prevention; and
                          ``(xxix) such other activities identified by 
                        the Service, a Tribal Health Program, or an 
                        Urban Indian Organization, to promote 
                        achievement of any of the objectives described 
                        in section 3(2).
          ``(12) The term `Indian', unless otherwise designated, means 
        any person who is a member of an Indian Tribe or is eligible 
        for health services under section 806, except that, for the 
        purpose of sections 102 and 103, the term also means any 
        individual who--
                  ``(A)(i) irrespective of whether the individual lives 
                on or near a reservation, is a member of a tribe, band, 
                or other organized group of Indians, including those 
                tribes, bands, or groups terminated since 1940 and 
                those recognized now or in the future by the State in 
                which they reside; or
                  ``(ii) is a descendant, in the first or second 
                degree, of any such member;
                  ``(B) is an Eskimo or Aleut or other Alaska Native;
                  ``(C) is considered by the Secretary of the Interior 
                to be an Indian for any purpose; or
                  ``(D) is determined to be an Indian under regulations 
                promulgated by the Secretary.
          ``(13) The term `Indian Health Program' means--
                  ``(A) any health program administered directly by the 
                Service;
                  ``(B) any Tribal Health Program; or
                  ``(C) any Indian Tribe or Tribal Organization to 
                which the Secretary provides funding pursuant to 
                section 23 of the Act of June 25, 1910 (25 U.S.C. 47) 
                (commonly known as the `Buy Indian Act').
          ``(14) The term `Indian Tribe' has the meaning given the term 
        in the Indian Self-Determination and Education Assistance Act 
        (25 U.S.C. 450 et seq.).
          ``(15) The term `junior or community college' has the meaning 
        given the term by section 312(e) of the Higher Education Act of 
        1965 (20 U.S.C. 1058(e)).
          ``(16) The term `reservation' means any federally recognized 
        Indian Tribe's reservation, Pueblo, or colony, including former 
        reservations in Oklahoma, Indian allotments, and Alaska Native 
        Regions established pursuant to the Alaska Native Claims 
        Settlement Act (43 U.S.C. 1601 et seq.).
          ``(17) The term `Secretary', unless otherwise designated, 
        means the Secretary of Health and Human Services.
          ``(18) The term `Service' means the Indian Health Service.
          ``(19) The term `Service Area' means the geographical area 
        served by each Area Office.
          ``(20) The term `Service Unit' means an administrative entity 
        of the Service, or a Tribal Health Program through which 
        services are provided, directly or by contract, to eligible 
        Indians within a defined geographic area.
          ``(21) The term `telehealth' has the meaning given the term 
        in section 330K(a) of the Public Health Service Act (42 U.S.C. 
        254c-16(a)).
          ``(22) The term `telemedicine' means a telecommunications 
        link to an end user through the use of eligible equipment that 
        electronically links health professionals or patients and 
        health professionals at separate sites in order to exchange 
        health care information in audio, video, graphic, or other 
        format for the purpose of providing improved health care 
        services.
          ``(23) The term `tribal college or university' has the 
        meaning given the term in section 316(b)(3) of the Higher 
        Education Act (20 U.S.C. 1059c(b)(3)).
          ``(24) The term `Tribal Health Program' means an Indian Tribe 
        or Tribal Organization that operates any health program, 
        service, function, activity, or facility funded, in whole or 
        part, by the Service through, or provided for in, a contract or 
        compact with the Service under the Indian Self-Determination 
        and Education Assistance Act (25 U.S.C. 450 et seq.).
          ``(25) The term `Tribal Organization' has the meaning given 
        the term in the Indian Self-Determination and Education 
        Assistance Act (25 U.S.C. 450 et seq.).
          ``(26) The term `Urban Center' means any community which has 
        a sufficient Urban Indian population with unmet health needs to 
        warrant assistance under title V of this Act, as determined by 
        the Secretary.
          ``(27) The term `Urban Indian' means any individual who 
        resides in an Urban Center and who meets 1 or more of the 
        following criteria:
                  ``(A) Irrespective of whether the individual lives on 
                or near a reservation, the individual is a member of a 
                tribe, band, or other organized group of Indians, 
                including those tribes, bands, or groups terminated 
                since 1940 and those tribes, bands, or groups that are 
                recognized by the States in which they reside, or who 
                is a descendant in the first or second degree of any 
                such member.
                  ``(B) The individual is an Eskimo, Aleut, or other 
                Alaska Native.
                  ``(C) The individual is considered by the Secretary 
                of the Interior to be an Indian for any purpose.
                  ``(D) The individual is determined to be an Indian 
                under regulations promulgated by the Secretary.
          ``(28) The term `Urban Indian Organization' means a nonprofit 
        corporate body that (A) is situated in an Urban Center; (B) is 
        governed by an Urban Indian-controlled board of directors; (C) 
        provides for the participation of all interested Indian groups 
        and individuals; and (D) is capable of legally cooperating with 
        other public and private entities for the purpose of performing 
        the activities described in section 503(a).

       ``TITLE I--INDIAN HEALTH, HUMAN RESOURCES, AND DEVELOPMENT

``SEC. 101. PURPOSE.

  ``The purpose of this title is to increase, to the maximum extent 
feasible, the number of Indians entering the health professions and 
providing health services, and to assure an optimum supply of health 
professionals to the Indian Health Programs and Urban Indian 
Organizations involved in the provision of health services to Indians.

``SEC. 102. HEALTH PROFESSIONS RECRUITMENT PROGRAM FOR INDIANS.

  ``(a) In General.--The Secretary, acting through the Service, shall 
make grants to public or nonprofit private health or educational 
entities, Tribal Health Programs, or Urban Indian Organizations to 
assist such entities in meeting the costs of--
          ``(1) identifying Indians with a potential for education or 
        training in the health professions and encouraging and 
        assisting them--
                  ``(A) to enroll in courses of study in such health 
                professions; or
                  ``(B) if they are not qualified to enroll in any such 
                courses of study, to undertake such postsecondary 
                education or training as may be required to qualify 
                them for enrollment;
          ``(2) publicizing existing sources of financial aid available 
        to Indians enrolled in any course of study referred to in 
        paragraph (1) or who are undertaking training necessary to 
        qualify them to enroll in any such course of study; or
          ``(3) establishing other programs which the Secretary 
        determines will enhance and facilitate the enrollment of 
        Indians in, and the subsequent pursuit and completion by them 
        of, courses of study referred to in paragraph (1).
  ``(b) Grants.--
          ``(1) Application.--The Secretary shall not make a grant 
        under this section unless an application has been submitted to, 
        and approved by, the Secretary. Such application shall be in 
        such form, submitted in such manner, and contain such 
        information, as the Secretary shall by regulation prescribe 
        pursuant to this Act. The Secretary shall give a preference to 
        applications submitted by Tribal Health Programs or Urban 
        Indian Organizations.
          ``(2) Amount of grants; payment.--The amount of a grant under 
        this section shall be determined by the Secretary. Payments 
        pursuant to this section may be made in advance or by way of 
        reimbursement, and at such intervals and on such conditions as 
        provided for in regulations issued pursuant to this Act. To the 
        extent not otherwise prohibited by law, grants shall be for 3 
        years, as provided in regulations issued pursuant to this Act.

``SEC. 103. HEALTH PROFESSIONS PREPARATORY SCHOLARSHIP PROGRAM FOR 
                    INDIANS.

  ``(a) Scholarships Authorized.--The Secretary, acting through the 
Service, shall provide scholarship grants to Indians who--
          ``(1) have successfully completed their high school education 
        or high school equivalency; and
          ``(2) have demonstrated the potential to successfully 
        complete courses of study in the health professions.
  ``(b) Purposes.--Scholarship grants provided pursuant to this section 
shall be for the following purposes:
          ``(1) Compensatory preprofessional education of any 
        recipient, such scholarship not to exceed 2 years on a full-
        time basis (or the part-time equivalent thereof, as determined 
        by the Secretary pursuant to regulations issued under this 
        Act).
          ``(2) Pregraduate education of any recipient leading to a 
        baccalaureate degree in an approved course of study preparatory 
        to a field of study in a health profession, such scholarship 
        not to exceed 4 years. An extension of up to 2 years (or the 
        part-time equivalent thereof, as determined by the Secretary 
        pursuant to regulations issued pursuant to this Act) may be 
        approved.
  ``(c) Other Conditions.--Scholarships under this section--
          ``(1) may cover costs of tuition, books, transportation, 
        board, and other necessary related expenses of a recipient 
        while attending school;
          ``(2) shall not be denied solely on the basis of the 
        applicant's scholastic achievement if such applicant has been 
        admitted to, or maintained good standing at, an accredited 
        institution; and
          ``(3) shall not be denied solely by reason of such 
        applicant's eligibility for assistance or benefits under any 
        other Federal program.

``SEC. 104. INDIAN HEALTH PROFESSIONS SCHOLARSHIPS.

  ``(a) In General.--
          ``(1) Authority.--The Secretary, acting through the Service, 
        shall make scholarship grants to Indians who are enrolled full 
        or part time in accredited schools pursuing courses of study in 
        the health professions. Such scholarships shall be designated 
        Indian Health Scholarships and shall be made in accordance with 
        section 338A of the Public Health Services Act (42 U.S.C. 
        254l), except as provided in subsection (b) of this section.
          ``(2) Determinations by secretary.--The Secretary, acting 
        through the Service, shall determine--
                  ``(A) who shall receive scholarship grants under 
                subsection (a); and
                  ``(B) the distribution of the scholarships among 
                health professions on the basis of the relative needs 
                of Indians for additional service in the health 
                professions.
          ``(3) Certain delegation not allowed.--The administration of 
        this section shall be a responsibility of the Assistant 
        Secretary and shall not be delegated in a contract or compact 
        under the Indian Self-Determination and Education Assistance 
        Act (25 U.S.C. 450 et seq.).
  ``(b) Active Duty Service Obligation.--
          ``(1) Obligation met.--The active duty service obligation 
        under a written contract with the Secretary under this section 
        that an Indian has entered into shall, if that individual is a 
        recipient of an Indian Health Scholarship, be met in full-time 
        practice equal to 1 year for each school year for which the 
        participant receives a scholarship award under this part, or 2 
        years, whichever is greater, by service in 1 or more of the 
        following:
                  ``(A) In an Indian Health Program.
                  ``(B) In a program assisted under title V of this 
                Act.
                  ``(C) In the private practice of the applicable 
                profession if, as determined by the Secretary, in 
                accordance with guidelines promulgated by the 
                Secretary, such practice is situated in a physician or 
                other health professional shortage area and addresses 
                the health care needs of a substantial number of 
                Indians.
                  ``(D) In a teaching capacity in a tribal college or 
                university nursing program (or a related health 
                profession program) if, as determined by the Secretary, 
                the health service provided to Indians would not 
                decrease.
          ``(2) Obligation deferred.--At the request of any individual 
        who has entered into a contract referred to in paragraph (1) 
        and who receives a 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:
                  ``(A) No period of internship, residency, or other 
                advanced clinical training shall be counted as 
                satisfying any period of obligated service under this 
                subsection.
                  ``(B) 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).
                  ``(C) The active duty service obligation will be 
                served in the health profession of that individual in a 
                manner consistent with paragraph (1).
                  ``(D) A recipient of a scholarship under this section 
                may, at the election of the recipient, meet the active 
                duty service obligation described in paragraph (1) by 
                service in a program specified under that paragraph 
                that--
                          ``(i) is located on the reservation of the 
                        Indian Tribe in which the recipient is 
                        enrolled; or
                          ``(ii) serves the Indian Tribe in which the 
                        recipient is enrolled.
          ``(3) Priority when making assignments.--Subject to paragraph 
        (2), the Secretary, in making assignments of Indian Health 
        Scholarship recipients required to meet the active duty service 
        obligation described in paragraph (1), shall give priority to 
        assigning individuals to service in those programs specified in 
        paragraph (1) that have a need for health professionals to 
        provide health care services as a result of individuals having 
        breached contracts entered into under this section.
  ``(c) Part-Time Students.--In the case of an individual receiving a 
scholarship under this section who is enrolled part time in an approved 
course of study--
          ``(1) such scholarship shall be for a period of years not to 
        exceed the part-time equivalent of 4 years, as determined by 
        the Secretary;
          ``(2) the period of obligated service described in subsection 
        (b)(1) shall be equal to the greater of--
                  ``(A) the part-time equivalent of 1 year for each 
                year for which the individual was provided a 
                scholarship (as determined by the Secretary); or
                  ``(B) 2 years; and
          ``(3) the amount of the monthly stipend specified in section 
        338A(g)(1)(B) of the Public Health Service Act (42 U.S.C. 
        254l(g)(1)(B)) shall be reduced pro rata (as determined by the 
        Secretary) based on the number of hours such student is 
        enrolled.
  ``(d) Breach of Contract.--
          ``(1) Specified breaches.--An individual shall be liable to 
        the United States for the amount which has been paid to the 
        individual, or on behalf of the individual, under a contract 
        entered into with the Secretary under this section on or after 
        the date of enactment of the Indian Health Care Improvement Act 
        Amendments of 2007 if that individual--
                  ``(A) fails to maintain an acceptable level of 
                academic standing in the educational institution in 
                which he or she is enrolled (such level determined by 
                the educational institution under regulations of the 
                Secretary);
                  ``(B) is dismissed from such educational institution 
                for disciplinary reasons;
                  ``(C) voluntarily terminates the training in such an 
                educational institution for which he or she is provided 
                a scholarship under such contract before the completion 
                of such training; or
                  ``(D) fails to accept payment, or instructs the 
                educational institution in which he or she is enrolled 
                not to accept payment, in whole or in part, of a 
                scholarship under such contract, in lieu of any service 
                obligation arising under such contract.
          ``(2) Other breaches.--If for any reason not specified in 
        paragraph (1) an individual breaches a written contract by 
        failing either to begin such individual's service obligation 
        required under such contract or to complete such service 
        obligation, the United States shall be entitled to recover from 
        the individual an amount determined in accordance with the 
        formula specified in subsection (l) of section 110 in the 
        manner provided for in such subsection.
          ``(3) Cancellation upon death of recipient.--Upon the death 
        of an individual who receives an Indian Health Scholarship, any 
        outstanding obligation of that individual for service or 
        payment that relates to that scholarship shall be canceled.
          ``(4) Waivers and suspensions.--
                  ``(A) In general.--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.
                  ``(B) Factors for consideration.--Before waiving or 
                suspending an obligation of service or payment under 
                subparagraph (A), the Secretary shall consult with the 
                affected Area Office, Indian Tribes, Tribal 
                Organizations, or Urban Indian Organizations, and may 
                take into consideration whether the obligation may be 
                satisfied in a teaching capacity at a tribal college or 
                university nursing program under subsection (b)(1)(D).
          ``(5) Extreme hardship.--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.
          ``(6) Bankruptcy.--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.

``SEC. 105. AMERICAN INDIANS INTO PSYCHOLOGY PROGRAM.

  ``(a) Grants Authorized.--The Secretary, acting through the Service, 
shall make grants of not more than $300,000 to each of 9 colleges and 
universities for the purpose of developing and maintaining Indian 
psychology career recruitment programs as a means of encouraging 
Indians to enter the behavioral health field. These programs shall be 
located at various locations throughout the country to maximize their 
availability to Indian students and new programs shall be established 
in different locations from time to time.
  ``(b) Quentin N. Burdick Program Grant.--The Secretary shall provide 
a grant authorized under subsection (a) to develop and maintain a 
program at the University of North Dakota to be known as the `Quentin 
N. Burdick American Indians Into Psychology Program'. Such program 
shall, to the maximum extent feasible, coordinate with the Quentin N. 
Burdick Indian Health Programs authorized under section 117(b), the 
Quentin N. Burdick American Indians Into Nursing Program authorized 
under section 115(e), and existing university research and 
communications networks.
  ``(c) Regulations.--The Secretary shall issue regulations pursuant to 
this Act for the competitive awarding of grants provided under this 
section.
  ``(d) Conditions of Grant.--Applicants under this section shall agree 
to provide a program which, at a minimum--
          ``(1) provides outreach and recruitment for health 
        professions to Indian communities including elementary, 
        secondary, and accredited and accessible community colleges 
        that will be served by the program;
          ``(2) incorporates a program advisory board comprised of 
        representatives from the tribes and communities that will be 
        served by the program;
          ``(3) provides summer enrichment programs to expose Indian 
        students to the various fields of psychology through research, 
        clinical, and experimental activities;
          ``(4) provides stipends to undergraduate and graduate 
        students to pursue a career in psychology;
          ``(5) develops affiliation agreements with tribal colleges 
        and universities, the Service, university affiliated programs, 
        and other appropriate accredited and accessible entities to 
        enhance the education of Indian students;
          ``(6) to the maximum extent feasible, uses existing 
        university tutoring, counseling, and student support services; 
        and
          ``(7) to the maximum extent feasible, employs qualified 
        Indians in the program.
  ``(e) Active Duty Service Requirement.--The active duty service 
obligation prescribed under section 338C of the Public Health Service 
Act (42 U.S.C. 254m) shall be met by each graduate who receives a 
stipend described in subsection (d)(4) that is funded under this 
section. Such obligation shall be met by service--
          ``(1) in an Indian Health Program;
          ``(2) in a program assisted under title V of this Act; or
          ``(3) in the private practice of psychology if, as determined 
        by the Secretary, in accordance with guidelines promulgated by 
        the Secretary, such practice is situated in a physician or 
        other health professional shortage area and addresses the 
        health care needs of a substantial number of Indians.
  ``(f) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section $2,700,000 for each of fiscal 
years 2008 through 2017.

``SEC. 106. SCHOLARSHIP PROGRAMS FOR INDIAN TRIBES.

  ``(a) In General.--
          ``(1) Grants authorized.--The Secretary, acting through the 
        Service, shall make grants to Tribal Health Programs for the 
        purpose of providing scholarships for Indians to serve as 
        health professionals in Indian communities.
          ``(2) Amount.--Amounts available under paragraph (1) for any 
        fiscal year shall not exceed 5 percent of the amounts available 
        for each fiscal year for Indian Health Scholarships under 
        section 104.
          ``(3) Application.--An application for a grant under 
        paragraph (1) shall be in such form and contain such 
        agreements, assurances, and information as consistent with this 
        section.
  ``(b) Requirements.--
          ``(1) In general.--A Tribal Health Program receiving a grant 
        under subsection (a) shall provide scholarships to Indians in 
        accordance with the requirements of this section.
          ``(2) Costs.--With respect to costs of providing any 
        scholarship pursuant to subsection (a)--
                  ``(A) 80 percent of the costs of the scholarship 
                shall be paid from the funds made available pursuant to 
                subsection (a)(1) provided to the Tribal Health 
                Program; and
                  ``(B) 20 percent of such costs may be paid from any 
                other source of funds.
  ``(c) Course of Study.--A Tribal Health Program shall provide 
scholarships under this section only to Indians enrolled or accepted 
for enrollment in a course of study (approved by the Secretary) in 1 of 
the health professions contemplated by this Act.
  ``(d) Contract.--
          ``(1) In general.--In providing scholarships under subsection 
        (b), the Secretary and the Tribal Health Program shall enter 
        into a written contract with each recipient of such 
        scholarship.
          ``(2) Requirements.--Such contract shall--
                  ``(A) obligate such recipient to provide service in 
                an Indian Health Program or Urban Indian Organization, 
                in the same Service Area where the Tribal Health 
                Program providing the scholarship is located, for--
                          ``(i) a number of years for which the 
                        scholarship is provided (or the part-time 
                        equivalent thereof, as determined by the 
                        Secretary), or for a period of 2 years, 
                        whichever period is greater; or
                          ``(ii) such greater period of time as the 
                        recipient and the Tribal Health Program may 
                        agree;
                  ``(B) provide that the amount of the scholarship--
                          ``(i) may only be expended for--
                                  ``(I) tuition expenses, other 
                                reasonable educational expenses, and 
                                reasonable living expenses incurred in 
                                attendance at the educational 
                                institution; and
                                  ``(II) payment to the recipient of a 
                                monthly stipend of not more than the 
                                amount authorized by section 
                                338(g)(1)(B) of the Public Health 
                                Service Act (42 U.S.C. 254m(g)(1)(B)), 
                                with such amount to be reduced pro rata 
                                (as determined by the Secretary) based 
                                on the number of hours such student is 
                                enrolled, and not to exceed, for any 
                                year of attendance for which the 
                                scholarship is provided, the total 
                                amount required for the year for the 
                                purposes authorized in this clause; and
                          ``(ii) may not exceed, for any year of 
                        attendance for which the scholarship is 
                        provided, the total amount required for the 
                        year for the purposes authorized in clause (i);
                  ``(C) require the recipient of such scholarship to 
                maintain an acceptable level of academic standing as 
                determined by the educational institution in accordance 
                with regulations issued pursuant to this Act; and
                  ``(D) require the recipient of such scholarship to 
                meet the educational and licensure requirements 
                appropriate to each health profession.
          ``(3) Service in other service areas.--The contract may allow 
        the recipient to serve in another Service Area, provided the 
        Tribal Health Program and Secretary approve and services are 
        not diminished to Indians in the Service Area where the Tribal 
        Health Program providing the scholarship is located.
  ``(e) Breach of Contract.--
          ``(1) Specific breaches.--An individual who has entered into 
        a written contract with the Secretary and a Tribal Health 
        Program under subsection (d) shall be liable to the United 
        States for the Federal share of the amount which has been paid 
        to him or her, or on his or her behalf, under the contract if 
        that individual--
                  ``(A) fails to maintain an acceptable level of 
                academic standing in the educational institution in 
                which he or she is enrolled (such level as determined 
                by the educational institution under regulations of the 
                Secretary);
                  ``(B) is dismissed from such educational institution 
                for disciplinary reasons;
                  ``(C) voluntarily terminates the training in such an 
                educational institution for which he or she is provided 
                a scholarship under such contract before the completion 
                of such training; or
                  ``(D) fails to accept payment, or instructs the 
                educational institution in which he or she is enrolled 
                not to accept payment, in whole or in part, of a 
                scholarship under such contract, in lieu of any service 
                obligation arising under such contract.
          ``(2) Other breaches.--If for any reason not specified in 
        paragraph (1), an individual breaches a written contract by 
        failing to either begin such individual's service obligation 
        required under such contract or to complete such service 
        obligation, the United States shall be entitled to recover from 
        the individual an amount determined in accordance with the 
        formula specified in subsection (l) of section 110 in the 
        manner provided for in such subsection.
          ``(3) Cancellation upon death of recipient.--Upon the death 
        of an individual who receives an Indian Health Scholarship, any 
        outstanding obligation of that individual for service or 
        payment that relates to that scholarship shall be canceled.
          ``(4) Information.--The Secretary may carry out this 
        subsection on the basis of information received from Tribal 
        Health Programs involved or on the basis of information 
        collected through such other means as the Secretary deems 
        appropriate.
  ``(f) Relation to Social Security Act.--The recipient of a 
scholarship under this section shall agree, in providing health care 
pursuant to the requirements herein--
          ``(1) not to discriminate against an individual seeking care 
        on the basis of the ability of the individual to pay for such 
        care or on the basis that payment for such care will be made 
        pursuant to a program established in title XVIII of the Social 
        Security Act or pursuant to the programs established in title 
        XIX or title XXI of such Act; and
          ``(2) to accept assignment under section 1842(b)(3)(B)(ii) of 
        the Social Security Act for all services for which payment may 
        be made under part B of title XVIII of such Act, and to enter 
        into an appropriate agreement with the State agency that 
        administers the State plan for medical assistance under title 
        XIX, or the State child health plan under title XXI, of such 
        Act to provide service to individuals entitled to medical 
        assistance or child health assistance, respectively, under the 
        plan.
  ``(g) Continuance of Funding.--The Secretary shall make payments 
under this section to a Tribal Health Program for any fiscal year 
subsequent to the first fiscal year of such payments unless the 
Secretary determines that, for the immediately preceding fiscal year, 
the Tribal Health Program has not complied with the requirements of 
this section.

``SEC. 107. INDIAN HEALTH SERVICE EXTERN PROGRAMS.

  ``(a) Employment Preference.--Any individual who receives a 
scholarship pursuant to section 104 or 106 shall be given preference 
for employment in the Service, or may be employed by a Tribal Health 
Program or an Urban Indian Organization, or other agencies of the 
Department as available, during any nonacademic period of the year.
  ``(b) Not Counted Toward Active Duty Service Obligation.--Periods of 
employment pursuant to this subsection shall not be counted in 
determining fulfillment of the service obligation incurred as a 
condition of the scholarship.
  ``(c) Timing; Length of Employment.--Any individual enrolled in a 
program, including a high school program, authorized under section 
102(a) may be employed by the Service or by a Tribal Health Program or 
an Urban Indian Organization during any nonacademic period of the year. 
Any such employment shall not exceed 120 days during any calendar year.
  ``(d) Nonapplicability of Competitive Personnel System.--Any 
employment pursuant to this section shall be made without regard to any 
competitive personnel system or agency personnel limitation and to a 
position which will enable the individual so employed to receive 
practical experience in the health profession in which he or she is 
engaged in study. Any individual so employed shall receive payment for 
his or her services comparable to the salary he or she would receive if 
he or she were employed in the competitive system. Any individual so 
employed shall not be counted against any employment ceiling affecting 
the Service or the Department.

``SEC. 108. CONTINUING EDUCATION ALLOWANCES.

  ``In order to encourage scholarship and stipend recipients under 
sections 104, 105, 106, and 115 and health professionals, including 
community health representatives and emergency medical technicians, to 
join or continue in an Indian Health Program and to provide their 
services in the rural and remote areas where a significant portion of 
Indians reside, the Secretary, acting through the Service, may--
          ``(1) provide programs or allowances to transition into an 
        Indian Health Program, including licensing, board or 
        certification examination assistance, and technical assistance 
        in fulfilling service obligations under sections 104, 105, 106, 
        and 115; and
          ``(2) provide programs or allowances to health professionals 
        employed in an Indian Health Program to enable them for a 
        period of time each year prescribed by regulation of the 
        Secretary to take leave of their duty stations for professional 
        consultation, management, leadership, and refresher training 
        courses.

``SEC. 109. COMMUNITY HEALTH REPRESENTATIVE PROGRAM.

  ``(a) In General.--Under the authority of the Act of November 2, 1921 
(25 U.S.C. 13) (commonly known as the `Snyder Act'), the Secretary, 
acting through the Service, shall maintain a Community Health 
Representative Program under which Indian Health Programs--
          ``(1) provide for the training of Indians as community health 
        representatives; and
          ``(2) use such community health representatives in the 
        provision of health care, health promotion, and disease 
        prevention services to Indian communities.
  ``(b) Duties.--The Community Health Representative Program of the 
Service, shall--
          ``(1) provide a high standard of training for community 
        health representatives to ensure that the community health 
        representatives provide quality health care, health promotion, 
        and disease prevention services to the Indian communities 
        served by the Program;
          ``(2) in order to provide such training, develop and maintain 
        a curriculum that--
                  ``(A) combines education in the theory of health care 
                with supervised practical experience in the provision 
                of health care; and
                  ``(B) provides instruction and practical experience 
                in health promotion and disease prevention activities, 
                with appropriate consideration given to lifestyle 
                factors that have an impact on Indian health status, 
                such as alcoholism, family dysfunction, and poverty;
          ``(3) maintain a system which identifies the needs of 
        community health representatives for continuing education in 
        health care, health promotion, and disease prevention and 
        develop programs that meet the needs for continuing education;
          ``(4) maintain a system that provides close supervision of 
        Community Health Representatives;
          ``(5) maintain a system under which the work of Community 
        Health Representatives is reviewed and evaluated; and
          ``(6) promote traditional health care practices of the Indian 
        Tribes served consistent with the Service standards for the 
        provision of health care, health promotion, and disease 
        prevention.

``SEC. 110. INDIAN HEALTH SERVICE LOAN REPAYMENT PROGRAM.

  ``(a) Establishment.--The Secretary, acting through the Service, 
shall establish and administer a program to be known as the Service 
Loan Repayment Program (hereinafter referred to as the `Loan Repayment 
Program') in order to ensure an adequate supply of trained health 
professionals necessary to maintain accreditation of, and provide 
health care services to Indians through, Indian Health Programs and 
Urban Indian Organizations.
  ``(b) Eligible Individuals.--To be eligible to participate in the 
Loan Repayment Program, an individual must--
          ``(1)(A) be enrolled--
                  ``(i) in a course of study or program in an 
                accredited educational institution (as determined by 
                the Secretary under section 338B(b)(1)(c)(i) of the 
                Public Health Service Act (42 U.S.C. 254l-
                1(b)(1)(c)(i))) and be scheduled to complete such 
                course of study in the same year such individual 
                applies to participate in such program; or
                  ``(ii) in an approved graduate training program in a 
                health profession; or
          ``(B) have--
                  ``(i) a degree in a health profession; and
                  ``(ii) a license to practice a health profession;
          ``(2)(A) be eligible for, or hold, an appointment as a 
        commissioned officer in the Regular or Reserve Corps of the 
        Public Health Service;
          ``(B) be eligible for selection for civilian service in the 
        Regular or Reserve Corps of the Public Health Service;
          ``(C) meet the professional standards for civil service 
        employment in the Service; or
          ``(D) be employed in an Indian Health Program or Urban Indian 
        Organization without a service obligation; and
          ``(3) submit to the Secretary an application for a contract 
        described in subsection (e).
  ``(c) Application.--
          ``(1) Information to be included with forms.--In 
        disseminating application forms and contract forms to 
        individuals desiring to participate in the Loan Repayment 
        Program, the Secretary shall include with such forms a fair 
        summary of the rights and liabilities of an individual whose 
        application is approved (and whose contract is accepted) by the 
        Secretary, including in the summary a clear explanation of the 
        damages to which the United States is entitled under subsection 
        (l) in the case of the individual's breach of contract. The 
        Secretary shall provide such individuals with sufficient 
        information regarding the advantages and disadvantages of 
        service as a commissioned officer in the Regular or Reserve 
        Corps of the Public Health Service or a civilian employee of 
        the Service to enable the individual to make a decision on an 
        informed basis.
          ``(2) Clear language.--The application form, contract form, 
        and all other information furnished by the Secretary under this 
        section shall be written in a manner calculated to be 
        understood by the average individual applying to participate in 
        the Loan Repayment Program.
          ``(3) Timely availability of forms.--The Secretary shall make 
        such application forms, contract forms, and other information 
        available to individuals desiring to participate in the Loan 
        Repayment Program on a date sufficiently early to ensure that 
        such individuals have adequate time to carefully review and 
        evaluate such forms and information.
  ``(d) Priorities.--
          ``(1) List.--Consistent with subsection (k), the Secretary 
        shall annually--
                  ``(A) identify the positions in each Indian Health 
                Program or Urban Indian Organization for which there is 
                a need or a vacancy; and
                  ``(B) rank those positions in order of priority.
          ``(2) Approvals.--Notwithstanding the priority determined 
        under paragraph (1), the Secretary, in determining which 
        applications under the Loan Repayment Program to approve (and 
        which contracts to accept), shall--
                  ``(A) give first priority to applications made by 
                individual Indians; and
                  ``(B) after making determinations on all applications 
                submitted by individual Indians as required under 
                subparagraph (A), give priority to--
                          ``(i) individuals recruited through the 
                        efforts of an Indian Health Program or Urban 
                        Indian Organization; and
                          ``(ii) other individuals based on the 
                        priority rankings under paragraph (1).
  ``(e) Recipient Contracts.--
          ``(1) Contract required.--An individual becomes a participant 
        in the Loan Repayment Program only upon the Secretary and the 
        individual entering into a written contract described in 
        paragraph (2).
          ``(2) Contents of contract.--The written contract referred to 
        in this section between the Secretary and an individual shall 
        contain--
                  ``(A) an agreement under which--
                          ``(i) subject to subparagraph (C), the 
                        Secretary agrees--
                                  ``(I) to pay loans on behalf of the 
                                individual in accordance with the 
                                provisions of this section; and
                                  ``(II) to accept (subject to the 
                                availability of appropriated funds for 
                                carrying out this section) the 
                                individual into the Service or place 
                                the individual with a Tribal Health 
                                Program or Urban Indian Organization as 
                                provided in clause (ii)(III); and
                          ``(ii) subject to subparagraph (C), the 
                        individual agrees--
                                  ``(I) to accept loan payments on 
                                behalf of the individual;
                                  ``(II) in the case of an individual 
                                described in subsection (b)(1)--
                                          ``(aa) to maintain enrollment 
                                        in a course of study or 
                                        training described in 
                                        subsection (b)(1)(A) until the 
                                        individual completes the course 
                                        of study or training; and
                                          ``(bb) while enrolled in such 
                                        course of study or training, to 
                                        maintain an acceptable level of 
                                        academic standing (as 
                                        determined under regulations of 
                                        the Secretary by the 
                                        educational institution 
                                        offering such course of study 
                                        or training); and
                                  ``(III) to serve for a time period 
                                (hereinafter in this section referred 
                                to as the `period of obligated 
                                service') equal to 2 years or such 
                                longer period as the individual may 
                                agree to serve in the full-time 
                                clinical practice of such individual's 
                                profession in an Indian Health Program 
                                or Urban Indian Organization to which 
                                the individual may be assigned by the 
                                Secretary;
                  ``(B) a provision permitting the Secretary to extend 
                for such longer additional periods, as the individual 
                may agree to, the period of obligated service agreed to 
                by the individual under subparagraph (A)(ii)(III);
                  ``(C) a provision that any financial obligation of 
                the United States arising out of a contract entered 
                into under this section and any obligation of the 
                individual which is conditioned thereon is contingent 
                upon funds being appropriated for loan repayments under 
                this section;
                  ``(D) a statement of the damages to which the United 
                States is entitled under subsection (l) for the 
                individual's breach of the contract; and
                  ``(E) such other statements of the rights and 
                liabilities of the Secretary and of the individual, not 
                inconsistent with this section.
  ``(f) Deadline for Decision on Application.--The Secretary shall 
provide written notice to an individual within 21 days on--
          ``(1) the Secretary's approving, under subsection (e)(1), of 
        the individual's participation in the Loan Repayment Program, 
        including extensions resulting in an aggregate period of 
        obligated service in excess of 4 years; or
          ``(2) the Secretary's disapproving an individual's 
        participation in such Program.
  ``(g) Payments.--
          ``(1) In general.--A loan repayment provided for an 
        individual under a written contract under the Loan Repayment 
        Program shall consist of payment, in accordance with paragraph 
        (2), on behalf of the individual of the principal, interest, 
        and related expenses on government and commercial loans 
        received by the individual regarding the undergraduate or 
        graduate education of the individual (or both), which loans 
        were made for--
                  ``(A) tuition expenses;
                  ``(B) all other reasonable educational expenses, 
                including fees, books, and laboratory expenses, 
                incurred by the individual; and
                  ``(C) reasonable living expenses as determined by the 
                Secretary.
          ``(2) Amount.--For each year of obligated service that an 
        individual contracts to serve under subsection (e), the 
        Secretary may pay up to $35,000 or an amount equal to the 
        amount specified in section 338B(g)(2)(A) of the Public Health 
        Service Act, whichever is more, on behalf of the individual for 
        loans described in paragraph (1). In making a determination of 
        the amount to pay for a year of such service by an individual, 
        the Secretary shall consider the extent to which each such 
        determination--
                  ``(A) affects the ability of the Secretary to 
                maximize the number of contracts that can be provided 
                under the Loan Repayment Program from the amounts 
                appropriated for such contracts;
                  ``(B) provides an incentive to serve in Indian Health 
                Programs and Urban Indian Organizations with the 
                greatest shortages of health professionals; and
                  ``(C) provides an incentive with respect to the 
                health professional involved remaining in an Indian 
                Health Program or Urban Indian Organization with such a 
                health professional shortage, and continuing to provide 
                primary health services, after the completion of the 
                period of obligated service under the Loan Repayment 
                Program.
          ``(3) Timing.--Any arrangement made by the Secretary for the 
        making of loan repayments in accordance with this subsection 
        shall provide that any repayments for a year of obligated 
        service shall be made no later than the end of the fiscal year 
        in which the individual completes such year of service.
          ``(4) Reimbursements for tax liability.--For the purpose of 
        providing reimbursements for tax liability resulting from a 
        payment under paragraph (2) on behalf of an individual, the 
        Secretary--
                  ``(A) in addition to such payments, may make payments 
                to the individual in an amount equal to not less than 
                20 percent and not more than 39 percent of the total 
                amount of loan repayments made for the taxable year 
                involved; and
                  ``(B) may make such additional payments as the 
                Secretary determines to be appropriate with respect to 
                such purpose.
          ``(5) Payment schedule.--The Secretary may enter into an 
        agreement with the holder of any loan for which payments are 
        made under the Loan Repayment Program to establish a schedule 
        for the making of such payments.
  ``(h) Employment Ceiling.--Notwithstanding any other provision of 
law, individuals who have entered into written contracts with the 
Secretary under this section shall not be counted against any 
employment ceiling affecting the Department while those individuals are 
undergoing academic training.
  ``(i) Recruitment.--The Secretary shall conduct recruiting programs 
for the Loan Repayment Program and other manpower programs of the 
Service at educational institutions training health professionals or 
specialists identified in subsection (a).
  ``(j) Applicability of Law.--Section 214 of the Public Health Service 
Act (42 U.S.C. 215) shall not apply to individuals during their period 
of obligated service under the Loan Repayment Program.
  ``(k) Assignment of Individuals.--The Secretary, in assigning 
individuals to serve in Indian Health Programs or Urban Indian 
Organizations pursuant to contracts entered into under this section, 
shall--
          ``(1) ensure that the staffing needs of Tribal Health 
        Programs and Urban Indian Organizations receive consideration 
        on an equal basis with programs that are administered directly 
        by the Service; and
          ``(2) give priority to assigning individuals to Indian Health 
        Programs and Urban Indian Organizations that have a need for 
        health professionals to provide health care services as a 
        result of individuals having breached contracts entered into 
        under this section.
  ``(l) Breach of Contract.--
          ``(1) Specific breaches.--An individual who has entered into 
        a written contract with the Secretary under this section and 
        has not received a waiver under subsection (m) shall be liable, 
        in lieu of any service obligation arising under such contract, 
        to the United States for the amount which has been paid on such 
        individual's behalf under the contract if that individual--
                  ``(A) is enrolled in the final year of a course of 
                study and--
                          ``(i) fails to maintain an acceptable level 
                        of academic standing in the educational 
                        institution in which he or she is enrolled 
                        (such level determined by the educational 
                        institution under regulations of the 
                        Secretary);
                          ``(ii) voluntarily terminates such 
                        enrollment; or
                          ``(iii) is dismissed from such educational 
                        institution before completion of such course of 
                        study; or
                  ``(B) is enrolled in a graduate training program and 
                fails to complete such training program.
          ``(2) Other breaches; formula for amount owed.--If, for any 
        reason not specified in paragraph (1), an individual breaches 
        his or her written contract under this section by failing 
        either to begin, or complete, such individual's period of 
        obligated service in accordance with subsection (e)(2), the 
        United States shall be entitled to recover from such individual 
        an amount to be determined in accordance with the following 
        formula: A=3Z(t-s/t) in which--
                  ``(A) `A' is the amount the United States is entitled 
                to recover;
                  ``(B) `Z' is the sum of the amounts paid under this 
                section to, or on behalf of, the individual and the 
                interest on such amounts which would be payable if, at 
                the time the amounts were paid, they were loans bearing 
                interest at the maximum legal prevailing rate, as 
                determined by the Secretary of the Treasury;
                  ``(C) `t' is the total number of months in the 
                individual's period of obligated service in accordance 
                with subsection (f); and
                  ``(D) `s' is the number of months of such period 
                served by such individual in accordance with this 
                section.
          ``(3) Deductions in medicare payments.--Amounts not paid 
        within such period shall be subject to collection through 
        deductions in Medicare payments pursuant to section 1892 of the 
        Social Security Act.
          ``(4) Time period for repayment.--Any amount of damages which 
        the United States is entitled to recover under this subsection 
        shall be paid to the United States within the 1-year period 
        beginning on the date of the breach or such longer period 
        beginning on such date as shall be specified by the Secretary.
          ``(5) Recovery of delinquency.--
                  ``(A) In general.--If damages described in paragraph 
                (4) are delinquent for 3 months, the Secretary shall, 
                for the purpose of recovering such damages--
                          ``(i) use collection agencies contracted with 
                        by the Administrator of General Services; or
                          ``(ii) enter into contracts for the recovery 
                        of such damages with collection agencies 
                        selected by the Secretary.
                  ``(B) Report.--Each contract for recovering damages 
                pursuant to this subsection shall provide that the 
                contractor will, not less than once each 6 months, 
                submit to the Secretary a status report on the success 
                of the contractor in collecting such damages. Section 
                3718 of title 31, United States Code, shall apply to 
                any such contract to the extent not inconsistent with 
                this subsection.
  ``(m) Waiver or Suspension of Obligation.--
          ``(1) In general.--The Secretary shall by regulation provide 
        for the partial or total waiver or suspension of any obligation 
        of service or payment by an individual under the Loan Repayment 
        Program whenever compliance by the individual is impossible or 
        would involve extreme hardship to the individual and if 
        enforcement of such obligation with respect to any individual 
        would be unconscionable.
          ``(2) Canceled upon death.--Any obligation of an individual 
        under the Loan Repayment Program for service or payment of 
        damages shall be canceled upon the death of the individual.
          ``(3) Hardship waiver.--The Secretary may waive, in whole or 
        in part, the rights of the United States to recover amounts 
        under this section in any case of extreme hardship or other 
        good cause shown, as determined by the Secretary.
          ``(4) Bankruptcy.--Any obligation of an individual under the 
        Loan Repayment Program for payment of damages may be released 
        by a discharge in bankruptcy under title 11 of the United 
        States Code only if such discharge is granted after the 
        expiration of the 5-year period beginning on the first date 
        that payment of such damages is required, and only if the 
        bankruptcy court finds that nondischarge of the obligation 
        would be unconscionable.
  ``(n) Report.--The Secretary shall submit to the President, for 
inclusion in the report required to be submitted to Congress under 
section 801, a report concerning the previous fiscal year which sets 
forth by Service Area the following:
          ``(1) A list of the health professional positions maintained 
        by Indian Health Programs and Urban Indian Organizations for 
        which recruitment or retention is difficult.
          ``(2) The number of Loan Repayment Program applications filed 
        with respect to each type of health profession.
          ``(3) The number of contracts described in subsection (e) 
        that are entered into with respect to each health profession.
          ``(4) The amount of loan payments made under this section, in 
        total and by health profession.
          ``(5) The number of scholarships that are provided under 
        sections 104 and 106 with respect to each health profession.
          ``(6) The amount of scholarship grants provided under section 
        104 and 106, in total and by health profession.
          ``(7) The number of providers of health care that will be 
        needed by Indian Health Programs and Urban Indian 
        Organizations, by location and profession, during the 3 fiscal 
        years beginning after the date the report is filed.
          ``(8) The measures the Secretary plans to take to fill the 
        health professional positions maintained by Indian Health 
        Programs or Urban Indian Organizations for which recruitment or 
        retention is difficult.

``SEC. 111. SCHOLARSHIP AND LOAN REPAYMENT RECOVERY FUND.

  ``(a) Establishment.--There is established in the Treasury of the 
United States a fund to be known as the Indian Health Scholarship and 
Loan Repayment Recovery Fund (hereafter in this section referred to as 
the `LRRF'). The LRRF shall consist of such amounts as may be collected 
from individuals under section 104(d), section 106(e), and section 
110(l) for breach of contract, such funds as may be appropriated to the 
LRRF, and interest earned on amounts in the LRRF. All amounts 
collected, appropriated, or earned relative to the LRRF shall remain 
available until expended.
  ``(b) Use of Funds.--
          ``(1) By secretary.--Amounts in the LRRF may be expended by 
        the Secretary, acting through the Service, to make payments to 
        an Indian Health Program--
                  ``(A) to which a scholarship recipient under section 
                104 and 106 or a loan repayment program participant 
                under section 110 has been assigned to meet the 
                obligated service requirements pursuant to such 
                sections; and
                  ``(B) that has a need for a health professional to 
                provide health care services as a result of such 
                recipient or participant having breached the contract 
                entered into under section 104, 106, or section 110.
          ``(2) By tribal health programs.--A Tribal Health Program 
        receiving payments pursuant to paragraph (1) may expend the 
        payments to provide scholarships or recruit and employ, 
        directly or by contract, health professionals to provide health 
        care services.
  ``(c) Investment of Funds.--The Secretary of the Treasury shall 
invest such amounts of the LRRF as the Secretary of Health and Human 
Services determines are not required to meet current withdrawals from 
the LRRF. Such investments may be made only in interest bearing 
obligations of the United States. For such purpose, such obligations 
may be acquired on original issue at the issue price, or by purchase of 
outstanding obligations at the market price.
  ``(d) Sale of Obligations.--Any obligation acquired by the LRRF may 
be sold by the Secretary of the Treasury at the market price.

``SEC. 112. RECRUITMENT ACTIVITIES.

  ``(a) Reimbursement for Travel.--The Secretary, acting through the 
Service, may reimburse health professionals seeking positions with 
Indian Health Programs or Urban Indian Organizations, including 
individuals considering entering into a contract under section 110 and 
their spouses, for actual and reasonable expenses incurred in traveling 
to and from their places of residence to an area in which they may be 
assigned for the purpose of evaluating such area with respect to such 
assignment.
  ``(b) Recruitment Personnel.--The Secretary, acting through the 
Service, shall assign 1 individual in each Area Office to be 
responsible on a full-time basis for recruitment activities.

``SEC. 113. INDIAN RECRUITMENT AND RETENTION PROGRAM.

  ``(a) In General.--The Secretary, acting through the Service, shall 
fund, on a competitive basis, innovative demonstration projects for a 
period not to exceed 3 years to enable Tribal Health Programs and Urban 
Indian Organizations to recruit, place, and retain health professionals 
to meet their staffing needs.
  ``(b) Eligible Entities; Application.--Any Tribal Health Program or 
Urban Indian Organization may submit an application for funding of a 
project pursuant to this section.

``SEC. 114. ADVANCED TRAINING AND RESEARCH.

  ``(a) Demonstration Program.--The Secretary, acting through the 
Service, shall establish a demonstration project to enable health 
professionals who have worked in an Indian Health Program or Urban 
Indian Organization for a substantial period of time to pursue advanced 
training or research areas of study for which the Secretary determines 
a need exists.
  ``(b) Service Obligation.--An individual who participates in a 
program under subsection (a), where the educational costs are borne by 
the Service, shall incur an obligation to serve in an Indian Health 
Program or Urban Indian Organization for a period of obligated service 
equal to at least the period of time during which the individual 
participates in such program. In the event that the individual fails to 
complete such obligated service, the individual shall be liable to the 
United States for the period of service remaining. In such event, with 
respect to individuals entering the program after the date of enactment 
of the Indian Health Care Improvement Act Amendments of 2007, the 
United States shall be entitled to recover from such individual an 
amount to be determined in accordance with the formula specified in 
subsection (l) of section 110 in the manner provided for in such 
subsection.
  ``(c) Equal Opportunity for Participation.--Health professionals from 
Tribal Health Programs and Urban Indian Organizations shall be given an 
equal opportunity to participate in the program under subsection (a).

``SEC. 115. QUENTIN N. BURDICK AMERICAN INDIANS INTO NURSING PROGRAM.

  ``(a) Grants Authorized.--For the purpose of increasing the number of 
nurses, nurse midwives, and nurse practitioners who deliver health care 
services to Indians, the Secretary, acting through the Service, shall 
provide grants to the following:
          ``(1) Public or private schools of nursing.
          ``(2) Tribal colleges or universities.
          ``(3) Nurse midwife programs and advanced practice nurse 
        programs that are provided by any tribal college or university 
        accredited nursing program, or in the absence of such, any 
        other public or private institutions.
  ``(b) Use of Grants.--Grants provided under subsection (a) may be 
used for 1 or more of the following:
          ``(1) To recruit individuals for programs which train 
        individuals to be nurses, nurse midwives, or advanced practice 
        nurses.
          ``(2) To provide scholarships to Indians enrolled in such 
        programs that may pay the tuition charged for such program and 
        other expenses incurred in connection with such program, 
        including books, fees, room and board, and stipends for living 
        expenses.
          ``(3) To provide a program that encourages nurses, nurse 
        midwives, and advanced practice nurses to provide, or continue 
        to provide, health care services to Indians.
          ``(4) To provide a program that increases the skills of, and 
        provides continuing education to, nurses, nurse midwives, and 
        advanced practice nurses.
          ``(5) To provide any program that is designed to achieve the 
        purpose described in subsection (a).
  ``(c) Applications.--Each application for a grant under subsection 
(a) shall include such information as the Secretary may require to 
establish the connection between the program of the applicant and a 
health care facility that primarily serves Indians.
  ``(d) Preferences for Grant Recipients.--In providing grants under 
subsection (a), the Secretary shall extend a preference to the 
following:
          ``(1) Programs that provide a preference to Indians.
          ``(2) Programs that train nurse midwives or advanced practice 
        nurses.
          ``(3) Programs that are interdisciplinary.
          ``(4) Programs that are conducted in cooperation with a 
        program for gifted and talented Indian students.
          ``(5) Programs conducted by tribal colleges and universities.
  ``(e) Quentin N. Burdick Program Grant.--The Secretary shall provide 
1 of the grants authorized under subsection (a) to establish and 
maintain a program at the University of North Dakota to be known as the 
`Quentin N. Burdick American Indians Into Nursing Program'. Such 
program shall, to the maximum extent feasible, coordinate with the 
Quentin N. Burdick Indian Health Programs established under section 
117(b) and the Quentin N. Burdick American Indians Into Psychology 
Program established under section 105(b).
  ``(f) Active Duty Service Obligation.--The active duty service 
obligation prescribed under section 338C of the Public Health Service 
Act (42 U.S.C. 254m) shall be met by each individual who receives 
training or assistance described in paragraph (1) or (2) of subsection 
(b) that is funded by a grant provided under subsection (a). Such 
obligation shall be met by service--
          ``(1) in the Service;
          ``(2) in a program of an Indian Tribe or Tribal Organization 
        conducted under the Indian Self-Determination and Education 
        Assistance Act (25 U.S.C. 450 et seq.) (including programs 
        under agreements with the Bureau of Indian Affairs);
          ``(3) in a program assisted under title V of this Act;
          ``(4) in the private practice of nursing if, as determined by 
        the Secretary, in accordance with guidelines promulgated by the 
        Secretary, such practice is situated in a physician or other 
        health shortage area and addresses the health care needs of a 
        substantial number of Indians; or
          ``(5) in a teaching capacity in a tribal college or 
        university nursing program (or a related health profession 
        program) if, as determined by the Secretary, health services 
        provided to Indians would not decrease.

``SEC. 116. TRIBAL CULTURAL ORIENTATION.

  ``(a) Cultural Education of Employees.--The Secretary, acting through 
the Service, shall require that appropriate employees of the Service 
who serve Indian Tribes in each Service Area receive educational 
instruction in the history and culture of such Indian Tribes and their 
relationship to the Service.
  ``(b) Program.--In carrying out subsection (a), the Secretary shall 
establish a program which shall, to the extent feasible--
          ``(1) be developed in consultation with the affected Indian 
        Tribes, Tribal Organizations, and Urban Indian Organizations;
          ``(2) be carried out through tribal colleges or universities;
          ``(3) include instruction in American Indian studies; and
          ``(4) describe the use and place of traditional health care 
        practices of the Indian Tribes in the Service Area.

``SEC. 117. INMED PROGRAM.

  ``(a) Grants Authorized.--The Secretary, acting through the Service, 
is authorized to provide grants to colleges and universities for the 
purpose of maintaining and expanding the Indian health careers 
recruitment program known as the `Indians Into Medicine Program' 
(hereinafter in this section referred to as `INMED') as a means of 
encouraging Indians to enter the health professions.
  ``(b) Quentin N. Burdick Grant.--The Secretary shall provide 1 of the 
grants authorized under subsection (a) to maintain the INMED program at 
the University of North Dakota, to be known as the `Quentin N. Burdick 
Indian Health Programs', unless the Secretary makes a determination, 
based upon program reviews, that the program is not meeting the 
purposes of this section. Such program shall, to the maximum extent 
feasible, coordinate with the Quentin N. Burdick American Indians Into 
Psychology Program established under section 105(b) and the Quentin N. 
Burdick American Indians Into Nursing Program established under section 
115.
  ``(c) Regulations.--The Secretary, pursuant to this Act, shall 
develop regulations to govern grants pursuant to this section.
  ``(d) Requirements.--Applicants for grants provided under this 
section shall agree to provide a program which--
          ``(1) provides outreach and recruitment for health 
        professions to Indian communities including elementary and 
        secondary schools and community colleges located on 
        reservations which will be served by the program;
          ``(2) incorporates a program advisory board comprised of 
        representatives from the Indian Tribes and Indian communities 
        which will be served by the program;
          ``(3) provides summer preparatory programs for Indian 
        students who need enrichment in the subjects of math and 
        science in order to pursue training in the health professions;
          ``(4) provides tutoring, counseling, and support to students 
        who are enrolled in a health career program of study at the 
        respective college or university; and
          ``(5) to the maximum extent feasible, employs qualified 
        Indians in the program.

``SEC. 118. HEALTH TRAINING PROGRAMS OF COMMUNITY COLLEGES.

  ``(a) Grants to Establish Programs.--
          ``(1) In general.--The Secretary, acting through the Service, 
        shall award grants to accredited and accessible community 
        colleges for the purpose of assisting such community colleges 
        in the establishment of programs which provide education in a 
        health profession leading to a degree or diploma in a health 
        profession for individuals who desire to practice such 
        profession on or near a reservation or in an Indian Health 
        Program.
          ``(2) Amount of grants.--The amount of any grant awarded to a 
        community college under paragraph (1) for the first year in 
        which such a grant is provided to the community college shall 
        not exceed $250,000.
  ``(b) Grants for Maintenance and Recruiting.--
          ``(1) In general.--The Secretary, acting through the Service, 
        shall award grants to accredited and accessible community 
        colleges that have established a program described in 
        subsection (a)(1) for the purpose of maintaining the program 
        and recruiting students for the program.
          ``(2) Requirements.--Grants may only be made under this 
        section to a community college which--
                  ``(A) is accredited;
                  ``(B) has a relationship with a hospital facility, 
                Service facility, or hospital that could provide 
                training of nurses or health professionals;
                  ``(C) has entered into an agreement with an 
                accredited college or university medical school, the 
                terms of which--
                          ``(i) provide a program that enhances the 
                        transition and recruitment of students into 
                        advanced baccalaureate or graduate programs 
                        that train health professionals; and
                          ``(ii) stipulate certifications necessary to 
                        approve internship and field placement 
                        opportunities at Indian Health Programs;
                  ``(D) has a qualified staff which has the appropriate 
                certifications;
                  ``(E) is capable of obtaining State or regional 
                accreditation of the program described in subsection 
                (a)(1); and
                  ``(F) agrees to provide for Indian preference for 
                applicants for programs under this section.
  ``(c) Technical Assistance.--The Secretary shall encourage community 
colleges described in subsection (b)(2) to establish and maintain 
programs described in subsection (a)(1) by--
          ``(1) entering into agreements with such colleges for the 
        provision of qualified personnel of the Service to teach 
        courses of study in such programs; and
          ``(2) providing technical assistance and support to such 
        colleges.
  ``(d) Advanced Training.--
          ``(1) Required.--Any program receiving assistance under this 
        section that is conducted with respect to a health profession 
        shall also offer courses of study which provide advanced 
        training for any health professional who--
                  ``(A) has already received a degree or diploma in 
                such health profession; and
                  ``(B) provides clinical services on or near a 
                reservation or for an Indian Health Program.
          ``(2) May be offered at alternate site.--Such courses of 
        study may be offered in conjunction with the college or 
        university with which the community college has entered into 
        the agreement required under subsection (b)(2)(C).
  ``(e) Priority.--Where the requirements of subsection (b) are met, 
grant award priority shall be provided to tribal colleges and 
universities in Service Areas where they exist.

``SEC. 119. RETENTION BONUS.

  ``(a) Bonus Authorized.--The Secretary may pay a retention bonus to 
any health professional employed by, or assigned to, and serving in, an 
Indian Health Program or Urban Indian Organization either as a civilian 
employee or as a commissioned officer in the Regular or Reserve Corps 
of the Public Health Service who--
          ``(1) is assigned to, and serving in, a position for which 
        recruitment or retention of personnel is difficult;
          ``(2) the Secretary determines is needed by Indian Health 
        Programs and Urban Indian Organizations;
          ``(3) has--
                  ``(A) completed 2 years of employment with an Indian 
                Health Program or Urban Indian Organization; or
                  ``(B) completed any service obligations incurred as a 
                requirement of--
                          ``(i) any Federal scholarship program; or
                          ``(ii) any Federal education loan repayment 
                        program; and
          ``(4) enters into an agreement with an Indian Health Program 
        or Urban Indian Organization for continued employment for a 
        period of not less than 1 year.
  ``(b) Rates.--The Secretary may establish rates for the retention 
bonus which shall provide for a higher annual rate for multiyear 
agreements than for single year agreements referred to in subsection 
(a)(4), but in no event shall the annual rate be more than $25,000 per 
annum.
  ``(c) Default of Retention Agreement.--Any health professional 
failing to complete the agreed upon term of service, except where such 
failure is through no fault of the individual, shall be obligated to 
refund to the Government the full amount of the retention bonus for the 
period covered by the agreement, plus interest as determined by the 
Secretary in accordance with section 110(l)(2)(B).
  ``(d) Other Retention Bonus.--The Secretary may pay a retention bonus 
to any health professional employed by a Tribal Health Program if such 
health professional is serving in a position which the Secretary 
determines is--
          ``(1) a position for which recruitment or retention is 
        difficult; and
          ``(2) necessary for providing health care services to 
        Indians.

``SEC. 120. NURSING RESIDENCY PROGRAM.

  ``(a) Establishment of Program.--The Secretary, acting through the 
Service, shall establish a program to enable Indians who are licensed 
practical nurses, licensed vocational nurses, and registered nurses who 
are working in an Indian Health Program or Urban Indian Organization, 
and have done so for a period of not less than 1 year, to pursue 
advanced training. Such program shall include a combination of 
education and work study in an Indian Health Program or Urban Indian 
Organization leading to an associate or bachelor's degree (in the case 
of a licensed practical nurse or licensed vocational nurse), a 
bachelor's degree (in the case of a registered nurse), or advanced 
degrees or certifications in nursing and public health.
  ``(b) Service Obligation.--An individual who participates in a 
program under subsection (a), where the educational costs are paid by 
the Service, shall incur an obligation to serve in an Indian Health 
Program or Urban Indian Organization for a period of obligated service 
equal to 1 year for every year that nonprofessional employee (licensed 
practical nurses, licensed vocational nurses, nursing assistants, and 
various health care technicals), or 2 years for every year that 
professional nurse (associate degree and bachelor-prepared registered 
nurses), participates in such program. In the event that the individual 
fails to complete such obligated service, the United States shall be 
entitled to recover from such individual an amount determined in 
accordance with the formula specified in subsection (l) of section 110 
in the manner provided for in such subsection.

``SEC. 121. COMMUNITY HEALTH AIDE PROGRAM.

  ``(a) General Purposes of Program.--Under the authority of the Act of 
November 2, 1921 (25 U.S.C. 13) (commonly known as the `Snyder Act'), 
the Secretary, acting through the Service, shall develop and operate a 
Community Health Aide Program in Alaska under which the Service--
          ``(1) provides for the training of Alaska Natives as health 
        aides or community health practitioners;
          ``(2) uses such aides or practitioners in the provision of 
        health care, health promotion, and disease prevention services 
        to Alaska Natives living in villages in rural Alaska; and
          ``(3) provides for the establishment of teleconferencing 
        capacity in health clinics located in or near such villages for 
        use by community health aides or community health 
        practitioners.
  ``(b) Specific Program Requirements.--The Secretary, acting through 
the Community Health Aide Program of the Service, shall--
          ``(1) using trainers accredited by the Program, provide a 
        high standard of training to community health aides and 
        community health practitioners to ensure that such aides and 
        practitioners provide quality health care, health promotion, 
        and disease prevention services to the villages served by the 
        Program;
          ``(2) in order to provide such training, develop a curriculum 
        that--
                  ``(A) combines education in the theory of health care 
                with supervised practical experience in the provision 
                of health care;
                  ``(B) provides instruction and practical experience 
                in the provision of acute care, emergency care, health 
                promotion, disease prevention, and the efficient and 
                effective management of clinic pharmacies, supplies, 
                equipment, and facilities; and
                  ``(C) promotes the achievement of the health status 
                objectives specified in section 3(2);
          ``(3) establish and maintain a Community Health Aide 
        Certification Board to certify as community health aides or 
        community health practitioners individuals who have 
        successfully completed the training described in paragraph (1) 
        or can demonstrate equivalent experience;
          ``(4) develop and maintain a system which identifies the 
        needs of community health aides and community health 
        practitioners for continuing education in the provision of 
        health care, including the areas described in paragraph (2)(B), 
        and develop programs that meet the needs for such continuing 
        education;
          ``(5) develop and maintain a system that provides close 
        supervision of community health aides and community health 
        practitioners;
          ``(6) develop a system under which the work of community 
        health aides and community health practitioners is reviewed and 
        evaluated to assure the provision of quality health care, 
        health promotion, and disease prevention services; and
          ``(7) ensure that pulpal therapy (not including pulpotomies 
        on deciduous teeth) or extraction of adult teeth can be 
        performed by a dental health aide therapist only after 
        consultation with a licensed dentist who determines that the 
        procedure is a medical emergency that cannot be resolved with 
        palliative treatment, and further that dental health aide 
        therapists are strictly prohibited from performing all other 
        oral or jaw surgeries, provided that uncomplicated extractions 
        shall not be considered oral surgery under this section.
  ``(c) Program Review.--
          ``(1) Neutral panel.--
                  ``(A) Establishment.--The Secretary, acting through 
                the Service, shall establish a neutral panel to carry 
                out the study under paragraph (2).
                  ``(B) Membership.--Members of the neutral panel shall 
                be appointed by the Secretary from among clinicians, 
                economists, community practitioners, oral 
                epidemiologists, and Alaska Natives.
          ``(2) Study.--
                  ``(A) In general.--The neutral panel established 
                under paragraph (1) shall conduct a study of the dental 
                health aide therapist services provided by the 
                Community Health Aide Program under this section to 
                ensure that the quality of care provided through those 
                services is adequate and appropriate.
                  ``(B) Parameters of study.--The Secretary, in 
                consultation with interested parties, including 
                professional dental organizations, shall develop the 
                parameters of the study.
                  ``(C) Inclusions.--The study shall include a 
                determination by the neutral panel with respect to--
                          ``(i) the ability of the dental health aide 
                        therapist services under this section to 
                        address the dental care needs of Alaska 
                        Natives;
                          ``(ii) the quality of care provided through 
                        those services, including any training, 
                        improvement, or additional oversight required 
                        to improve the quality of care; and
                          ``(iii) whether safer and less costly 
                        alternatives to the dental health aide 
                        therapist services exist.
                  ``(D) Consultation.--In carrying out the study under 
                this paragraph, the neutral panel shall consult with 
                Alaska Tribal Organizations with respect to the 
                adequacy and accuracy of the study.
          ``(3) Report.--The neutral panel shall submit to the 
        Secretary, the Committee on Indian Affairs of the Senate, and 
        the Committee on Natural Resources of the House of 
        Representatives a report describing the results of the study 
        under paragraph (2), including a description of--
                  ``(A) any determination of the neutral panel under 
                paragraph (2)(C); and
                  ``(B) any comments received from an Alaska Tribal 
                Organization under paragraph (2)(D).
  ``(d) Nationalization of Program.--
          ``(1) In general.--Except as provided in paragraph (2), the 
        Secretary, acting through the Service, may establish a national 
        Community Health Aide Program in accordance with the program 
        under this section, as the Secretary determines to be 
        appropriate.
          ``(2) Exception.--The national Community Health Aide Program 
        under paragraph (1) shall not include dental health aide 
        therapist services.
          ``(3) Requirement.--In establishing a national program under 
        paragraph (1), the Secretary shall not reduce the amount of 
        funds provided for the Community Health Aide Program described 
        in subsections (a) and (b).

``SEC. 122. TRIBAL HEALTH PROGRAM ADMINISTRATION.

  ``The Secretary, acting through the Service, shall, by contract or 
otherwise, provide training for Indians in the administration and 
planning of Tribal Health Programs.

``SEC. 123. HEALTH PROFESSIONAL CHRONIC SHORTAGE DEMONSTRATION 
                    PROGRAMS.

  ``(a) Demonstration Programs Authorized.--The Secretary, acting 
through the Service, may fund demonstration programs for Tribal Health 
Programs to address the chronic shortages of health professionals.
  ``(b) Purposes of Programs.--The purposes of demonstration programs 
funded under subsection (a) shall be--
          ``(1) to provide direct clinical and practical experience at 
        a Service Unit to health profession students and residents from 
        medical schools;
          ``(2) to improve the quality of health care for Indians by 
        assuring access to qualified health care professionals; and
          ``(3) to provide academic and scholarly opportunities for 
        health professionals serving Indians by identifying all 
        academic and scholarly resources of the region.
  ``(c) Advisory Board.--The demonstration programs established 
pursuant to subsection (a) shall incorporate a program advisory board 
composed of representatives from the Indian Tribes and Indian 
communities in the area which will be served by the program.

``SEC. 124. NATIONAL HEALTH SERVICE CORPS.

  ``(a) No Reduction in Services.--The Secretary shall not--
          ``(1) remove a member of the National Health Service Corps 
        from an Indian Health Program or Urban Indian Organization; or
          ``(2) withdraw funding used to support such member, unless 
        the Secretary, acting through the Service, has ensured that the 
        Indians receiving services from such member will experience no 
        reduction in services.
  ``(b) Exemption From Limitations.--National Health Service Corps 
scholars qualifying for the Commissioned Corps in the Public Health 
Service shall be exempt from the full-time equivalent limitations of 
the National Health Service Corps and the Service when serving as a 
commissioned corps officer in a Tribal Health Program or an Urban 
Indian Organization.

``SEC. 125. SUBSTANCE ABUSE COUNSELOR EDUCATIONAL CURRICULA 
                    DEMONSTRATION PROGRAMS.

  ``(a) Contracts and Grants.--The Secretary, acting through the 
Service, may enter into contracts with, or make grants to, accredited 
tribal colleges and universities and eligible accredited and accessible 
community colleges to establish demonstration programs to develop 
educational curricula for substance abuse counseling.
  ``(b) Use of Funds.--Funds provided under this section shall be used 
only for developing and providing educational curriculum for substance 
abuse counseling (including paying salaries for instructors). Such 
curricula may be provided through satellite campus programs.
  ``(c) Time Period of Assistance; Renewal.--A contract entered into or 
a grant provided under this section shall be for a period of 3 years. 
Such contract or grant may be renewed for an additional 2-year period 
upon the approval of the Secretary.
  ``(d) Criteria for Review and Approval of Applications.--Not later 
than 180 days after the date of enactment of the Indian Health Care 
Improvement Act Amendments of 2007, the Secretary, after consultation 
with Indian Tribes and administrators of tribal colleges and 
universities and eligible accredited and accessible community colleges, 
shall develop and issue criteria for the review and approval of 
applications for funding (including applications for renewals of 
funding) under this section. Such criteria shall ensure that 
demonstration programs established under this section promote the 
development of the capacity of such entities to educate substance abuse 
counselors.
  ``(e) Assistance.--The Secretary shall provide such technical and 
other assistance as may be necessary to enable grant recipients to 
comply with the provisions of this section.
  ``(f) Report.--Each fiscal year, the Secretary shall submit to the 
President, for inclusion in the report which is required to be 
submitted under section 801 for that fiscal year, a report on the 
findings and conclusions derived from the demonstration programs 
conducted under this section during that fiscal year.
  ``(g) Definition.--For the purposes of this section, the term 
`educational curriculum' means 1 or more of the following:
          ``(1) Classroom education.
          ``(2) Clinical work experience.
          ``(3) Continuing education workshops.

``SEC. 126. BEHAVIORAL HEALTH TRAINING AND COMMUNITY EDUCATION 
                    PROGRAMS.

  ``(a) Study; List.--The Secretary, acting through the Service, and 
the Secretary of the Interior, in consultation with Indian Tribes and 
Tribal Organizations, shall conduct a study and compile a list of the 
types of staff positions specified in subsection (b) whose 
qualifications include, or should include, training in the 
identification, prevention, education, referral, or treatment of mental 
illness, or dysfunctional and self destructive behavior.
  ``(b) Positions.--The positions referred to in subsection (a) are--
          ``(1) staff positions within the Bureau of Indian Affairs, 
        including existing positions, in the fields of--
                  ``(A) elementary and secondary education;
                  ``(B) social services and family and child welfare;
                  ``(C) law enforcement and judicial services; and
                  ``(D) alcohol and substance abuse;
          ``(2) staff positions within the Service; and
          ``(3) staff positions similar to those identified in 
        paragraphs (1) and (2) established and maintained by Indian 
        Tribes, Tribal Organizations (without regard to the funding 
        source), and Urban Indian Organizations.
  ``(c) Training Criteria.--
          ``(1) In general.--The appropriate Secretary shall provide 
        training criteria appropriate to each type of position 
        identified in subsection (b)(1) and (b)(2) and ensure that 
        appropriate training has been, or shall be provided to any 
        individual in any such position. With respect to any such 
        individual in a position identified pursuant to subsection 
        (b)(3), the respective Secretaries shall provide appropriate 
        training to, or provide funds to, an Indian Tribe, Tribal 
        Organization, or Urban Indian Organization for training of 
        appropriate individuals. In the case of positions funded under 
        a contract or compact under the Indian Self-Determination and 
        Education Assistance Act (25 U.S.C. 450 et seq.), the 
        appropriate Secretary shall ensure that such training costs are 
        included in the contract or compact, as the Secretary 
        determines necessary.
          ``(2) Position specific training criteria.--Position specific 
        training criteria shall be culturally relevant to Indians and 
        Indian Tribes and shall ensure that appropriate information 
        regarding traditional health care practices is provided.
  ``(d) Community Education on Mental Illness.--The Service shall 
develop and implement, on request of an Indian Tribe, Tribal 
Organization, or Urban Indian Organization, or assist the Indian Tribe, 
Tribal Organization, or Urban Indian Organization to develop and 
implement, a program of community education on mental illness. In 
carrying out this subsection, the Service shall, upon request of an 
Indian Tribe, Tribal Organization, or Urban Indian Organization, 
provide technical assistance to the Indian Tribe, Tribal Organization, 
or Urban Indian Organization to obtain and develop community 
educational materials on the identification, prevention, referral, and 
treatment of mental illness and dysfunctional and self-destructive 
behavior.
  ``(e) Plan.--Not later than 90 days after the date of enactment of 
the Indian Health Care Improvement Act Amendments of 2007, the 
Secretary shall develop a plan under which the Service will increase 
the health care staff providing behavioral health services by at least 
500 positions within 5 years after the date of enactment of this 
section, with at least 200 of such positions devoted to child, 
adolescent, and family services. The plan developed under this 
subsection shall be implemented under the Act of November 2, 1921 (25 
U.S.C. 13) (commonly known as the `Snyder Act').

``SEC. 127. AUTHORIZATION OF APPROPRIATIONS.

  ``There are authorized to be appropriated such sums as may be 
necessary for each fiscal year through fiscal year 2017 to carry out 
this title.

                      ``TITLE II--HEALTH SERVICES

``SEC. 201. INDIAN HEALTH CARE IMPROVEMENT FUND.

  ``(a) Use of Funds.--The Secretary, acting through the Service, is 
authorized to expend funds, directly or under the authority of the 
Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 
et seq.), which are appropriated under the authority of this section, 
for the purposes of--
          ``(1) eliminating the deficiencies in health status and 
        health resources of all Indian Tribes;
          ``(2) eliminating backlogs in the provision of health care 
        services to Indians;
          ``(3) meeting the health needs of Indians in an efficient and 
        equitable manner, including the use of telehealth and 
        telemedicine when appropriate;
          ``(4) eliminating inequities in funding for both direct care 
        and contract health service programs; and
          ``(5) augmenting the ability of the Service to meet the 
        following health service responsibilities with respect to those 
        Indian Tribes with the highest levels of health status 
        deficiencies and resource deficiencies:
                  ``(A) Clinical care, including inpatient care, 
                outpatient care (including audiology, clinical eye, and 
                vision care), primary care, secondary and tertiary 
                care, and long-term care.
                  ``(B) Preventive health, including mammography and 
                other cancer screening in accordance with section 207.
                  ``(C) Dental care.
                  ``(D) Mental health, including community mental 
                health services, inpatient mental health services, 
                dormitory mental health services, therapeutic and 
                residential treatment centers, and training of 
                traditional health care practitioners.
                  ``(E) Emergency medical services.
                  ``(F) Treatment and control of, and rehabilitative 
                care related to, alcoholism and drug abuse (including 
                fetal alcohol syndrome) among Indians.
                  ``(G) Injury prevention programs, including data 
                collection and evaluation, demonstration projects, 
                training, and capacity building.
                  ``(H) Home health care.
                  ``(I) Community health representatives.
                  ``(J) Maintenance and improvement.
  ``(b) No Offset or Limitation.--Any funds appropriated under the 
authority of this section shall not be used to offset or limit any 
other appropriations made to the Service under this Act or the Act of 
November 2, 1921 (25 U.S.C. 13) (commonly known as the `Snyder Act'), 
or any other provision of law.
  ``(c) Allocation; Use.--
          ``(1) In general.--Funds appropriated under the authority of 
        this section shall be allocated to Service Units, Indian 
        Tribes, or Tribal Organizations. The funds allocated to each 
        Indian Tribe, Tribal Organization, or Service Unit under this 
        paragraph shall be used by the Indian Tribe, Tribal 
        Organization, or Service Unit under this paragraph to improve 
        the health status and reduce the resource deficiency of each 
        Indian Tribe served by such Service Unit, Indian Tribe, or 
        Tribal Organization.
          ``(2) Apportionment of allocated funds.--The apportionment of 
        funds allocated to a Service Unit, Indian Tribe, or Tribal 
        Organization under paragraph (1) among the health service 
        responsibilities described in subsection (a)(5) shall be 
        determined by the Service in consultation with, and with the 
        active participation of, the affected Indian Tribes and Tribal 
        Organizations.
  ``(d) Provisions Relating to Health Status and Resource 
Deficiencies.--For the purposes of this section, the following 
definitions apply:
          ``(1) Definition.--The term `health status and resource 
        deficiency' means the extent to which--
                  ``(A) the health status objectives set forth in 
                section 3(2) are not being achieved; and
                  ``(B) the Indian Tribe or Tribal Organization does 
                not have available to it the health resources it needs, 
                taking into account the actual cost of providing health 
                care services given local geographic, climatic, rural, 
                or other circumstances.
          ``(2) Available resources.--The health resources available to 
        an Indian Tribe or Tribal Organization include health resources 
        provided by the Service as well as health resources used by the 
        Indian Tribe or Tribal Organization, including services and 
        financing systems provided by any Federal programs, private 
        insurance, and programs of State or local governments.
          ``(3) Process for review of determinations.--The Secretary 
        shall establish procedures which allow any Indian Tribe or 
        Tribal Organization to petition the Secretary for a review of 
        any determination of the extent of the health status and 
        resource deficiency of such Indian Tribe or Tribal 
        Organization.
  ``(e) Eligibility for Funds.--Tribal Health Programs shall be 
eligible for funds appropriated under the authority of this section on 
an equal basis with programs that are administered directly by the 
Service.
  ``(f) Report.--By no later than the date that is 3 years after the 
date of enactment of the Indian Health Care Improvement Act Amendments 
of 2007, the Secretary shall submit to Congress the current health 
status and resource deficiency report of the Service for each Service 
Unit, including newly recognized or acknowledged Indian Tribes. Such 
report shall set out--
          ``(1) the methodology then in use by the Service for 
        determining Tribal health status and resource deficiencies, as 
        well as the most recent application of that methodology;
          ``(2) the extent of the health status and resource deficiency 
        of each Indian Tribe served by the Service or a Tribal Health 
        Program;
          ``(3) the amount of funds necessary to eliminate the health 
        status and resource deficiencies of all Indian Tribes served by 
        the Service or a Tribal Health Program; and
          ``(4) an estimate of--
                  ``(A) the amount of health service funds appropriated 
                under the authority of this Act, or any other Act, 
                including the amount of any funds transferred to the 
                Service for the preceding fiscal year which is 
                allocated to each Service Unit, Indian Tribe, or Tribal 
                Organization;
                  ``(B) the number of Indians eligible for health 
                services in each Service Unit or Indian Tribe or Tribal 
                Organization; and
                  ``(C) the number of Indians using the Service 
                resources made available to each Service Unit, Indian 
                Tribe or Tribal Organization, and, to the extent 
                available, information on the waiting lists and number 
                of Indians turned away for services due to lack of 
                resources.
  ``(g) Inclusion in Base Budget.--Funds appropriated under this 
section for any fiscal year shall be included in the base budget of the 
Service for the purpose of determining appropriations under this 
section in subsequent fiscal years.
  ``(h) Clarification.--Nothing in this section is intended to diminish 
the primary responsibility of the Service to eliminate existing 
backlogs in unmet health care needs, nor are the provisions of this 
section intended to discourage the Service from undertaking additional 
efforts to achieve equity among Indian Tribes and Tribal Organizations.
  ``(i) Funding Designation.--Any funds appropriated under the 
authority of this section shall be designated as the `Indian Health 
Care Improvement Fund'.

``SEC. 202. CATASTROPHIC HEALTH EMERGENCY FUND.

  ``(a) Establishment.--There is established an Indian Catastrophic 
Health Emergency Fund (hereafter in this section referred to as the 
`CHEF') consisting of--
          ``(1) the amounts deposited under subsection (f); and
          ``(2) the amounts appropriated to CHEF under this section.
  ``(b) Administration.--CHEF shall be administered by the Secretary, 
acting through the headquarters 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.
  ``(c) Conditions on Use of Fund.--No part of CHEF or its 
administration shall be subject to contract or grant under any law, 
including the Indian Self-Determination and Education Assistance Act 
(25 U.S.C. 450 et seq.), nor shall CHEF funds be allocated, 
apportioned, or delegated on an Area Office, Service Unit, or other 
similar basis.
  ``(d) Regulations.--The Secretary shall promulgate regulations 
consistent with the provisions of this section to--
          ``(1) establish a definition of disasters and catastrophic 
        illnesses for which the cost of the treatment provided under 
        contract would qualify for payment from CHEF;
          ``(2) provide that a Service Unit shall not be eligible for 
        reimbursement for the cost of treatment from CHEF 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) the 2000 level of $19,000; and
                  ``(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 that exceeds such threshold cost incurred 
        by--
                  ``(A) Service Units; or
                  ``(B) whenever otherwise authorized by the Service, 
                non-Service facilities or providers;
          ``(4) establish a procedure for payment from CHEF 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 CHEF 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.
  ``(e) No Offset or Limitation.--Amounts appropriated to CHEF under 
this section shall not be used to offset or limit appropriations made 
to the Service under the authority of the Act of November 2, 1921 (25 
U.S.C. 13) (commonly known as the `Snyder Act'), or any other law.
  ``(f) Deposit of Reimbursement Funds.--There shall be deposited into 
CHEF 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 CHEF.

``SEC. 203. HEALTH PROMOTION AND DISEASE PREVENTION SERVICES.

  ``(a) Findings.--Congress finds that health promotion and disease 
prevention activities--
          ``(1) improve the health and well-being of Indians; and
          ``(2) reduce the expenses for health care of Indians.
  ``(b) Provision of Services.--The Secretary, acting through the 
Service and Tribal Health Programs, shall provide health promotion and 
disease prevention services to Indians to achieve the health status 
objectives set forth in section 3(2).
  ``(c) Evaluation.--The Secretary, after obtaining input from the 
affected Tribal Health Programs, shall submit to the President for 
inclusion in the report which is required to be submitted to Congress 
under section 801 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 and Tribal Health 
        Programs to meet such needs; and
          ``(4) the resources which would be required to enable the 
        Service and Tribal Health Programs to undertake the health 
        promotion and disease prevention activities necessary to meet 
        such needs.

``SEC. 204. DIABETES PREVENTION, TREATMENT, AND CONTROL.

  ``(a) Determinations Regarding Diabetes.--The Secretary, acting 
through the Service, and in consultation with Indian Tribes and Tribal 
Organizations, shall determine--
          ``(1) by Indian Tribe and by Service Unit, the incidence of, 
        and the types of complications resulting from, diabetes among 
        Indians; and
          ``(2) based on the determinations made pursuant to paragraph 
        (1), the measures (including patient education and effective 
        ongoing monitoring of disease indicators) each Service Unit 
        should take to reduce the incidence of, and prevent, treat, and 
        control the complications resulting from, diabetes among Indian 
        Tribes within that Service Unit.
  ``(b) Diabetes Screening.--To the extent medically indicated and with 
informed consent, 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 and 
establish a cost-effective approach to ensure ongoing monitoring of 
disease indicators. Such screening and monitoring may be conducted by a 
Tribal Health Program and may be conducted through appropriate 
Internet-based health care management programs.
  ``(c) Diabetes Projects.--The Secretary shall continue to maintain 
each model diabetes project in existence on the date of enactment of 
the Indian Health Care Improvement Act Amendments of 2007, any such 
other diabetes programs operated by the Service or Tribal Health 
Programs, and any additional diabetes projects, such as the Medical 
Vanguard program provided for in title IV of Public Law 108-87, as 
implemented to serve Indian Tribes. Tribal Health Programs shall 
receive recurring funding for the diabetes projects that they operate 
pursuant to this section, both at the date of enactment of the Indian 
Health Care Improvement Act Amendments of 2007 and for projects which 
are added and funded thereafter.
  ``(d) Dialysis Programs.--The Secretary is authorized to provide, 
through the Service, Indian Tribes, and Tribal Organizations, dialysis 
programs, including the purchase of dialysis equipment and the 
provision of necessary staffing.
  ``(e) Other Duties of the Secretary.--
          ``(1) In general.--The Secretary shall, to the extent funding 
        is available--
                  ``(A) in each Area Office, consult with Indian Tribes 
                and Tribal Organizations regarding programs for the 
                prevention, treatment, and control of diabetes;
                  ``(B) establish in each Area Office a registry of 
                patients with diabetes to track the incidence of 
                diabetes and the complications from diabetes in that 
                area; and
                  ``(C) ensure that data collected in each Area Office 
                regarding diabetes and related complications among 
                Indians are disseminated to all other Area Offices, 
                subject to applicable patient privacy laws.
          ``(2) Diabetes control officers.--
                  ``(A) In general.--The Secretary may establish and 
                maintain in each Area Office a position of diabetes 
                control officer to coordinate and manage any activity 
                of that Area Office relating to the prevention, 
                treatment, or control of diabetes to assist the 
                Secretary in carrying out a program under this section 
                or section 330C of the Public Health Service Act (42 
                U.S.C. 254c-3).
                  ``(B) Certain activities.--Any activity carried out 
                by a diabetes control officer under subparagraph (A) 
                that is the subject of a contract or compact under the 
                Indian Self-Determination and Education Assistance Act 
                (25 U.S.C. 450 et seq.), and any funds made available 
                to carry out such an activity, shall not be divisible 
                for purposes of that Act.

``SEC. 205. SHARED SERVICES FOR LONG-TERM CARE.

  ``(a) Long-Term Care.--Notwithstanding any other provision of law, 
the Secretary, acting through the Service, is authorized to provide 
directly, or enter into contracts or compacts under the Indian Self-
Determination and Education Assistance Act (25 U.S.C. 450 et seq.) with 
Indian Tribes or Tribal Organizations for, the delivery of long-term 
care (including health care services associated with long-term care) 
provided in a facility to Indians. Such agreements shall provide for 
the sharing of staff or other services between the Service or a Tribal 
Health Program and a long-term care or related facility owned and 
operated (directly or through a contract or compact under the Indian 
Self-Determination and Education Assistance Act (25 U.S.C. 450 et 
seq.)) by such Indian Tribe or Tribal Organization.
  ``(b) Contents of Agreements.--An agreement entered into pursuant to 
subsection (a)--
          ``(1) may, at the request of the Indian Tribe or Tribal 
        Organization, delegate to such Indian Tribe or Tribal 
        Organization such powers of supervision and control over 
        Service employees as the Secretary deems necessary to carry out 
        the purposes of this section;
          ``(2) shall provide that expenses (including salaries) 
        relating to services that are shared between the Service and 
        the Tribal Health Program be allocated proportionately between 
        the Service and the Indian Tribe or Tribal Organization; and
          ``(3) may authorize such Indian Tribe or Tribal Organization 
        to construct, renovate, or expand a long-term care or other 
        similar facility (including the construction of a facility 
        attached to a Service facility).
  ``(c) Minimum Requirement.--Any nursing facility provided for under 
this section shall meet the requirements for nursing facilities under 
section 1919 of the Social Security Act.
  ``(d) Other Assistance.--The Secretary shall provide such technical 
and other assistance as may be necessary to enable applicants to comply 
with the provisions of this section.
  ``(e) Use of Existing or Underused Facilities.--The Secretary shall 
encourage the use of existing facilities that are underused or allow 
the use of swing beds for long-term or similar care.

``SEC. 206. HEALTH SERVICES RESEARCH.

  ``(a) In General.--The Secretary, acting through the Service, shall 
make funding available for research to further the performance of the 
health service responsibilities of Indian Health Programs.
  ``(b) Coordination of Resources and Activities.--The Secretary shall 
also, to the maximum extent practicable, coordinate departmental 
research resources and activities to address relevant Indian Health 
Program research needs.
  ``(c) Availability.--Tribal Health Programs shall be given an equal 
opportunity to compete for, and receive, research funds under this 
section.
  ``(d) Use of Funds.--This funding may be used for both clinical and 
nonclinical research.
  ``(e) Evaluation and Dissemination.--The Secretary shall 
periodically--
          ``(1) evaluate the impact of research conducted under this 
        section; and
          ``(2) disseminate to Tribal Health Programs information 
        regarding that research as the Secretary determines to be 
        appropriate.

``SEC. 207. MAMMOGRAPHY AND OTHER CANCER SCREENING.

  ``The Secretary, acting through the Service or Tribal Health 
Programs, shall provide for screening as follows:
          ``(1) Screening mammography (as defined in section 1861(jj) 
        of the Social Security Act) for Indian women at a frequency 
        appropriate to such women under accepted and appropriate 
        national standards, and under such terms and conditions as are 
        consistent with standards established by the Secretary to 
        ensure the safety and accuracy of screening mammography under 
        part B of title XVIII of such Act.
          ``(2) Other cancer screening that receives an A or B rating 
        as recommended by the United States Preventive Services Task 
        Force established under section 915(a)(1) of the Public Health 
        Service Act (42 U.S.C. 299b-4(a)(1)). The Secretary shall 
        ensure that screening provided for under this paragraph 
        complies with the recommendations of the Task Force with 
        respect to--
                  ``(A) frequency;
                  ``(B) the population to be served;
                  ``(C) the procedure or technology to be used;
                  ``(D) evidence of effectiveness; and
                  ``(E) other matters that the Secretary determines 
                appropriate.

``SEC. 208. PATIENT TRAVEL COSTS.

  ``(a) Definition of Qualified Escort.--In this section, the term 
`qualified escort' means--
          ``(1) an adult escort (including a parent, guardian, or other 
        family member) who is required because of the physical or 
        mental condition, or age, of the applicable patient;
          ``(2) a health professional for the purpose of providing 
        necessary medical care during travel by the applicable patient; 
        or
          ``(3) other escorts, as the Secretary or applicable Indian 
        Health Program determines to be appropriate.
  ``(b) Provision of Funds.--The Secretary, acting through the Service 
and Tribal Health Programs, is authorized to provide funds for the 
following patient travel costs, including qualified escorts, associated 
with receiving health care services provided (either through direct or 
contract care or through a contract or compact under the Indian Self-
Determination and Education Assistance Act (25 U.S.C. 450 et seq.)) 
under this Act--
          ``(1) emergency air transportation and non-emergency air 
        transportation where ground transportation is infeasible;
          ``(2) transportation by private vehicle (where no other means 
        of transportation is available), specially equipped vehicle, 
        and ambulance; and
          ``(3) transportation by such other means as may be available 
        and required when air or motor vehicle transportation is not 
        available.

``SEC. 209. EPIDEMIOLOGY CENTERS.

  ``(a) Establishment of Centers.--The Secretary shall establish an 
epidemiology center in each Service Area to carry out the functions 
described in subsection (b). Any new center established after the date 
of the enactment of the Indian Health Care Improvement Act Amendments 
of 2007 may be operated under a grant authorized by subsection (d), but 
funding under such a grant shall not be divisible.
  ``(b) Functions of Centers.--In consultation with and upon the 
request of Indian Tribes, Tribal Organizations, and Urban Indian 
Organizations, each Service Area epidemiology center established under 
this subsection shall, with respect to such Service Area--
          ``(1) collect data relating to, and monitor progress made 
        toward meeting, each of the health status objectives of the 
        Service, the Indian Tribes, Tribal Organizations, and Urban 
        Indian Organizations in the Service Area;
          ``(2) evaluate existing delivery systems, data systems, and 
        other systems that impact the improvement of Indian health;
          ``(3) assist Indian Tribes, Tribal Organizations, and Urban 
        Indian Organizations in identifying their highest priority 
        health status objectives and the services needed to achieve 
        such objectives, based on epidemiological data;
          ``(4) make recommendations for the targeting of services 
        needed by the populations served;
          ``(5) make recommendations to improve health care delivery 
        systems for Indians and Urban Indians;
          ``(6) provide requested technical assistance to Indian 
        Tribes, Tribal Organizations, and Urban Indian Organizations in 
        the development of local health service priorities and 
        incidence and prevalence rates of disease and other illness in 
        the community; and
          ``(7) provide disease surveillance and assist Indian Tribes, 
        Tribal Organizations, and Urban Indian Organizations to promote 
        public health.
  ``(c) Technical Assistance.--The Director of the Centers for Disease 
Control and Prevention shall provide technical assistance to the 
centers in carrying out the requirements of this subsection.
  ``(d) Grants for Studies.--
          ``(1) In general.--The Secretary may make grants to Indian 
        Tribes, Tribal Organizations, Urban Indian Organizations, and 
        eligible intertribal consortia to conduct epidemiological 
        studies of Indian communities.
          ``(2) Eligible intertribal consortia.--An intertribal 
        consortium is eligible to receive a grant under this subsection 
        if--
                  ``(A) the intertribal consortium is incorporated for 
                the primary purpose of improving Indian health; and
                  ``(B) the intertribal consortium is representative of 
                the Indian Tribes or urban Indian communities in which 
                the intertribal consortium is located.
          ``(3) Applications.--An application for a grant under this 
        subsection shall be submitted in such manner and at such time 
        as the Secretary shall prescribe.
          ``(4) Requirements.--An applicant for a grant under this 
        subsection shall--
                  ``(A) demonstrate the technical, administrative, and 
                financial expertise necessary to carry out the 
                functions described in paragraph (5);
                  ``(B) consult and cooperate with providers of related 
                health and social services in order to avoid 
                duplication of existing services; and
                  ``(C) demonstrate cooperation from Indian tribes or 
                Urban Indian Organizations in the area to be served.
          ``(5) Use of funds.--A grant awarded under paragraph (1) may 
        be used--
                  ``(A) to carry out the functions described in 
                subsection (b);
                  ``(B) to provide information to and consult with 
                tribal leaders, urban Indian community leaders, and 
                related health staff on health care and health service 
                management issues; and
                  ``(C) in collaboration with Indian Tribes, Tribal 
                Organizations, and urban Indian communities, to provide 
                the Service with information regarding ways to improve 
                the health status of Indians.
  ``(e) Access to Information.--An epidemiology center operated by a 
grantee pursuant to a grant awarded under subsection (d) shall be 
treated as a public health authority for purposes of the Health 
Insurance Portability and Accountability Act of 1996 (Public Law 104-
191; 110 Stat. 2033), as such entities are defined in part 164.501 of 
title 45, Code of Federal Regulations (or a successor regulation). The 
Secretary shall grant such grantees access to and use of data, data 
sets, monitoring systems, delivery systems, and other protected health 
information in the possession of the Secretary.

``SEC. 210. COMPREHENSIVE SCHOOL HEALTH EDUCATION PROGRAMS.

  ``(a) Funding for Development of Programs.--In addition to carrying 
out any other program for health promotion or disease prevention, the 
Secretary, acting through the Service, is authorized to award grants to 
Indian Tribes, Tribal Organizations, and Urban Indian Organizations to 
develop comprehensive school health education programs for children 
from pre-school through grade 12 in schools for the benefit of Indian 
and Urban Indian children.
  ``(b) Use of Grant Funds.--A grant awarded under this section may be 
used for purposes which may include, but are not limited to, the 
following:
          ``(1) Developing health education materials both for regular 
        school programs and afterschool programs.
          ``(2) Training teachers in comprehensive school health 
        education materials.
          ``(3) Integrating school-based, community-based, and other 
        public and private health promotion efforts.
          ``(4) Encouraging healthy, tobacco-free school environments.
          ``(5) Coordinating school-based health programs with existing 
        services and programs available in the community.
          ``(6) Developing school programs on nutrition education, 
        personal health, oral health, and fitness.
          ``(7) Developing behavioral health wellness programs.
          ``(8) Developing chronic disease prevention programs.
          ``(9) Developing substance abuse prevention programs.
          ``(10) Developing injury prevention and safety education 
        programs.
          ``(11) Developing activities for the prevention and control 
        of communicable diseases.
          ``(12) Developing community and environmental health 
        education programs that include traditional health care 
        practitioners.
          ``(13) Violence prevention.
          ``(14) Such other health issues as are appropriate.
  ``(c) Technical Assistance.--Upon request, the Secretary, acting 
through the Service, shall provide technical assistance to Indian 
Tribes, Tribal Organizations, and Urban Indian Organizations in the 
development of comprehensive health education plans and the 
dissemination of comprehensive health education materials and 
information on existing health programs and resources.
  ``(d) Criteria for Review and Approval of Applications.--The 
Secretary, acting through the Service, and in consultation with Indian 
Tribes, Tribal Organizations, and Urban Indian Organizations, shall 
establish criteria for the review and approval of applications for 
grants awarded under this section.
  ``(e) Development of Program for BIA-Funded Schools.--
          ``(1) In general.--The Secretary of the Interior, acting 
        through the Bureau of Indian Affairs and in cooperation with 
        the Secretary, acting through the Service, and affected Indian 
        Tribes and Tribal Organizations, shall develop a comprehensive 
        school health education program for children from preschool 
        through grade 12 in schools for which support is provided by 
        the Bureau of Indian Affairs.
          ``(2) Requirements for programs.--Such programs shall 
        include--
                  ``(A) school programs on nutrition education, 
                personal health, oral health, and fitness;
                  ``(B) behavioral health wellness programs;
                  ``(C) chronic disease prevention programs;
                  ``(D) substance abuse prevention programs;
                  ``(E) injury prevention and safety education 
                programs; and
                  ``(F) activities for the prevention and control of 
                communicable diseases.
          ``(3) Duties of the secretary.--The Secretary of the Interior 
        shall--
                  ``(A) provide training to teachers in comprehensive 
                school health education materials;
                  ``(B) ensure the integration and coordination of 
                school-based programs with existing services and health 
                programs available in the community; and
                  ``(C) encourage healthy, tobacco-free school 
                environments.

``SEC. 211. INDIAN YOUTH PROGRAM.

  ``(a) Program Authorized.--The Secretary, acting through the Service, 
is authorized to establish and administer a program to provide grants 
to Indian Tribes, Tribal Organizations, and Urban Indian Organizations 
for innovative mental and physical disease prevention and health 
promotion and treatment programs for Indian and Urban Indian 
preadolescent and adolescent youths.
  ``(b) Use of Funds.--
          ``(1) Allowable uses.--Funds made available under this 
        section may be used to--
                  ``(A) develop prevention and treatment programs for 
                Indian youth which promote mental and physical health 
                and incorporate cultural values, community and family 
                involvement, and traditional health care practitioners; 
                and
                  ``(B) develop and provide community training and 
                education.
          ``(2) Prohibited use.--Funds made available under this 
        section may not be used to provide services described in 
        section 707(c).
  ``(c) Duties of the Secretary.--The Secretary shall--
          ``(1) disseminate to Indian Tribes, Tribal Organizations, and 
        Urban Indian Organizations information regarding models for the 
        delivery of comprehensive health care services to Indian and 
        Urban Indian adolescents;
          ``(2) encourage the implementation of such models; and
          ``(3) at the request of an Indian Tribe, Tribal Organization, 
        or Urban Indian Organization, provide technical assistance in 
        the implementation of such models.
  ``(d) Criteria for Review and Approval of Applications.--The 
Secretary, in consultation with Indian Tribes, Tribal Organizations, 
and Urban Indian Organizations, shall establish criteria for the review 
and approval of applications or proposals under this section.

``SEC. 212. PREVENTION, CONTROL, AND ELIMINATION OF COMMUNICABLE AND 
                    INFECTIOUS DISEASES.

  ``(a) Grants Authorized.--The Secretary, acting through the Service, 
and after consultation with the Centers for Disease Control and 
Prevention, may make grants available to Indian Tribes, Tribal 
Organizations, and Urban Indian Organizations for the following:
          ``(1) Projects for the prevention, control, and elimination 
        of communicable and infectious diseases, including 
        tuberculosis, hepatitis, HIV, respiratory syncytial virus, 
        hanta virus, sexually transmitted diseases, and H. Pylori.
          ``(2) Public information and education programs for the 
        prevention, control, and elimination of communicable and 
        infectious diseases.
          ``(3) Education, training, and clinical skills improvement 
        activities in the prevention, control, and elimination of 
        communicable and infectious diseases for health professionals, 
        including allied health professionals.
          ``(4) Demonstration projects for the screening, treatment, 
        and prevention of hepatitis C virus (HCV).
  ``(b) Application Required.--The Secretary may provide funding under 
subsection (a) only if an application or proposal for funding is 
submitted to the Secretary.
  ``(c) Coordination With Health Agencies.--Indian Tribes, Tribal 
Organizations, and Urban Indian Organizations receiving funding under 
this section are encouraged to coordinate their activities with the 
Centers for Disease Control and Prevention and State and local health 
agencies.
  ``(d) Technical Assistance; Report.--In carrying out this section, 
the Secretary--
          ``(1) may, at the request of an Indian Tribe, Tribal 
        Organization, or Urban Indian Organization, provide technical 
        assistance; and
          ``(2) shall prepare and submit a report to Congress 
        biennially on the use of funds under this section and on the 
        progress made toward the prevention, control, and elimination 
        of communicable and infectious diseases among Indians and Urban 
        Indians.

``SEC. 213. AUTHORITY FOR PROVISION OF OTHER SERVICES.

  ``(a) Funding Authorized.--The Secretary, acting through the Service, 
Indian Tribes, and Tribal Organizations, may provide funding under this 
Act to meet the objectives set forth in section 3 through health care-
related services and programs not otherwise described in this Act, 
including--
          ``(1) hospice care;
          ``(2) assisted living;
          ``(3) long-term care; and
          ``(4) home- and community-based services.
  ``(b) Terms and Conditions.--
          ``(1) In general.--Any service provided under this section 
        shall be in accordance with such terms and conditions as are 
        consistent with accepted and appropriate standards relating to 
        the service, including any licensing term or condition under 
        this Act.
          ``(2) Standards.--
                  ``(A) In general.--The Secretary may establish, by 
                regulation, the standards for a service provided under 
                this section, provided that such standards shall not be 
                more stringent than the standards required by the State 
                in which the service is provided.
                  ``(B) Use of state standards.--If the Secretary does 
                not, by regulation, establish standards for a service 
                provided under this section, the standards required by 
                the State in which the service is or will be provided 
                shall apply to such service.
                  ``(C) Indian tribes.--If a service under this section 
                is provided by an Indian Tribe or Tribal Organization 
                pursuant to the Indian Self-Determination and Education 
                Assistance Act (25 U.S.C. 450 et seq.), the 
                verification by the Secretary that the service meets 
                any standards required by the State in which the 
                service is or will be provided shall be considered to 
                meet the terms and conditions required under this 
                subsection.
          ``(3) Eligibility.--The following individuals shall be 
        eligible to receive long-term care under this section:
                  ``(A) Individuals who are unable to perform a certain 
                number of activities of daily living without 
                assistance.
                  ``(B) Individuals with a mental impairment, such as 
                dementia, Alzheimer's disease, or another disabling 
                mental illness, who may be able to perform activities 
                of daily living under supervision.
                  ``(C) Such other individuals as an applicable Indian 
                Health Program determines to be appropriate.
  ``(c) Definitions.--For the purposes of this section, the following 
definitions shall apply:
          ``(1) The term `home- and community-based services' means 1 
        or more of the services specified in paragraphs (1) through (9) 
        of section 1929(a) of the Social Security Act (42 U.S.C. 
        1396t(a)) (whether provided by the Service or by an Indian 
        Tribe or Tribal Organization pursuant to the Indian Self-
        Determination and Education Assistance Act (25 U.S.C. 450 et 
        seq.)) that are or will be provided in accordance with the 
        standards described in subsection (b).
          ``(2) The term `hospice care' means the items and services 
        specified in subparagraphs (A) through (H) of section 
        1861(dd)(1) of the Social Security Act (42 U.S.C. 
        1395x(dd)(1)), and such other services which an Indian Tribe or 
        Tribal Organization determines are necessary and appropriate to 
        provide in furtherance of this care.

``SEC. 214. INDIAN WOMEN'S HEALTH CARE.

  ``The Secretary, acting through the Service and Indian Tribes, Tribal 
Organizations, and Urban Indian Organizations, shall monitor and 
improve the quality of health care for Indian women of all ages through 
the planning and delivery of programs administered by the Service, in 
order to improve and enhance the treatment models of care for Indian 
women.

``SEC. 215. ENVIRONMENTAL AND NUCLEAR HEALTH HAZARDS.

  ``(a) Studies and Monitoring.--The Secretary and the Service shall 
conduct, in conjunction with other appropriate Federal agencies and in 
consultation with concerned Indian Tribes and Tribal Organizations, 
studies and ongoing monitoring programs to determine trends in the 
health hazards to Indian miners and to Indians on or near reservations 
and Indian communities as a result of environmental hazards which may 
result in chronic or life threatening health problems, such as nuclear 
resource development, petroleum contamination, and contamination of 
water source and of the food chain. Such studies shall include--
          ``(1) an evaluation of the nature and extent of health 
        problems caused by environmental hazards currently exhibited 
        among Indians and the causes of such health problems;
          ``(2) an analysis of the potential effect of ongoing and 
        future environmental resource development on or near 
        reservations and Indian communities, including the cumulative 
        effect over time on health;
          ``(3) an evaluation of the types and nature of activities, 
        practices, and conditions causing or affecting such health 
        problems, including uranium mining and milling, uranium mine 
        tailing deposits, nuclear power plant operation and 
        construction, and nuclear waste disposal; oil and gas 
        production or transportation on or near reservations or Indian 
        communities; and other development that could affect the health 
        of Indians and their water supply and food chain;
          ``(4) a summary of any findings and recommendations provided 
        in Federal and State studies, reports, investigations, and 
        inspections during the 5 years prior to the date of enactment 
        of the Indian Health Care Improvement Act Amendments of 2007 
        that directly or indirectly relate to the activities, 
        practices, and conditions affecting the health or safety of 
        such Indians; and
          ``(5) the efforts that have been made by Federal and State 
        agencies and resource and economic development companies to 
        effectively carry out an education program for such Indians 
        regarding the health and safety hazards of such development.
  ``(b) Health Care Plans.--Upon completion of such studies, the 
Secretary and the Service shall take into account the results of such 
studies and develop health care plans to address the health problems 
studied under subsection (a). The plans shall include--
          ``(1) methods for diagnosing and treating Indians currently 
        exhibiting such health problems;
          ``(2) preventive care and testing for Indians who may be 
        exposed to such health hazards, including the monitoring of the 
        health of individuals who have or may have been exposed to 
        excessive amounts of radiation or affected by other activities 
        that have had or could have a serious impact upon the health of 
        such individuals; and
          ``(3) a program of education for Indians who, by reason of 
        their work or geographic proximity to such nuclear or other 
        development activities, may experience health problems.
  ``(c) Submission of Report and Plan to Congress.--The Secretary and 
the Service shall submit to Congress the study prepared under 
subsection (a) no later than 18 months after the date of enactment of 
the Indian Health Care Improvement Act Amendments of 2007. The health 
care plan prepared under subsection (b) shall be submitted in a report 
no later than 1 year after the study prepared under subsection (a) is 
submitted to Congress. Such report shall include recommended activities 
for the implementation of the plan, as well as an evaluation of any 
activities previously undertaken by the Service to address such health 
problems.
  ``(d) Intergovernmental Task Force.--
          ``(1) Establishment; members.--There is established an 
        Intergovernmental Task Force to be composed of the following 
        individuals (or their designees):
                  ``(A) The Secretary of Energy.
                  ``(B) The Secretary of the Environmental Protection 
                Agency.
                  ``(C) The Director of the Bureau of Mines.
                  ``(D) The Assistant Secretary for Occupational Safety 
                and Health.
                  ``(E) The Secretary of the Interior.
                  ``(F) The Secretary of Health and Human Services.
                  ``(G) The Director of the Indian Health Service.
          ``(2) Duties.--The Task Force shall--
                  ``(A) identify existing and potential operations 
                related to nuclear resource development or other 
                environmental hazards that affect or may affect the 
                health of Indians on or near a reservation or in an 
                Indian community; and
                  ``(B) enter into activities to correct existing 
                health hazards and ensure that current and future 
                health problems resulting from nuclear resource or 
                other development activities are minimized or reduced.
          ``(3) Chairman; meetings.--The Secretary of Health and Human 
        Services shall be the Chairman of the Task Force. The Task 
        Force shall meet at least twice each year.
  ``(e) Health Services to Certain Employees.--In the case of any 
Indian who--
          ``(1) as a result of employment in or near a uranium mine or 
        mill or near any other environmental hazard, suffers from a 
        work-related illness or condition;
          ``(2) is eligible to receive diagnosis and treatment services 
        from an Indian Health Program; and
          ``(3) by reason of such Indian's employment, is entitled to 
        medical care at the expense of such mine or mill operator or 
        entity responsible for the environmental hazard, the Indian 
        Health Program shall, at the request of such Indian, render 
        appropriate medical care to such Indian for such illness or 
        condition and may be reimbursed for any medical care so 
        rendered to which such Indian is entitled at the expense of 
        such operator or entity from such operator or entity. Nothing 
        in this subsection shall affect the rights of such Indian to 
        recover damages other than such amounts paid to the Indian 
        Health Program from the employer for providing medical care for 
        such illness or condition.

``SEC. 216. ARIZONA AS A CONTRACT HEALTH SERVICE DELIVERY AREA.

  ``(a) In General.--For fiscal years beginning with the fiscal year 
ending September 30, 1983, and ending with the fiscal year ending 
September 30, 2016, the State of Arizona shall be designated as a 
contract health service delivery area by the Service for the purpose of 
providing contract health care services to members of federally 
recognized Indian Tribes of Arizona.
  ``(b) Maintenance of Services.--The Service shall not curtail any 
health care services provided to Indians residing on reservations in 
the State of Arizona if such curtailment is due to the provision of 
contract services in such State pursuant to the designation of such 
State as a contract health service delivery area pursuant to subsection 
(a).

``SEC. 217. NORTH DAKOTA AND SOUTH DAKOTA AS CONTRACT HEALTH SERVICE 
                    DELIVERY AREA.

  ``(a) In General.--Beginning in fiscal year 2003, the States of North 
Dakota and South Dakota shall be designated as a contract health 
service delivery area by the Service for the purpose of providing 
contract health care services to members of federally recognized Indian 
Tribes of North Dakota and South Dakota.
  ``(b) Limitation.--The Service shall not curtail any health care 
services provided to Indians residing on any reservation, or in any 
county that has a common boundary with any reservation, in the State of 
North Dakota or South Dakota if such curtailment is due to the 
provision of contract services in such States pursuant to the 
designation of such States as a contract health service delivery area 
pursuant to subsection (a).

``SEC. 218. CALIFORNIA CONTRACT HEALTH SERVICES PROGRAM.

  ``(a) Funding Authorized.--The Secretary is authorized to fund a 
program using the California Rural Indian Health Board (hereafter in 
this section referred to as the `CRIHB') as a contract care 
intermediary to improve the accessibility of health services to 
California Indians.
  ``(b) Reimbursement Contract.--The Secretary shall enter into an 
agreement with the CRIHB to reimburse the CRIHB for costs (including 
reasonable administrative costs) incurred pursuant to this section, in 
providing medical treatment under contract to California Indians 
described in section 806(a) throughout the California contract health 
services delivery area described in section 218 with respect to high 
cost contract care cases.
  ``(c) Administrative Expenses.--Not more than 5 percent of the 
amounts provided to the CRIHB under this section for any fiscal year 
may be for reimbursement for administrative expenses incurred by the 
CRIHB during such fiscal year.
  ``(d) Limitation on Payment.--No payment may be made for treatment 
provided hereunder to the extent payment may be made for such treatment 
under the Indian Catastrophic Health Emergency Fund described in 
section 202 or from amounts appropriated or otherwise made available to 
the California contract health service delivery area for a fiscal year.
  ``(e) Advisory Board.--There is established an advisory board which 
shall advise the CRIHB in carrying out this section. The advisory board 
shall be composed of representatives, selected by the CRIHB, from not 
less than 8 Tribal Health Programs serving California Indians covered 
under this section at least \1/2\ of whom of whom are not affiliated 
with the CRIHB.

``SEC. 219. CALIFORNIA AS A CONTRACT HEALTH SERVICE DELIVERY AREA.

  ``The State of California, excluding the counties of Alameda, Contra 
Costa, Los Angeles, Marin, Orange, Sacramento, San Francisco, San 
Mateo, Santa Clara, Kern, Merced, Monterey, Napa, San Benito, San 
Joaquin, San Luis Obispo, Santa Cruz, Solano, Stanislaus, and Ventura, 
shall be designated as a contract health service delivery area by the 
Service for the purpose of providing contract health services to 
California Indians. However, any of the counties listed herein may only 
be included in the contract health services delivery area if funding is 
specifically provided by the Service for such services in those 
counties.

``SEC. 220. CONTRACT HEALTH SERVICES FOR THE TRENTON SERVICE AREA.

  ``(a) Authorization for Services.--The Secretary, acting through the 
Service, is directed to provide contract health services to members of 
the Turtle Mountain Band of Chippewa Indians that reside in the Trenton 
Service Area of Divide, McKenzie, and Williams counties in the State of 
North Dakota and the adjoining counties of Richland, Roosevelt, and 
Sheridan in the State of Montana.
  ``(b) No Expansion of Eligibility.--Nothing in this section may be 
construed as expanding the eligibility of members of the Turtle 
Mountain Band of Chippewa Indians for health services provided by the 
Service beyond the scope of eligibility for such health services that 
applied on May 1, 1986.

``SEC. 221. PROGRAMS OPERATED BY INDIAN TRIBES AND TRIBAL 
                    ORGANIZATIONS.

  ``The Service shall provide funds for health care programs and 
facilities operated by Tribal Health Programs on the same basis as such 
funds are provided to programs and facilities operated directly by the 
Service.

``SEC. 222. LICENSING.

  ``Health care professionals employed by a Tribal Health Program 
shall, if licensed in any State, be exempt from the licensing 
requirements of the State in which the Tribal Health Program performs 
the services described in its contract or compact under the Indian 
Self-Determination and Education Assistance Act (25 U.S.C. 450 et 
seq.).

``SEC. 223. NOTIFICATION OF PROVISION OF EMERGENCY CONTRACT HEALTH 
                    SERVICES.

  ``With respect to an elderly Indian or an Indian with a disability 
receiving emergency medical care or services from a non-Service 
provider or in a non-Service facility under the authority of this Act, 
the time limitation (as a condition of payment) for notifying the 
Service of such treatment or admission shall be 30 days.

``SEC. 224. PROMPT ACTION ON PAYMENT OF CLAIMS.

  ``(a) Deadline for Response.--The Service shall respond to a 
notification of a claim by a provider of a contract care service with 
either an individual purchase order or a denial of the claim within 5 
working days after the receipt of such notification.
  ``(b) Effect of Untimely Response.--If the Service fails to respond 
to a notification of a claim in accordance with subsection (a), the 
Service shall accept as valid the claim submitted by the provider of a 
contract care service.
  ``(c) Deadline for Payment of Valid Claim.--The Service shall pay a 
valid contract care service claim within 30 days after the completion 
of the claim.

``SEC. 225. LIABILITY FOR PAYMENT.

  ``(a) No Patient Liability.--A patient who receives contract health 
care services that are authorized by the Service shall not be liable 
for the payment of any charges or costs associated with the provision 
of such services.
  ``(b) Notification.--The Secretary shall notify a contract care 
provider and any patient who receives contract health care services 
authorized by the Service that such patient is not liable for the 
payment of any charges or costs associated with the provision of such 
services not later than 5 business days after receipt of a notification 
of a claim by a provider of contract care services.
  ``(c) No Recourse.--Following receipt of the notice provided under 
subsection (b), or, if a claim has been deemed accepted under section 
223(b), the provider shall have no further recourse against the patient 
who received the services.

``SEC. 226. OFFICE OF INDIAN MEN'S HEALTH.

  ``(a) Establishment.--The Secretary may establish within the Service 
an office to be known as the `Office of Indian Men's Health' (referred 
to in this section as the `Office').
  ``(b) Director.--
          ``(1) In general.--The Office shall be headed by a director, 
        to be appointed by the Secretary.
          ``(2) Duties.--The director shall coordinate and promote the 
        status of the health of Indian men in the United States.
  ``(c) Report.--Not later than 2 years after the date of enactment of 
the Indian Health Care Improvement Act Amendments of 2007, the 
Secretary, acting through the director of the Office, shall submit to 
Congress a report describing--
          ``(1) any activity carried out by the director as of the date 
        on which the report is prepared; and
          ``(2) any finding of the director with respect to the health 
        of Indian men.

``SEC. 227. AUTHORIZATION OF APPROPRIATIONS.

  ``There are authorized to be appropriated such sums as may be 
necessary for each fiscal year through fiscal year 2017 to carry out 
this title.

                        ``TITLE III--FACILITIES

``SEC. 301. CONSULTATION; CONSTRUCTION AND RENOVATION OF FACILITIES; 
                    REPORTS.

  ``(a) Prerequisites for Expenditure of Funds.--Prior to the 
expenditure of, or the making of any binding commitment to expend, any 
funds appropriated for the planning, design, construction, or 
renovation of facilities pursuant to the Act of November 2, 1921 (25 
U.S.C. 13) (commonly known as the `Snyder Act'), the Secretary, acting 
through the Service, shall--
          ``(1) consult with any Indian Tribe that would be 
        significantly affected by such expenditure for the purpose of 
        determining and, whenever practicable, honoring tribal 
        preferences concerning size, location, type, and other 
        characteristics of any facility on which such expenditure is to 
        be made; and
          ``(2) ensure, whenever practicable and applicable, that such 
        facility meets the construction standards of any accrediting 
        body recognized by the Secretary for the purposes of the 
        Medicare, Medicaid, and SCHIP programs under titles XVIII, XIX, 
        and XXI of the Social Security Act by not later than 1 year 
        after the date on which the construction or renovation of such 
        facility is completed.
  ``(b) Closures.--
          ``(1) Evaluation required.--Notwithstanding any other 
        provision of law, no facility operated by the Service, or any 
        portion of such facility, may be closed if the Secretary has 
        not submitted to Congress, not less than 1 year and not more 
        than 2 years before the date of the proposed closure, an 
        evaluation, completed not more than 2 years before such 
        submission, of the impact of the proposed closure that 
        specifies, in addition to other considerations--
                  ``(A) the accessibility of alternative health care 
                resources for the population served by such facility;
                  ``(B) the cost-effectiveness of such closure;
                  ``(C) the quality of health care to be provided to 
                the population served by such facility after such 
                closure;
                  ``(D) the availability of contract health care funds 
                to maintain existing levels of service;
                  ``(E) the views of the Indian Tribes served by such 
                facility concerning such closure;
                  ``(F) the level of use of such facility by all 
                eligible Indians; and
                  ``(G) the distance between such facility and the 
                nearest operating Service hospital.
          ``(2) Exception for certain temporary closures.--Paragraph 
        (1) shall not apply to any temporary closure of a facility or 
        any portion of a facility if such closure is necessary for 
        medical, environmental, or construction safety reasons.
  ``(c) Health Care Facility Priority System.--
          ``(1) In general.--
                  ``(A) Priority system.--The Secretary, acting through 
                the Service, shall maintain a health care facility 
                priority system, which--
                          ``(i) shall be developed in consultation with 
                        Indian Tribes and Tribal Organizations;
                          ``(ii) shall give Indian Tribes' needs the 
                        highest priority;
                          ``(iii)(I) may include the lists required in 
                        paragraph (2)(B)(ii); and
                          ``(II) shall include the methodology required 
                        in paragraph (2)(B)(v); and
                          ``(III) may include such other facilities, 
                        and such renovation or expansion needs of any 
                        health care facility, as the Service, Indian 
                        Tribes, and Tribal Organizations may identify; 
                        and
                          ``(iv) shall provide an opportunity for the 
                        nomination of planning, design, and 
                        construction projects by the Service, Indian 
                        Tribes, and Tribal Organizations for 
                        consideration under the priority system at 
                        least once every 3 years, or more frequently as 
                        the Secretary determines to be appropriate.
                  ``(B) Needs of facilities under isdeaa agreements.--
                The Secretary shall ensure that the planning, design, 
                construction, renovation, and expansion needs of 
                Service and non-Service facilities operated under 
                contracts or compacts in accordance with the Indian 
                Self-Determination and Education Assistance Act (25 
                U.S.C. 450 et seq.) are fully and equitably integrated 
                into the health care facility priority system.
                  ``(C) Criteria for evaluating needs.--For purposes of 
                this subsection, the Secretary, in evaluating the needs 
                of facilities operated under a contract or compact 
                under the Indian Self-Determination and Education 
                Assistance Act (25 U.S.C. 450 et seq.), shall use the 
                criteria used by the Secretary in evaluating the needs 
                of facilities operated directly by the Service.
                  ``(D) Priority of certain projects protected.--The 
                priority of any project established under the 
                construction priority system in effect on the date of 
                enactment of the Indian Health Care Improvement Act 
                Amendments of 2007 shall not be affected by any change 
                in the construction priority system taking place after 
                that date if the project--
                          ``(i) was identified in the fiscal year 2008 
                        Service budget justification as--
                                  ``(I) 1 of the 10 top-priority 
                                inpatient projects;
                                  ``(II) 1 of the 10 top-priority 
                                outpatient projects;
                                  ``(III) 1 of the 10 top-priority 
                                staff quarters developments; or
                                  ``(IV) 1 of the 10 top-priority Youth 
                                Regional Treatment Centers;
                          ``(ii) had completed both Phase I and Phase 
                        II of the construction priority system in 
                        effect on the date of enactment of such Act; or
                          ``(iii) is not included in clause (i) or (ii) 
                        and is selected, as determined by the 
                        Secretary--
                                  ``(I) on the initiative of the 
                                Secretary; or
                                  ``(II) pursuant to a request of an 
                                Indian Tribe or Tribal Organization.
          ``(2) Report; contents.--
                  ``(A) Initial comprehensive report.--
                          ``(i) Definitions.--In this subparagraph:
                                  ``(I) Facilities appropriation 
                                advisory board.--The term `Facilities 
                                Appropriation Advisory Board' means the 
                                advisory board, comprised of 12 members 
                                representing Indian tribes and 2 
                                members representing the Service, 
                                established at the discretion of the 
                                Assistant Secretary--
                                          ``(aa) to provide advice and 
                                        recommendations for policies 
                                        and procedures of the programs 
                                        funded pursuant to facilities 
                                        appropriations; and
                                          ``(bb) to address other 
                                        facilities issues.
                                  ``(II) Facilities needs assessment 
                                workgroup.--The term `Facilities Needs 
                                Assessment Workgroup' means the 
                                workgroup established at the discretion 
                                of the Assistant Secretary--
                                          ``(aa) to review the health 
                                        care facilities construction 
                                        priority system; and
                                          ``(bb) to make 
                                        recommendations to the 
                                        Facilities Appropriation 
                                        Advisory Board for revising the 
                                        priority system.
                          ``(ii) Initial report.--
                                  ``(I) In general.--Not later than 1 
                                year after the date of enactment of the 
                                Indian Health Care Improvement Act 
                                Amendments of 2007, the Secretary shall 
                                submit to the Committee on Indian 
                                Affairs of the Senate and the Committee 
                                on Natural Resources of the House of 
                                Representatives a report that describes 
                                the comprehensive, national, ranked 
                                list of all health care facilities 
                                needs for the Service, Indian Tribes, 
                                and Tribal Organizations (including 
                                inpatient health care facilities, 
                                outpatient health care facilities, 
                                specialized health care facilities 
                                (such as for long-term care and alcohol 
                                and drug abuse treatment), wellness 
                                centers, staff quarters and hostels 
                                associated with health care facilities, 
                                and the renovation and expansion needs, 
                                if any, of such facilities) developed 
                                by the Service, Indian Tribes, and 
                                Tribal Organizations for the Facilities 
                                Needs Assessment Workgroup and the 
                                Facilities Appropriation Advisory 
                                Board.
                                  ``(II) Inclusions.--The initial 
                                report shall include--
                                          ``(aa) the methodology and 
                                        criteria used by the Service in 
                                        determining the needs and 
                                        establishing the ranking of the 
                                        facilities needs; and
                                          ``(bb) such other information 
                                        as the Secretary determines to 
                                        be appropriate.
                          ``(iii) Updates of report.--Beginning in 
                        calendar year 2011, the Secretary shall--
                                  ``(I) update the report under clause 
                                (ii) not less frequently that once 
                                every 5 years; and
                                  ``(II) include the updated report in 
                                the appropriate annual report under 
                                subparagraph (B) for submission to 
                                Congress under section 801.
                  ``(B) Annual reports.--The Secretary shall submit to 
                the President, for inclusion in the report required to 
                be transmitted to Congress under section 801, a report 
                which sets forth the following:
                          ``(i) A description of the health care 
                        facility priority system of the Service 
                        established under paragraph (1).
                          ``(ii) Health care facilities lists, which 
                        may include--
                                  ``(I) the 10 top-priority inpatient 
                                health care facilities;
                                  ``(II) the 10 top-priority outpatient 
                                health care facilities;
                                  ``(III) the 10 top-priority 
                                specialized health care facilities 
                                (such as long-term care and alcohol and 
                                drug abuse treatment);
                                  ``(IV) the 10 top-priority staff 
                                quarters developments associated with 
                                health care facilities; and
                                  ``(V) the 10 top-priority hostels 
                                associated with health care facilities.
                          ``(iii) The justification for such order of 
                        priority.
                          ``(iv) The projected cost of such projects.
                          ``(v) The methodology adopted by the Service 
                        in establishing priorities under its health 
                        care facility priority system.
          ``(3) Requirements for preparation of reports.--In preparing 
        the report required under paragraph (2), the Secretary shall--
                  ``(A) consult with and obtain information on all 
                health care facilities needs from Indian Tribes, Tribal 
                Organizations, and Urban Indian Organizations; and
                  ``(B) review the total unmet needs of all Indian 
                Tribes, Tribal Organizations, and Urban Indian 
                Organizations for health care facilities (including 
                hostels and staff quarters), including needs for 
                renovation and expansion of existing facilities.
  ``(d) Review of Methodology Used for Health Facilities Construction 
Priority System.--
          ``(1) In general.--Not later than 1 year after the 
        establishment of the priority system under subsection 
        (c)(1)(A), the Comptroller General of the United States shall 
        prepare and finalize a report reviewing the methodologies 
        applied, and the processes followed, by the Service in making 
        each assessment of needs for the list under subsection 
        (c)(2)(A)(ii) and developing the priority system under 
        subsection (c)(1), including a review of--
                  ``(A) the recommendations of the Facilities 
                Appropriation Advisory Board and the Facilities Needs 
                Assessment Workgroup (as those terms are defined in 
                subsection (c)(2)(A)(i)); and
                  ``(B) the relevant criteria used in ranking or 
                prioritizing facilities other than hospitals or 
                clinics.
          ``(2) Submission to congress.--The Comptroller General of the 
        United States shall submit the report under paragraph (1) to--
                  ``(A) the Committees on Indian Affairs and 
                Appropriations of the Senate;
                  ``(B) the Committees on Natural Resources and 
                Appropriations of the House of Representatives; and
                  ``(C) the Secretary.
  ``(e) Funding Condition.--All funds appropriated under the Act of 
November 2, 1921 (25 U.S.C. 13) (commonly known as the `Snyder Act'), 
for the planning, design, construction, or renovation of health 
facilities for the benefit of 1 or more Indian Tribes shall be subject 
to the provisions of the Indian Self-Determination and Education 
Assistance Act (25 U.S.C. 450 et seq.).
  ``(f) Development of Innovative Approaches.--The Secretary shall 
consult and cooperate with Indian Tribes, Tribal Organizations, and 
Urban Indian Organizations in developing innovative approaches to 
address all or part of the total unmet need for construction of health 
facilities, including those provided for in other sections of this 
title and other approaches.

``SEC. 302. SANITATION FACILITIES.

  ``(a) Findings.--Congress finds the following:
          ``(1) The provision of sanitation facilities is primarily a 
        health consideration and function.
          ``(2) Indian people suffer an inordinately high incidence of 
        disease, injury, and illness directly attributable to the 
        absence or inadequacy of sanitation facilities.
          ``(3) The long-term cost to the United States of treating and 
        curing such disease, injury, and illness is substantially 
        greater than the short-term cost of providing sanitation 
        facilities and other preventive health measures.
          ``(4) Many Indian homes and Indian communities still lack 
        sanitation facilities.
          ``(5) It is in the interest of the United States, and it is 
        the policy of the United States, that all Indian communities 
        and Indian homes, new and existing, be provided with sanitation 
        facilities.
  ``(b) Facilities and Services.--In furtherance of the findings made 
in subsection (a), Congress reaffirms the primary responsibility and 
authority of the Service to provide the necessary sanitation facilities 
and services as provided in section 7 of the Act of August 5, 1954 (42 
U.S.C. 2004a). Under such authority, the Secretary, acting through the 
Service, is authorized to provide the following:
          ``(1) Financial and technical assistance to Indian Tribes, 
        Tribal Organizations, and Indian communities in the 
        establishment, training, and equipping of utility organizations 
        to operate and maintain sanitation facilities, including the 
        provision of existing plans, standard details, and 
        specifications available in the Department, to be used at the 
        option of the Indian Tribe, Tribal Organization, or Indian 
        community.
          ``(2) Ongoing technical assistance and training to Indian 
        Tribes, Tribal Organizations, and Indian communities in the 
        management of utility organizations which operate and maintain 
        sanitation facilities.
          ``(3) Priority funding for operation and maintenance 
        assistance for, and emergency repairs to, sanitation facilities 
        operated by an Indian Tribe, Tribal Organization or Indian 
        community when necessary to avoid an imminent health threat or 
        to protect the investment in sanitation facilities and the 
        investment in the health benefits gained through the provision 
        of sanitation facilities.
  ``(c) Funding.--Notwithstanding any other provision of law--
          ``(1) the Secretary of Housing and Urban Development is 
        authorized to transfer funds appropriated under the Native 
        American Housing Assistance and Self-Determination Act of 1996 
        (25 U.S.C. 4101 et seq.) to the Secretary of Health and Human 
        Services;
          ``(2) the Secretary of Health and Human Services is 
        authorized to accept and use such funds for the purpose of 
        providing sanitation facilities and services for Indians under 
        section 7 of the Act of August 5, 1954 (42 U.S.C. 2004a);
          ``(3) unless specifically authorized when funds are 
        appropriated, the Secretary shall not use funds appropriated 
        under section 7 of the Act of August 5, 1954 (42 U.S.C. 2004a), 
        to provide sanitation facilities to new homes constructed using 
        funds provided by the Department of Housing and Urban 
        Development;
          ``(4) the Secretary of Health and Human Services is 
        authorized to accept from any source, including Federal and 
        State agencies, funds for the purpose of providing sanitation 
        facilities and services and place these funds into contracts or 
        compacts under the Indian Self-Determination and Education 
        Assistance Act (25 U.S.C. 450 et seq.);
          ``(5) except as otherwise prohibited by this section, the 
        Secretary may use funds appropriated under the authority of 
        section 7 of the Act of August 5, 1954 (42 U.S.C. 2004a), to 
        fund up to 100 percent of the amount of an Indian Tribe's loan 
        obtained under any Federal program for new projects to 
        construct eligible sanitation facilities to serve Indian homes;
          ``(6) except as otherwise prohibited by this section, the 
        Secretary may use funds appropriated under the authority of 
        section 7 of the Act of August 5, 1954 (42 U.S.C. 2004a) to 
        meet matching or cost participation requirements under other 
        Federal and non-Federal programs for new projects to construct 
        eligible sanitation facilities;
          ``(7) all Federal agencies are authorized to transfer to the 
        Secretary funds identified, granted, loaned, or appropriated 
        whereby the Department's applicable policies, rules, and 
        regulations shall apply in the implementation of such projects;
          ``(8) the Secretary of Health and Human Services shall enter 
        into interagency agreements with Federal and State agencies for 
        the purpose of providing financial assistance for sanitation 
        facilities and services under this Act;
          ``(9) the Secretary of Health and Human Services shall, by 
        regulation, establish standards applicable to the planning, 
        design, and construction of sanitation facilities funded under 
        this Act; and
          ``(10) the Secretary of Health and Human Services is 
        authorized to accept payments for goods and services furnished 
        by the Service from appropriate public authorities, nonprofit 
        organizations or agencies, or Indian Tribes, as contributions 
        by that authority, organization, agency, or tribe to agreements 
        made under section 7 of the Act of August 5, 1954 (42 U.S.C. 
        2004a), and such payments shall be credited to the same or 
        subsequent appropriation account as funds appropriated under 
        the authority of section 7 of the Act of August 5, 1954 (42 
        U.S.C. 2004a).
  ``(d) Certain Capabilities Not Prerequisite.--The financial and 
technical capability of an Indian Tribe, Tribal Organization, or Indian 
community to safely operate, manage, and maintain a sanitation facility 
shall not be a prerequisite to the provision or construction of 
sanitation facilities by the Secretary.
  ``(e) Financial Assistance.--The Secretary is authorized to provide 
financial assistance to Indian Tribes, Tribal Organizations, and Indian 
communities for operation, management, and maintenance of their 
sanitation facilities.
  ``(f) Operation, Management, and Maintenance of Facilities.--The 
Indian Tribe has the primary responsibility to establish, collect, and 
use reasonable user fees, or otherwise set aside funding, for the 
purpose of operating, managing, and maintaining sanitation facilities. 
If a sanitation facility serving a community that is operated by an 
Indian Tribe or Tribal Organization is threatened with imminent failure 
and such operator lacks capacity to maintain the integrity or the 
health benefits of the sanitation facility, then the Secretary is 
authorized to assist the Indian Tribe, Tribal Organization, or Indian 
community in the resolution of the problem on a short-term basis 
through cooperation with the emergency coordinator or by providing 
operation, management, and maintenance service.
  ``(g) ISDEAA Program Funded on Equal Basis.--Tribal Health Programs 
shall be eligible (on an equal basis with programs that are 
administered directly by the Service) for--
          ``(1) any funds appropriated pursuant to this section; and
          ``(2) any funds appropriated for the purpose of providing 
        sanitation facilities.
  ``(h) Report.--
          ``(1) Required; contents.--The Secretary, in consultation 
        with the Secretary of Housing and Urban Development, Indian 
        Tribes, Tribal Organizations, and tribally designated housing 
        entities (as defined in section 4 of the Native American 
        Housing Assistance and Self-Determination Act of 1996 (25 
        U.S.C. 4103)) shall submit to the President, for inclusion in 
        the report required to be transmitted to Congress under section 
        801, a report which sets forth--
                  ``(A) the current Indian sanitation facility priority 
                system of the Service;
                  ``(B) the methodology for determining sanitation 
                deficiencies and needs;
                  ``(C) the criteria on which the deficiencies and 
                needs will be evaluated;
                  ``(D) the level of initial and final sanitation 
                deficiency for each type of sanitation facility for 
                each project of each Indian Tribe or Indian community;
                  ``(E) the amount and most effective use of funds, 
                derived from whatever source, necessary to accommodate 
                the sanitation facilities needs of new homes assisted 
                with funds under the Native American Housing Assistance 
                and Self-Determination Act (25 U.S.C. 4101 et seq.), 
                and to reduce the identified sanitation deficiency 
                levels of all Indian Tribes and Indian communities to 
                level I sanitation deficiency as defined in paragraph 
                (3)(A); and
                  ``(F) a 10-year plan to provide sanitation facilities 
                to serve existing Indian homes and Indian communities 
                and new and renovated Indian homes.
          ``(2) Uniform methodology.--The methodology used by the 
        Secretary in determining, preparing cost estimates for, and 
        reporting sanitation deficiencies for purposes of paragraph (1) 
        shall be applied uniformly to all Indian Tribes and Indian 
        communities.
          ``(3) Sanitation deficiency levels.--For purposes of this 
        subsection, the sanitation deficiency levels for an individual, 
        Indian Tribe, or Indian community sanitation facility to serve 
        Indian homes are determined as follows:
                  ``(A) A level I deficiency exists if a sanitation 
                facility serving an individual, Indian Tribe, or Indian 
                community--
                          ``(i) complies with all applicable water 
                        supply, pollution control, and solid waste 
                        disposal laws; and
                          ``(ii) deficiencies relate to routine 
                        replacement, repair, or maintenance needs.
                  ``(B) A level II deficiency exists if a sanitation 
                facility serving an individual, Indian Tribe, or Indian 
                community substantially or recently complied with all 
                applicable water supply, pollution control, and solid 
                waste laws and any deficiencies relate to--
                          ``(i) small or minor capital improvements 
                        needed to bring the facility back into 
                        compliance;
                          ``(ii) capital improvements that are 
                        necessary to enlarge or improve the facilities 
                        in order to meet the current needs for domestic 
                        sanitation facilities; or
                          ``(iii) the lack of equipment or training by 
                        an Indian Tribe, Tribal Organization, or an 
                        Indian community to properly operate and 
                        maintain the sanitation facilities.
                  ``(C) A level III deficiency exists if a sanitation 
                facility serving an individual, Indian Tribe or Indian 
                community meets 1 or more of the following conditions--
                          ``(i) water or sewer service in the home is 
                        provided by a haul system with holding tanks 
                        and interior plumbing;
                          ``(ii) major significant interruptions to 
                        water supply or sewage disposal occur 
                        frequently, requiring major capital 
                        improvements to correct the deficiencies; or
                          ``(iii) there is no access to or no approved 
                        or permitted solid waste facility available.
                  ``(D) A level IV deficiency exists--
                          ``(i) if a sanitation facility for an 
                        individual home, an Indian Tribe, or an Indian 
                        community exists but--
                                  ``(I) lacks--
                                          ``(aa) a safe water supply 
                                        system; or
                                          ``(bb) a waste disposal 
                                        system;
                                  ``(II) contains no piped water or 
                                sewer facilities; or
                                  ``(III) has become inoperable due to 
                                a major component failure; or
                          ``(ii) if only a washeteria or central 
                        facility exists in the community.
                  ``(E) A level V deficiency exists in the absence of a 
                sanitation facility, where individual homes do not have 
                access to safe drinking water or adequate wastewater 
                (including sewage) disposal.
  ``(i) Definitions.--For purposes of this section, the following terms 
apply:
          ``(1) Indian community.--The term `Indian community' means a 
        geographic area, a significant proportion of whose inhabitants 
        are Indians and which is served by or capable of being served 
        by a facility described in this section.
          ``(2) Sanitation facilities.--The terms `sanitation facility' 
        and `sanitation facilities' mean safe and adequate water supply 
        systems, sanitary sewage disposal systems, and sanitary solid 
        waste systems (and all related equipment and support 
        infrastructure).

``SEC. 303. PREFERENCE TO INDIANS AND INDIAN FIRMS.

  ``(a) Buy Indian Act.--The Secretary, acting through the Service, may 
use the negotiating authority of section 23 of the Act of June 25, 1910 
(25 U.S.C. 47, commonly known as the `Buy Indian Act'), to give 
preference to any Indian or any enterprise, partnership, corporation, 
or other type of business organization owned and controlled by an 
Indian or Indians including former or currently federally recognized 
Indian Tribes in the State of New York (hereinafter referred to as an 
`Indian firm') in the construction and renovation of Service facilities 
pursuant to section 301 and in the construction of sanitation 
facilities pursuant to section 302. Such preference may be accorded by 
the Secretary unless the Secretary finds, pursuant to regulations, that 
the project or function to be contracted for will not be satisfactory 
or such project or function cannot be properly completed or maintained 
under the proposed contract. The Secretary, in arriving at such a 
finding, shall consider whether the Indian or Indian firm will be 
deficient with respect to--
          ``(1) ownership and control by Indians;
          ``(2) equipment;
          ``(3) bookkeeping and accounting procedures;
          ``(4) substantive knowledge of the project or function to be 
        contracted for;
          ``(5) adequately trained personnel; or
          ``(6) other necessary components of contract performance.
  ``(b) Labor Standards.--For the purposes of implementing the 
provisions of this title, contracts for the construction or renovation 
of health care facilities, staff quarters, and sanitation facilities, 
and related support infrastructure, funded in whole or in part with 
funds made available pursuant to this title, shall contain a provision 
requiring compliance with subchapter IV of chapter 31 of title 40, 
United States Code (commonly known as the `Davis-Bacon Act').

``SEC. 304. EXPENDITURE OF NON-SERVICE FUNDS FOR RENOVATION.

  ``(a) In General.--Notwithstanding any other provision of law, if the 
requirements of subsection (c) are met, the Secretary, acting through 
the Service, is authorized to accept any major expansion, renovation, 
or modernization by any Indian Tribe or Tribal Organization of any 
Service facility or of any other Indian health facility operated 
pursuant to a contract or compact under the Indian Self-Determination 
and Education Assistance Act (25 U.S.C. 450 et seq.), including--
          ``(1) any plans or designs for such expansion, renovation, or 
        modernization; and
          ``(2) any expansion, renovation, or modernization for which 
        funds appropriated under any Federal law were lawfully 
        expended.
  ``(b) Priority List.--
          ``(1) In general.--The Secretary shall maintain a separate 
        priority list to address the needs for increased operating 
        expenses, personnel, or equipment for such facilities. The 
        methodology for establishing priorities shall be developed 
        through regulations. The list of priority facilities will be 
        revised annually in consultation with Indian Tribes and Tribal 
        Organizations.
          ``(2) Report.--The Secretary shall submit to the President, 
        for inclusion in the report required to be transmitted to 
        Congress under section 801, the priority list maintained 
        pursuant to paragraph (1).
  ``(c) Requirements.--The requirements of this subsection are met with 
respect to any expansion, renovation, or modernization if--
          ``(1) the Indian Tribe or Tribal Organization--
                  ``(A) provides notice to the Secretary of its intent 
                to expand, renovate, or modernize; and
                  ``(B) applies to the Secretary to be placed on a 
                separate priority list to address the needs of such new 
                facilities for increased operating expenses, personnel, 
                or equipment; and
          ``(2) the expansion, renovation, or modernization--
                  ``(A) is approved by the appropriate area director of 
                the Service for Federal facilities; and
                  ``(B) is administered by the Indian Tribe or Tribal 
                Organization in accordance with any applicable 
                regulations prescribed by the Secretary with respect to 
                construction or renovation of Service facilities.
  ``(d) Additional Requirement for Expansion.--In addition to the 
requirements under subsection (c), for any expansion, the Indian Tribe 
or Tribal Organization shall provide to the Secretary additional 
information pursuant to regulations, including additional staffing, 
equipment, and other costs associated with the expansion.
  ``(e) Closure or Conversion of Facilities.--If any Service facility 
which has been expanded, renovated, or modernized by an Indian Tribe or 
Tribal Organization under this section ceases to be used as a Service 
facility during the 20-year period beginning on the date such 
expansion, renovation, or modernization is completed, such Indian Tribe 
or Tribal Organization shall be entitled to recover from the United 
States an amount which bears the same ratio to the value of such 
facility at the time of such cessation as the value of such expansion, 
renovation, or modernization (less the total amount of any funds 
provided specifically for such facility under any Federal program that 
were expended for such expansion, renovation, or modernization) bore to 
the value of such facility at the time of the completion of such 
expansion, renovation, or modernization.

``SEC. 305. FUNDING FOR THE CONSTRUCTION, EXPANSION, AND MODERNIZATION 
                    OF SMALL AMBULATORY CARE FACILITIES.

  ``(a) Grants.--
          ``(1) In general.--The Secretary, acting through the Service, 
        shall make grants to Indian Tribes and Tribal Organizations for 
        the construction, expansion, or modernization of facilities for 
        the provision of ambulatory care services to eligible Indians 
        (and noneligible persons pursuant to subsections (b)(2) and 
        (c)(1)(C)). A grant made under this section may cover up to 100 
        percent of the costs of such construction, expansion, or 
        modernization. For the purposes of this section, the term 
        `construction' includes the replacement of an existing 
        facility.
          ``(2) Grant agreement required.--A grant under paragraph (1) 
        may only be made available to a Tribal Health Program operating 
        an Indian health facility (other than a facility owned or 
        constructed by the Service, including a facility originally 
        owned or constructed by the Service and transferred to an 
        Indian Tribe or Tribal Organization).
  ``(b) Use of Grant Funds.--
          ``(1) Allowable uses.--A grant awarded under this section may 
        be used for the construction, expansion, or modernization 
        (including the planning and design of such construction, 
        expansion, or modernization) of an ambulatory care facility--
                  ``(A) located apart from a hospital;
                  ``(B) not funded under section 301 or section 306; 
                and
                  ``(C) which, upon completion of such construction or 
                modernization will--
                          ``(i) have a total capacity appropriate to 
                        its projected service population;
                          ``(ii) provide annually no fewer than 150 
                        patient visits by eligible Indians and other 
                        users who are eligible for services in such 
                        facility in accordance with section 807(c)(2); 
                        and
                          ``(iii) provide ambulatory care in a Service 
                        Area (specified in the contract or compact 
                        under the Indian Self-Determination and 
                        Education Assistance Act (25 U.S.C. 450 et 
                        seq.)) with a population of no fewer than 1,500 
                        eligible Indians and other users who are 
                        eligible for services in such facility in 
                        accordance with section 807(c)(2).
          ``(2) Additional allowable use.--The Secretary may also 
        reserve a portion of the funding provided under this section 
        and use those reserved funds to reduce an outstanding debt 
        incurred by Indian Tribes or Tribal Organizations for the 
        construction, expansion, or modernization of an ambulatory care 
        facility that meets the requirements under paragraph (1). The 
        provisions of this section shall apply, except that such 
        applications for funding under this paragraph shall be 
        considered separately from applications for funding under 
        paragraph (1).
          ``(3) Use only for certain portion of costs.--A grant 
        provided under this section may be used only for the cost of 
        that portion of a construction, expansion, or modernization 
        project that benefits the Service population identified above 
        in subsection (b)(1)(C) (ii) and (iii). The requirements of 
        clauses (ii) and (iii) of paragraph (1)(C) shall not apply to 
        an Indian Tribe or Tribal Organization applying for a grant 
        under this section for a health care facility located or to be 
        constructed on an island or when such facility is not located 
        on a road system providing direct access to an inpatient 
        hospital where care is available to the Service population.
  ``(c) Grants.--
          ``(1) Application.--No grant may be made under this section 
        unless an application or proposal for the grant has been 
        approved by the Secretary in accordance with applicable 
        regulations and has set forth reasonable assurance by the 
        applicant that, at all times after the construction, expansion, 
        or modernization of a facility carried out using a grant 
        received under this section--
                  ``(A) adequate financial support will be available 
                for the provision of services at such facility;
                  ``(B) such facility will be available to eligible 
                Indians without regard to ability to pay or source of 
                payment; and
                  ``(C) such facility will, as feasible without 
                diminishing the quality or quantity of services 
                provided to eligible Indians, serve noneligible persons 
                on a cost basis.
          ``(2) Priority.--In awarding grants under this section, the 
        Secretary shall give priority to Indian Tribes and Tribal 
        Organizations that demonstrate--
                  ``(A) a need for increased ambulatory care services; 
                and
                  ``(B) insufficient capacity to deliver such services.
          ``(3) Peer review panels.--The Secretary may provide for the 
        establishment of peer review panels, as necessary, to review 
        and evaluate applications and proposals and to advise the 
        Secretary regarding such applications using the criteria 
        developed pursuant to subsection (a)(1).
  ``(d) Reversion of Facilities.--If any facility (or portion thereof) 
with respect to which funds have been paid under this section, ceases, 
at any time after completion of the construction, expansion, or 
modernization carried out with such funds, to be used for the purposes 
of providing health care services to eligible Indians, all of the 
right, title, and interest in and to such facility (or portion thereof) 
shall transfer to the United States unless otherwise negotiated by the 
Service and the Indian Tribe or Tribal Organization.
  ``(e) Funding Nonrecurring.--Funding provided under this section 
shall be nonrecurring and shall not be available for inclusion in any 
individual Indian Tribe's tribal share for an award under the Indian 
Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.) 
or for reallocation or redesign thereunder.

``SEC. 306. INDIAN HEALTH CARE DELIVERY DEMONSTRATION PROJECT.

  ``(a) Health Care Demonstration Projects.--The Secretary, acting 
through the Service, is authorized to enter into contracts under the 
Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 
et seq.) with Indian Tribes or Tribal Organizations for the purpose of 
carrying out a health care delivery demonstration project to test 
alternative means of delivering health care and services to Indians 
through facilities.
  ``(b) Use of Funds.--The Secretary, in approving projects pursuant to 
this section, may authorize such contracts for the construction and 
renovation of hospitals, health centers, health stations, and other 
facilities to deliver health care services and is authorized to--
          ``(1) waive any leasing prohibition;
          ``(2) permit carryover of funds appropriated for the 
        provision of health care services;
          ``(3) permit the use of other available funds;
          ``(4) permit the use of funds or property donated from any 
        source for project purposes;
          ``(5) provide for the reversion of donated real or personal 
        property to the donor; and
          ``(6) permit the use of Service funds to match other funds, 
        including Federal funds.
  ``(c) Regulations.--The Secretary shall develop and promulgate 
regulations, not later than 1 year after the date of enactment of the 
Indian Health Care Improvement Act Amendments of 2007, for the review 
and approval of applications submitted under this section.
  ``(d) Criteria.--The Secretary may approve projects that meet the 
following criteria:
          ``(1) There is a need for a new facility or program or the 
        reorientation of an existing facility or program.
          ``(2) A significant number of Indians, including those with 
        low health status, will be served by the project.
          ``(3) The project has the potential to deliver services in an 
        efficient and effective manner.
          ``(4) The project is economically viable.
          ``(5) The Indian Tribe or Tribal Organization has the 
        administrative and financial capability to administer the 
        project.
          ``(6) The project is integrated with providers of related 
        health and social services and is coordinated with, and avoids 
        duplication of, existing services.
  ``(e) Peer Review Panels.--The Secretary may provide for the 
establishment of peer review panels, as necessary, to review and 
evaluate applications using the criteria developed pursuant to 
subsection (d).
  ``(f) Priority.--The Secretary shall give priority to applications 
for demonstration projects in each of the following Service Units to 
the extent that such applications are timely filed and meet the 
criteria specified in subsection (d):
          ``(1) Cass Lake, Minnesota.
          ``(2) Mescalero, New Mexico.
          ``(3) Owyhee, Nevada.
          ``(4) Schurz, Nevada.
          ``(5) Ft. Yuma, California.
  ``(g) Technical Assistance.--The Secretary shall provide such 
technical and other assistance as may be necessary to enable applicants 
to comply with the provisions of this section.
  ``(h) Service to Ineligible Persons.--Subject to section 807, the 
authority to provide services to persons otherwise ineligible for the 
health care benefits of the Service and the authority to extend 
hospital privileges in Service facilities to non-Service health 
practitioners as provided in section 807 may be included, subject to 
the terms of such section, in any demonstration project approved 
pursuant to this section.
  ``(i) Equitable Treatment.--For purposes of subsection (d)(1), the 
Secretary shall, in evaluating facilities operated under any contract 
or compact under the Indian Self-Determination and Education Assistance 
Act (25 U.S.C. 450 et seq.), use the same criteria that the Secretary 
uses in evaluating facilities operated directly by the Service.
  ``(j) Equitable Integration of Facilities.--The Secretary shall 
ensure that the planning, design, construction, renovation, and 
expansion needs of Service and non-Service facilities which are the 
subject of a contract or compact under the Indian Self-Determination 
and Education Assistance Act (25 U.S.C. 450 et seq.) for health 
services are fully and equitably integrated into the implementation of 
the health care delivery demonstration projects under this section.

``SEC. 307. LAND TRANSFER.

  ``Notwithstanding any other provision of law, the Bureau of Indian 
Affairs and all other agencies and departments of the United States are 
authorized to transfer, at no cost, land and improvements to the 
Service for the provision of health care services. The Secretary is 
authorized to accept such land and improvements for such purposes.

``SEC. 308. LEASES, CONTRACTS, AND OTHER AGREEMENTS.

  ``The Secretary, acting through the Service, may enter into leases, 
contracts, and other agreements with Indian Tribes and Tribal 
Organizations which hold (1) title to, (2) a leasehold interest in, or 
(3) a beneficial interest in (when title is held by the United States 
in trust for the benefit of an Indian Tribe) facilities used or to be 
used for the administration and delivery of health services by an 
Indian Health Program. Such leases, contracts, or agreements may 
include provisions for construction or renovation and provide for 
compensation to the Indian Tribe or Tribal Organization of rental and 
other costs consistent with section 105(l) of the Indian Self-
Determination and Education Assistance Act (25 U.S.C. 450j(l)) and 
regulations thereunder.

``SEC. 309. STUDY ON LOANS, LOAN GUARANTEES, AND LOAN REPAYMENT.

  ``(a) In General.--The Secretary, in consultation with the Secretary 
of the Treasury, Indian Tribes, and Tribal Organizations, shall carry 
out a study to determine the feasibility of establishing a loan fund to 
provide to Indian Tribes and Tribal Organizations direct loans or 
guarantees for loans for the construction of health care facilities, 
including--
          ``(1) inpatient facilities;
          ``(2) outpatient facilities;
          ``(3) staff quarters;
          ``(4) hostels; and
          ``(5) specialized care facilities, such as behavioral health 
        and elder care facilities.
  ``(b) Determinations.--In carrying out the study under subsection 
(a), the Secretary shall determine--
          ``(1) the maximum principal amount of a loan or loan 
        guarantee that should be offered to a recipient from the loan 
        fund;
          ``(2) the percentage of eligible costs, not to exceed 100 
        percent, that may be covered by a loan or loan guarantee from 
        the loan fund (including costs relating to planning, design, 
        financing, site land development, construction, rehabilitation, 
        renovation, conversion, improvements, medical equipment and 
        furnishings, and other facility-related costs and capital 
        purchase (but excluding staffing));
          ``(3) the cumulative total of the principal of direct loans 
        and loan guarantees, respectively, that may be outstanding at 
        any 1 time;
          ``(4) the maximum term of a loan or loan guarantee that may 
        be made for a facility from the loan fund;
          ``(5) the maximum percentage of funds from the loan fund that 
        should be allocated for payment of costs associated with 
        planning and applying for a loan or loan guarantee;
          ``(6) whether acceptance by the Secretary of an assignment of 
        the revenue of an Indian Tribe or Tribal Organization as 
        security for any direct loan or loan guarantee from the loan 
        fund would be appropriate;
          ``(7) whether, in the planning and design of health 
        facilities under this section, users eligible under section 
        807(c) may be included in any projection of patient population;
          ``(8) whether funds of the Service provided through loans or 
        loan guarantees from the loan fund should be eligible for use 
        in matching other Federal funds under other programs;
          ``(9) the appropriateness of, and best methods for, 
        coordinating the loan fund with the health care priority system 
        of the Service under section 301; and
          ``(10) any legislative or regulatory changes required to 
        implement recommendations of the Secretary based on results of 
        the study.
  ``(c) Report.--Not later than September 30, 2009, the Secretary shall 
submit to the Committee on Indian Affairs of the Senate and the 
Committee on Natural Resources and the Committee on Energy and Commerce 
of the House of Representatives a report that describes--
          ``(1) the manner of consultation made as required by 
        subsection (a); and
          ``(2) the results of the study, including any recommendations 
        of the Secretary based on results of the study.

``SEC. 310. TRIBAL LEASING.

  ``A Tribal Health Program may lease permanent structures for the 
purpose of providing health care services without obtaining advance 
approval in appropriation Acts.

``SEC. 311. INDIAN HEALTH SERVICE/TRIBAL FACILITIES JOINT VENTURE 
                    PROGRAM.

  ``(a) In General.--The Secretary, acting through the Service, shall 
make arrangements with Indian Tribes and Tribal Organizations to 
establish joint venture demonstration projects under which an Indian 
Tribe or Tribal Organization shall expend tribal, private, or other 
available funds, for the acquisition or construction of a health 
facility for a minimum of 10 years, under a no-cost lease, in exchange 
for agreement by the Service to provide the equipment, supplies, and 
staffing for the operation and maintenance of such a health facility. 
An Indian Tribe or Tribal Organization may use tribal funds, private 
sector, or other available resources, including loan guarantees, to 
fulfill its commitment under a joint venture entered into under this 
subsection. An Indian Tribe or Tribal Organization shall be eligible to 
establish a joint venture project if, when it submits a letter of 
intent, it--
          ``(1) has begun but not completed the process of acquisition 
        or construction of a health facility to be used in the joint 
        venture project; or
          ``(2) has not begun the process of acquisition or 
        construction of a health facility for use in the joint venture 
        project.
  ``(b) Requirements.--The Secretary shall make such an arrangement 
with an Indian Tribe or Tribal Organization only if--
          ``(1) the Secretary first determines that the Indian Tribe or 
        Tribal Organization has the administrative and financial 
        capabilities necessary to complete the timely acquisition or 
        construction of the relevant health facility; and
          ``(2) the Indian Tribe or Tribal Organization meets the need 
        criteria determined using the criteria developed under the 
        health care facility priority system under section 301, unless 
        the Secretary determines, pursuant to regulations, that other 
        criteria will result in a more cost-effective and efficient 
        method of facilitating and completing construction of health 
        care facilities.
  ``(c) Continued Operation.--The Secretary shall negotiate an 
agreement with the Indian Tribe or Tribal Organization regarding the 
continued operation of the facility at the end of the initial 10 year 
no-cost lease period.
  ``(d) Breach of Agreement.--An Indian Tribe or Tribal Organization 
that has entered into a written agreement with the Secretary under this 
section, and that breaches or terminates without cause such agreement, 
shall be liable to the United States for the amount that has been paid 
to the Indian Tribe or Tribal Organization, or paid to a third party on 
the Indian Tribe's or Tribal Organization's behalf, under the 
agreement. The Secretary has the right to recover tangible property 
(including supplies) and equipment, less depreciation, and any funds 
expended for operations and maintenance under this section. The 
preceding sentence does not apply to any funds expended for the 
delivery of health care services, personnel, or staffing.
  ``(e) Recovery for Nonuse.--An Indian Tribe or Tribal Organization 
that has entered into a written agreement with the Secretary under this 
subsection shall be entitled to recover from the United States an 
amount that is proportional to the value of such facility if, at any 
time within the 10-year term of the agreement, the Service ceases to 
use the facility or otherwise breaches the agreement.
  ``(f) Definition.--For the purposes of this section, the term `health 
facility' or `health facilities' includes quarters needed to provide 
housing for staff of the relevant Tribal Health Program.

``SEC. 312. LOCATION OF FACILITIES.

  ``(a) In General.--In all matters involving the reorganization or 
development of Service facilities or in the establishment of related 
employment projects to address unemployment conditions in economically 
depressed areas, the Bureau of Indian Affairs and the Service shall 
give priority to locating such facilities and projects on Indian lands, 
or lands in Alaska owned by any Alaska Native village, or village or 
regional corporation under the Alaska Native Claims Settlement Act (43 
U.S.C. 1601 et seq.), or any land allotted to any Alaska Native, if 
requested by the Indian owner and the Indian Tribe with jurisdiction 
over such lands or other lands owned or leased by the Indian Tribe or 
Tribal Organization. Top priority shall be given to Indian land owned 
by 1 or more Indian Tribes.
  ``(b) Definition.--For purposes of this section, the term `Indian 
lands' means--
          ``(1) all lands within the exterior boundaries of any 
        reservation; and
          ``(2) any lands title to which is held in trust by the United 
        States for the benefit of any Indian Tribe or individual Indian 
        or held by any Indian Tribe or individual Indian subject to 
        restriction by the United States against alienation.

``SEC. 313. MAINTENANCE AND IMPROVEMENT OF HEALTH CARE FACILITIES.

  ``(a) Report.--The Secretary shall submit to the President, for 
inclusion in the report required to be transmitted to Congress under 
section 801, a report which identifies the backlog of maintenance and 
repair work required at both Service and tribal health care facilities, 
including new health care facilities expected to be in operation in the 
next fiscal year. The report shall also identify the need for 
renovation and expansion of existing facilities to support the growth 
of health care programs.
  ``(b) Maintenance of Newly Constructed Space.--The Secretary, acting 
through the Service, is authorized to expend maintenance and 
improvement funds to support maintenance of newly constructed space 
only if such space falls within the approved supportable space 
allocation for the Indian Tribe or Tribal Organization. Supportable 
space allocation shall be defined through the health care facility 
priority system under section 301(c).
  ``(c) Replacement Facilities.--In addition to using maintenance and 
improvement funds for renovation, modernization, and expansion of 
facilities, an Indian Tribe or Tribal Organization may use maintenance 
and improvement funds for construction of a replacement facility if the 
costs of renovation of such facility would exceed a maximum renovation 
cost threshold. The maximum renovation cost threshold shall be 
determined through the negotiated rulemaking process provided for under 
section 802.

``SEC. 314. TRIBAL MANAGEMENT OF FEDERALLY-OWNED QUARTERS.

  ``(a) Rental Rates.--
          ``(1) Establishment.--Notwithstanding any other provision of 
        law, a Tribal Health Program which operates a hospital or other 
        health facility and the federally-owned quarters associated 
        therewith pursuant to a contract or compact under the Indian 
        Self-Determination and Education Assistance Act (25 U.S.C. 450 
        et seq.) shall have the authority to establish the rental rates 
        charged to the occupants of such quarters by providing notice 
        to the Secretary of its election to exercise such authority.
          ``(2) Objectives.--In establishing rental rates pursuant to 
        authority of this subsection, a Tribal Health Program shall 
        endeavor to achieve the following objectives:
                  ``(A) To base such rental rates on the reasonable 
                value of the quarters to the occupants thereof.
                  ``(B) To generate sufficient funds to prudently 
                provide for the operation and maintenance of the 
                quarters, and subject to the discretion of the Tribal 
                Health Program, to supply reserve funds for capital 
                repairs and replacement of the quarters.
          ``(3) Equitable funding.--Any quarters whose rental rates are 
        established by a Tribal Health Program pursuant to this 
        subsection shall remain eligible for quarters improvement and 
        repair funds to the same extent as all federally-owned quarters 
        used to house personnel in Services-supported programs.
          ``(4) Notice of rate change.--A Tribal Health Program which 
        exercises the authority provided under this subsection shall 
        provide occupants with no less than 60 days notice of any 
        change in rental rates.
  ``(b) Direct Collection of Rent.--
          ``(1) In general.--Notwithstanding any other provision of 
        law, and subject to paragraph (2), a Tribal Health Program 
        shall have the authority to collect rents directly from Federal 
        employees who occupy such quarters in accordance with the 
        following:
                  ``(A) The Tribal Health Program shall notify the 
                Secretary and the subject Federal employees of its 
                election to exercise its authority to collect rents 
                directly from such Federal employees.
                  ``(B) Upon receipt of a notice described in 
                subparagraph (A), the Federal employees shall pay rents 
                for occupancy of such quarters directly to the Tribal 
                Health Program and the Secretary shall have no further 
                authority to collect rents from such employees through 
                payroll deduction or otherwise.
                  ``(C) Such rent payments shall be retained by the 
                Tribal Health Program and shall not be made payable to 
                or otherwise be deposited with the United States.
                  ``(D) Such rent payments shall be deposited into a 
                separate account which shall be used by the Tribal 
                Health Program for the maintenance (including capital 
                repairs and replacement) and operation of the quarters 
                and facilities as the Tribal Health Program shall 
                determine.
          ``(2) Retrocession of authority.--If a Tribal Health Program 
        which has made an election under paragraph (1) requests 
        retrocession of its authority to directly collect rents from 
        Federal employees occupying federally-owned quarters, such 
        retrocession shall become effective on the earlier of--
                  ``(A) the first day of the month that begins no less 
                than 180 days after the Tribal Health Program notifies 
                the Secretary of its desire to retrocede; or
                  ``(B) such other date as may be mutually agreed by 
                the Secretary and the Tribal Health Program.
  ``(c) Rates in Alaska.--To the extent that a Tribal Health Program, 
pursuant to authority granted in subsection (a), establishes rental 
rates for federally-owned quarters provided to a Federal employee in 
Alaska, such rents may be based on the cost of comparable private 
rental housing in the nearest established community with a year-round 
population of 1,500 or more individuals.

``SEC. 315. APPLICABILITY OF BUY AMERICAN ACT REQUIREMENT.

  ``(a) Applicability.--The Secretary shall ensure that the 
requirements of the Buy American Act apply to all procurements made 
with funds provided pursuant to section 317. Indian Tribes and Tribal 
Organizations shall be exempt from these requirements.
  ``(b) Effect of Violation.--If it has been finally determined by a 
court or Federal agency that any person intentionally affixed a label 
bearing a `Made in America' inscription or any inscription with the 
same meaning, to any product sold in or shipped to the United States 
that is not made in the United States, such person shall be ineligible 
to receive any contract or subcontract made with funds provided 
pursuant to section 317, pursuant to the debarment, suspension, and 
ineligibility procedures described in sections 9.400 through 9.409 of 
title 48, Code of Federal Regulations.
  ``(c) Definitions.--For purposes of this section, the term `Buy 
American Act' means title III of the Act entitled `An Act making 
appropriations for the Treasury and Post Office Departments for the 
fiscal year ending June 30, 1934, and for other purposes', approved 
March 3, 1933 (41 U.S.C. 10a et seq.).

``SEC. 316. OTHER FUNDING FOR FACILITIES.

  ``(a) Authority To Accept Funds.--The Secretary is authorized to 
accept from any source, including Federal and State agencies, funds 
that are available for the construction of health care facilities and 
use such funds to plan, design, and construct health care facilities 
for Indians and to place such funds into a contract or compact under 
the Indian Self-Determination and Education Assistance Act (25 U.S.C. 
450 et seq.). Receipt of such funds shall have no effect on the 
priorities established pursuant to section 301.
  ``(b) Interagency Agreements.--The Secretary is authorized to enter 
into interagency agreements with other Federal agencies or State 
agencies and other entities and to accept funds from such Federal or 
State agencies or other sources to provide for the planning, design, 
and construction of health care facilities to be administered by Indian 
Health Programs in order to carry out the purposes of this Act and the 
purposes for which the funds were appropriated or for which the funds 
were otherwise provided.
  ``(c) Establishment of Standards.--The Secretary, through the 
Service, shall establish standards by regulation for the planning, 
design, and construction of health care facilities serving Indians 
under this Act.

``SEC. 317. AUTHORIZATION OF APPROPRIATIONS.

  ``There are authorized to be appropriated such sums as may be 
necessary for each fiscal year through fiscal year 2017 to carry out 
this title.

                 ``TITLE IV--ACCESS TO HEALTH SERVICES

``SEC. 401. TREATMENT OF PAYMENTS UNDER SOCIAL SECURITY ACT HEALTH 
                    BENEFITS PROGRAMS.

  ``(a) Disregard of Medicare, Medicaid, and SCHIP Payments in 
Determining Appropriations.--Any payments received by an Indian Health 
Program or by an Urban Indian Organization under title XVIII, XIX, or 
XXI of the Social Security Act for services provided to Indians 
eligible for benefits under such respective titles shall not be 
considered in determining appropriations for the provision of health 
care and services to Indians.
  ``(b) Nonpreferential Treatment.--Nothing in this Act authorizes the 
Secretary to provide services to an Indian with coverage under title 
XVIII, XIX, or XXI of the Social Security Act in preference to an 
Indian without such coverage.
  ``(c) Use of Funds.--
          ``(1) Special fund.--
                  ``(A) 100 percent pass-through of payments due to 
                facilities.--Notwithstanding any other provision of 
                law, but subject to paragraph (2), payments to which a 
                facility of the Service is entitled by reason of a 
                provision of the Social Security Act shall be placed in 
                a special fund to be held by the Secretary. In making 
                payments from such fund, the Secretary shall ensure 
                that each Service Unit of the Service receives 100 
                percent of the amount to which the facilities of the 
                Service, for which such Service Unit makes collections, 
                are entitled by reason of a provision of the Social 
                Security Act.
                  ``(B) Use of funds.--Amounts received by a facility 
                of the Service under subparagraph (A) shall first be 
                used (to such extent or in such amounts as are provided 
                in appropriation Acts) for the purpose of making any 
                improvements in the programs of the Service operated by 
                or through such facility which may be necessary to 
                achieve or maintain compliance with the applicable 
                conditions and requirements of titles XVIII and XIX of 
                the Social Security Act. Any amounts so received that 
                are in excess of the amount necessary to achieve or 
                maintain such conditions and requirements shall, 
                subject to consultation with the Indian Tribes being 
                served by the Service Unit, be used for reducing the 
                health resource deficiencies (as determined under 
                section 201(d)) of such Indian Tribes.
          ``(2) Direct payment option.--Paragraph (1) shall not apply 
        to a Tribal Health Program upon the election of such Program 
        under subsection (d) to receive payments directly. No payment 
        may be made out of the special fund described in such paragraph 
        with respect to reimbursement made for services provided by 
        such Program during the period of such election.
  ``(d) Direct Billing.--
          ``(1) In general.--Subject to complying with the requirements 
        of paragraph (2), a Tribal Health Program may elect to directly 
        bill for, and receive payment for, health care items and 
        services provided by such Program for which payment is made 
        under title XVIII or XIX of the Social Security Act or from any 
        other third party payor.
          ``(2) Direct reimbursement.--
                  ``(A) Use of funds.--Each Tribal Health Program 
                making the election described in paragraph (1) with 
                respect to a program under a title of the Social 
                Security Act shall be reimbursed directly by that 
                program for items and services furnished without regard 
                to subsection (c)(1), but all amounts so reimbursed 
                shall be used by the Tribal Health Program for the 
                purpose of making any improvements in facilities of the 
                Tribal Health Program that may be necessary to achieve 
                or maintain compliance with the conditions and 
                requirements applicable generally to such items and 
                services under the program under such title and to 
                provide additional health care services, improvements 
                in health care facilities and Tribal Health Programs, 
                any health care related purpose, or otherwise to 
                achieve the objectives provided in section 3 of this 
                Act.
                  ``(B) Audits.--The amounts paid to a Tribal Health 
                Program making the election described in paragraph (1) 
                with respect to a program under a title of the Social 
                Security Act shall be subject to all auditing 
                requirements applicable to the program under such 
                title, as well as all auditing requirements applicable 
                to programs administered by an Indian Health Program. 
                Nothing in the preceding sentence shall be construed as 
                limiting the application of auditing requirements 
                applicable to amounts paid under title XVIII, XIX, or 
                XXI of the Social Security Act.
                  ``(C) Identification of source of payments.--Any 
                Tribal Health Program that receives reimbursements or 
                payments under title XVIII, XIX, or XXI of the Social 
                Security Act, shall provide to the Service a list of 
                each provider enrollment number (or other identifier) 
                under which such Program receives such reimbursements 
                or payments.
          ``(3) Examination and implementation of changes.--
                  ``(A) In general.--The Secretary, acting through the 
                Service and with the assistance of the Administrator of 
                the Centers for Medicare & Medicaid Services, shall 
                examine on an ongoing basis and implement any 
                administrative changes that may be necessary to 
                facilitate direct billing and reimbursement under the 
                program established under this subsection, including 
                any agreements with States that may be necessary to 
                provide for direct billing under a program under a 
                title of the Social Security Act.
                  ``(B) Coordination of information.--The Service shall 
                provide the Administrator of the Centers for Medicare & 
                Medicaid Services with copies of the lists submitted to 
                the Service under paragraph (2)(C), enrollment data 
                regarding patients served by the Service (and by Tribal 
                Health Programs, to the extent such data is available 
                to the Service), and such other information as the 
                Administrator may require for purposes of administering 
                title XVIII, XIX, or XXI of the Social Security Act.
          ``(4) Withdrawal from program.--A Tribal Health Program that 
        bills directly under the program established under this 
        subsection may withdraw from participation in the same manner 
        and under the same conditions that an Indian Tribe or Tribal 
        Organization may retrocede a contracted program to the 
        Secretary under the authority of the Indian Self-Determination 
        and Education Assistance Act (25 U.S.C. 450 et seq.). All cost 
        accounting and billing authority under the program established 
        under this subsection shall be returned to the Secretary upon 
        the Secretary's acceptance of the withdrawal of participation 
        in this program.
          ``(5) Termination for failure to comply with requirements.--
        The Secretary may terminate the participation of a Tribal 
        Health Program or in the direct billing program established 
        under this subsection if the Secretary determines that the 
        Program has failed to comply with the requirements of paragraph 
        (2). The Secretary shall provide a Tribal Health Program with 
        notice of a determination that the Program has failed to comply 
        with any such requirement and a reasonable opportunity to 
        correct such noncompliance prior to terminating the Program's 
        participation in the direct billing program established under 
        this subsection.
  ``(e) Related Provisions Under the Social Security Act.--For 
provisions related to subsections (c) and (d), see sections 1880, 1911, 
and 2107(e)(1)(D) of the Social Security Act.

``SEC. 402. GRANTS TO AND CONTRACTS WITH THE SERVICE, INDIAN TRIBES, 
                    TRIBAL ORGANIZATIONS, AND URBAN INDIAN 
                    ORGANIZATIONS TO FACILITATE OUTREACH, ENROLLMENT, 
                    AND COVERAGE OF INDIANS UNDER SOCIAL SECURITY ACT 
                    HEALTH BENEFIT PROGRAMS AND OTHER HEALTH BENEFITS 
                    PROGRAMS.

  ``(a) Indian Tribes and Tribal Organizations.--From funds 
appropriated to carry out this title in accordance with section 416, 
the Secretary, acting through the Service, shall make grants to or 
enter into contracts with Indian Tribes and Tribal Organizations to 
assist such Tribes and Tribal Organizations in establishing and 
administering programs on or near reservations and trust lands to 
assist individual Indians--
          ``(1) to enroll for benefits under a program established 
        under title XVIII, XIX, or XXI of the Social Security Act and 
        other health benefits programs; and
          ``(2) with respect to such programs for which the charging of 
        premiums and cost sharing is not prohibited under such 
        programs, to pay premiums or cost sharing for coverage for such 
        benefits, which may be based on financial need (as determined 
        by the Indian Tribe or Tribes or Tribal Organizations being 
        served based on a schedule of income levels developed or 
        implemented by such Tribe, Tribes, or Tribal Organizations).
  ``(b) Conditions.--The Secretary, acting through the Service, shall 
place conditions as deemed necessary to effect the purpose of this 
section in any grant or contract which the Secretary makes with any 
Indian Tribe or Tribal Organization pursuant to this section. Such 
conditions shall include requirements that the Indian Tribe or Tribal 
Organization successfully undertake--
          ``(1) to determine the population of Indians eligible for the 
        benefits described in subsection (a);
          ``(2) to educate Indians with respect to the benefits 
        available under the respective programs;
          ``(3) to provide transportation for such individual Indians 
        to the appropriate offices for enrollment or applications for 
        such benefits; and
          ``(4) to develop and implement methods of improving the 
        participation of Indians in receiving benefits under such 
        programs.
  ``(c) Application to Urban Indian Organizations.--
          ``(1) In general.--The provisions of subsection (a) shall 
        apply with respect to grants and other funding to Urban Indian 
        Organizations with respect to populations served by such 
        organizations in the same manner they apply to grants and 
        contracts with Indian Tribes and Tribal Organizations with 
        respect to programs on or near reservations.
          ``(2) Requirements.--The Secretary shall include in the 
        grants or contracts made or provided under paragraph (1) 
        requirements that are--
                  ``(A) consistent with the requirements imposed by the 
                Secretary under subsection (b);
                  ``(B) appropriate to Urban Indian Organizations and 
                Urban Indians; and
                  ``(C) necessary to effect the purposes of this 
                section.
  ``(d) Facilitating Cooperation.--The Secretary, acting through the 
Centers for Medicare & Medicaid Services, shall take such steps as are 
necessary to facilitate cooperation with, and agreements between, 
States and the Service, Indian Tribes, Tribal Organizations, or Urban 
Indian Organizations with respect to the provision of health care items 
and services to Indians under the programs established under title 
XVIII, XIX, or XXI of the Social Security Act.
  ``(e) Agreements Relating To Improving Enrollment of Indians Under 
Social Security Act Health Benefits Programs.--For provisions relating 
to agreements between the Secretary, acting through the Service, and 
Indian Tribes, Tribal Organizations, and Urban Indian Organizations for 
the collection, preparation, and submission of applications by Indians 
for assistance under the Medicaid and State children's health insurance 
programs established under titles XIX and XXI of the Social Security 
Act, and benefits under the Medicare program established under title 
XVIII of such Act, see subsections (a) and (b) of section 1139 of the 
Social Security Act.
  ``(f) Definition of Premiums and Cost Sharing.--In this section:
          ``(1) Premium.--The term `premium' includes any enrollment 
        fee or similar charge.
          ``(2) Cost sharing.--The term `cost sharing' includes any 
        deduction, deductible, copayment, coinsurance, or similar 
        charge.

``SEC. 403. REIMBURSEMENT FROM CERTAIN THIRD PARTIES OF COSTS OF HEALTH 
                    SERVICES.

  ``(a) Right of Recovery.--Except as provided in subsection (f), the 
United States, an Indian Tribe, or Tribal Organization shall have the 
right to recover from an insurance company, health maintenance 
organization, employee benefit plan, third-party tortfeasor, or any 
other responsible or liable third party (including a political 
subdivision or local governmental entity of a State) the reasonable 
charges billed by the Secretary, an Indian Tribe, or Tribal 
Organization in providing health services through the Service, an 
Indian Tribe, or Tribal Organization to any individual to the same 
extent that such individual, or any nongovernmental provider of such 
services, would be eligible to receive damages, reimbursement, or 
indemnification for such charges or expenses if--
          ``(1) such services had been provided by a nongovernmental 
        provider; and
          ``(2) such individual had been required to pay such charges 
        or expenses and did pay such charges or expenses.
  ``(b) Limitations on Recoveries From States.--Subsection (a) 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) Nonapplication of Other Laws.--No law of any State, or of any 
political subdivision of a State and no provision of any contract, 
insurance or health maintenance organization policy, employee benefit 
plan, self-insurance plan, managed care plan, or other health care plan 
or program entered into or renewed after the date of the enactment of 
the Indian Health Care Amendments of 1988, shall prevent or hinder the 
right of recovery of the United States, an Indian Tribe, or Tribal 
Organization under subsection (a).
  ``(d) No Effect on Private Rights of Action.--No action taken by the 
United States, an Indian Tribe, or Tribal Organization to enforce the 
right of recovery provided under this section shall operate to deny to 
the injured person the recovery for that portion of the person's damage 
not covered hereunder.
  ``(e) Enforcement.--
          ``(1) In general.--The United States, an Indian Tribe, or 
        Tribal Organization may enforce the right of recovery provided 
        under subsection (a) by--
                  ``(A) intervening or joining in any civil action or 
                proceeding brought--
                          ``(i) by the individual for whom health 
                        services were provided by the Secretary, an 
                        Indian Tribe, or Tribal Organization; or
                          ``(ii) by any representative or heirs of such 
                        individual, or
                  ``(B) instituting a civil action, including a civil 
                action for injunctive relief and other relief and 
                including, with respect to a political subdivision or 
                local governmental entity of a State, such an action 
                against an official thereof.
          ``(2) Notice.--All reasonable efforts shall be made to 
        provide notice of action instituted under paragraph (1)(B) to 
        the individual to whom health services were provided, either 
        before or during the pendency of such action.
          ``(3) Recovery from tortfeasors.--
                  ``(A) In general.--In any case in which an Indian 
                Tribe or Tribal Organization that is authorized or 
                required under a compact or contract issued pursuant to 
                the Indian Self-Determination and Education Assistance 
                Act (25 U.S.C. 450 et seq.) to furnish or pay for 
                health services to a person who is injured or suffers a 
                disease on or after the date of enactment of the Indian 
                Health Care Improvement Act Amendments of 2007 under 
                circumstances that establish grounds for a claim of 
                liability against the tortfeasor with respect to the 
                injury or disease, the Indian Tribe or Tribal 
                Organization shall have a right to recover from the 
                tortfeasor (or an insurer of the tortfeasor) the 
                reasonable value of the health services so furnished, 
                paid for, or to be paid for, in accordance with the 
                Federal Medical Care Recovery Act (42 U.S.C. 2651 et 
                seq.), to the same extent and under the same 
                circumstances as the United States may recover under 
                that Act.
                  ``(B) Treatment.--The right of an Indian Tribe or 
                Tribal Organization to recover under subparagraph (A) 
                shall be independent of the rights of the injured or 
                diseased person served by the Indian Tribe or Tribal 
                Organization.
  ``(f) Limitation.--Absent specific written authorization by the 
governing body of an Indian Tribe for the period of such authorization 
(which may not be for a period of more than 1 year and which may be 
revoked at any time upon written notice by the governing body to the 
Service), 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, Tribal Organization, or Urban Indian Organization. 
Where such authorization is provided, the Service may receive and 
expend such amounts for the provision of additional health services 
consistent with such authorization.
  ``(g) Costs and Attorneys' Fees.--In any action brought to enforce 
the provisions of this section, a prevailing plaintiff shall be awarded 
its reasonable attorneys' fees and costs of litigation.
  ``(h) Nonapplication of Claims Filing Requirements.--An insurance 
company, health maintenance organization, self-insurance plan, managed 
care plan, or other health care plan or program (under the Social 
Security Act or otherwise) may not deny a claim for benefits submitted 
by the Service or by an Indian Tribe or Tribal Organization based on 
the format in which the claim is submitted if such format complies with 
the format required for submission of claims under title XVIII of the 
Social Security Act or recognized under section 1175 of such Act.
  ``(i) Application to Urban Indian Organizations.--The previous 
provisions of this section shall apply to Urban Indian Organizations 
with respect to populations served by such Organizations in the same 
manner they apply to Indian Tribes and Tribal Organizations with 
respect to populations served by such Indian Tribes and Tribal 
Organizations.
  ``(j) Statute of Limitations.--The provisions of section 2415 of 
title 28, United States Code, shall apply to all actions commenced 
under this section, and the references therein to the United States are 
deemed to include Indian Tribes, Tribal Organizations, and Urban Indian 
Organizations.
  ``(k) Savings.--Nothing in this section shall be construed to limit 
any right of recovery available to the United States, an Indian Tribe, 
or Tribal Organization under the provisions of any applicable, Federal, 
State, or Tribal law, including medical lien laws.

``SEC. 404. CREDITING OF REIMBURSEMENTS.

  ``(a) Use of Amounts.--
          ``(1) Retention by program.--Except as provided in section 
        202(f) (relating to the Catastrophic Health Emergency Fund) and 
        section 807 (relating to health services for ineligible 
        persons), all reimbursements received or recovered under any of 
        the programs described in paragraph (2), including under 
        section 807, by reason of the provision of health services by 
        the Service, by an Indian Tribe or Tribal Organization, or by 
        an Urban Indian Organization, shall be credited to the Service, 
        such Indian Tribe or Tribal Organization, or such Urban Indian 
        Organization, respectively, and may be used as provided in 
        section 401. In the case of such a service provided by or 
        through a Service Unit, such amounts shall be credited to such 
        unit and used for such purposes.
          ``(2) Programs covered.--The programs referred to in 
        paragraph (1) are the following:
                  ``(A) Titles XVIII, XIX, and XXI of the Social 
                Security Act.
                  ``(B) This Act, including section 807.
                  ``(C) Public Law 87-693.
                  ``(D) Any other provision of law.
  ``(b) No Offset of Amounts.--The Service may not offset or limit any 
amount obligated to any Service Unit or entity receiving funding from 
the Service because of the receipt of reimbursements under subsection 
(a).

``SEC. 405. PURCHASING HEALTH CARE COVERAGE.

  ``(a) In General.--Insofar as amounts are made available under law 
(including a provision of the Social Security Act, the Indian Self-
Determination and Education Assistance Act (25 U.S.C. 450 et seq.), or 
other law, other than under section 402) to Indian Tribes, Tribal 
Organizations, and Urban Indian Organizations for health benefits for 
Service beneficiaries, Indian Tribes, Tribal Organizations, and Urban 
Indian Organizations may use such amounts to purchase health benefits 
coverage for such beneficiaries in any manner, including through--
          ``(1) a tribally owned and operated health care plan;
          ``(2) a State or locally authorized or licensed health care 
        plan;
          ``(3) a health insurance provider or managed care 
        organization; or
          ``(4) a self-insured plan.
The purchase of such coverage by an Indian Tribe, Tribal Organization, 
or Urban Indian Organization may be based on the financial needs of 
such beneficiaries (as determined by the Indian Tribe or Tribes being 
served based on a schedule of income levels developed or implemented by 
such Indian Tribe or Tribes).
  ``(b) Expenses for Self-Insured Plan.--In the case of a self-insured 
plan under subsection (a)(4), the amounts may be used for expenses of 
operating the plan, including administration and insurance to limit the 
financial risks to the entity offering the plan.
  ``(c) Construction.--Nothing in this section shall be construed as 
affecting the use of any amounts not referred to in subsection (a).

``SEC. 406. SHARING ARRANGEMENTS WITH FEDERAL AGENCIES.

  ``(a) Authority.--
          ``(1) In general.--The Secretary may enter into (or expand) 
        arrangements for the sharing of medical facilities and services 
        between the Service, Indian Tribes, and Tribal Organizations 
        and the Department of Veterans Affairs and the Department of 
        Defense.
          ``(2) Consultation by secretary required.--The Secretary may 
        not finalize any arrangement between the Service and a 
        Department described in paragraph (1) without first consulting 
        with the Indian Tribes which will be significantly affected by 
        the arrangement.
  ``(b) Limitations.--The Secretary shall not take any action under 
this section or under subchapter IV of chapter 81 of title 38, United 
States Code, which would impair--
          ``(1) the priority access of any Indian to health care 
        services provided through the Service and the eligibility of 
        any Indian to receive health services through the Service;
          ``(2) the quality of health care services provided to any 
        Indian through the Service;
          ``(3) the priority access of any veteran to health care 
        services provided by the Department of Veterans Affairs;
          ``(4) the quality of health care services provided by the 
        Department of Veterans Affairs or the Department of Defense; or
          ``(5) the eligibility of any Indian who is a veteran to 
        receive health services through the Department of Veterans 
        Affairs.
  ``(c) Reimbursement.--The Service, Indian Tribe, or Tribal 
Organization shall be reimbursed by the Department of Veterans Affairs 
or the Department of Defense (as the case may be) where services are 
provided through the Service, an Indian Tribe, or a Tribal Organization 
to beneficiaries eligible for services from either such Department, 
notwithstanding any other provision of law.
  ``(d) Construction.--Nothing in this section may be construed as 
creating any right of a non-Indian veteran to obtain health services 
from the Service.

``SEC. 407. PAYOR OF LAST RESORT.

  ``Indian Health Programs and health care programs operated by Urban 
Indian Organizations shall be the payor of last resort for services 
provided to persons eligible for services from Indian Health Programs 
and Urban Indian Organizations, notwithstanding any Federal, State, or 
local law to the contrary.

``SEC. 408. NONDISCRIMINATION UNDER FEDERAL HEALTH CARE PROGRAMS IN 
                    QUALIFICATIONS FOR REIMBURSEMENT FOR SERVICES.

  ``(a) Requirement To Satisfy Generally Applicable Participation 
Requirements.--
          ``(1) In general.--A Federal health care program must accept 
        an entity that is operated by the Service, an Indian Tribe, 
        Tribal Organization, or Urban Indian Organization as a provider 
        eligible to receive payment under the program for health care 
        services furnished to an Indian on the same basis as any other 
        provider qualified to participate as a provider of health care 
        services under the program if the entity meets generally 
        applicable State or other requirements for participation as a 
        provider of health care services under the program.
          ``(2) Satisfaction of state or local licensure or recognition 
        requirements.--Any requirement for participation as a provider 
        of health care services under a Federal health care program 
        that an entity be licensed or recognized under the State or 
        local law where the entity is located to furnish health care 
        services shall be deemed to have been met in the case of an 
        entity operated by the Service, an Indian Tribe, Tribal 
        Organization, or Urban Indian Organization if the entity meets 
        all the applicable standards for such licensure or recognition, 
        regardless of whether the entity obtains a license or other 
        documentation under such State or local law. In accordance with 
        section 221, the absence of the licensure of a health care 
        professional employed by such an entity under the State or 
        local law where the entity is located shall not be taken into 
        account for purposes of determining whether the entity meets 
        such standards, if the professional is licensed in another 
        State.
  ``(b) Application of Exclusion From Participation in Federal Health 
Care Programs.--
          ``(1) Excluded entities.--No entity operated by the Service, 
        an Indian Tribe, Tribal Organization, or Urban Indian 
        Organization that has been excluded from participation in any 
        Federal health care program or for which a license is under 
        suspension or has been revoked by the State where the entity is 
        located shall be eligible to receive payment or reimbursement 
        under any such program for health care services furnished to an 
        Indian.
          ``(2) Excluded individuals.--No individual who has been 
        excluded from participation in any Federal health care program 
        or whose State license is under suspension shall be eligible to 
        receive payment or reimbursement under any such program for 
        health care services furnished by that individual, directly or 
        through an entity that is otherwise eligible to receive payment 
        for health care services, to an Indian.
          ``(3) Federal health care program defined.--In this 
        subsection, the term, `Federal health care program' has the 
        meaning given that term in section 1128B(f) of the Social 
        Security Act (42 U.S.C. 1320a-7b(f)), except that, for purposes 
        of this subsection, such term shall include the health 
        insurance program under chapter 89 of title 5, United States 
        Code.
  ``(c) Related Provisions.--For provisions related to 
nondiscrimination against providers operated by the Service, an Indian 
Tribe, Tribal Organization, or Urban Indian Organization, see section 
1139(c) of the Social Security Act (42 U.S.C. 1320b-9(c)).

``SEC. 409. CONSULTATION.

  ``For provisions related to consultation with representatives of 
Indian Health Programs and Urban Indian Organizations with respect to 
the health care programs established under titles XVIII, XIX, and XXI 
of the Social Security Act, see section 1139(d) of the Social Security 
Act (42 U.S.C. 1320b-9(d)).

``SEC. 410. STATE CHILDREN'S HEALTH INSURANCE PROGRAM (SCHIP).

  ``For provisions relating to--
          ``(1) outreach to families of Indian children likely to be 
        eligible for child health assistance under the State children's 
        health insurance program established under title XXI of the 
        Social Security Act, see sections 2105(c)(2)(C) and 1139(a) of 
        such Act (42 U.S.C. 1397ee(c)(2), 1320b-9); and
          ``(2) ensuring that child health assistance is provided under 
        such program to targeted low-income children who are Indians 
        and that payments are made under such program to Indian Health 
        Programs and Urban Indian Organizations operating in the State 
        that provide such assistance, see sections 2102(b)(3)(D) and 
        2105(c)(6)(B) of such Act (42 U.S.C. 1397bb(b)(3)(D), 
        1397ee(c)(6)(B)).

``SEC. 411. EXCLUSION WAIVER AUTHORITY FOR AFFECTED INDIAN HEALTH 
                    PROGRAMS AND SAFE HARBOR TRANSACTIONS UNDER THE 
                    SOCIAL SECURITY ACT.

  ``For provisions relating to--
          ``(1) exclusion waiver authority for affected Indian Health 
        Programs under the Social Security Act, see section 1128(k) of 
        the Social Security Act (42 U.S.C. 1320a-7(k)); and
          ``(2) certain transactions involving Indian Health Programs 
        deemed to be in safe harbors under that Act, see section 
        1128B(b)(4) of the Social Security Act (42 U.S.C. 1320a-
        7b(b)(4)).

``SEC. 412. PREMIUM AND COST SHARING PROTECTIONS AND ELIGIBILITY 
                    DETERMINATIONS UNDER MEDICAID AND SCHIP AND 
                    PROTECTION OF CERTAIN INDIAN PROPERTY FROM MEDICAID 
                    ESTATE RECOVERY.

  ``For provisions relating to--
          ``(1) premiums or cost sharing protections for Indians 
        furnished items or services directly by Indian Health Programs 
        or through referral under the contract health service under the 
        Medicaid program established under title XIX of the Social 
        Security Act, see sections 1916(j) and 1916A(a)(1) of the 
        Social Security Act (42 U.S.C. 1396o(j), 1396o-1(a)(1));
          ``(2) rules regarding the treatment of certain property for 
        purposes of determining eligibility under such programs, see 
        sections 1902(e)(13) and 2107(e)(1)(B) of such Act (42 U.S.C. 
        1396a(e)(13), 1397gg(e)(1)(B)); and
          ``(3) the protection of certain property from estate recovery 
        provisions under the Medicaid program, see section 
        1917(b)(3)(B) of such Act (42 U.S.C. 1396p(b)(3)(B)).

``SEC. 413. TREATMENT UNDER MEDICAID AND SCHIP MANAGED CARE.

  ``For provisions relating to the treatment of Indians enrolled in a 
managed care entity under the Medicaid program under title XIX of the 
Social Security Act and Indian Health Programs and Urban Indian 
Organizations that are providers of items or services to such Indian 
enrollees, see sections 1932(h) and 2107(e)(1)(H) of the Social 
Security Act (42 U.S.C. 1396u-2(h), 1397gg(e)(1)(H)).

``SEC. 414. NAVAJO NATION MEDICAID AGENCY FEASIBILITY STUDY.

  ``(a) Study.--The Secretary shall conduct a study to determine the 
feasibility of treating the Navajo Nation as a State for the purposes 
of title XIX of the Social Security Act, to provide services to Indians 
living within the boundaries of the Navajo Nation through an entity 
established having the same authority and performing the same functions 
as single-State medicaid agencies responsible for the administration of 
the State plan under title XIX of the Social Security Act.
  ``(b) Considerations.--In conducting the study, the Secretary shall 
consider the feasibility of--
          ``(1) assigning and paying all expenditures for the provision 
        of services and related administration funds, under title XIX 
        of the Social Security Act, to Indians living within the 
        boundaries of the Navajo Nation that are currently paid to or 
        would otherwise be paid to the State of Arizona, New Mexico, or 
        Utah;
          ``(2) providing assistance to the Navajo Nation in the 
        development and implementation of such entity for the 
        administration, eligibility, payment, and delivery of medical 
        assistance under title XIX of the Social Security Act;
          ``(3) providing an appropriate level of matching funds for 
        Federal medical assistance with respect to amounts such entity 
        expends for medical assistance for services and related 
        administrative costs; and
          ``(4) authorizing the Secretary, at the option of the Navajo 
        Nation, to treat the Navajo Nation as a State for the purposes 
        of title XIX of the Social Security Act (relating to the State 
        children's health insurance program) under terms equivalent to 
        those described in paragraphs (2) through (4).
  ``(c) Report.--Not later then 3 years after the date of enactment of 
the Indian Health Care Improvement Act Amendments of 2007, the 
Secretary shall submit to the Committee on Indian Affairs and Committee 
on Finance of the Senate and the Committee on Natural Resources and 
Committee on Energy and Commerce of the House of Representatives a 
report that includes--
          ``(1) the results of the study under this section;
          ``(2) a summary of any consultation that occurred between the 
        Secretary and the Navajo Nation, other Indian Tribes, the 
        States of Arizona, New Mexico, and Utah, counties which include 
        Navajo Lands, and other interested parties, in conducting this 
        study;
          ``(3) projected costs or savings associated with 
        establishment of such entity, and any estimated impact on 
        services provided as described in this section in relation to 
        probable costs or savings; and
          ``(4) legislative actions that would be required to authorize 
        the establishment of such entity if such entity is determined 
        by the Secretary to be feasible.

``SEC. 415. GENERAL EXCEPTIONS.

  ``The requirements of this title shall not apply to any excepted 
benefits described in paragraph (1)(A) or (3) of section 2791(c) of the 
Public Health Service Act (42 U.S.C. 300gg-91).

``SEC. 416. AUTHORIZATION OF APPROPRIATIONS.

  ``There are authorized to be appropriated such sums as may be 
necessary for each fiscal year through fiscal year 2017 to carry out 
this title.

              ``TITLE V--HEALTH SERVICES FOR URBAN INDIANS

``SEC. 501. PURPOSE.

  ``The purpose of this title is to establish and maintain programs in 
Urban Centers to make health services more accessible and available to 
Urban Indians.

``SEC. 502. CONTRACTS WITH, AND GRANTS TO, URBAN INDIAN ORGANIZATIONS.

  ``Under authority of the Act of November 2, 1921 (25 U.S.C. 13) 
(commonly known as the `Snyder Act'), the Secretary, acting through the 
Service, shall enter into contracts with, or make grants to, Urban 
Indian Organizations to assist such organizations in the establishment 
and administration, within Urban Centers, of programs which meet the 
requirements set forth in this title. Subject to section 506, the 
Secretary, acting through the Service, shall include such conditions as 
the Secretary considers necessary to effect the purpose of this title 
in any contract into which the Secretary enters with, or in any grant 
the Secretary makes to, any Urban Indian Organization pursuant to this 
title.

``SEC. 503. CONTRACTS AND GRANTS FOR THE PROVISION OF HEALTH CARE AND 
                    REFERRAL SERVICES.

  ``(a) Requirements for Grants and Contracts.--Under authority of the 
Act of November 2, 1921 (25 U.S.C. 13) (commonly known as the `Snyder 
Act'), the Secretary, acting through the Service, shall enter into 
contracts with, and make grants to, Urban Indian Organizations for the 
provision of health care and referral services for Urban Indians. Any 
such contract or grant shall include requirements that the Urban Indian 
Organization successfully undertake to--
          ``(1) estimate the population of Urban Indians residing in 
        the Urban Center or centers that the organization proposes to 
        serve who are or could be recipients of health care or referral 
        services;
          ``(2) estimate the current health status of Urban Indians 
        residing in such Urban Center or centers;
          ``(3) estimate the current health care needs of Urban Indians 
        residing in such Urban Center or centers;
          ``(4) provide basic health education, including health 
        promotion and disease prevention education, to Urban Indians;
          ``(5) make recommendations to the Secretary and Federal, 
        State, local, and other resource agencies on methods of 
        improving health service programs to meet the needs of Urban 
        Indians; and
          ``(6) where necessary, provide, or enter into contracts for 
        the provision of, health care services for Urban Indians.
  ``(b) Criteria.--The Secretary, acting through the Service, shall, by 
regulation, prescribe the criteria for selecting Urban Indian 
Organizations to enter into contracts or receive grants under this 
section. Such criteria shall, among other factors, include--
          ``(1) the extent of unmet health care needs of Urban Indians 
        in the Urban Center or centers involved;
          ``(2) the size of the Urban Indian population in the Urban 
        Center or centers involved;
          ``(3) the extent, if any, to which the activities set forth 
        in subsection (a) would duplicate any project funded under this 
        title, or under any current public health service project 
        funded in a manner other than pursuant to this title;
          ``(4) the capability of an Urban Indian Organization to 
        perform the activities set forth in subsection (a) and to enter 
        into a contract with the Secretary or to meet the requirements 
        for receiving a grant under this section;
          ``(5) the satisfactory performance and successful completion 
        by an Urban Indian Organization of other contracts with the 
        Secretary under this title;
          ``(6) the appropriateness and likely effectiveness of 
        conducting the activities set forth in subsection (a) in an 
        Urban Center or centers; and
          ``(7) the extent of existing or likely future participation 
        in the activities set forth in subsection (a) by appropriate 
        health and health-related Federal, State, local, and other 
        agencies.
  ``(c) Access to Health Promotion and Disease Prevention Programs.--
The Secretary, acting through the Service, shall facilitate access to 
or provide health promotion and disease prevention services for Urban 
Indians through grants made to Urban Indian Organizations administering 
contracts entered into or receiving grants under subsection (a).
  ``(d) Immunization Services.--
          ``(1) Access or services provided.--The Secretary, acting 
        through the Service, shall facilitate access to, or provide, 
        immunization services for Urban Indians through grants made to 
        Urban Indian Organizations administering contracts entered into 
        or receiving grants under this section.
          ``(2) Definition.--For purposes of this subsection, the term 
        `immunization services' means services to provide without 
        charge immunizations against vaccine-preventable diseases.
  ``(e) Behavioral Health Services.--
          ``(1) Access or services provided.--The Secretary, acting 
        through the Service, shall facilitate access to, or provide, 
        behavioral health services for Urban Indians through grants 
        made to Urban Indian Organizations administering contracts 
        entered into or receiving grants under subsection (a).
          ``(2) Assessment required.--Except as provided by paragraph 
        (3)(A), a grant may not be made under this subsection to an 
        Urban Indian Organization until that organization has prepared, 
        and the Service has approved, an assessment of the following:
                  ``(A) The behavioral health needs of the Urban Indian 
                population concerned.
                  ``(B) The behavioral health services and other 
                related resources available to that population.
                  ``(C) The barriers to obtaining those services and 
                resources.
                  ``(D) The needs that are unmet by such services and 
                resources.
          ``(3) Purposes of grants.--Grants may be made under this 
        subsection for the following:
                  ``(A) To prepare assessments required under paragraph 
                (2).
                  ``(B) To provide outreach, educational, and referral 
                services to Urban Indians regarding the availability of 
                direct behavioral health services, to educate Urban 
                Indians about behavioral health issues and services, 
                and effect coordination with existing behavioral health 
                providers in order to improve services to Urban 
                Indians.
                  ``(C) To provide outpatient behavioral health 
                services to Urban Indians, including the identification 
                and assessment of illness, therapeutic treatments, case 
                management, support groups, family treatment, and other 
                treatment.
                  ``(D) To develop innovative behavioral health service 
                delivery models which incorporate Indian cultural 
                support systems and resources.
  ``(f) Prevention of Child Abuse.--
          ``(1) Access or services provided.--The Secretary, acting 
        through the Service, shall facilitate access to or provide 
        services for Urban Indians through grants to Urban Indian 
        Organizations administering contracts entered into or receiving 
        grants under subsection (a) to prevent and treat child abuse 
        (including sexual abuse) among Urban Indians.
          ``(2) Evaluation required.--Except as provided by paragraph 
        (3)(A), a grant may not be made under this subsection to an 
        Urban Indian Organization until that organization has prepared, 
        and the Service has approved, an assessment that documents the 
        prevalence of child abuse in the Urban Indian population 
        concerned and specifies the services and programs (which may 
        not duplicate existing services and programs) for which the 
        grant is requested.
          ``(3) Purposes of grants.--Grants may be made under this 
        subsection for the following:
                  ``(A) To prepare assessments required under paragraph 
                (2).
                  ``(B) For the development of prevention, training, 
                and education programs for Urban Indians, including 
                child education, parent education, provider training on 
                identification and intervention, education on reporting 
                requirements, prevention campaigns, and establishing 
                service networks of all those involved in Indian child 
                protection.
                  ``(C) To provide direct outpatient treatment services 
                (including individual treatment, family treatment, 
                group therapy, and support groups) to Urban Indians who 
                are child victims of abuse (including sexual abuse) or 
                adult survivors of child sexual abuse, to the families 
                of such child victims, and to Urban Indian perpetrators 
                of child abuse (including sexual abuse).
          ``(4) Considerations when making grants.--In making grants to 
        carry out this subsection, the Secretary shall take into 
        consideration--
                  ``(A) the support for the Urban Indian Organization 
                demonstrated by the child protection authorities in the 
                area, including committees or other services funded 
                under the Indian Child Welfare Act of 1978 (25 U.S.C. 
                1901 et seq.), if any;
                  ``(B) the capability and expertise demonstrated by 
                the Urban Indian Organization to address the complex 
                problem of child sexual abuse in the community; and
                  ``(C) the assessment required under paragraph (2).
  ``(g) Other Grants.--The Secretary, acting through the Service, may 
enter into a contract with or make grants to an Urban Indian 
Organization that provides or arranges for the provision of health care 
services (through satellite facilities, provider networks, or 
otherwise) to Urban Indians in more than 1 Urban Center.

``SEC. 504. CONTRACTS AND GRANTS FOR THE DETERMINATION OF UNMET HEALTH 
                    CARE NEEDS.

  ``(a) Grants and Contracts Authorized.--Under authority of the Act of 
November 2, 1921 (25 U.S.C. 13) (commonly known as the `Snyder Act'), 
the Secretary, acting through the Service, may enter into contracts 
with or make grants to Urban Indian Organizations situated in Urban 
Centers for which contracts have not been entered into or grants have 
not been made under section 503.
  ``(b) Purpose.--The purpose of a contract or grant made under this 
section shall be the determination of the matters described in 
subsection (c)(1) in order to assist the Secretary in assessing the 
health status and health care needs of Urban Indians in the Urban 
Center involved and determining whether the Secretary should enter into 
a contract or make a grant under section 503 with respect to the Urban 
Indian Organization which the Secretary has entered into a contract 
with, or made a grant to, under this section.
  ``(c) Grant and Contract Requirements.--Any contract entered into, or 
grant made, by the Secretary under this section shall include 
requirements that--
          ``(1) the Urban Indian Organization successfully undertakes 
        to--
                  ``(A) document the health care status and unmet 
                health care needs of Urban Indians in the Urban Center 
                involved; and
                  ``(B) with respect to Urban Indians in the Urban 
                Center involved, determine the matters described in 
                paragraphs (2), (3), (4), and (7) of section 503(b); 
                and
          ``(2) the Urban Indian Organization complete performance of 
        the contract, or carry out the requirements of the grant, 
        within 1 year after the date on which the Secretary and such 
        organization enter into such contract, or within 1 year after 
        such organization receives such grant, whichever is applicable.
  ``(d) No Renewals.--The Secretary may not renew any contract entered 
into or grant made under this section.

``SEC. 505. EVALUATIONS; RENEWALS.

  ``(a) Procedures for Evaluations.--The Secretary, acting through the 
Service, shall develop procedures to evaluate compliance with grant 
requirements and compliance with and performance of contracts entered 
into by Urban Indian Organizations under this title. Such procedures 
shall include provisions for carrying out the requirements of this 
section.
  ``(b) Evaluations.--The Secretary, acting through the Service, shall 
evaluate the compliance of each Urban Indian Organization which has 
entered into a contract or received a grant under section 503 with the 
terms of such contract or grant. For purposes of this evaluation, the 
Secretary shall--
          ``(1) acting through the Service, conduct an annual onsite 
        evaluation of the organization; or
          ``(2) accept in lieu of such onsite evaluation evidence of 
        the organization's provisional or full accreditation by a 
        private independent entity recognized by the Secretary for 
        purposes of conducting quality reviews of providers 
        participating in the Medicare program under title XVIII of the 
        Social Security Act.
  ``(c) Noncompliance; Unsatisfactory Performance.--If, as a result of 
the evaluations conducted under this section, the Secretary determines 
that an Urban Indian Organization has not complied with the 
requirements of a grant or complied with or satisfactorily performed a 
contract under section 503, the Secretary shall, prior to renewing such 
contract or grant, attempt to resolve with the organization the areas 
of noncompliance or unsatisfactory performance and modify the contract 
or grant to prevent future occurrences of noncompliance or 
unsatisfactory performance. If the Secretary determines that the 
noncompliance or unsatisfactory performance cannot be resolved and 
prevented in the future, the Secretary shall not renew the contract or 
grant with the organization and is authorized to enter into a contract 
or make a grant under section 503 with another Urban Indian 
Organization which is situated in the same Urban Center as the Urban 
Indian Organization whose contract or grant is not renewed under this 
section.
  ``(d) Considerations for Renewals.--In determining whether to renew a 
contract or grant with an Urban Indian Organization under section 503 
which has completed performance of a contract or grant under section 
504, the Secretary shall review the records of the Urban Indian 
Organization, the reports submitted under section 507, and shall 
consider the results of the onsite evaluations or accreditations under 
subsection (b).

``SEC. 506. OTHER CONTRACT AND GRANT REQUIREMENTS.

  ``(a) Procurement.--Contracts with Urban Indian Organizations entered 
into pursuant to this title shall be in accordance with all Federal 
contracting laws and regulations relating to procurement except that in 
the discretion of the Secretary, such contracts may be negotiated 
without advertising and need not conform to the provisions of sections 
1304 and 3131 through 3133 of title 40, United States Code.
  ``(b) Payments Under Contracts or Grants.--
          ``(1) In general.--Payments under any contracts or grants 
        pursuant to this title, notwithstanding any term or condition 
        of such contract or grant--
                  ``(A) may be made in a single advance payment by the 
                Secretary to the Urban Indian Organization by no later 
                than the end of the first 30 days of the funding period 
                with respect to which the payments apply, unless the 
                Secretary determines through an evaluation under 
                section 505 that the organization is not capable of 
                administering such a single advance payment; and
                  ``(B) if any portion thereof is unexpended by the 
                Urban Indian Organization during the funding period 
                with respect to which the payments initially apply, 
                shall be carried forward for expenditure with respect 
                to allowable or reimbursable costs incurred by the 
                organization during 1 or more subsequent funding 
                periods without additional justification or 
                documentation by the organization as a condition of 
                carrying forward the availability for expenditure of 
                such funds.
          ``(2) Semiannual and quarterly payments and reimbursements.--
        If the Secretary determines under paragraph (1)(A) that an 
        Urban Indian Organization is not capable of administering an 
        entire single advance payment, on request of the Urban Indian 
        Organization, the payments may be made--
                  ``(A) in semiannual or quarterly payments by not 
                later than 30 days after the date on which the funding 
                period with respect to which the payments apply begins; 
                or
                  ``(B) by way of reimbursement.
  ``(c) Revision or Amendment of Contracts.--Notwithstanding any 
provision of law to the contrary, the Secretary may, at the request and 
consent of an Urban Indian Organization, revise or amend any contract 
entered into by the Secretary with such organization under this title 
as necessary to carry out the purposes of this title.
  ``(d) Fair and Uniform Services and Assistance.--Contracts with or 
grants to Urban Indian Organizations and regulations adopted pursuant 
to this title shall include provisions to assure the fair and uniform 
provision to Urban Indians of services and assistance under such 
contracts or grants by such organizations.

``SEC. 507. REPORTS AND RECORDS.

  ``(a) Reports.--
          ``(1) In general.--For each fiscal year during which an Urban 
        Indian Organization receives or expends funds pursuant to a 
        contract entered into or a grant received pursuant to this 
        title, such Urban Indian Organization shall submit to the 
        Secretary not more frequently than every 6 months, a report 
        that includes the following:
                  ``(A) In the case of a contract or grant under 
                section 503, recommendations pursuant to section 
                503(a)(5).
                  ``(B) Information on activities conducted by the 
                organization pursuant to the contract or grant.
                  ``(C) An accounting of the amounts and purpose for 
                which Federal funds were expended.
                  ``(D) A minimum set of data, using uniformly defined 
                elements, as specified by the Secretary after 
                consultation with Urban Indian Organizations.
          ``(2) Health status and services.--
                  ``(A) In general.--Not later than 18 months after the 
                date of enactment of the Indian Health Care Improvement 
                Act Amendments of 2007, the Secretary, acting through 
                the Service, shall submit to Congress a report 
                evaluating--
                          ``(i) the health status of Urban Indians;
                          ``(ii) the services provided to Indians 
                        pursuant to this title; and
                          ``(iii) areas of unmet needs in the delivery 
                        of health services to Urban Indians.
                  ``(B) Consultation and contracts.--In preparing the 
                report under paragraph (1), the Secretary--
                          ``(i) shall consult with Urban Indian 
                        Organizations; and
                          ``(ii) may enter into a contract with a 
                        national organization representing Urban Indian 
                        Organizations to conduct any aspect of the 
                        report.
  ``(b) Audit.--The reports and records of the Urban Indian 
Organization with respect to a contract or grant under this title shall 
be subject to audit by the Secretary and the Comptroller General of the 
United States.
  ``(c) Costs of Audits.--The Secretary shall allow as a cost of any 
contract or grant entered into or awarded under section 502 or 503 the 
cost of an annual independent financial audit conducted by--
          ``(1) a certified public accountant; or
          ``(2) a certified public accounting firm qualified to conduct 
        Federal compliance audits.

``SEC. 508. LIMITATION ON CONTRACT AUTHORITY.

  ``The authority of the Secretary to enter into contracts or to award 
grants under this title shall be to the extent, and in an amount, 
provided for in appropriation Acts.

``SEC. 509. FACILITIES.

  ``(a) Grants.--The Secretary, acting through the Service, may make 
grants to contractors or grant recipients under this title for the 
lease, purchase, renovation, construction, or expansion of facilities, 
including leased facilities, in order to assist such contractors or 
grant recipients in complying with applicable licensure or 
certification requirements.
  ``(b) Loan Fund Study.--The Secretary, acting through the Service, 
may carry out a study to determine the feasibility of establishing a 
loan fund to provide to Urban Indian Organizations direct loans or 
guarantees for loans for the construction of health care facilities in 
a manner consistent with section 309, including by submitting a report 
in accordance with subsection (c) of that section.

``SEC. 510. DIVISION OF URBAN INDIAN HEALTH.

  ``There is established within the Service a Division of Urban Indian 
Health, which shall be responsible for--
          ``(1) carrying out the provisions of this title;
          ``(2) providing central oversight of the programs and 
        services authorized under this title; and
          ``(3) providing technical assistance to Urban Indian 
        Organizations.

``SEC. 511. GRANTS FOR ALCOHOL AND SUBSTANCE ABUSE-RELATED SERVICES.

  ``(a) Grants Authorized.--The Secretary, acting through the Service, 
may make grants for the provision of health-related services in 
prevention of, treatment of, rehabilitation of, or school- and 
community-based education regarding, alcohol and substance abuse in 
Urban Centers to those Urban Indian Organizations with which the 
Secretary has entered into a contract under this title or under section 
201.
  ``(b) Goals.--Each grant made pursuant to subsection (a) shall set 
forth the goals to be accomplished pursuant to the grant. The goals 
shall be specific to each grant as agreed to between the Secretary and 
the grantee.
  ``(c) Criteria.--The Secretary shall establish criteria for the 
grants made under subsection (a), including criteria relating to the 
following:
          ``(1) The size of the Urban Indian population.
          ``(2) Capability of the organization to adequately perform 
        the activities required under the grant.
          ``(3) Satisfactory performance standards for the organization 
        in meeting the goals set forth in such grant. The standards 
        shall be negotiated and agreed to between the Secretary and the 
        grantee on a grant-by-grant basis.
          ``(4) Identification of the need for services.
  ``(d) Allocation of Grants.--The Secretary shall develop a 
methodology for allocating grants made pursuant to this section based 
on the criteria established pursuant to subsection (c).
  ``(e) Grants Subject to Criteria.--Any grant received by an Urban 
Indian Organization under this Act for substance abuse prevention, 
treatment, and rehabilitation shall be subject to the criteria set 
forth in subsection (c).

``SEC. 512. TREATMENT OF CERTAIN DEMONSTRATION PROJECTS.

  ``Notwithstanding any other provision of law, the Tulsa Clinic and 
Oklahoma City Clinic demonstration projects shall--
          ``(1) be permanent programs within the Service's direct care 
        program;
          ``(2) continue to be treated as Service Units and Operating 
        Units in the allocation of resources and coordination of care; 
        and
          ``(3) continue to meet the requirements and definitions of an 
        Urban Indian Organization in this Act, and shall not be subject 
        to the provisions of the Indian Self-Determination and 
        Education Assistance Act (25 U.S.C. 450 et seq.).

``SEC. 513. URBAN NIAAA TRANSFERRED PROGRAMS.

  ``(a) Grants and Contracts.--The Secretary, through the Division of 
Urban Indian Health, shall make grants or enter into contracts with 
Urban Indian Organizations, to take effect not later than September 30, 
2010, for the administration of Urban Indian alcohol programs that were 
originally established under the National Institute on Alcoholism and 
Alcohol Abuse (hereafter in this section referred to as `NIAAA') and 
transferred to the Service.
  ``(b) Use of Funds.--Grants provided or contracts entered into under 
this section shall be used to provide support for the continuation of 
alcohol prevention and treatment services for Urban Indian populations 
and such other objectives as are agreed upon between the Service and a 
recipient of a grant or contract under this section.
  ``(c) Eligibility.--Urban Indian Organizations that operate Indian 
alcohol programs originally funded under the NIAAA and subsequently 
transferred to the Service are eligible for grants or contracts under 
this section.
  ``(d) Report.--The Secretary shall evaluate and report to Congress on 
the activities of programs funded under this section not less than 
every 5 years.

``SEC. 514. CONSULTATION WITH URBAN INDIAN ORGANIZATIONS.

  ``(a) In General.--The Secretary shall ensure that the Service 
consults, to the greatest extent practicable, with Urban Indian 
Organizations.
  ``(b) Definition of Consultation.--For purposes of subsection (a), 
consultation is the open and free exchange of information and opinions 
which leads to mutual understanding and comprehension and which 
emphasizes trust, respect, and shared responsibility.

``SEC. 515. URBAN YOUTH TREATMENT CENTER DEMONSTRATION.

  ``(a) Construction and Operation.--The Secretary, acting through the 
Service, through grant or contract, is authorized to fund the 
construction and operation of at least 2 residential treatment centers 
in each State described in subsection (b) to demonstrate the provision 
of alcohol and substance abuse treatment services to Urban Indian youth 
in a culturally competent residential setting.
  ``(b) Definition of State.--A State described in this subsection is a 
State in which--
          ``(1) there resides Urban Indian youth with need for alcohol 
        and substance abuse treatment services in a residential 
        setting; and
          ``(2) there is a significant shortage of culturally competent 
        residential treatment services for Urban Indian youth.

``SEC. 516. GRANTS FOR DIABETES PREVENTION, TREATMENT, AND CONTROL.

  ``(a) Grants Authorized.--The Secretary may make grants to those 
Urban Indian Organizations that have entered into a contract or have 
received a grant under this title for the provision of services for the 
prevention and treatment of, and control of the complications resulting 
from, diabetes among Urban Indians.
  ``(b) Goals.--Each grant made pursuant to subsection (a) shall set 
forth the goals to be accomplished under the grant. The goals shall be 
specific to each grant as agreed to between the Secretary and the 
grantee.
  ``(c) Establishment of Criteria.--The Secretary shall establish 
criteria for the grants made under subsection (a) relating to--
          ``(1) the size and location of the Urban Indian population to 
        be served;
          ``(2) the need for prevention of and treatment of, and 
        control of the complications resulting from, diabetes among the 
        Urban Indian population to be served;
          ``(3) performance standards for the organization in meeting 
        the goals set forth in such grant that are negotiated and 
        agreed to by the Secretary and the grantee;
          ``(4) the capability of the organization to adequately 
        perform the activities required under the grant; and
          ``(5) the willingness of the organization to collaborate with 
        the registry, if any, established by the Secretary under 
        section 204(e) in the Area Office of the Service in which the 
        organization is located.
  ``(d) Funds Subject to Criteria.--Any funds received by an Urban 
Indian Organization under this Act for the prevention, treatment, and 
control of diabetes among Urban Indians shall be subject to the 
criteria developed by the Secretary under subsection (c).

``SEC. 517. COMMUNITY HEALTH REPRESENTATIVES.

  ``The Secretary, acting through the Service, may enter into contracts 
with, and make grants to, Urban Indian Organizations for the employment 
of Indians trained as health service providers through the Community 
Health Representatives Program under section 109 in the provision of 
health care, health promotion, and disease prevention services to Urban 
Indians.

``SEC. 518. EFFECTIVE DATE.

  ``The amendments made by the Indian Health Care Improvement Act 
Amendments of 2007 to this title shall take effect beginning on the 
date of enactment of that Act, regardless of whether the Secretary has 
promulgated regulations implementing such amendments.

``SEC. 519. ELIGIBILITY FOR SERVICES.

  ``Urban Indians shall be eligible for, and the ultimate beneficiaries 
of, health care or referral services provided pursuant to this title.

``SEC. 520. AUTHORIZATION OF APPROPRIATIONS.

  ``There are authorized to be appropriated such sums as may be 
necessary for each fiscal year through fiscal year 2017 to carry out 
this title.

                ``TITLE VI--ORGANIZATIONAL IMPROVEMENTS

``SEC. 601. ESTABLISHMENT OF THE INDIAN HEALTH SERVICE AS AN AGENCY OF 
                    THE PUBLIC HEALTH SERVICE.

  ``(a) Establishment.--
          ``(1) In general.--In order to more effectively and 
        efficiently carry out the responsibilities, authorities, and 
        functions of the United States to provide health care services 
        to Indians and Indian Tribes, as are or may be hereafter 
        provided by Federal statute or treaties, there is established 
        within the Public Health Service of the Department the Indian 
        Health Service.
          ``(2) Assistant secretary of indian health.--The Service 
        shall be administered by an Assistant Secretary of Indian 
        Health, who shall be appointed by the President, by and with 
        the advice and consent of the Senate. The Assistant Secretary 
        shall report to the Secretary. Effective with respect to an 
        individual appointed by the President, by and with the advice 
        and consent of the Senate, after January 1, 2007, the term of 
        service of the Assistant Secretary shall be 4 years. An 
        Assistant Secretary may serve more than 1 term.
          ``(3) Incumbent.--The individual serving in the position of 
        Director of the Service on the day before the date of enactment 
        of the Indian Health Care Improvement Act Amendments of 2007 
        shall serve as Assistant Secretary.
          ``(4) Advocacy and consultation.--The position of Assistant 
        Secretary is established to, in a manner consistent with the 
        government-to-government relationship between the United States 
        and Indian Tribes--
                  ``(A) facilitate advocacy for the development of 
                appropriate Indian health policy; and
                  ``(B) promote consultation on matters relating to 
                Indian health.
  ``(b) Agency.--The Service shall be an agency within the Public 
Health Service of the Department, and shall not be an office, 
component, or unit of any other agency of the Department.
  ``(c) Duties.--The Assistant Secretary shall--
          ``(1) perform all functions that were, on the day before the 
        date of enactment of the Indian Health Care Improvement Act 
        Amendments of 2007, carried out by or under the direction of 
        the individual serving as Director of the Service on that day;
          ``(2) perform all functions of the Secretary relating to the 
        maintenance and operation of hospital and health facilities for 
        Indians and the planning for, and provision and utilization of, 
        health services for Indians;
          ``(3) administer all health programs under which health care 
        is provided to Indians based upon their status as Indians which 
        are administered by the Secretary, including programs under--
                  ``(A) this Act;
                  ``(B) the Act of November 2, 1921 (25 U.S.C. 13);
                  ``(C) the Act of August 5, 1954 (42 U.S.C. 2001 et 
                seq.);
                  ``(D) the Act of August 16, 1957 (42 U.S.C. 2005 et 
                seq.); and
                  ``(E) the Indian Self-Determination and Education 
                Assistance Act (25 U.S.C. 450 et seq.);
          ``(4) administer all scholarship and loan functions carried 
        out under title I;
          ``(5) report directly to the Secretary concerning all policy- 
        and budget-related matters affecting Indian health;
          ``(6) collaborate with the Assistant Secretary for Health 
        concerning appropriate matters of Indian health that affect the 
        agencies of the Public Health Service;
          ``(7) advise each Assistant Secretary of the Department 
        concerning matters of Indian health with respect to which that 
        Assistant Secretary has authority and responsibility;
          ``(8) advise the heads of other agencies and programs of the 
        Department concerning matters of Indian health with respect to 
        which those heads have authority and responsibility;
          ``(9) coordinate the activities of the Department concerning 
        matters of Indian health; and
          ``(10) perform such other functions as the Secretary may 
        designate.
  ``(d) Authority.--
          ``(1) In general.--The Secretary, acting through the 
        Assistant Secretary, shall have the authority--
                  ``(A) except to the extent provided for in paragraph 
                (2), to appoint and compensate employees for the 
                Service in accordance with title 5, United States Code;
                  ``(B) to enter into contracts for the procurement of 
                goods and services to carry out the functions of the 
                Service; and
                  ``(C) to manage, expend, and obligate all funds 
                appropriated for the Service.
          ``(2) Personnel actions.--Notwithstanding any other provision 
        of law, the provisions of section 12 of the Act of June 18, 
        1934 (48 Stat. 986; 25 U.S.C. 472), shall apply to all 
        personnel actions taken with respect to new positions created 
        within the Service as a result of its establishment under 
        subsection (a).
  ``(e) References.--Any reference to the Director of the Indian Health 
Service in any other Federal law, Executive order, rule, regulation, or 
delegation of authority, or in any document of or relating to the 
Director of the Indian Health Service, shall be deemed to refer to the 
Assistant Secretary.

``SEC. 602. AUTOMATED MANAGEMENT INFORMATION SYSTEM.

  ``(a) Establishment.--
          ``(1) In general.--The Secretary shall establish an automated 
        management information system for the Service.
          ``(2) Requirements of system.--The information system 
        established under paragraph (1) shall include--
                  ``(A) a financial management system;
                  ``(B) a patient care information system for each area 
                served by the Service;
                  ``(C) a privacy component that protects the privacy 
                of patient information held by, or on behalf of, the 
                Service;
                  ``(D) a services-based cost accounting component that 
                provides estimates of the costs associated with the 
                provision of specific medical treatments or services in 
                each Area office of the Service;
                  ``(E) an interface mechanism for patient billing and 
                accounts receivable system; and
                  ``(F) a training component.
  ``(b) Provision of Systems to Tribes and Organizations.--The 
Secretary shall provide each Tribal Health Program automated management 
information systems which--
          ``(1) meet the management information needs of such Tribal 
        Health Program with respect to the treatment by the Tribal 
        Health Program of patients of the Service; and
          ``(2) meet the management information needs of the Service.
  ``(c) Access to Records.--Notwithstanding any other provision of law, 
each patient shall have reasonable access to the medical or health 
records of such patient which are held by, or on behalf of, the 
Service.
  ``(d) Authority To Enhance Information Technology.--The Secretary, 
acting through the Assistant Secretary, shall have the authority to 
enter into contracts, agreements, or joint ventures with other Federal 
agencies, States, private and nonprofit organizations, for the purpose 
of enhancing information technology in Indian Health Programs and 
facilities.

``SEC. 603. AUTHORIZATION OF APPROPRIATIONS.

  ``There is authorized to be appropriated such sums as may be 
necessary for each fiscal year through fiscal year 2017 to carry out 
this title.

                ``TITLE VII--BEHAVIORAL HEALTH PROGRAMS

``SEC. 701. BEHAVIORAL HEALTH PREVENTION AND TREATMENT SERVICES.

  ``(a) Purposes.--The purposes of this section are as follows:
          ``(1) To authorize and direct the Secretary, acting through 
        the Service, Indian Tribes, Tribal Organizations, and Urban 
        Indian Organizations, to develop a comprehensive behavioral 
        health prevention and treatment program which emphasizes 
        collaboration among alcohol and substance abuse, social 
        services, and mental health programs.
          ``(2) To provide information, direction, and guidance 
        relating to mental illness and dysfunction and self-destructive 
        behavior, including child abuse and family violence, to those 
        Federal, tribal, State, and local agencies responsible for 
        programs in Indian communities in areas of health care, 
        education, social services, child and family welfare, alcohol 
        and substance abuse, law enforcement, and judicial services.
          ``(3) To assist Indian Tribes to identify services and 
        resources available to address mental illness and dysfunctional 
        and self-destructive behavior.
          ``(4) To provide authority and opportunities for Indian 
        Tribes and Tribal Organizations to develop, implement, and 
        coordinate with community-based programs which include 
        identification, prevention, education, referral, and treatment 
        services, including through multidisciplinary resource teams.
          ``(5) To ensure that Indians, as citizens of the United 
        States and of the States in which they reside, have the same 
        access to behavioral health services to which all citizens have 
        access.
          ``(6) To modify or supplement existing programs and 
        authorities in the areas identified in paragraph (2).
  ``(b) Plans.--
          ``(1) Development.--The Secretary, acting through the 
        Service, Indian Tribes, Tribal Organizations, and Urban Indian 
        Organizations, shall encourage Indian Tribes and Tribal 
        Organizations to develop tribal plans, and Urban Indian 
        Organizations to develop local plans, and for all such groups 
        to participate in developing areawide plans for Indian 
        Behavioral Health Services. The plans shall include, to the 
        extent feasible, the following components:
                  ``(A) An assessment of the scope of alcohol or other 
                substance abuse, mental illness, and dysfunctional and 
                self-destructive behavior, including suicide, child 
                abuse, and family violence, among Indians, including--
                          ``(i) the number of Indians served who are 
                        directly or indirectly affected by such illness 
                        or behavior; or
                          ``(ii) an estimate of the financial and human 
                        cost attributable to such illness or behavior.
                  ``(B) An assessment of the existing and additional 
                resources necessary for the prevention and treatment of 
                such illness and behavior, including an assessment of 
                the progress toward achieving the availability of the 
                full continuum of care described in subsection (c).
                  ``(C) An estimate of the additional funding needed by 
                the Service, Indian Tribes, Tribal Organizations, and 
                Urban Indian Organizations to meet their 
                responsibilities under the plans.
          ``(2) National clearinghouse.--The Secretary, acting through 
        the Service, shall coordinate with existing national 
        clearinghouses and information centers to include at the 
        clearinghouses and centers plans and reports on the outcomes of 
        such plans developed by Indian Tribes, Tribal Organizations, 
        Urban Indian Organizations, and Service Areas relating to 
        behavioral health. The Secretary shall ensure access to these 
        plans and outcomes by any Indian Tribe, Tribal Organization, 
        Urban Indian Organization, or the Service.
          ``(3) Technical assistance.--The Secretary shall provide 
        technical assistance to Indian Tribes, Tribal Organizations, 
        and Urban Indian Organizations in preparation of plans under 
        this section and in developing standards of care that may be 
        used and adopted locally.
  ``(c) Programs.--The Secretary, acting through the Service, Indian 
Tribes, and Tribal Organizations, shall provide, to the extent feasible 
and if funding is available, programs including the following:
          ``(1) Comprehensive care.--A comprehensive continuum of 
        behavioral health care which provides--
                  ``(A) community-based prevention, intervention, 
                outpatient, and behavioral health aftercare;
                  ``(B) detoxification (social and medical);
                  ``(C) acute hospitalization;
                  ``(D) intensive outpatient/day treatment;
                  ``(E) residential treatment;
                  ``(F) transitional living for those needing a 
                temporary, stable living environment that is supportive 
                of treatment and recovery goals;
                  ``(G) emergency shelter;
                  ``(H) intensive case management; and
                  ``(I) diagnostic services.
          ``(2) Child care.--Behavioral health services for Indians 
        from birth through age 17, including--
                  ``(A) preschool and school age fetal alcohol disorder 
                services, including assessment and behavioral 
                intervention;
                  ``(B) mental health and substance abuse services 
                (emotional, organic, alcohol, drug, inhalant, and 
                tobacco);
                  ``(C) identification and treatment of co-occurring 
                disorders and comorbidity;
                  ``(D) prevention of alcohol, drug, inhalant, and 
                tobacco use;
                  ``(E) early intervention, treatment, and aftercare;
                  ``(F) promotion of healthy approaches to risk and 
                safety issues; and
                  ``(G) identification and treatment of neglect and 
                physical, mental, and sexual abuse.
          ``(3) Adult care.--Behavioral health services for Indians 
        from age 18 through 55, including--
                  ``(A) early intervention, treatment, and aftercare;
                  ``(B) mental health and substance abuse services 
                (emotional, alcohol, drug, inhalant, and tobacco), 
                including sex specific services;
                  ``(C) identification and treatment of co-occurring 
                disorders (dual diagnosis) and comorbidity;
                  ``(D) promotion of healthy approaches for risk-
                related behavior;
                  ``(E) treatment services for women at risk of giving 
                birth to a child with a fetal alcohol disorder; and
                  ``(F) sex specific treatment for sexual assault and 
                domestic violence.
          ``(4) Family care.--Behavioral health services for families, 
        including--
                  ``(A) early intervention, treatment, and aftercare 
                for affected families;
                  ``(B) treatment for sexual assault and domestic 
                violence; and
                  ``(C) promotion of healthy approaches relating to 
                parenting, domestic violence, and other abuse issues.
          ``(5) Elder care.--Behavioral health services for Indians 56 
        years of age and older, including--
                  ``(A) early intervention, treatment, and aftercare;
                  ``(B) mental health and substance abuse services 
                (emotional, alcohol, drug, inhalant, and tobacco), 
                including sex specific services;
                  ``(C) identification and treatment of co-occurring 
                disorders (dual diagnosis) and comorbidity;
                  ``(D) promotion of healthy approaches to managing 
                conditions related to aging;
                  ``(E) sex specific treatment for sexual assault, 
                domestic violence, neglect, physical and mental abuse 
                and exploitation; and
                  ``(F) identification and treatment of dementias 
                regardless of cause.
  ``(d) Community Behavioral Health Plan.--
          ``(1) Establishment.--The governing body of any Indian Tribe, 
        Tribal Organization, or Urban Indian Organization may adopt a 
        resolution for the establishment of a community behavioral 
        health plan providing for the identification and coordination 
        of available resources and programs to identify, prevent, or 
        treat substance abuse, mental illness, or dysfunctional and 
        self-destructive behavior, including child abuse and family 
        violence, among its members or its service population. This 
        plan should include behavioral health services, social 
        services, intensive outpatient services, and continuing 
        aftercare.
          ``(2) Technical assistance.--At the request of an Indian 
        Tribe, Tribal Organization, or Urban Indian Organization, the 
        Bureau of Indian Affairs and the Service shall cooperate with 
        and provide technical assistance to the Indian Tribe, Tribal 
        Organization, or Urban Indian Organization in the development 
        and implementation of such plan.
          ``(3) Funding.--The Secretary, acting through the Service, 
        may make funding available to Indian Tribes and Tribal 
        Organizations which adopt a resolution pursuant to paragraph 
        (1) to obtain technical assistance for the development of a 
        community behavioral health plan and to provide administrative 
        support in the implementation of such plan.
  ``(e) Coordination for Availability of Services.--The Secretary, 
acting through the Service, Indian Tribes, Tribal Organizations, and 
Urban Indian Organizations, shall coordinate behavioral health 
planning, to the extent feasible, with other Federal agencies and with 
State agencies, to encourage comprehensive behavioral health services 
for Indians regardless of their place of residence.
  ``(f) Mental Health Care Need Assessment.--Not later than 1 year 
after the date of enactment of the Indian Health Care Improvement Act 
Amendments of 2007, the Secretary, acting through the Service, shall 
make an assessment of the need for inpatient mental health care among 
Indians and the availability and cost of inpatient mental health 
facilities which can meet such need. In making such assessment, the 
Secretary shall consider the possible conversion of existing, underused 
Service hospital beds into psychiatric units to meet such need.

``SEC. 702. MEMORANDA OF AGREEMENT WITH THE DEPARTMENT OF THE INTERIOR.

  ``(a) Contents.--Not later than 12 months after the date of enactment 
of the Indian Health Care Improvement Act Amendments of 2007, the 
Secretary, acting through the Service, and the Secretary of the 
Interior shall develop and enter into a memoranda of agreement, or 
review and update any existing memoranda of agreement, as required by 
section 4205 of the Indian Alcohol and Substance Abuse Prevention and 
Treatment Act of 1986 (25 U.S.C. 2411) under which the Secretaries 
address the following:
          ``(1) The scope and nature of mental illness and 
        dysfunctional and self-destructive behavior, including child 
        abuse and family violence, among Indians.
          ``(2) The existing Federal, tribal, State, local, and private 
        services, resources, and programs available to provide 
        behavioral health services for Indians.
          ``(3) The unmet need for additional services, resources, and 
        programs necessary to meet the needs identified pursuant to 
        paragraph (1).
          ``(4)(A) The right of Indians, as citizens of the United 
        States and of the States in which they reside, to have access 
        to behavioral health services to which all citizens have 
        access.
          ``(B) The right of Indians to participate in, and receive the 
        benefit of, such services.
          ``(C) The actions necessary to protect the exercise of such 
        right.
          ``(5) The responsibilities of the Bureau of Indian Affairs 
        and the Service, including mental illness identification, 
        prevention, education, referral, and treatment services 
        (including services through multidisciplinary resource teams), 
        at the central, area, and agency and Service Unit, Service 
        Area, and headquarters levels to address the problems 
        identified in paragraph (1).
          ``(6) A strategy for the comprehensive coordination of the 
        behavioral health services provided by the Bureau of Indian 
        Affairs and the Service to meet the problems identified 
        pursuant to paragraph (1), including--
                  ``(A) the coordination of alcohol and substance abuse 
                programs of the Service, the Bureau of Indian Affairs, 
                and Indian Tribes and Tribal Organizations (developed 
                under the Indian Alcohol and Substance Abuse Prevention 
                and Treatment Act of 1986 (25 U.S.C. 2401 et seq.)) 
                with behavioral health initiatives pursuant to this 
                Act, particularly with respect to the referral and 
                treatment of dually diagnosed individuals requiring 
                behavioral health and substance abuse treatment; and
                  ``(B) ensuring that the Bureau of Indian Affairs and 
                Service programs and services (including 
                multidisciplinary resource teams) addressing child 
                abuse and family violence are coordinated with such 
                non-Federal programs and services.
          ``(7) Directing appropriate officials of the Bureau of Indian 
        Affairs and the Service, particularly at the agency and Service 
        Unit levels, to cooperate fully with tribal requests made 
        pursuant to community behavioral health plans adopted under 
        section 701(c) and section 4206 of the Indian Alcohol and 
        Substance Abuse Prevention and Treatment Act of 1986 (25 U.S.C. 
        2412).
          ``(8) Providing for an annual review of such agreement by the 
        Secretaries which shall be provided to Congress and Indian 
        Tribes and Tribal Organizations.
  ``(b) Specific Provisions Required.--The memoranda of agreement 
updated or entered into pursuant to subsection (a) shall include 
specific provisions pursuant to which the Service shall assume 
responsibility for--
          ``(1) the determination of the scope of the problem of 
        alcohol and substance abuse among Indians, including the number 
        of Indians within the jurisdiction of the Service who are 
        directly or indirectly affected by alcohol and substance abuse 
        and the financial and human cost;
          ``(2) an assessment of the existing and needed resources 
        necessary for the prevention of alcohol and substance abuse and 
        the treatment of Indians affected by alcohol and substance 
        abuse; and
          ``(3) an estimate of the funding necessary to adequately 
        support a program of prevention of alcohol and substance abuse 
        and treatment of Indians affected by alcohol and substance 
        abuse.
  ``(c) Publication.--Each memorandum of agreement entered into or 
renewed (and amendments or modifications thereto) under subsection (a) 
shall be published in the Federal Register. At the same time as 
publication in the Federal Register, the Secretary shall provide a copy 
of such memoranda, amendment, or modification to each Indian Tribe, 
Tribal Organization, and Urban Indian Organization.

``SEC. 703. COMPREHENSIVE BEHAVIORAL HEALTH PREVENTION AND TREATMENT 
                    PROGRAM.

  ``(a) Establishment.--
          ``(1) In general.--The Secretary, acting through the Service, 
        Indian Tribes, and Tribal Organizations, shall provide a 
        program of comprehensive behavioral health, prevention, 
        treatment, and aftercare, which shall include--
                  ``(A) prevention, through educational intervention, 
                in Indian communities;
                  ``(B) acute detoxification, psychiatric 
                hospitalization, residential, and intensive outpatient 
                treatment;
                  ``(C) community-based rehabilitation and aftercare;
                  ``(D) community education and involvement, including 
                extensive training of health care, educational, and 
                community-based personnel;
                  ``(E) specialized residential treatment programs for 
                high-risk populations, including pregnant and 
                postpartum women and their children; and
                  ``(F) diagnostic services.
          ``(2) Target populations.--The target population of such 
        programs shall be members of Indian Tribes. Efforts to train 
        and educate key members of the Indian community shall also 
        target employees of health, education, judicial, law 
        enforcement, legal, and social service programs.
  ``(b) Contract Health Services.--
          ``(1) In general.--The Secretary, acting through the Service, 
        Indian Tribes, and Tribal Organizations, may enter into 
        contracts with public or private providers of behavioral health 
        treatment services for the purpose of carrying out the program 
        required under subsection (a).
          ``(2) Provision of assistance.--In carrying out this 
        subsection, the Secretary shall provide assistance to Indian 
        Tribes and Tribal Organizations to develop criteria for the 
        certification of behavioral health service providers and 
        accreditation of service facilities which meet minimum 
        standards for such services and facilities.

``SEC. 704. MENTAL HEALTH TECHNICIAN PROGRAM.

  ``(a) In General.--Under the authority of the Act of November 2, 1921 
(25 U.S.C. 13) (commonly known as the `Snyder Act'), the Secretary 
shall establish and maintain a mental health technician program within 
the Service which--
          ``(1) provides for the training of Indians as mental health 
        technicians; and
          ``(2) employs such technicians in the provision of community-
        based mental health care that includes identification, 
        prevention, education, referral, and treatment services.
  ``(b) Paraprofessional Training.--In carrying out subsection (a), the 
Secretary, acting through the Service, Indian Tribes, and Tribal 
Organizations, shall provide high-standard paraprofessional training in 
mental health care necessary to provide quality care to the Indian 
communities to be served. Such training shall be based upon a 
curriculum developed or approved by the Secretary which combines 
education in the theory of mental health care with supervised practical 
experience in the provision of such care.
  ``(c) Supervision and Evaluation of Technicians.--The Secretary, 
acting through the Service, Indian Tribes, and Tribal Organizations, 
shall supervise and evaluate the mental health technicians in the 
training program.
  ``(d) Traditional Health Care Practices.--The Secretary, acting 
through the Service, shall ensure that the program established pursuant 
to this subsection involves the use and promotion of the traditional 
health care practices of the Indian Tribes to be served.

``SEC. 705. LICENSING REQUIREMENT FOR MENTAL HEALTH CARE WORKERS.

  ``(a) In General.--Subject to the provisions of section 221, and 
except as provided in subsection (b), any individual employed as a 
psychologist, social worker, or marriage and family therapist for the 
purpose of providing mental health care services to Indians in a 
clinical setting under this Act is required to be licensed as a 
psychologist, social worker, or marriage and family therapist, 
respectively.
  ``(b) Trainees.--An individual may be employed as a trainee in 
psychology, social work, or marriage and family therapy to provide 
mental health care services described in subsection (a) if such 
individual--
          ``(1) works under the direct supervision of a licensed 
        psychologist, social worker, or marriage and family therapist, 
        respectively;
          ``(2) is enrolled in or has completed at least 2 years of 
        course work at a post-secondary, accredited education program 
        for psychology, social work, marriage and family therapy, or 
        counseling; and
          ``(3) meets such other training, supervision, and quality 
        review requirements as the Secretary may establish.

``SEC. 706. INDIAN WOMEN TREATMENT PROGRAMS.

  ``(a) Grants.--The Secretary, consistent with section 701, may make 
grants to Indian Tribes, Tribal Organizations, and Urban Indian 
Organizations to develop and implement a comprehensive behavioral 
health program of prevention, intervention, treatment, and relapse 
prevention services that specifically addresses the cultural, 
historical, social, and child care needs of Indian women, regardless of 
age.
  ``(b) Use of Grant Funds.--A grant made pursuant to this section may 
be used to--
          ``(1) develop and provide community training, education, and 
        prevention programs for Indian women relating to behavioral 
        health issues, including fetal alcohol disorders;
          ``(2) identify and provide psychological services, 
        counseling, advocacy, support, and relapse prevention to Indian 
        women and their families; and
          ``(3) develop prevention and intervention models for Indian 
        women which incorporate traditional health care practices, 
        cultural values, and community and family involvement.
  ``(c) Criteria.--The Secretary, in consultation with Indian Tribes 
and Tribal Organizations, shall establish criteria for the review and 
approval of applications and proposals for funding under this section.
  ``(d) Earmark of Certain Funds.--Twenty percent of the funds 
appropriated pursuant to this section shall be used to make grants to 
Urban Indian Organizations.

``SEC. 707. INDIAN YOUTH PROGRAM.

  ``(a) Detoxification and Rehabilitation.--The Secretary, acting 
through the Service, consistent with section 701, shall develop and 
implement a program for acute detoxification and treatment for Indian 
youths, including behavioral health services. The program shall include 
regional treatment centers designed to include detoxification and 
rehabilitation for both sexes on a referral basis and programs 
developed and implemented by Indian Tribes or Tribal Organizations at 
the local level under the Indian Self-Determination and Education 
Assistance Act (25 U.S.C. 450 et seq.). Regional centers shall be 
integrated with the intake and rehabilitation programs based in the 
referring Indian community.
  ``(b) Alcohol and Substance Abuse Treatment Centers or Facilities.--
          ``(1) Establishment.--
                  ``(A) In general.--The Secretary, acting through the 
                Service, Indian Tribes, and Tribal Organizations, shall 
                construct, renovate, or, as necessary, purchase, and 
                appropriately staff and operate, at least 1 youth 
                regional treatment center or treatment network in each 
                area under the jurisdiction of an Area Office.
                  ``(B) Area office in california.--For the purposes of 
                this subsection, the Area Office in California shall be 
                considered to be 2 Area Offices, 1 office whose 
                jurisdiction shall be considered to encompass the 
                northern area of the State of California, and 1 office 
                whose jurisdiction shall be considered to encompass the 
                remainder of the State of California for the purpose of 
                implementing California treatment networks.
          ``(2) Funding.--For the purpose of staffing and operating 
        such centers or facilities, funding shall be pursuant to the 
        Act of November 2, 1921 (25 U.S.C. 13).
          ``(3) Location.--A youth treatment center constructed or 
        purchased under this subsection shall be constructed or 
        purchased at a location within the area described in paragraph 
        (1) agreed upon (by appropriate tribal resolution) by a 
        majority of the Indian Tribes to be served by such center.
          ``(4) Specific provision of funds.--
                  ``(A) In general.--Notwithstanding any other 
                provision of this title, the Secretary may, from 
                amounts authorized to be appropriated for the purposes 
                of carrying out this section, make funds available to--
                          ``(i) the Tanana Chiefs Conference, 
                        Incorporated, for the purpose of leasing, 
                        constructing, renovating, operating, and 
                        maintaining a residential youth treatment 
                        facility in Fairbanks, Alaska; and
                          ``(ii) the Southeast Alaska Regional Health 
                        Corporation to staff and operate a residential 
                        youth treatment facility without regard to the 
                        proviso set forth in section 4(l) of the Indian 
                        Self-Determination and Education Assistance Act 
                        (25 U.S.C. 450b(l)).
                  ``(B) Provision of services to eligible youths.--
                Until additional residential youth treatment facilities 
                are established in Alaska pursuant to this section, the 
                facilities specified in subparagraph (A) shall make 
                every effort to provide services to all eligible Indian 
                youths residing in Alaska.
  ``(c) Intermediate Adolescent Behavioral Health Services.--
          ``(1) In general.--The Secretary, acting through the Service, 
        Indian Tribes, and Tribal Organizations, may provide 
        intermediate behavioral health services to Indian children and 
        adolescents, including--
                  ``(A) pretreatment assistance;
                  ``(B) inpatient, outpatient, and aftercare services;
                  ``(C) emergency care;
                  ``(D) suicide prevention and crisis intervention; and
                  ``(E) prevention and treatment of mental illness and 
                dysfunctional and self-destructive behavior, including 
                child abuse and family violence.
          ``(2) Use of funds.--Funds provided under this subsection may 
        be used--
                  ``(A) to construct or renovate an existing health 
                facility to provide intermediate behavioral health 
                services;
                  ``(B) to hire behavioral health professionals;
                  ``(C) to staff, operate, and maintain an intermediate 
                mental health facility, group home, sober housing, 
                transitional housing or similar facilities, or youth 
                shelter where intermediate behavioral health services 
                are being provided;
                  ``(D) to make renovations and hire appropriate staff 
                to convert existing hospital beds into adolescent 
                psychiatric units; and
                  ``(E) for intensive home- and community-based 
                services.
          ``(3) Criteria.--The Secretary, acting through the Service, 
        shall, in consultation with Indian Tribes and Tribal 
        Organizations, establish criteria for the review and approval 
        of applications or proposals for funding made available 
        pursuant to this subsection.
  ``(d) Federally-Owned Structures.--
          ``(1) In general.--The Secretary, in consultation with Indian 
        Tribes and Tribal Organizations, shall--
                  ``(A) identify and use, where appropriate, federally-
                owned structures suitable for local residential or 
                regional behavioral health treatment for Indian youths; 
                and
                  ``(B) establish guidelines for determining the 
                suitability of any such federally-owned structure to be 
                used for local residential or regional behavioral 
                health treatment for Indian youths.
          ``(2) Terms and conditions for use of structure.--Any 
        structure described in paragraph (1) may be used under such 
        terms and conditions as may be agreed upon by the Secretary and 
        the agency having responsibility for the structure and any 
        Indian Tribe or Tribal Organization operating the program.
  ``(e) Rehabilitation and Aftercare Services.--
          ``(1) In general.--The Secretary, Indian Tribes, or Tribal 
        Organizations, in cooperation with the Secretary of the 
        Interior, shall develop and implement within each Service Unit, 
        community-based rehabilitation and follow-up services for 
        Indian youths who are having significant behavioral health 
        problems, and require long-term treatment, community 
        reintegration, and monitoring to support the Indian youths 
        after their return to their home community.
          ``(2) Administration.--Services under paragraph (1) shall be 
        provided by trained staff within the community who can assist 
        the Indian youths in their continuing development of self-
        image, positive problem-solving skills, and nonalcohol or 
        substance abusing behaviors. Such staff may include alcohol and 
        substance abuse counselors, mental health professionals, and 
        other health professionals and paraprofessionals, including 
        community health representatives.
  ``(f) Inclusion of Family in Youth Treatment Program.--In providing 
the treatment and other services to Indian youths authorized by this 
section, the Secretary, acting through the Service, Indian Tribes, and 
Tribal Organizations, shall provide for the inclusion of family members 
of such youths in the treatment programs or other services as may be 
appropriate. Not less than 10 percent of the funds appropriated for the 
purposes of carrying out subsection (e) shall be used for outpatient 
care of adult family members related to the treatment of an Indian 
youth under that subsection.
  ``(g) Multidrug Abuse Program.--The Secretary, acting through the 
Service, Indian Tribes, Tribal Organizations, and Urban Indian 
Organizations, shall provide, consistent with section 701, programs and 
services to prevent and treat the abuse of multiple forms of 
substances, including alcohol, drugs, inhalants, and tobacco, among 
Indian youths residing in Indian communities, on or near reservations, 
and in urban areas and provide appropriate mental health services to 
address the incidence of mental illness among such youths.
  ``(h) Indian Youth Mental Health.--The Secretary, acting through the 
Service, shall collect data for the report under section 801 with 
respect to--
          ``(1) the number of Indian youth who are being provided 
        mental health services through the Service and Tribal Health 
        Programs;
          ``(2) a description of, and costs associated with, the mental 
        health services provided for Indian youth through the Service 
        and Tribal Health Programs;
          ``(3) the number of youth referred to the Service or Tribal 
        Health Programs for mental health services;
          ``(4) the number of Indian youth provided residential 
        treatment for mental health and behavioral problems through the 
        Service and Tribal Health Programs, reported separately for on- 
        and off-reservation facilities; and
          ``(5) the costs of the services described in paragraph (4).

``SEC. 708. INDIAN YOUTH TELEMENTAL HEALTH DEMONSTRATION PROJECT.

  ``(a) Purpose.--The purpose of this section is to authorize the 
Secretary to carry out a demonstration project to test the use of 
telemental health services in suicide prevention, intervention and 
treatment of Indian youth, including through--
          ``(1) the use of psychotherapy, psychiatric assessments, 
        diagnostic interviews, therapies for mental health conditions 
        predisposing to suicide, and alcohol and substance abuse 
        treatment;
          ``(2) the provision of clinical expertise to, consultation 
        services with, and medical advice and training for frontline 
        health care providers working with Indian youth;
          ``(3) training and related support for community leaders, 
        family members and health and education workers who work with 
        Indian youth;
          ``(4) the development of culturally-relevant educational 
        materials on suicide; and
          ``(5) data collection and reporting.
  ``(b) Definitions.--For the purpose of this section, the following 
definitions shall apply:
          ``(1) Demonstration project.--The term `demonstration 
        project' means the Indian youth telemental health demonstration 
        project authorized under subsection (c).
          ``(2) Telemental health.--The term `telemental health' means 
        the use of electronic information and telecommunications 
        technologies to support long distance mental health care, 
        patient and professional-related education, public health, and 
        health administration.
  ``(c) Authorization.--
          ``(1) In general.--The Secretary is authorized to award 
        grants under the demonstration project for the provision of 
        telemental health services to Indian youth who--
                  ``(A) have expressed suicidal ideas;
                  ``(B) have attempted suicide; or
                  ``(C) have mental health conditions that increase or 
                could increase the risk of suicide.
          ``(2) Eligibility for grants.--Such grants shall be awarded 
        to Indian Tribes and Tribal Organizations that operate 1 or 
        more facilities--
                  ``(A) located in Alaska and part of the Alaska 
                Federal Health Care Access Network;
                  ``(B) reporting active clinical telehealth 
                capabilities; or
                  ``(C) offering school-based telemental health 
                services relating to psychiatry to Indian youth.
          ``(3) Grant period.--The Secretary shall award grants under 
        this section for a period of up to 4 years.
          ``(4) Awarding of grants.--Not more than 5 grants shall be 
        provided under paragraph (1), with priority consideration given 
        to Indian Tribes and Tribal Organizations that--
                  ``(A) serve a particular community or geographic area 
                where there is a demonstrated need to address Indian 
                youth suicide;
                  ``(B) enter in to collaborative partnerships with 
                Indian Health Service or Tribal Health Programs or 
                facilities to provide services under this demonstration 
                project;
                  ``(C) serve an isolated community or geographic area 
                which has limited or no access to behavioral health 
                services; or
                  ``(D) operate a detention facility at which Indian 
                youth are detained.
  ``(d) Use of Funds.--
          ``(1) In general.--An Indian Tribe or Tribal Organization 
        shall use a grant received under subsection (c) for the 
        following purposes:
                  ``(A) To provide telemental health services to Indian 
                youth, including the provision of--
                          ``(i) psychotherapy;
                          ``(ii) psychiatric assessments and diagnostic 
                        interviews, therapies for mental health 
                        conditions predisposing to suicide, and 
                        treatment; and
                          ``(iii) alcohol and substance abuse 
                        treatment.
                  ``(B) To provide clinician-interactive medical 
                advice, guidance and training, assistance in diagnosis 
                and interpretation, crisis counseling and intervention, 
                and related assistance to Service, tribal, or urban 
                clinicians and health services providers working with 
                youth being served under this demonstration project.
                  ``(C) To assist, educate and train community leaders, 
                health education professionals and paraprofessionals, 
                tribal outreach workers, and family members who work 
                with the youth receiving telemental health services 
                under this demonstration project, including with 
                identification of suicidal tendencies, crisis 
                intervention and suicide prevention, emergency skill 
                development, and building and expanding networks among 
                these individuals and with State and local health 
                services providers.
                  ``(D) To develop and distribute culturally 
                appropriate community educational materials on--
                          ``(i) suicide prevention;
                          ``(ii) suicide education;
                          ``(iii) suicide screening;
                          ``(iv) suicide intervention; and
                          ``(v) ways to mobilize communities with 
                        respect to the identification of risk factors 
                        for suicide.
                  ``(E) For data collection and reporting related to 
                Indian youth suicide prevention efforts.
          ``(2) Traditional health care practices.--In carrying out the 
        purposes described in paragraph (1), an Indian Tribe or Tribal 
        Organization may use and promote the traditional health care 
        practices of the Indian Tribes of the youth to be served.
  ``(e) Applications.--To be eligible to receive a grant under 
subsection (c), an Indian Tribe or Tribal Organization shall prepare 
and submit to the Secretary an application, at such time, in such 
manner, and containing such information as the Secretary may require, 
including--
          ``(1) a description of the project that the Indian Tribe or 
        Tribal Organization will carry out using the funds provided 
        under the grant;
          ``(2) a description of the manner in which the project funded 
        under the grant would--
                  ``(A) meet the telemental health care needs of the 
                Indian youth population to be served by the project; or
                  ``(B) improve the access of the Indian youth 
                population to be served to suicide prevention and 
                treatment services;
          ``(3) evidence of support for the project from the local 
        community to be served by the project;
          ``(4) a description of how the families and leadership of the 
        communities or populations to be served by the project would be 
        involved in the development and ongoing operations of the 
        project;
          ``(5) a plan to involve the tribal community of the youth who 
        are provided services by the project in planning and evaluating 
        the mental health care and suicide prevention efforts provided, 
        in order to ensure the integration of community, clinical, 
        environmental, and cultural components of the treatment; and
          ``(6) a plan for sustaining the project after Federal 
        assistance for the demonstration project has terminated.
  ``(f) Collaboration; Reporting to National Clearinghouse.--
          ``(1) Collaboration.--The Secretary, acting through the 
        Service, shall encourage Indian Tribes and Tribal Organizations 
        receiving grants under this section to collaborate to enable 
        comparisons about best practices across projects.
          ``(2) Reporting to national clearinghouse.--The Secretary, 
        acting through the Service, shall also encourage Indian Tribes 
        and Tribal Organizations receiving grants under this section to 
        submit relevant, declassified project information to the 
        national clearinghouse authorized under section 701(b)(2) in 
        order to better facilitate program performance and improve 
        suicide prevention, intervention, and treatment services.
  ``(g) Annual Report.--Each grant recipient shall submit to the 
Secretary an annual report that--
          ``(1) describes the number of telemental health services 
        provided; and
          ``(2) includes any other information that the Secretary may 
        require.
  ``(h) Report to Congress.--Not later than 270 days after the 
termination of the demonstration project, the Secretary shall submit to 
the Committee on Indian Affairs of the Senate and the Committee on 
Natural Resources and Committee on Energy and Commerce of the House of 
Representatives a final report, based on the annual reports provided by 
grant recipients under subsection (h), that--
          ``(1) describes the results of the projects funded by grants 
        awarded under this section, including any data available which 
        indicates the number of attempted suicides;
          ``(2) evaluates the impact of the telemental health services 
        funded by the grants in reducing the number of completed 
        suicides among Indian youth;
          ``(3) evaluates whether the demonstration project should be--
                  ``(A) expanded to provide more than 5 grants; and
                  ``(B) designated a permanent program; and
          ``(4) evaluates the benefits of expanding the demonstration 
        project to include Urban Indian Organizations.
  ``(i) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section $1,500,000 for each of fiscal 
years 2008 through 2011.

``SEC. 709. INPATIENT AND COMMUNITY-BASED MENTAL HEALTH FACILITIES 
                    DESIGN, CONSTRUCTION, AND STAFFING.

  ``Not later than 1 year after the date of enactment of the Indian 
Health Care Improvement Act Amendments of 2007, the Secretary, acting 
through the Service, Indian Tribes, and Tribal Organizations, may 
provide, in each area of the Service, not less than 1 inpatient mental 
health care facility, or the equivalent, for Indians with behavioral 
health problems. For the purposes of this subsection, California shall 
be considered to be 2 Area Offices, 1 office whose location shall be 
considered to encompass the northern area of the State of California 
and 1 office whose jurisdiction shall be considered to encompass the 
remainder of the State of California. The Secretary shall consider the 
possible conversion of existing, underused Service hospital beds into 
psychiatric units to meet such need.

``SEC. 710. TRAINING AND COMMUNITY EDUCATION.

  ``(a) Program.--The Secretary, in cooperation with the Secretary of 
the Interior, shall develop and implement or assist Indian Tribes and 
Tribal Organizations to develop and implement, within each Service Unit 
or tribal program, a program of community education and involvement 
which shall be designed to provide concise and timely information to 
the community leadership of each tribal community. Such program shall 
include education about behavioral health issues to political leaders, 
Tribal judges, law enforcement personnel, members of tribal health and 
education boards, health care providers including traditional 
practitioners, and other critical members of each tribal community. 
Such program may also include community-based training to develop local 
capacity and tribal community provider training for prevention, 
intervention, treatment, and aftercare.
  ``(b) Instruction.--The Secretary, acting through the Service, shall, 
either directly or through Indian Tribes and Tribal Organizations, 
provide instruction in the area of behavioral health issues, including 
instruction in crisis intervention and family relations in the context 
of alcohol and substance abuse, child sexual abuse, youth alcohol and 
substance abuse, and the causes and effects of fetal alcohol disorders 
to appropriate employees of the Bureau of Indian Affairs and the 
Service, and to personnel in schools or programs operated under any 
contract with the Bureau of Indian Affairs or the Service, including 
supervisors of emergency shelters and halfway houses described in 
section 4213 of the Indian Alcohol and Substance Abuse Prevention and 
Treatment Act of 1986 (25 U.S.C. 2433).
  ``(c) Training Models.--In carrying out the education and training 
programs required by this section, the Secretary, in consultation with 
Indian Tribes, Tribal Organizations, Indian behavioral health experts, 
and Indian alcohol and substance abuse prevention experts, shall 
develop and provide community-based training models. Such models shall 
address--
          ``(1) the elevated risk of alcohol and behavioral health 
        problems faced by children of alcoholics;
          ``(2) the cultural, spiritual, and multigenerational aspects 
        of behavioral health problem prevention and recovery; and
          ``(3) community-based and multidisciplinary strategies for 
        preventing and treating behavioral health problems.

``SEC. 711. BEHAVIORAL HEALTH PROGRAM.

  ``(a) Innovative Programs.--The Secretary, acting through the 
Service, Indian Tribes, and Tribal Organizations, consistent with 
section 701, may plan, develop, implement, and carry out programs to 
deliver innovative community-based behavioral health services to 
Indians.
  ``(b) Awards; Criteria.--The Secretary may award a grant for a 
project under subsection (a) to an Indian Tribe or Tribal Organization 
and may consider the following criteria:
          ``(1) The project will address significant unmet behavioral 
        health needs among Indians.
          ``(2) The project will serve a significant number of Indians.
          ``(3) The project has the potential to deliver services in an 
        efficient and effective manner.
          ``(4) The Indian Tribe or Tribal Organization has the 
        administrative and financial capability to administer the 
        project.
          ``(5) The project may deliver services in a manner consistent 
        with traditional health care practices.
          ``(6) The project is coordinated with, and avoids duplication 
        of, existing services.
  ``(c) Equitable Treatment.--For purposes of this subsection, the 
Secretary shall, in evaluating project applications or proposals, use 
the same criteria that the Secretary uses in evaluating any other 
application or proposal for such funding.

``SEC. 712. FETAL ALCOHOL DISORDER PROGRAMS.

  ``(a) Programs.--
          ``(1) Establishment.--The Secretary, consistent with section 
        701, acting through the Service, Indian Tribes, and Tribal 
        Organizations, is authorized to establish and operate fetal 
        alcohol disorder programs as provided in this section for the 
        purposes of meeting the health status objectives specified in 
        section 3.
          ``(2) Use of funds.--
                  ``(A) In general.--Funding provided pursuant to this 
                section shall be used for the following:
                          ``(i) To develop and provide for Indians 
                        community and in-school training, education, 
                        and prevention programs relating to fetal 
                        alcohol disorders.
                          ``(ii) To identify and provide behavioral 
                        health treatment to high-risk Indian women and 
                        high-risk women pregnant with an Indian's 
                        child.
                          ``(iii) To identify and provide appropriate 
                        psychological services, educational and 
                        vocational support, counseling, advocacy, and 
                        information to fetal alcohol disorder affected 
                        Indians and their families or caretakers.
                          ``(iv) To develop and implement counseling 
                        and support programs in schools for fetal 
                        alcohol disorder affected Indian children.
                          ``(v) To develop prevention and intervention 
                        models which incorporate practitioners of 
                        traditional health care practices, cultural 
                        values, and community involvement.
                          ``(vi) To develop, print, and disseminate 
                        education and prevention materials on fetal 
                        alcohol disorder.
                          ``(vii) To develop and implement, in 
                        consultation with Indian Tribes, Tribal 
                        Organizations, and Urban Indian Organizations, 
                        culturally sensitive assessment and diagnostic 
                        tools including dysmorphology clinics and 
                        multidisciplinary fetal alcohol disorder 
                        clinics for use in Indian communities and Urban 
                        Centers.
                  ``(B) Additional uses.--In addition to any purpose 
                under subparagraph (A), funding provided pursuant to 
                this section may be used for 1 or more of the 
                following:
                          ``(i) Early childhood intervention projects 
                        from birth on to mitigate the effects of fetal 
                        alcohol disorder among Indians.
                          ``(ii) Community-based support services for 
                        Indians and women pregnant with Indian 
                        children.
                          ``(iii) Community-based housing for adult 
                        Indians with fetal alcohol disorder.
          ``(3) Criteria for applications.--The Secretary shall 
        establish criteria for the review and approval of applications 
        for funding under this section.
  ``(b) Services.--The Secretary, acting through the Service and Indian 
Tribes, Tribal Organizations, and Urban Indian Organizations, shall--
          ``(1) develop and provide services for the prevention, 
        intervention, treatment, and aftercare for those affected by 
        fetal alcohol disorder in Indian communities; and
          ``(2) provide supportive services, including services to meet 
        the special educational, vocational, school-to-work transition, 
        and independent living needs of adolescent and adult Indians 
        with fetal alcohol disorder.
  ``(c) Task Force.--The Secretary shall establish a task force to be 
known as the Fetal Alcohol Disorder Task Force to advise the Secretary 
in carrying out subsection (b). Such task force shall be composed of 
representatives from the following:
          ``(1) The National Institute on Drug Abuse.
          ``(2) The National Institute on Alcohol and Alcoholism.
          ``(3) The Office of Substance Abuse Prevention.
          ``(4) The National Institute of Mental Health.
          ``(5) The Service.
          ``(6) The Office of Minority Health of the Department of 
        Health and Human Services.
          ``(7) The Administration for Native Americans.
          ``(8) The National Institute of Child Health and Human 
        Development (NICHD).
          ``(9) The Centers for Disease Control and Prevention.
          ``(10) The Bureau of Indian Affairs.
          ``(11) Indian Tribes.
          ``(12) Tribal Organizations.
          ``(13) Urban Indian Organizations.
          ``(14) Indian fetal alcohol disorder experts.
  ``(d) Applied Research Projects.--The Secretary, acting through the 
Substance Abuse and Mental Health Services Administration, shall make 
grants to Indian Tribes, Tribal Organizations, and Urban Indian 
Organizations for applied research projects which propose to elevate 
the understanding of methods to prevent, intervene, treat, or provide 
rehabilitation and behavioral health aftercare for Indians and Urban 
Indians affected by fetal alcohol disorder.
  ``(e) Funding for Urban Indian Organizations.--Ten percent of the 
funds appropriated pursuant to this section shall be used to make 
grants to Urban Indian Organizations funded under title V.

``SEC. 713. CHILD SEXUAL ABUSE AND PREVENTION TREATMENT PROGRAMS.

  ``(a) Establishment.--The Secretary, acting through the Service, and 
the Secretary of the Interior, Indian Tribes, and Tribal Organizations, 
shall establish, consistent with section 701, in every Service Area, 
programs involving treatment for--
          ``(1) victims of sexual abuse who are Indian children or 
        children in an Indian household; and
          ``(2) perpetrators of child sexual abuse who are Indian or 
        members of an Indian household.
  ``(b) Use of Funds.--Funding provided pursuant to this section shall 
be used for the following:
          ``(1) To develop and provide community education and 
        prevention programs related to sexual abuse of Indian children 
        or children in an Indian household.
          ``(2) To identify and provide behavioral health treatment to 
        victims of sexual abuse who are Indian children or children in 
        an Indian household, and to their family members who are 
        affected by sexual abuse.
          ``(3) To develop prevention and intervention models which 
        incorporate traditional health care practices, cultural values, 
        and community involvement.
          ``(4) To develop and implement culturally sensitive 
        assessment and diagnostic tools for use in Indian communities 
        and Urban Centers.
          ``(5) To identify and provide behavioral health treatment to 
        Indian perpetrators and perpetrators who are members of an 
        Indian household--
                  ``(A) making efforts to begin offender and behavioral 
                health treatment while the perpetrator is incarcerated 
                or at the earliest possible date if the perpetrator is 
                not incarcerated; and
                  ``(B) providing treatment after the perpetrator is 
                released, until it is determined that the perpetrator 
                is not a threat to children.
  ``(c) Coordination.--The programs established under subsection (a) 
shall be carried out in coordination with programs and services 
authorized under the Indian Child Protection and Family Violence 
Prevention Act (25 U.S.C. 3201 et seq.).

``SEC. 714. BEHAVIORAL HEALTH RESEARCH.

  ``The Secretary, in consultation with appropriate Federal agencies, 
shall make grants to, or enter into contracts with, Indian Tribes, 
Tribal Organizations, and Urban Indian Organizations or enter into 
contracts with, or make grants to appropriate institutions for, the 
conduct of research on the incidence and prevalence of behavioral 
health problems among Indians served by the Service, Indian Tribes, or 
Tribal Organizations and among Indians in urban areas. Research 
priorities under this section shall include--
          ``(1) the multifactorial causes of Indian youth suicide, 
        including--
                  ``(A) protective and risk factors and scientific data 
                that identifies those factors; and
                  ``(B) the effects of loss of cultural identity and 
                the development of scientific data on those effects;
          ``(2) the interrelationship and interdependence of behavioral 
        health problems with alcoholism and other substance abuse, 
        suicide, homicides, other injuries, and the incidence of family 
        violence; and
          ``(3) the development of models of prevention techniques.
The effect of the interrelationships and interdependencies referred to 
in paragraph (2) on children, and the development of prevention 
techniques under paragraph (3) applicable to children, shall be 
emphasized.

``SEC. 715. DEFINITIONS.

  ``For the purpose of this title, the following definitions shall 
apply:
          ``(1) Assessment.--The term `assessment' means the systematic 
        collection, analysis, and dissemination of information on 
        health status, health needs, and health problems.
          ``(2) Alcohol-related neurodevelopmental disorders or arnd.--
        The term `alcohol-related neurodevelopmental disorders' or 
        `ARND' means, with a history of maternal alcohol consumption 
        during pregnancy, central nervous system involvement such as 
        developmental delay, intellectual deficit, or neurologic 
        abnormalities. Behaviorally, there can be problems with 
        irritability, and failure to thrive as infants. As children 
        become older there will likely be hyperactivity, attention 
        deficit, language dysfunction, and perceptual and judgment 
        problems.
          ``(3) Behavioral health aftercare.--The term `behavioral 
        health aftercare' includes those activities and resources used 
        to support recovery following inpatient, residential, intensive 
        substance abuse, or mental health outpatient or outpatient 
        treatment. The purpose is to help prevent or deal with relapse 
        by ensuring that by the time a client or patient is discharged 
        from a level of care, such as outpatient treatment, an 
        aftercare plan has been developed with the client. An aftercare 
        plan may use such resources as a community-based therapeutic 
        group, transitional living facilities, a 12-step sponsor, a 
        local 12-step or other related support group, and other 
        community-based providers.
          ``(4) Dual diagnosis.--The term `dual diagnosis' means 
        coexisting substance abuse and mental illness conditions or 
        diagnosis. Such clients are sometimes referred to as mentally 
        ill chemical abusers (MICAs).
          ``(5) Fetal alcohol disorders.--The term `fetal alcohol 
        disorders' means fetal alcohol syndrome, partial fetal alcohol 
        syndrome and alcohol related neurodevelopmental disorder 
        (ARND).
          ``(6) Fetal alcohol syndrome or fas.--The term `fetal alcohol 
        syndrome' or `FAS' means a syndrome in which, with a history of 
        maternal alcohol consumption during pregnancy, the following 
        criteria are met:
                  ``(A) Central nervous system involvement such as 
                developmental delay, intellectual deficit, 
                microencephaly, or neurologic abnormalities.
                  ``(B) Craniofacial abnormalities with at least 2 of 
                the following: microophthalmia, short palpebral 
                fissures, poorly developed philtrum, thin upper lip, 
                flat nasal bridge, and short upturned nose.
                  ``(C) Prenatal or postnatal growth delay.
          ``(7) Partial fas.--The term `partial FAS' means, with a 
        history of maternal alcohol consumption during pregnancy, 
        having most of the criteria of FAS, though not meeting a 
        minimum of at least 2 of the following: microophthalmia, short 
        palpebral fissures, poorly developed philtrum, thin upper lip, 
        flat nasal bridge, and short upturned nose.
          ``(8) Rehabilitation.--The term `rehabilitation' means to 
        restore the ability or capacity to engage in usual and 
        customary life activities through education and therapy.
          ``(9) Substance abuse.--The term `substance abuse' includes 
        inhalant abuse.

``SEC. 716. AUTHORIZATION OF APPROPRIATIONS.

  ``There is authorized to be appropriated such sums as may be 
necessary for each fiscal year through fiscal year 2017 to carry out 
the provisions of this title.

                      ``TITLE VIII--MISCELLANEOUS

``SEC. 801. REPORTS.

  ``For each fiscal year following the date of enactment of the Indian 
Health Care Improvement Act Amendments of 2007, the Secretary shall 
transmit to Congress a report containing the following:
          ``(1) A report on the progress made in meeting the objectives 
        of this Act, including a review of programs established or 
        assisted pursuant to this Act and assessments and 
        recommendations of additional programs or additional assistance 
        necessary to, at a minimum, provide health services to Indians 
        and ensure a health status for Indians, which are at a parity 
        with the health services available to and the health status of 
        the general population.
          ``(2) A report on whether, and to what extent, new national 
        health care programs, benefits, initiatives, or financing 
        systems have had an impact on the purposes of this Act and any 
        steps that the Secretary may have taken to consult with Indian 
        Tribes, Tribal Organizations, and Urban Indian Organizations to 
        address such impact, including a report on proposed changes in 
        allocation of funding pursuant to section 808.
          ``(3) A report on the use of health services by Indians--
                  ``(A) on a national and area or other relevant 
                geographical basis;
                  ``(B) by gender and age;
                  ``(C) by source of payment and type of service;
                  ``(D) comparing such rates of use with rates of use 
                among comparable non-Indian populations; and
                  ``(E) provided under contracts.
          ``(4) A report of contractors to the Secretary on Health Care 
        Educational Loan Repayments every 6 months required by section 
        110.
          ``(5) A general audit report of the Secretary on the Health 
        Care Educational Loan Repayment Program as required by section 
        110(n).
          ``(6) A report of the findings and conclusions of 
        demonstration programs on development of educational curricula 
        for substance abuse counseling as required in section 125(f).
          ``(7) A separate statement which specifies the amount of 
        funds requested to carry out the provisions of section 201.
          ``(8) A report of the evaluations of health promotion and 
        disease prevention as required in section 203(c).
          ``(9) A biennial report to Congress on infectious diseases as 
        required by section 212.
          ``(10) A report on environmental and nuclear health hazards 
        as required by section 215.
          ``(11) An annual report on the status of all health care 
        facilities needs as required by section 301(c)(2)(B) and 
        301(d).
          ``(12) Reports on safe water and sanitary waste disposal 
        facilities as required by section 302(h).
          ``(13) An annual report on the expenditure of non-Service 
        funds for renovation as required by sections 304(b)(2).
          ``(14) A report identifying the backlog of maintenance and 
        repair required at Service and tribal facilities required by 
        section 313(a).
          ``(15) A report providing an accounting of reimbursement 
        funds made available to the Secretary under titles XVIII, XIX, 
        and XXI of the Social Security Act.
          ``(16) A report on any arrangements for the sharing of 
        medical facilities or services, as authorized by section 406.
          ``(17) A report on evaluation and renewal of Urban Indian 
        programs under section 505.
          ``(18) A report on the evaluation of programs as required by 
        section 513(d).
          ``(19) A report on alcohol and substance abuse as required by 
        section 701(f).
          ``(20) A report on Indian youth mental health services as 
        required by section 707(h).
          ``(21) A report on the reallocation of base resources if 
        required by section 808.
          ``(22) Report regarding patient movement.--A report on the 
        movement of patients between Service Units, including--
                  ``(A) a list of those Service Units that have a net 
                increase and those that have a net decrease of patients 
                due to patients assigned to one Service Unit 
                voluntarily choosing to receive service at another 
                Service Unit;
                  ``(B) an analysis of the effect of patient movement 
                on the quality of services for those Service Units 
                experiencing an increase in the number of patients 
                served; and
                  ``(C) what funding changes are necessary to maintain 
                a consistent quality of service at Service Units that 
                have an increase in the number of patients served.

``SEC. 802. REGULATIONS.

  ``(a) Deadlines.--
          ``(1) Procedures.--Not later than 90 days after the date of 
        enactment of the Indian Health Care Improvement Act Amendments 
        of 2007, the Secretary shall initiate procedures under 
        subchapter III of chapter 5 of title 5, United States Code, to 
        negotiate and promulgate such regulations or amendments thereto 
        that are necessary to carry out titles II (except section 202) 
        and VII, the sections of title III for which negotiated 
        rulemaking is specifically required, and section 807. Unless 
        otherwise required, the Secretary may promulgate regulations to 
        carry out titles I, III, IV, and V, and section 202, using the 
        procedures required by chapter V of title 5, United States Code 
        (commonly known as the `Administrative Procedure Act').
          ``(2) Proposed regulations.--Proposed regulations to 
        implement this Act shall be published in the Federal Register 
        by the Secretary no later than 2 years after the date of 
        enactment of the Indian Health Care Improvement Act Amendments 
        of 2007 and shall have no less than a 120-day comment period.
          ``(3) Final regulations.--The Secretary shall publish in the 
        Federal Register final regulations to implement this Act by not 
        later than 3 years after the date of enactment of the Indian 
        Health Care Improvement Act Amendments of 2007.
  ``(b) Committee.--A negotiated rulemaking committee established 
pursuant to section 565 of title 5, United States Code, to carry out 
this section shall have as its members only representatives of the 
Federal Government and representatives of Indian Tribes, and Tribal 
Organizations, a majority of whom shall be nominated by and be 
representatives of Indian Tribes and Tribal Organizations from each 
Service Area.
  ``(c) Adaptation of Procedures.--The Secretary shall adapt the 
negotiated rulemaking procedures to the unique context of self-
governance and the government-to-government relationship between the 
United States and Indian Tribes.
  ``(d) Lack of Regulations.--The lack of promulgated regulations shall 
not limit the effect of this Act.
  ``(e) Inconsistent Regulations.--The provisions of this Act shall 
supersede any conflicting provisions of law in effect on the day before 
the date of enactment of the Indian Health Care Improvement Act 
Amendments of 2007, and the Secretary is authorized to repeal any 
regulation inconsistent with the provisions of this Act.

``SEC. 803. PLAN OF IMPLEMENTATION.

  ``Not later than 9 months after the date of enactment of the Indian 
Health Care Improvement Act Amendments of 2007, the Secretary, in 
consultation with Indian Tribes, Tribal Organizations, and Urban Indian 
Organizations, shall submit to Congress a plan explaining the manner 
and schedule, by title and section, by which the Secretary will 
implement the provisions of this Act. This consultation may be 
conducted jointly with the annual budget consultation pursuant to the 
Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 
et seq).

``SEC. 804. AVAILABILITY OF FUNDS.

  ``The funds appropriated pursuant to this Act shall remain available 
until expended.

``SEC. 805. LIMITATION ON USE OF FUNDS APPROPRIATED TO INDIAN HEALTH 
                    SERVICE.

  ``Any limitation on the use of funds contained in an Act providing 
appropriations for the Department for a period with respect to the 
performance of abortions shall apply for that period with respect to 
the performance of abortions using funds contained in an Act providing 
appropriations for the Service.

``SEC. 806. ELIGIBILITY OF CALIFORNIA INDIANS.

  ``(a) In General.--The following California Indians shall be eligible 
for health services provided by the Service:
          ``(1) Any member of a federally recognized Indian Tribe.
          ``(2) Any descendant of an Indian who was residing in 
        California on June 1, 1852, if such descendant--
                  ``(A) is a member of the Indian community served by a 
                local program of the Service; and
                  ``(B) is regarded as an Indian by the community in 
                which such descendant lives.
          ``(3) Any Indian who holds trust interests in public domain, 
        national forest, or reservation allotments in California.
          ``(4) Any Indian in California who is listed on the plans for 
        distribution of the assets of rancherias and reservations 
        located within the State of California under the Act of August 
        18, 1958 (72 Stat. 619), and any descendant of such an Indian.
  ``(b) Clarification.--Nothing in this section may be construed as 
expanding the eligibility of California Indians for health services 
provided by the Service beyond the scope of eligibility for such health 
services that applied on May 1, 1986.

``SEC. 807. HEALTH SERVICES FOR INELIGIBLE PERSONS.

  ``(a) Children.--Any individual who--
          ``(1) has not attained 19 years of age;
          ``(2) is the natural or adopted child, stepchild, foster 
        child, legal ward, or orphan of an eligible Indian; and
          ``(3) is not otherwise eligible for health services provided 
        by the Service,
shall be eligible for all health services provided by the Service on 
the same basis and subject to the same rules that apply to eligible 
Indians until such individual attains 19 years of age. The existing and 
potential health needs of all such individuals shall be taken into 
consideration by the Service in determining the need for, or the 
allocation of, the health resources of the Service. If such an 
individual has been determined to be legally incompetent prior to 
attaining 19 years of age, such individual shall remain eligible for 
such services until 1 year after the date of a determination of 
competency.
  ``(b) Spouses.--Any spouse of an eligible Indian who is not an 
Indian, or who is of Indian descent but is not otherwise eligible for 
the health services provided by the Service, shall be eligible for such 
health services if all such spouses or spouses who are married to 
members of each Indian Tribe being served are made eligible, as a 
class, by an appropriate resolution of the governing body of the Indian 
Tribe or Tribal Organization providing such services. The health needs 
of persons made eligible under this paragraph shall not be taken into 
consideration by the Service in determining the need for, or allocation 
of, its health resources.
  ``(c) Provision of Services to Other Individuals.--
          ``(1) In general.--The Secretary is authorized to provide 
        health services under this subsection through health programs 
        operated directly by the Service to individuals who reside 
        within the Service Unit and who are not otherwise eligible for 
        such health services if--
                  ``(A) the Indian Tribes served by such Service Unit 
                request such provision of health services to such 
                individuals; and
                  ``(B) the Secretary and the served Indian Tribes have 
                jointly determined that--
                          ``(i) the provision of such health services 
                        will not result in a denial or diminution of 
                        health services to eligible Indians; and
                          ``(ii) there is no reasonable alternative 
                        health facilities or services, within or 
                        without the Service Unit, available to meet the 
                        health needs of such individuals.
          ``(2) ISDEAA programs.--In the case of health programs and 
        facilities operated under a contract or compact entered into 
        under the Indian Self-Determination and Education Assistance 
        Act (25 U.S.C. 450 et seq.), the governing body of the Indian 
        Tribe or Tribal Organization providing health services under 
        such contract or compact is authorized to determine whether 
        health services should be provided under such contract to 
        individuals who are not eligible for such health services under 
        any other subsection of this section or under any other 
        provision of law. In making such determinations, the governing 
        body of the Indian Tribe or Tribal Organization shall take into 
        account the considerations described in paragraph (1)(B).
          ``(3) Payment for services.--
                  ``(A) In general.--Persons receiving health services 
                provided by the Service under this subsection shall be 
                liable for payment of such health services under a 
                schedule of charges prescribed by the Secretary which, 
                in the judgment of the Secretary, results in 
                reimbursement in an amount not less than the actual 
                cost of providing the health services. Notwithstanding 
                section 404 of this Act or any other provision of law, 
                amounts collected under this subsection, including 
                Medicare, Medicaid, or SCHIP reimbursements under 
                titles XVIII, XIX, and XXI of the Social Security Act, 
                shall be credited to the account of the program 
                providing the service and shall be used for the 
                purposes listed in section 401(d)(2) and amounts 
                collected under this subsection shall be available for 
                expenditure within such program.
                  ``(B) Indigent people.--Health services may be 
                provided by the Secretary through the Service under 
                this subsection to an indigent individual who would not 
                be otherwise eligible for such health services but for 
                the provisions of paragraph (1) only if an agreement 
                has been entered into with a State or local government 
                under which the State or local government agrees to 
                reimburse the Service for the expenses incurred by the 
                Service in providing such health services to such 
                indigent individual.
          ``(4) Revocation of consent for services.--
                  ``(A) Single tribe service area.--In the case of a 
                Service Area which serves only 1 Indian Tribe, the 
                authority of the Secretary to provide health services 
                under paragraph (1) shall terminate at the end of the 
                fiscal year succeeding the fiscal year in which the 
                governing body of the Indian Tribe revokes its 
                concurrence to the provision of such health services.
                  ``(B) Multitribal service area.--In the case of a 
                multitribal Service Area, the authority of the 
                Secretary to provide health services under paragraph 
                (1) shall terminate at the end of the fiscal year 
                succeeding the fiscal year in which at least 51 percent 
                of the number of Indian Tribes in the Service Area 
                revoke their concurrence to the provisions of such 
                health services.
  ``(d) Other Services.--The Service may provide health services under 
this subsection to individuals who are not eligible for health services 
provided by the Service under any other provision of law in order to--
          ``(1) achieve stability in a medical emergency;
          ``(2) prevent the spread of a communicable disease or 
        otherwise deal with a public health hazard;
          ``(3) provide care to non-Indian women pregnant with an 
        eligible Indian's child for the duration of the pregnancy 
        through postpartum; or
          ``(4) provide care to immediate family members of an eligible 
        individual if such care is directly related to the treatment of 
        the eligible individual.
  ``(e) Hospital Privileges for Practitioners.--Hospital privileges in 
health facilities operated and maintained by the Service or operated 
under a contract or compact pursuant to the Indian Self-Determination 
and Education Assistance Act (25 U.S.C. 450 et seq.) may be extended to 
non-Service health care practitioners who provide services to 
individuals described in subsection (a), (b), (c), or (d). Such non-
Service health care practitioners may, as part of the privileging 
process, be designated as employees of the Federal Government for 
purposes of section 1346(b) and chapter 171 of title 28, United States 
Code (relating to Federal tort claims) only with respect to acts or 
omissions which occur in the course of providing services to eligible 
individuals as a part of the conditions under which such hospital 
privileges are extended.
  ``(f) Eligible Indian.--For purposes of this section, the term 
`eligible Indian' means any Indian who is eligible for health services 
provided by the Service without regard to the provisions of this 
section.

``SEC. 808. REALLOCATION OF BASE RESOURCES.

  ``(a) Report Required.--Notwithstanding any other provision of law, 
any allocation of Service funds for a fiscal year that reduces by 5 
percent or more from the previous fiscal year the funding for any 
recurring program, project, or activity of a Service Unit may be 
implemented only after the Secretary has submitted to Congress, under 
section 801, a report on the proposed change in allocation of funding, 
including the reasons for the change and its likely effects.
  ``(b) Exception.--Subsection (a) shall not apply if the total amount 
appropriated to the Service for a fiscal year is at least 5 percent 
less than the amount appropriated to the Service for the previous 
fiscal year.

``SEC. 809. RESULTS OF DEMONSTRATION PROJECTS.

  ``The Secretary shall provide for the dissemination to Indian Tribes, 
Tribal Organizations, and Urban Indian Organizations of the findings 
and results of demonstration projects conducted under this Act.

``SEC. 810. PROVISION OF SERVICES IN MONTANA.

  ``(a) Consistent With Court Decision.--The Secretary, acting through 
the Service, shall provide services and benefits for Indians in Montana 
in a manner consistent with the decision of the United States Court of 
Appeals for the Ninth Circuit in McNabb for McNabb v. Bowen, 829 F.2d 
787 (9th Cir. 1987).
  ``(b) Clarification.--The provisions of subsection (a) shall not be 
construed to be an expression of the sense of Congress on the 
application of the decision described in subsection (a) with respect to 
the provision of services or benefits for Indians living in any State 
other than Montana.

``SEC. 811. MORATORIUM.

  ``During the period of the moratorium imposed on implementation of 
the final rule published in the Federal Register on September 16, 1987, 
by the Department of Health and Human Services, relating to eligibility 
for the health care services of the Indian Health Service, the Indian 
Health Service shall provide services pursuant to the criteria for 
eligibility for such services that were in effect on September 15, 
1987, subject to the provisions of sections 806 and 807, until the 
Service has submitted to the Committees on Appropriations of the Senate 
and the House of Representatives a budget request reflecting the 
increased costs associated with the proposed final rule, and the 
request has been included in an appropriations Act and enacted into 
law.

``SEC. 812. SEVERABILITY PROVISIONS.

  ``If any provision of this Act, any amendment made by the Act, or the 
application of such provision or amendment to any person or 
circumstances is held to be invalid, the remainder of this Act, the 
remaining amendments made by this Act, and the application of such 
provisions to persons or circumstances other than those to which it is 
held invalid, shall not be affected thereby.

``SEC. 813. ESTABLISHMENT OF NATIONAL BIPARTISAN COMMISSION ON INDIAN 
                    HEALTH CARE.

  ``(a) Establishment.--There is established the National Bipartisan 
Indian Health Care Commission (the `Commission').
  ``(b) Duties of Commission.--The duties of the Commission are the 
following:
          ``(1) To establish a study committee composed of those 
        members of the Commission appointed by the Director of the 
        Service and at least 4 members of Congress from among the 
        members of the Commission, the duties of which shall be the 
        following:
                  ``(A) To the extent necessary to carry out its 
                duties, collect and compile data necessary to 
                understand the extent of Indian needs with regard to 
                the provision of health services, regardless of the 
                location of Indians, including holding hearings and 
                soliciting the views of Indians, Indian Tribes, Tribal 
                Organizations, and Urban Indian Organizations, which 
                may include authorizing and making funds available for 
                feasibility studies of various models for providing and 
                funding health services for all Indian beneficiaries, 
                including those who live outside of a reservation, 
                temporarily or permanently.
                  ``(B) To make legislative recommendations to the 
                Commission regarding the delivery of Federal health 
                care services to Indians. Such recommendations shall 
                include those related to issues of eligibility, 
                benefits, the range of service providers, the cost of 
                such services, financing such services, and the optimal 
                manner in which to provide such services.
                  ``(C) To determine the effect of the enactment of 
                such recommendations on (i) the existing system of 
                delivery of health services for Indians, and (ii) the 
                sovereign status of Indian Tribes.
                  ``(D) Not later than 12 months after the appointment 
                of all members of the Commission, to submit a written 
                report of its findings and recommendations to the full 
                Commission. The report shall include a statement of the 
                minority and majority position of the Committee and 
                shall be disseminated, at a minimum, to every Indian 
                Tribe, Tribal Organization, and Urban Indian 
                Organization for comment to the Commission.
                  ``(E) To report regularly to the full Commission 
                regarding the findings and recommendations developed by 
                the study committee in the course of carrying out its 
                duties under this section.
          ``(2) To review and analyze the recommendations of the report 
        of the study committee.
          ``(3) To make legislative recommendations to Congress 
        regarding the delivery of Federal health care services to 
        Indians. Such recommendations shall include those related to 
        issues of eligibility, benefits, the range of service 
        providers, the cost of such services, financing such services, 
        and the optimal manner in which to provide such services.
          ``(4) Not later than 18 months following the date of 
        appointment of all members of the Commission, submit a written 
        report to Congress regarding the delivery of Federal health 
        care services to Indians. Such recommendations shall include 
        those related to issues of eligibility, benefits, the range of 
        service providers, the cost of such services, financing such 
        services, and the optimal manner in which to provide such 
        services.
  ``(c) Members.--
          ``(1) Appointment.--The Commission shall be composed of 25 
        members, appointed as follows:
                  ``(A) Ten members of Congress, including 3 from the 
                House of Representatives and 2 from the Senate, 
                appointed by their respective majority leaders, and 3 
                from the House of Representatives and 2 from the 
                Senate, appointed by their respective minority leaders, 
                and who shall be members of the standing committees of 
                Congress that consider legislation affecting health 
                care to Indians.
                  ``(B) Twelve persons chosen by the congressional 
                members of the Commission, 1 from each Service Area as 
                currently designated by the Director of the Service to 
                be chosen from among 3 nominees from each Service Area 
                put forward by the Indian Tribes within the area, with 
                due regard being given to the experience and expertise 
                of the nominees in the provision of health care to 
                Indians and to a reasonable representation on the 
                commission of members who are familiar with various 
                health care delivery modes and who represent Indian 
                Tribes of various size populations.
                  ``(C) Three persons appointed by the Director who are 
                knowledgeable about the provision of health care to 
                Indians, at least 1 of whom shall be appointed from 
                among 3 nominees put forward by those programs whose 
                funds are provided in whole or in part by the Service 
                primarily or exclusively for the benefit of Urban 
                Indians.
                  ``(D) All those persons chosen by the congressional 
                members of the Commission and by the Director shall be 
                members of federally recognized Indian Tribes.
          ``(2) Chair; vice chair.--The Chair and Vice Chair of the 
        Commission shall be selected by the congressional members of 
        the Commission.
          ``(3) Terms.--The terms of members of the Commission shall be 
        for the life of the Commission.
          ``(4) Deadline for appointments.--Congressional members of 
        the Commission shall be appointed not later than 180 days after 
        the date of enactment of the Indian Health Care Improvement Act 
        Amendments of 2007, and the remaining members of the Commission 
        shall be appointed not later than 60 days following the 
        appointment of the congressional members.
          ``(5) Vacancy.--A vacancy in the Commission shall be filled 
        in the manner in which the original appointment was made.
  ``(d) Compensation.--
          ``(1) Congressional members.--Each congressional member of 
        the Commission shall receive no additional pay, allowances, or 
        benefits by reason of their service on the Commission and shall 
        receive travel expenses and per diem in lieu of subsistence in 
        accordance with sections 5702 and 5703 of title 5, United 
        States Code.
          ``(2) Other members.--Remaining members of the Commission, 
        while serving on the business of the Commission (including 
        travel time), shall be entitled to receive compensation at the 
        per diem equivalent of the rate provided for level IV of the 
        Executive Schedule under section 5315 of title 5, United States 
        Code, and while so serving away from home and the member's 
        regular place of business, a member may be allowed travel 
        expenses, as authorized by the Chairman of the Commission. For 
        purpose of pay (other than pay of members of the Commission) 
        and employment benefits, rights, and privileges, all personnel 
        of the Commission shall be treated as if they were employees of 
        the United States Senate.
  ``(e) Meetings.--The Commission shall meet at the call of the Chair.
  ``(f) Quorum.--A quorum of the Commission shall consist of not less 
than 15 members, provided that no less than 6 of the members of 
Congress who are Commission members are present and no less than 9 of 
the members who are Indians are present.
  ``(g) Executive Director; Staff; Facilities.--
          ``(1) Appointment; pay.--The Commission shall appoint an 
        executive director of the Commission. The executive director 
        shall be paid the rate of basic pay for level V of the 
        Executive Schedule.
          ``(2) Staff appointment.--With the approval of the 
        Commission, the executive director may appoint such personnel 
        as the executive director deems appropriate.
          ``(3) Staff pay.--The staff of the Commission shall be 
        appointed without regard to the provisions of title 5, United 
        States Code, governing appointments in the competitive service, 
        and shall be paid without regard to the provisions of chapter 
        51 and subchapter III of chapter 53 of such title (relating to 
        classification and General Schedule pay rates).
          ``(4) Temporary services.--With the approval of the 
        Commission, the executive director may procure temporary and 
        intermittent services under section 3109(b) of title 5, United 
        States Code.
          ``(5) Facilities.--The Administrator of General Services 
        shall locate suitable office space for the operation of the 
        Commission. The facilities shall serve as the headquarters of 
        the Commission and shall include all necessary equipment and 
        incidentals required for the proper functioning of the 
        Commission.
  ``(h) Hearings.--(1) For the purpose of carrying out its duties, the 
Commission may hold such hearings and undertake such other activities 
as the Commission determines to be necessary to carry out its duties, 
provided that at least 6 regional hearings are held in different areas 
of the United States in which large numbers of Indians are present. 
Such hearings are to be held to solicit the views of Indians regarding 
the delivery of health care services to them. To constitute a hearing 
under this subsection, at least 5 members of the Commission, including 
at least 1 member of Congress, must be present. Hearings held by the 
study committee established in this section may count toward the number 
of regional hearings required by this subsection.
  ``(2) Upon request of the Commission, the Comptroller General shall 
conduct such studies or investigations as the Commission determines to 
be necessary to carry out its duties.
  ``(3)(A) The Director of the Congressional Budget Office or the Chief 
Actuary of the Centers for Medicare & Medicaid Services, or both, shall 
provide to the Commission, upon the request of the Commission, such 
cost estimates as the Commission determines to be necessary to carry 
out its duties.
  ``(B) The Commission shall reimburse the Director of the 
Congressional Budget Office for expenses relating to the employment in 
the office of that Director of such additional staff as may be 
necessary for the Director to comply with requests by the Commission 
under subparagraph (A).
  ``(4) Upon the request of the Commission, the head of any Federal 
agency is authorized to detail, without reimbursement, any of the 
personnel of such agency to the Commission to assist the Commission in 
carrying out its duties. Any such detail shall not interrupt or 
otherwise affect the civil service status or privileges of the Federal 
employee.
  ``(5) Upon the request of the Commission, the head of a Federal 
agency shall provide such technical assistance to the Commission as the 
Commission determines to be necessary to carry out its duties.
  ``(6) The Commission may use the United States mails in the same 
manner and under the same conditions as Federal agencies and shall, for 
purposes of the frank, be considered a commission of Congress as 
described in section 3215 of title 39, United States Code.
  ``(7) The Commission may secure directly from any Federal agency 
information necessary to enable it to carry out its duties, if the 
information may be disclosed under section 552 of title 4, United 
States Code. Upon request of the Chairman of the Commission, the head 
of such agency shall furnish such information to the Commission.
  ``(8) Upon the request of the Commission, the Administrator of 
General Services shall provide to the Commission on a reimbursable 
basis such administrative support services as the Commission may 
request.
  ``(9) For purposes of costs relating to printing and binding, 
including the cost of personnel detailed from the Government Printing 
Office, the Commission shall be deemed to be a committee of Congress.
  ``(i) Authorization of Appropriations.--There is authorized to be 
appropriated $4,000,000 to carry out the provisions of this section, 
which sum shall not be deducted from or affect any other appropriation 
for health care for Indian persons.
  ``(j) Nonapplicability of FACA.--The Federal Advisory Committee Act 
(5 U.S.C. App.) shall not apply to the Commission.

``SEC. 814. CONFIDENTIALITY OF MEDICAL QUALITY ASSURANCE RECORDS; 
                    QUALIFIED IMMUNITY FOR PARTICIPANTS.

  ``(a) Confidentiality of Records.--Medical quality assurance records 
created by or for any Indian Health Program or a health program of an 
Urban Indian Organization as part of a medical quality assurance 
program are confidential and privileged. Such records may not be 
disclosed to any person or entity, except as provided in subsection 
(c).
  ``(b) Prohibition on Disclosure and Testimony.--
          ``(1) In general.--No part of any medical quality assurance 
        record described in subsection (a) may be subject to discovery 
        or admitted into evidence in any judicial or administrative 
        proceeding, except as provided in subsection (c).
          ``(2) Testimony.--A person who reviews or creates medical 
        quality assurance records for any Indian Health Program or 
        Urban Indian Organization who participates in any proceeding 
        that reviews or creates such records may not be permitted or 
        required to testify in any judicial or administrative 
        proceeding with respect to such records or with respect to any 
        finding, recommendation, evaluation, opinion, or action taken 
        by such person or body in connection with such records except 
        as provided in this section.
  ``(c) Authorized Disclosure and Testimony.--
          ``(1) In general.--Subject to paragraph (2), a medical 
        quality assurance record described in subsection (a) may be 
        disclosed, and a person referred to in subsection (b) may give 
        testimony in connection with such a record, only as follows:
                  ``(A) To a Federal executive agency or private 
                organization, if such medical quality assurance record 
                or testimony is needed by such agency or organization 
                to perform licensing or accreditation functions related 
                to any Indian Health Program or to a health program of 
                an Urban Indian Organization to perform monitoring, 
                required by law, of such program or organization.
                  ``(B) To an administrative or judicial proceeding 
                commenced by a present or former Indian Health Program 
                or Urban Indian Organization provider concerning the 
                termination, suspension, or limitation of clinical 
                privileges of such health care provider.
                  ``(C) To a governmental board or agency or to a 
                professional health care society or organization, if 
                such medical quality assurance record or testimony is 
                needed by such board, agency, society, or organization 
                to perform licensing, credentialing, or the monitoring 
                of professional standards with respect to any health 
                care provider who is or was an employee of any Indian 
                Health Program or Urban Indian Organization.
                  ``(D) To a hospital, medical center, or other 
                institution that provides health care services, if such 
                medical quality assurance record or testimony is needed 
                by such institution to assess the professional 
                qualifications of any health care provider who is or 
                was an employee of any Indian Health Program or Urban 
                Indian Organization and who has applied for or been 
                granted authority or employment to provide health care 
                services in or on behalf of such program or 
                organization.
                  ``(E) To an officer, employee, or contractor of the 
                Indian Health Program or Urban Indian Organization that 
                created the records or for which the records were 
                created. If that officer, employee, or contractor has a 
                need for such record or testimony to perform official 
                duties.
                  ``(F) To a criminal or civil law enforcement agency 
                or instrumentality charged under applicable law with 
                the protection of the public health or safety, if a 
                qualified representative of such agency or 
                instrumentality makes a written request that such 
                record or testimony be provided for a purpose 
                authorized by law.
                  ``(G) In an administrative or judicial proceeding 
                commenced by a criminal or civil law enforcement agency 
                or instrumentality referred to in subparagraph (F), but 
                only with respect to the subject of such proceeding.
          ``(2) Identity of participants.--With the exception of the 
        subject of a quality assurance action, the identity of any 
        person receiving health care services from any Indian Health 
        Program or Urban Indian Organization or the identity of any 
        other person associated with such program or organization for 
        purposes of a medical quality assurance program that is 
        disclosed in a medical quality assurance record described in 
        subsection (a) shall be deleted from that record or document 
        before any disclosure of such record is made outside such 
        program or organization. Such requirement does not apply to the 
        release of information pursuant to section 552a of title 5.
  ``(d) Disclosure for Certain Purposes.--
          ``(1) In general.--Nothing in this section shall be construed 
        as authorizing or requiring the withholding from any person or 
        entity aggregate statistical information regarding the results 
        of any Indian Health Program or Urban Indian Organizations's 
        medical quality assurance programs.
          ``(2) Withholding from congress.--Nothing in this section 
        shall be construed as authority to withhold any medical quality 
        assurance record from a committee of either House of Congress, 
        any joint committee of Congress, or the Government 
        Accountability Office if such record pertains to any matter 
        within their respective jurisdictions.
  ``(e) Prohibition on Disclosure of Record or Testimony.--A person or 
entity having possession of or access to a record or testimony 
described by this section may not disclose the contents of such record 
or testimony in any manner or for any purpose except as provided in 
this section.
  ``(f) Exemption From Freedom of Information Act.--Medical quality 
assurance records described in subsection (a) may not be made available 
to any person under section 552 of title 5.
  ``(g) Limitation on Civil Liability.--A person who participates in or 
provides information to a person or body that reviews or creates 
medical quality assurance records described in subsection (a) shall not 
be civilly liable for such participation or for providing such 
information if the participation or provision of information was in 
good faith based on prevailing professional standards at the time the 
medical quality assurance program activity took place.
  ``(h) Application to Information in Certain Other Records.--Nothing 
in this section shall be construed as limiting access to the 
information in a record created and maintained outside a medical 
quality assurance program, including a patient's medical records, on 
the grounds that the information was presented during meetings of a 
review body that are part of a medical quality assurance program.
  ``(i) Regulations.--The Secretary, acting through the Service, shall 
promulgate regulations pursuant to section 802.
  ``(j) Definitions.--In this section:
          ``(1) The term `health care provider' means any health care 
        professional, including community health aides and 
        practitioners certified under section 121, who are granted 
        clinical practice privileges or employed to provide health care 
        services in an Indian Health Program or health program of an 
        Urban Indian Organization, who is licensed or certified to 
        perform health care services by a governmental board or agency 
        or professional health care society or organization.
          ``(2) The term `medical quality assurance program' means any 
        activity carried out before, on, or after the date of enactment 
        of this Act by or for any Indian Health Program or Urban Indian 
        Organization to assess the quality of medical care, including 
        activities conducted by or on behalf of individuals, Indian 
        Health Program or Urban Indian Organization medical or dental 
        treatment review committees, or other review bodies responsible 
        for quality assurance, credentials, infection control, patient 
        safety, patient care assessment (including treatment 
        procedures, blood, drugs, and therapeutics), medical records, 
        health resources management review and identification and 
        prevention of medical or dental incidents and risks.
          ``(3) The term `medical quality assurance record' means the 
        proceedings, records, minutes, and reports that emanate from 
        quality assurance program activities described in paragraph (2) 
        and are produced or compiled by or for an Indian Health Program 
        or Urban Indian Organization as part of a medical quality 
        assurance program.

``SEC. 815. APPROPRIATIONS; AVAILABILITY.

  ``Any new spending authority (described in subparagraph (A) or (B) of 
section 401(c)(2) of the Congressional Budget Act of 1974 (Public Law 
93-344; 88 Stat. 317)) which is provided under this Act shall be 
effective for any fiscal year only to such extent or in such amounts as 
are provided in appropriation Acts.

``SEC. 816. AUTHORIZATION OF APPROPRIATIONS.

  ``There are authorized to be appropriated such sums as may be 
necessary for each fiscal year through fiscal year 2017 to carry out 
this title.''.
  (b) Rate of Pay.--
          (1) Positions at level iv.--Section 5315 of title 5, United 
        States Code, is amended by striking ``Assistant Secretaries of 
        Health and Human Services (6)'' and inserting ``Assistant 
        Secretaries of Health and Human Services (7)''.
          (2) Positions at level v.--Section 5316 of title 5, United 
        States Code, is amended by striking ``Director, Indian Health 
        Service, Department of Health and Human Services''.
  (c) Amendments to Other Provisions of Law.--
          (1) Section 3307(b)(1)(C) of the Children's Health Act of 
        2000 (25 U.S.C. 1671 note; Public Law 106-310) is amended by 
        striking ``Director of the Indian Health Service'' and 
        inserting ``Assistant Secretary for Indian Health''.
          (2) The Indian Lands Open Dump Cleanup Act of 1994 is 
        amended--
                  (A) in section 3 (25 U.S.C. 3902)--
                          (i) by striking paragraph (2);
                          (ii) by redesignating paragraphs (1), (3), 
                        (4), (5), and (6) as paragraphs (4), (5), (2), 
                        (6), and (1), respectively, and moving those 
                        paragraphs so as to appear in numerical order; 
                        and
                          (iii) by inserting before paragraph (4) (as 
                        redesignated by clause (ii)) the following:
          ``(3) Assistant secretary.--The term `Assistant Secretary' 
        means the Assistant Secretary for Indian Health.'';
                  (B) in section 5 (25 U.S.C. 3904), by striking the 
                section designation and heading and inserting the 
                following:

``SEC. 5. AUTHORITY OF ASSISTANT SECRETARY FOR INDIAN HEALTH.'';

                  (C) in section 6(a) (25 U.S.C. 3905(a)), in the 
                subsection heading, by striking ``Director'' and 
                inserting ``Assistant Secretary'';
                  (D) in section 9(a) (25 U.S.C. 3908(a)), in the 
                subsection heading, by striking ``Director'' and 
                inserting ``Assistant Secretary''; and
                  (E) by striking ``Director'' each place it appears 
                and inserting ``Assistant Secretary''.
          (3) Section 5504(d)(2) of the Augustus F. Hawkins-Robert T. 
        Stafford Elementary and Secondary School Improvement Amendments 
        of 1988 (25 U.S.C. 2001 note; Public Law 100-297) is amended by 
        striking ``Director of the Indian Health Service'' and 
        inserting ``Assistant Secretary for Indian Health''.
          (4) Section 203(a)(1) of the Rehabilitation Act of 1973 (29 
        U.S.C. 763(a)(1)) is amended by striking ``Director of the 
        Indian Health Service'' and inserting ``Assistant Secretary for 
        Indian Health''.
          (5) Subsections (b) and (e) of section 518 of the Federal 
        Water Pollution Control Act (33 U.S.C. 1377) are amended by 
        striking ``Director of the Indian Health Service'' each place 
        it appears and inserting ``Assistant Secretary for Indian 
        Health''.
          (6) Section 317M(b) of the Public Health Service Act (42 
        U.S.C. 247b-14(b)) is amended--
                  (A) by striking ``Director of the Indian Health 
                Service'' each place it appears and inserting 
                ``Assistant Secretary for Indian Health''; and
                  (B) in paragraph (2)(A), by striking ``the Directors 
                referred to in such paragraph'' and inserting ``the 
                Director of the Centers for Disease Control and 
                Prevention and the Assistant Secretary for Indian 
                Health''.
          (7) Section 417C(b) of the Public Health Service Act (42 
        U.S.C. 285-9(b)) is amended by striking ``Director of the 
        Indian Health Service'' and inserting ``Assistant Secretary for 
        Indian Health''.
          (8) Section 1452(i) of the Safe Drinking Water Act (42 U.S.C. 
        300j-12(i)) is amended by striking ``Director of the Indian 
        Health Service'' each place it appears and inserting 
        ``Assistant Secretary for Indian Health''.
          (9) Section 803B(d)(1) of the Native American Programs Act of 
        1974 (42 U.S.C. 2991b-2(d)(1)) is amended in the last sentence 
        by striking ``Director of the Indian Health Service'' and 
        inserting ``Assistant Secretary for Indian Health''.
          (10) Section 203(b) of the Michigan Indian Land Claims 
        Settlement Act (Public Law 105-143; 111 Stat. 2666) is amended 
        by striking ``Director of the Indian Health Service'' and 
        inserting ``Assistant Secretary for Indian Health''.

SEC. 102. SOBOBA SANITATION FACILITIES.

  The Act of December 17, 1970 (84 Stat. 1465), is amended by adding at 
the end the following:
  ``Sec. 9.  Nothing in this Act shall preclude the Soboba Band of 
Mission Indians and the Soboba Indian Reservation from being provided 
with sanitation facilities and services under the authority of section 
7 of the Act of August 5, 1954 (68 Stat. 674), as amended by the Act of 
July 31, 1959 (73 Stat. 267).''.

SEC. 103. NATIVE AMERICAN HEALTH AND WELLNESS FOUNDATION.

  (a) In General.--The Indian Self-Determination and Education 
Assistance Act (25 U.S.C. 450 et seq.) is amended by adding at the end 
the following:

      ``TITLE VIII--NATIVE AMERICAN HEALTH AND WELLNESS FOUNDATION

``SEC. 801. DEFINITIONS.

  ``In this title:
          ``(1) Board.--The term `Board' means the Board of Directors 
        of the Foundation.
          ``(2) Committee.--The term `Committee' means the Committee 
        for the Establishment of Native American Health and Wellness 
        Foundation established under section 802(f).
          ``(3) Foundation.--The term `Foundation' means the Native 
        American Health and Wellness Foundation established under 
        section 802.
          ``(4) Secretary.--The term `Secretary' means the Secretary of 
        Health and Human Services.
          ``(5) Service.--The term `Service' means the Indian Health 
        Service of the Department of Health and Human Services.

``SEC. 802. NATIVE AMERICAN HEALTH AND WELLNESS FOUNDATION.

  ``(a) Establishment.--
          ``(1) In general.--As soon as practicable after the date of 
        enactment of this title, the Secretary shall establish, under 
        the laws of the District of Columbia and in accordance with 
        this title, the Native American Health and Wellness Foundation.
          ``(2) Funding determinations.--No funds, gift, property, or 
        other item of value (including any interest accrued on such an 
        item) acquired by the Foundation shall--
                  ``(A) be taken into consideration for purposes of 
                determining Federal appropriations relating to the 
                provision of health care and services to Indians; or
                  ``(B) otherwise limit, diminish, or affect the 
                Federal responsibility for the provision of health care 
                and services to Indians.
  ``(b) Perpetual Existence.--The Foundation shall have perpetual 
existence.
  ``(c) Nature of Corporation.--The Foundation--
          ``(1) shall be a charitable and nonprofit federally chartered 
        corporation; and
          ``(2) shall not be an agency or instrumentality of the United 
        States.
  ``(d) Place of Incorporation and Domicile.--The Foundation shall be 
incorporated and domiciled in the District of Columbia.
  ``(e) Duties.--The Foundation shall--
          ``(1) encourage, accept, and administer private gifts of real 
        and personal property, and any income from or interest in such 
        gifts, for the benefit of, or in support of, the mission of the 
        Service;
          ``(2) undertake and conduct such other activities as will 
        further the health and wellness activities and opportunities of 
        Native Americans; and
          ``(3) participate with and assist Federal, State, and tribal 
        governments, agencies, entities, and individuals in undertaking 
        and conducting activities that will further the health and 
        wellness activities and opportunities of Native Americans.
  ``(f) Committee for the Establishment of Native American Health and 
Wellness Foundation.--
          ``(1) In general.--The Secretary shall establish the 
        Committee for the Establishment of Native American Health and 
        Wellness Foundation to assist the Secretary in establishing the 
        Foundation.
          ``(2) Duties.--Not later than 180 days after the date of 
        enactment of this section, the Committee shall--
                  ``(A) carry out such activities as are necessary to 
                incorporate the Foundation under the laws of the 
                District of Columbia, including acting as incorporators 
                of the Foundation;
                  ``(B) ensure that the Foundation qualifies for and 
                maintains the status required to carry out this 
                section, until the Board is established;
                  ``(C) establish the constitution and initial bylaws 
                of the Foundation;
                  ``(D) provide for the initial operation of the 
                Foundation, including providing for temporary or 
                interim quarters, equipment, and staff; and
                  ``(E) appoint the initial members of the Board in 
                accordance with the constitution and initial bylaws of 
                the Foundation.
  ``(g) Board of Directors.--
          ``(1) In general.--The Board of Directors shall be the 
        governing body of the Foundation.
          ``(2) Powers.--The Board may exercise, or provide for the 
        exercise of, the powers of the Foundation.
          ``(3) Selection.--
                  ``(A) In general.--Subject to subparagraph (B), the 
                number of members of the Board, the manner of selection 
                of the members (including the filling of vacancies), 
                and the terms of office of the members shall be as 
                provided in the constitution and bylaws of the 
                Foundation.
                  ``(B) Requirements.--
                          ``(i) Number of members.--The Board shall 
                        have at least 11 members, who shall have 
                        staggered terms.
                          ``(ii) Initial voting members.--The initial 
                        voting members of the Board--
                                  ``(I) shall be appointed by the 
                                Committee not later than 180 days after 
                                the date on which the Foundation is 
                                established; and
                                  ``(II) shall have staggered terms.
                          ``(iii) Qualification.--The members of the 
                        Board shall be United States citizens who are 
                        knowledgeable or experienced in Native American 
                        health care and related matters.
                  ``(C) Compensation.--A member of the Board shall not 
                receive compensation for service as a member, but shall 
                be reimbursed for actual and necessary travel and 
                subsistence expenses incurred in the performance of the 
                duties of the Foundation.
  ``(h) Officers.--
          ``(1) In general.--The officers of the Foundation shall be--
                  ``(A) a secretary, elected from among the members of 
                the Board; and
                  ``(B) any other officers provided for in the 
                constitution and bylaws of the Foundation.
          ``(2) Chief operating officer.--The secretary of the 
        Foundation may serve, at the direction of the Board, as the 
        chief operating officer of the Foundation, or the Board may 
        appoint a chief operating officer, who shall serve at the 
        direction of the Board.
          ``(3) Election.--The manner of election, term of office, and 
        duties of the officers of the Foundation shall be as provided 
        in the constitution and bylaws of the Foundation.
  ``(i) Powers.--The Foundation--
          ``(1) shall adopt a constitution and bylaws for the 
        management of the property of the Foundation and the regulation 
        of the affairs of the Foundation;
          ``(2) may adopt and alter a corporate seal;
          ``(3) may enter into contracts;
          ``(4) may acquire (through a gift or otherwise), own, lease, 
        encumber, and transfer real or personal property as necessary 
        or convenient to carry out the purposes of the Foundation;
          ``(5) may sue and be sued; and
          ``(6) may perform any other act necessary and proper to carry 
        out the purposes of the Foundation.
  ``(j) Principal Office.--
          ``(1) In general.--The principal office of the Foundation 
        shall be in the District of Columbia.
          ``(2) Activities; offices.--The activities of the Foundation 
        may be conducted, and offices may be maintained, throughout the 
        United States in accordance with the constitution and bylaws of 
        the Foundation.
  ``(k) Service of Process.--The Foundation shall comply with the law 
on service of process of each State in which the Foundation is 
incorporated and of each State in which the Foundation carries on 
activities.
  ``(l) Liability of Officers, Employees, and Agents.--
          ``(1) In general.--The Foundation shall be liable for the 
        acts of the officers, employees, and agents of the Foundation 
        acting within the scope of their authority.
          ``(2) Personal liability.--A member of the Board shall be 
        personally liable only for gross negligence in the performance 
        of the duties of the member.
  ``(m) Restrictions.--
          ``(1) Limitation on spending.--Beginning with the fiscal year 
        following the first full fiscal year during which the 
        Foundation is in operation, the administrative costs of the 
        Foundation shall not exceed the percentage described in 
        paragraph (2) of the sum of--
                  ``(A) the amounts transferred to the Foundation under 
                subsection (o) during the preceding fiscal year; and
                  ``(B) donations received from private sources during 
                the preceding fiscal year.
          ``(2) Percentages.--The percentages referred to in paragraph 
        (1) are--
                  ``(A) for the first fiscal year described in that 
                paragraph, 20 percent;
                  ``(B) for the following fiscal year, 15 percent; and
                  ``(C) for each fiscal year thereafter, 10 percent.
          ``(3) Appointment and hiring.--The appointment of officers 
        and employees of the Foundation shall be subject to the 
        availability of funds.
          ``(4) Status.--A member of the Board or officer, employee, or 
        agent of the Foundation shall not by reason of association with 
        the Foundation be considered to be an officer, employee, or 
        agent of the United States.
  ``(n) Audits.--The Foundation shall comply with section 10101 of 
title 36, United States Code, as if the Foundation were a corporation 
under part B of subtitle II of that title.
  ``(o) Funding.--
          ``(1) Authorization of appropriations.--There is authorized 
        to be appropriated to carry out subsection (e)(1) $500,000 for 
        each fiscal year, as adjusted to reflect changes in the 
        Consumer Price Index for all-urban consumers published by the 
        Department of Labor.
          ``(2) Transfer of donated funds.--The Secretary shall 
        transfer to the Foundation funds held by the Department of 
        Health and Human Services under the Act of August 5, 1954 (42 
        U.S.C. 2001 et seq.), if the transfer or use of the funds is 
        not prohibited by any term under which the funds were donated.

``SEC. 803. ADMINISTRATIVE SERVICES AND SUPPORT.

  ``(a) Provision of Support by Secretary.--Subject to subsection (b), 
during the 5-year period beginning on the date on which the Foundation 
is established, the Secretary--
          ``(1) may provide personnel, facilities, and other 
        administrative support services to the Foundation;
          ``(2) may provide funds for initial operating costs and to 
        reimburse the travel expenses of the members of the Board; and
          ``(3) shall require and accept reimbursements from the 
        Foundation for--
                  ``(A) services provided under paragraph (1); and
                  ``(B) funds provided under paragraph (2).
  ``(b) Reimbursement.--Reimbursements accepted under subsection 
(a)(3)--
          ``(1) shall be deposited in the Treasury of the United States 
        to the credit of the applicable appropriations account; and
          ``(2) shall be chargeable for the cost of providing services 
        described in subsection (a)(1) and travel expenses described in 
        subsection (a)(2).
  ``(c) Continuation of Certain Services.--The Secretary may continue 
to provide facilities and necessary support services to the Foundation 
after the termination of the 5-year period specified in subsection (a) 
if the facilities and services--
          ``(1) are available; and
          ``(2) are provided on reimbursable cost basis.''.
  (b) Technical Amendments.--The Indian Self-Determination and 
Education Assistance Act is amended--
          (1) by redesignating the second title V (25 U.S.C. 458bbb et 
        seq.) as title VII;
          (2) by redesignating sections 501, 502, and 503 (25 U.S.C. 
        458bbb, 458bbb-1, 458bbb-2) as sections 701, 702, and 703, 
        respectively; and
          (3) in subsection (a)(2) of section 702 and paragraph (2) of 
        section 703 (as redesignated by paragraph (2)), by striking 
        ``section 501'' and inserting ``section 701''.

 TITLE II--IMPROVEMENT OF INDIAN HEALTH CARE PROVIDED UNDER THE SOCIAL 
                              SECURITY ACT

SEC. 201. EXPANSION OF PAYMENTS UNDER MEDICARE, MEDICAID, AND SCHIP FOR 
                    ALL COVERED SERVICES FURNISHED BY INDIAN HEALTH 
                    PROGRAMS.

  (a) Medicaid.--
          (1) Expansion to all covered services.--Section 1911 of the 
        Social Security Act (42 U.S.C. 1396j) is amended--
                  (A) by amending the section designation and heading 
                to read as follows:

``SEC. 1911. INDIAN HEALTH PROGRAMS.''; AND

                  (B) by amending subsection (a) to read as follows:
  ``(a) Eligibility for Payment for Medical Assistance.--The Indian 
Health Service and an Indian Tribe, Tribal Organization, or an Urban 
Indian Organization shall be eligible for payment for medical 
assistance provided under a State plan or under waiver authority with 
respect to items and services furnished by the Indian Health Service, 
Indian Tribe, Tribal Organization, or Urban Indian Organization if the 
furnishing of such services meets all the conditions and requirements 
which are applicable generally to the furnishing of items and services 
under this title and under such plan or waiver authority.''.
          (2) Compliance with conditions and requirements.--Subsection 
        (b) of such section is amended to read as follows:
  ``(b) Compliance With Conditions and Requirements.--A facility of the 
Indian Health Service or an Indian Tribe, Tribal Organization, or an 
Urban Indian Organization which is eligible for payment under 
subsection (a) with respect to the furnishing of items and services, 
but which does not meet all of the conditions and requirements of this 
title and under a State plan or waiver authority which are applicable 
generally to such facility, shall make such improvements as are 
necessary to achieve or maintain compliance with such conditions and 
requirements in accordance with a plan submitted to and accepted by the 
Secretary for achieving or maintaining compliance with such conditions 
and requirements, and shall be deemed to meet such conditions and 
requirements (and to be eligible for payment under this title), without 
regard to the extent of its actual compliance with such conditions and 
requirements, during the first 12 months after the month in which such 
plan is submitted.''.
          (3) Revision of authority to enter into agreements.--
        Subsection (c) of such section is amended to read as follows:
  ``(c) Authority To Enter Into Agreements.--The Secretary may enter 
into an agreement with a State for the purpose of reimbursing the State 
for medical assistance provided by the Indian Health Service, an Indian 
Tribe, Tribal Organization, or an Urban Indian Organization (as so 
defined), directly, through referral, or under contracts or other 
arrangements between the Indian Health Service, an Indian Tribe, Tribal 
Organization, or an Urban Indian Organization and another health care 
provider to Indians who are eligible for medical assistance under the 
State plan or under waiver authority.''.
          (4) Cross-references to special fund for improvement of ihs 
        facilities; direct billing option; definitions.--Such section 
        is further amended by striking subsection (d) and adding at the 
        end the following new subsections:
  ``(d) Special Fund for Improvement of IHS Facilities.--For provisions 
relating to the authority of the Secretary to place payments to which a 
facility of the Indian Health Service is eligible for payment under 
this title into a special fund established under section 401(c)(1) of 
the Indian Health Care Improvement Act, and the requirement to use 
amounts paid from such fund for making improvements in accordance with 
subsection (b), see subparagraphs (A) and (B) of section 401(c)(1) of 
such Act.
  ``(e) Direct Billing.--For provisions relating to the authority of a 
Tribal Health Program or an Urban Indian Organization to elect to 
directly bill for, and receive payment for, health care items and 
services provided by such Program or Organization for which payment is 
made under this title, see section 401(d) of the Indian Health Care 
Improvement Act.
  ``(f) Definitions.--In this section, the terms `Indian Health 
Program', `Indian Tribe', `Tribal Health Program', `Tribal 
Organization', and `Urban Indian Organization' have the meanings given 
those terms in section 4 of the Indian Health Care Improvement Act.''.
  (b) Medicare.--
          (1) Expansion to all covered services.--Section 1880 of such 
        Act (42 U.S.C. 1395qq) is amended--
                  (A) by amending the section designation and heading 
                to read as follows:

``SEC. 1880. INDIAN HEALTH PROGRAMS.''; AND

                  (B) by amending subsection (a) to read as follows:
  ``(a) Eligibility for Payments.--Subject to subsection (e), the 
Indian Health Service and an Indian Tribe, Tribal Organization, or an 
Urban Indian Organization shall be eligible for payments under this 
title with respect to items and services furnished by the Indian Health 
Service, Indian Tribe, Tribal Organization, or Urban Indian 
Organization if the furnishing of such services meets all the 
conditions and requirements which are applicable generally to the 
furnishing of items and services under this title.''.
          (2) Compliance with conditions and requirements.--Subsection 
        (b) of such section is amended to read as follows:
  ``(b) Compliance With Conditions and Requirements.--Subject to 
subsection (e), a facility of the Indian Health Service or an Indian 
Tribe, Tribal Organization, or an Urban Indian Organization which is 
eligible for payment under subsection (a) with respect to the 
furnishing of items and services, but which does not meet all of the 
conditions and requirements of this title which are applicable 
generally to such facility, shall make such improvements as are 
necessary to achieve or maintain compliance with such conditions and 
requirements in accordance with a plan submitted to and accepted by the 
Secretary for achieving or maintaining compliance with such conditions 
and requirements, and shall be deemed to meet such conditions and 
requirements (and to be eligible for payment under this title), without 
regard to the extent of its actual compliance with such conditions and 
requirements, during the first 12 months after the month in which such 
plan is submitted.''.
          (3) Cross-references to special fund for improvement of ihs 
        facilities; direct billing option; definitions.--
                  (A) In general.--Such section is further amended by 
                striking subsections (c) and (d) and inserting the 
                following new subsections:
  ``(c) Special Fund for Improvement of IHS Facilities.--For provisions 
relating to the authority of the Secretary to place payments to which a 
facility of the Indian Health Service is eligible for payment under 
this title into a special fund established under section 401(c)(1) of 
the Indian Health Care Improvement Act, and the requirement to use 
amounts paid from such fund for making improvements in accordance with 
subsection (b), see subparagraphs (A) and (B) of section 401(c)(1) of 
such Act.
  ``(d) Direct Billing.--For provisions relating to the authority of a 
Tribal Health Program or an Urban Indian Organization to elect to 
directly bill for, and receive payment for, health care items and 
services provided by such Program or Organization for which payment is 
made under this title, see section 401(d) of the Indian Health Care 
Improvement Act.''.
                  (B) Conforming amendment.--Paragraph (3) of section 
                1880(e) of such Act (42 U.S.C. 1395qq(e)) is amended by 
                inserting ``and section 401(c)(1) of the Indian Health 
                Care Improvement Act'' after ``Subsection (c)''.
          (4) Definitions.--Such section is further amended by amending 
        subsection (f) to read as follows:
  ``(f) Definitions.--In this section, the terms `Indian Health 
Program', `Indian Tribe', `Service Unit', `Tribal Health Program', 
`Tribal Organization', and `Urban Indian Organization' have the 
meanings given those terms in section 4 of the Indian Health Care 
Improvement Act.''.
  (c) Application to SCHIP.--Section 2107(e)(1) of the Social Security 
Act (42 U.S.C. 1397gg(e)(1)) is amended--
          (1) by redesignating subparagraph (D) as subparagraph (E); 
        and
          (2) by inserting after subparagraph (C), the following new 
        subparagraph:
                  ``(D) Section 1911 (relating to Indian Health 
                Programs, other than subsection (d) of such 
                section).''.

SEC. 202. INCREASED OUTREACH TO INDIANS UNDER MEDICAID AND SCHIP AND 
                    IMPROVED COOPERATION IN THE PROVISION OF ITEMS AND 
                    SERVICES TO INDIANS UNDER SOCIAL SECURITY ACT 
                    HEALTH BENEFIT PROGRAMS.

  Section 1139 of the Social Security Act (42 U.S.C. 1320b-9) is 
amended to read as follows:

``SEC. 1139. IMPROVED ACCESS TO, AND DELIVERY OF, HEALTH CARE FOR 
                    INDIANS UNDER TITLES XVIII, XIX, AND XXI.

  ``(a) Agreements With States for Medicaid and SCHIP Outreach on or 
Near Reservations To Increase the Enrollment of Indians in Those 
Programs.--
          ``(1) In general.--In order to improve the access of Indians 
        residing on or near a reservation to obtain benefits under the 
        Medicaid and State children's health insurance programs 
        established under titles XIX and XXI, the Secretary shall 
        encourage the State to take steps to provide for enrollment on 
        or near the reservation. Such steps may include outreach 
        efforts such as the outstationing of eligibility workers, 
        entering into agreements with the Indian Health Service, Indian 
        Tribes, Tribal Organizations, and Urban Indian Organizations to 
        provide outreach, education regarding eligibility and benefits, 
        enrollment, and translation services when such services are 
        appropriate.
          ``(2) Construction.--Nothing in subparagraph (A) shall be 
        construed as affecting arrangements entered into between States 
        and the Indian Health Service, Indian Tribes, Tribal 
        Organizations, or Urban Indian Organizations for such Service, 
        Tribes, or Organizations to conduct administrative activities 
        under such titles.
  ``(b) Requirement To Facilitate Cooperation.--The Secretary, acting 
through the Centers for Medicare & Medicaid Services, shall take such 
steps as are necessary to facilitate cooperation with, and agreements 
between, States and the Indian Health Service, Indian Tribes, Tribal 
Organizations, or Urban Indian Organizations with respect to the 
provision of health care items and services to Indians under the 
programs established under title XVIII, XIX, or XXI.
  ``(c) Definition of Indian; Indian Tribe; Indian Health Program; 
Tribal Organization; Urban Indian Organization.--In this section, the 
terms `Indian', `Indian Tribe', `Indian Health Program', `Tribal 
Organization', and `Urban Indian Organization' have the meanings given 
those terms in section 4 of the Indian Health Care Improvement Act.''.

SEC. 203. ADDITIONAL PROVISIONS TO INCREASE OUTREACH TO, AND ENROLLMENT 
                    OF, INDIANS IN SCHIP AND MEDICAID.

  (a) Nonapplication of 10 Percent Limit on Outreach and Certain Other 
Expenditures.--Section 2105(c)(2) of the Social Security Act (42 U.S.C. 
1397ee(c)(2)) is amended by adding at the end the following new 
subparagraph:
                  ``(C) Nonapplication to expenditures for outreach to 
                increase the enrollment of indian children under this 
                title and title xix.--The limitation under subparagraph 
                (A) on expenditures for items described in subsection 
                (a)(1)(D) shall not apply in the case of expenditures 
                for outreach activities to families of Indian children 
                likely to be eligible for child health assistance under 
                the plan or medical assistance under the State plan 
                under title XIX (or under a waiver of such plan), to 
                inform such families of the availability of, and to 
                assist them in enrolling their children in, such plans, 
                including such activities conducted under grants, 
                contracts, or agreements entered into under section 
                1139(a).''.
  (b) Assurance of Payments to Indian Health Care Providers for Child 
Health Assistance.--Section 2102(b)(3)(D) of such Act (42 U.S.C. 
1397bb(b)(3)(D)) is amended by striking ``(as defined in section 4(c) 
of the Indian Health Care Improvement Act, 25 U.S.C. 1603(c))'' and 
inserting ``, including how the State will ensure that payments are 
made to Indian Health Programs and Urban Indian Organizations operating 
in the State for the provision of such assistance''.
  (c) Inclusion of Other Indian Financed Health Care Programs in 
Exemption From Prohibition on Certain Payments.--Section 2105(c)(6)(B) 
of such Act (42 U.S.C. 1397ee(c)(6)(B)) is amended by striking 
``insurance program, other than an insurance program operated or 
financed by the Indian Health Service'' and inserting ``program, other 
than a health care program operated or financed by the Indian Health 
Service or by an Indian Tribe, Tribal Organization, or Urban Indian 
Organization''.
  (d) Satisfaction of Medicaid Documentation Requirements.--
          (1) In general.--Section 1903(x)(3)(B) of the Social Security 
        Act (42 U.S.C. 1396b(x)(3)(B)) is amended--
                  (A) by redesignating clause (v) as clause (vi); and
                  (B) by inserting after clause (iv), the following new 
                clause:
          ``(v)(I) Except as provided in subclause (II), a document 
        issued by a federally-recognized Indian tribe evidencing 
        membership or enrollment in, or affiliation with, such tribe.
          ``(II) With respect to those federally-recognized Indian 
        tribes located within States having an international border 
        whose membership includes individuals who are not citizens of 
        the United States, the Secretary shall, after consulting with 
        such tribes, issue regulations authorizing the presentation of 
        such other forms of documentation (including tribal 
        documentation, if appropriate) that the Secretary determines to 
        be satisfactory documentary evidence of citizenship or 
        nationality for purposes of satisfying the requirement of this 
        subsection.''.
          (2) Transition rule.--During the period that begins on July 
        1, 2006, and ends on the effective date of final regulations 
        issued under subclause (II) of section 1903(x)(3)(B)(v) of the 
        Social Security Act (42 U.S.C. 1396b(x)(3)(B)(v)) (as added by 
        paragraph (1)), an individual who is a member of a federally-
        recognized Indian tribe described in subclause (II) of that 
        section who presents a document described in subclause (I) of 
        such section that is issued by such Indian tribe, shall be 
        deemed to have presented satisfactory evidence of citizenship 
        or nationality for purposes of satisfying the requirement of 
        subsection (x) of section 1903 of such Act.
  (e) Definitions.--Section 2110(c) of such Act (42 U.S.C. 1397jj(c)) 
is amended by adding at the end the following new paragraph:
          ``(9) Indian; indian health program; indian tribe; etc.--The 
        terms `Indian', `Indian Health Program', `Indian Tribe', 
        `Tribal Organization', and `Urban Indian Organization' have the 
        meanings given those terms in section 4 of the Indian Health 
        Care Improvement Act.''.

SEC. 204. PREMIUMS AND COST SHARING PROTECTIONS UNDER MEDICAID, 
                    ELIGIBILITY DETERMINATIONS UNDER MEDICAID AND 
                    SCHIP, AND PROTECTION OF CERTAIN INDIAN PROPERTY 
                    FROM MEDICAID ESTATE RECOVERY.

  (a) Premiums and Cost Sharing Protection Under Medicaid.--
          (1) In general.--Section 1916 of the Social Security Act (42 
        U.S.C. 1396o) is amended--
                  (A) in subsection (a), in the matter preceding 
                paragraph (1), by striking ``and (i)'' and inserting 
                ``, (i), and (j)''; and
                  (B) by adding at the end the following new 
                subsection:
  ``(j) No Premiums or Cost Sharing for Indians Furnished Items or 
Services Directly by Indian Health Programs or Through Referral Under 
the Contract Health Service.--
          ``(1) No cost sharing for items or services furnished to 
        indians through indian health programs.--
                  ``(A) In general.--No enrollment fee, premium, or 
                similar charge, and no deduction, copayment, cost 
                sharing, or similar charge shall be imposed against an 
                Indian who is furnished an item or service directly by 
                the Indian Health Service, an Indian Tribe, Tribal 
                Organization, or Urban Indian Organization or through 
                referral under the contract health service for which 
                payment may be made under this title.
                  ``(B) No reduction in amount of payment to indian 
                health providers.--Payment due under this title to the 
                Indian Health Service, an Indian Tribe, Tribal 
                Organization, or Urban Indian Organization, or a health 
                care provider through referral under the contract 
                health service for the furnishing of an item or service 
                to an Indian who is eligible for assistance under such 
                title, may not be reduced by the amount of any 
                enrollment fee, premium, or similar charge, or any 
                deduction, copayment, cost sharing, or similar charge 
                that would be due from the Indian but for the operation 
                of subparagraph (A).
          ``(2) Rule of construction.--Nothing in this subsection shall 
        be construed as restricting the application of any other 
        limitations on the imposition of premiums or cost sharing that 
        may apply to an individual receiving medical assistance under 
        this title who is an Indian.
          ``(3) Definitions.--In this subsection, the terms `contract 
        health service', `Indian', `Indian Tribe', `Tribal 
        Organization', and `Urban Indian Organization' have the 
        meanings given those terms in section 4 of the Indian Health 
        Care Improvement Act.''.
          (2) Conforming amendment.--Section 1916A (a)(1) of such Act 
        (42 U.S.C. 1396o-1(a)(1)) is amended by striking ``section 
        1916(g)'' and inserting ``subsections (g), (i), or (j) of 
        section 1916''.
  (b) Treatment of Certain Property for Medicaid and SCHIP 
Eligibility.--
          (1) Medicaid.--Section 1902(e) of the Social Security Act (42 
        U.S.C. 1396a) is amended by adding at the end the following new 
        paragraph:
  ``(13) Notwithstanding any other requirement of this title or any 
other provision of Federal or State law, a State shall disregard the 
following property for purposes of determining the eligibility of an 
individual who is an Indian (as defined in section 4 of the Indian 
Health Care Improvement Act) for medical assistance under this title:
          ``(A) Property, including real property and improvements, 
        that is held in trust, subject to Federal restrictions, or 
        otherwise under the supervision of the Secretary of the 
        Interior, located on a reservation, including any federally 
        recognized Indian Tribe's reservation, pueblo, or colony, 
        including former reservations in Oklahoma, Alaska Native 
        regions established by the Alaska Native Claims Settlement Act, 
        and Indian allotments on or near a reservation as designated 
        and approved by the Bureau of Indian Affairs of the Department 
        of the Interior.
          ``(B) For any federally recognized Tribe not described in 
        subparagraph (A), property located within the most recent 
        boundaries of a prior Federal reservation.
          ``(C) Ownership interests in rents, leases, royalties, or 
        usage rights related to natural resources (including extraction 
        of natural resources or harvesting of timber, other plants and 
        plant products, animals, fish, and shellfish) resulting from 
        the exercise of federally protected rights.
          ``(D) Ownership interests in or usage rights to items not 
        covered by subparagraphs (A) through (C) that have unique 
        religious, spiritual, traditional, or cultural significance or 
        rights that support subsistence or a traditional lifestyle 
        according to applicable tribal law or custom.''.
          (2) Application to schip.--Section 2107(e)(1) of such Act (42 
        U.S.C. 1397gg(e)(1)), as amended by section 201(c), is 
        amended--
                  (A) by redesignating subparagraphs (B) through (E), 
                as subparagraphs (C) through (F), respectively; and
                  (B) by inserting after subparagraph (A), the 
                following new subparagraph:
                  ``(B) Section 1902(e)(13) (relating to disregard of 
                certain property for purposes of making eligibility 
                determinations).''.
  (c) Continuation of Current Law Protections of Certain Indian 
Property From Medicaid Estate Recovery.--Section 1917(b)(3) of the 
Social Security Act (42 U.S.C. 1396p(b)(3)) is amended--
          (1) by inserting ``(A)'' after ``(3)''; and
          (2) by adding at the end the following new subparagraph:
  ``(B) The standards specified by the Secretary under subparagraph (A) 
shall require that the procedures established by the State agency under 
subparagraph (A) exempt income, resources, and property that are exempt 
from the application of this subsection as of April 1, 2003, under 
manual instructions issued to carry out this subsection (as in effect 
on such date) because of the Federal responsibility for Indian Tribes 
and Alaska Native Villages. Nothing in this subparagraph shall be 
construed as preventing the Secretary from providing additional estate 
recovery exemptions under this title for Indians.''.

SEC. 205. NONDISCRIMINATION IN QUALIFICATIONS FOR PAYMENT FOR SERVICES 
                    UNDER FEDERAL HEALTH CARE PROGRAMS.

  Section 1139 of the Social Security Act (42 U.S.C. 1320b-9), as 
amended by section 202, is amended by redesignating subsection (c) as 
subsection (d), and inserting after subsection (b) the following new 
subsection:
  ``(c) Nondiscrimination in Qualifications for Payment for Services 
Under Federal Health Care Programs.--
          ``(1) Requirement to satisfy generally applicable 
        participation requirements.--
                  ``(A) In general.--A Federal health care program must 
                accept an entity that is operated by the Indian Health 
                Service, an Indian Tribe, Tribal Organization, or Urban 
                Indian Organization as a provider eligible to receive 
                payment under the program for health care services 
                furnished to an Indian on the same basis as any other 
                provider qualified to participate as a provider of 
                health care services under the program if the entity 
                meets generally applicable State or other requirements 
                for participation as a provider of health care services 
                under the program.
                  ``(B) Satisfaction of state or local licensure or 
                recognition requirements.--Any requirement for 
                participation as a provider of health care services 
                under a Federal health care program that an entity be 
                licensed or recognized under the State or local law 
                where the entity is located to furnish health care 
                services shall be deemed to have been met in the case 
                of an entity operated by the Indian Health Service, an 
                Indian Tribe, Tribal Organization, or Urban Indian 
                Organization if the entity meets all the applicable 
                standards for such licensure or recognition, regardless 
                of whether the entity obtains a license or other 
                documentation under such State or local law. In 
                accordance with section 221 of the Indian Health Care 
                Improvement Act, the absence of the licensure of a 
                health care professional employed by such an entity 
                under the State or local law where the entity is 
                located shall not be taken into account for purposes of 
                determining whether the entity meets such standards, if 
                the professional is licensed in another State.
          ``(2) Prohibition on federal payments to entities or 
        individuals excluded from participation in federal health care 
        programs or whose state licenses are under suspension or have 
        been revoked.--
                  ``(A) Excluded entities.--No entity operated by the 
                Indian Health Service, an Indian Tribe, Tribal 
                Organization, or Urban Indian Organization that has 
                been excluded from participation in any Federal health 
                care program or for which a license is under suspension 
                or has been revoked by the State where the entity is 
                located shall be eligible to receive payment under any 
                such program for health care services furnished to an 
                Indian.
                  ``(B) Excluded individuals.--No individual who has 
                been excluded from participation in any Federal health 
                care program or whose State license is under suspension 
                or has been revoked shall be eligible to receive 
                payment under any such program for health care services 
                furnished by that individual, directly or through an 
                entity that is otherwise eligible to receive payment 
                for health care services, to an Indian.
                  ``(C) Federal health care program defined.--In this 
                subsection, the term, `Federal health care program' has 
                the meaning given that term in section 1128B(f), except 
                that, for purposes of this subsection, such term shall 
                include the health insurance program under chapter 89 
                of title 5, United States Code.''.

SEC. 206. CONSULTATION ON MEDICAID, SCHIP, AND OTHER HEALTH CARE 
                    PROGRAMS FUNDED UNDER THE SOCIAL SECURITY ACT 
                    INVOLVING INDIAN HEALTH PROGRAMS AND URBAN INDIAN 
                    ORGANIZATIONS.

  (a) In General.--Section 1139 of the Social Security Act (42 U.S.C. 
1320b-9), as amended by sections 202 and 205, is amended by 
redesignating subsection (d) as subsection (e), and inserting after 
subsection (c) the following new subsection:
  ``(d) Consultation With Tribal Technical Advisory Group (TTAG).--The 
Secretary shall maintain within the Centers for Medicaid & Medicare 
Services (CMS) a Tribal Technical Advisory Group, established in 
accordance with requirements of the charter dated September 30, 2003, 
and in such group shall include a representative of the Urban Indian 
Organizations and the Service. The representative of the Urban Indian 
Organization shall be deemed to be an elected officer of a tribal 
government for purposes of applying section 204(b) of the Unfunded 
Mandates Reform Act of 1995 (2 U.S.C. 1534(b)).''.
  (b) Solicitation of Advice Under Medicaid and SCHIP.--
          (1) Medicaid state plan amendment.--Section 1902(a) of the 
        Social Security Act (42 U.S.C. 1396a(a)) is amended--
                  (A) in paragraph (69), by striking ``and'' at the 
                end;
                  (B) in paragraph (70)(B)(iv), by striking the period 
                at the end and inserting ``; and''; and
                  (C) by inserting after paragraph (70)(B)(iv), the 
                following new paragraph:
          ``(71) in the case of any State in which the Indian Health 
        Service operates or funds health care programs, or in which 1 
        or more Indian Health Programs or Urban Indian Organizations 
        (as such terms are defined in section 4 of the Indian Health 
        Care Improvement Act) provide health care in the State for 
        which medical assistance is available under such title, provide 
        for a process under which the State seeks advice on a regular, 
        ongoing basis from designees of such Indian Health Programs and 
        Urban Indian Organizations on matters relating to the 
        application of this title that are likely to have a direct 
        effect on such Indian Health Programs and Urban Indian 
        Organizations and that--
                  ``(A) shall include solicitation of advice prior to 
                submission of any plan amendments, waiver requests, and 
                proposals for demonstration projects likely to have a 
                direct effect on Indians, Indian Health Programs, or 
                Urban Indian Organizations; and
                  ``(B) may include appointment of an advisory 
                committee and of a designee of such Indian Health 
                Programs and Urban Indian Organizations to the medical 
                care advisory committee advising the State on its State 
                plan under this title.''.
          (2) Application to schip.--Section 2107(e)(1) of such Act (42 
        U.S.C. 1397gg(e)(1)), as amended by section 204(b)(2), is 
        amended--
                  (A) by redesignating subparagraphs (B) through (F) as 
                subparagraphs (C) through (G), respectively; and
                  (B) by inserting after subparagraph (A), the 
                following new subparagraph:
                  ``(B) Section 1902(a)(71) (relating to the option of 
                certain States to seek advice from designees of Indian 
                Health Programs and Urban Indian Organizations).''.
  (c) Rule of Construction.--Nothing in the amendments made by this 
section shall be construed as superseding existing advisory committees, 
working groups, guidance, or other advisory procedures established by 
the Secretary of Health and Human Services or by any State with respect 
to the provision of health care to Indians.

SEC. 207. EXCLUSION WAIVER AUTHORITY FOR AFFECTED INDIAN HEALTH 
                    PROGRAMS AND SAFE HARBOR TRANSACTIONS UNDER THE 
                    SOCIAL SECURITY ACT.

  (a) Exclusion Waiver Authority.--Section 1128 of the Social Security 
Act (42 U.S.C. 1320a-7) is amended by adding at the end the following 
new subsection:
  ``(k) Additional Exclusion Waiver Authority for Affected Indian 
Health Programs.--In addition to the authority granted the Secretary 
under subsections (c)(3)(B) and (d)(3)(B) to waive an exclusion under 
subsection (a)(1), (a)(3), (a)(4), or (b), the Secretary may, in the 
case of an Indian Health Program, waive such an exclusion upon the 
request of the administrator of an affected Indian Health Program (as 
defined in section 4 of the Indian Health Care Improvement Act) who 
determines that the exclusion would impose a hardship on individuals 
entitled to benefits under or enrolled in a Federal health care 
program.''.
  (b) Certain Transactions Involving Indian Health Care Programs Deemed 
To Be in Safe Harbors.--Section 1128B(b) of the Social Security Act (42 
U.S.C. 1320a-7b(b)) is amended by adding at the end the following new 
paragraph:
  ``(4) Subject to such conditions as the Secretary may promulgate from 
time to time as necessary to prevent fraud and abuse, for purposes of 
paragraphs (1) and (2) and section 1128A(a), the following transfers 
shall not be treated as remuneration:
          ``(A) Transfers between indian health programs, indian 
        tribes, tribal organizations, and urban indian organizations.--
        Transfers of anything of value between or among an Indian 
        Health Program, Indian Tribe, Tribal Organization, or Urban 
        Indian Organization, that are made for the purpose of providing 
        necessary health care items and services to any patient served 
        by such Program, Tribe, or Organization and that consist of--
                  ``(i) services in connection with the collection, 
                transport, analysis, or interpretation of diagnostic 
                specimens or test data;
                  ``(ii) inventory or supplies;
                  ``(iii) staff; or
                  ``(iv) a waiver of all or part of premiums or cost 
                sharing.
          ``(B) Transfers between indian health programs, indian 
        tribes, tribal organizations, or urban indian organizations and 
        patients.--Transfers of anything of value between an Indian 
        Health Program, Indian Tribe, Tribal Organization, or Urban 
        Indian Organization and any patient served or eligible for 
        service from an Indian Health Program, Indian Tribe, Tribal 
        Organization, or Urban Indian Organization, including any 
        patient served or eligible for service pursuant to section 807 
        of the Indian Health Care Improvement Act, but only if such 
        transfers--
                  ``(i) consist of expenditures related to providing 
                transportation for the patient for the provision of 
                necessary health care items or services, provided that 
                the provision of such transportation is not advertised, 
                nor an incentive of which the value is 
                disproportionately large in relationship to the value 
                of the health care item or service (with respect to the 
                value of the item or service itself or, for 
                preventative items or services, the future health care 
                costs reasonably expected to be avoided);
                  ``(ii) consist of expenditures related to providing 
                housing to the patient (including a pregnant patient) 
                and immediate family members or an escort necessary to 
                assuring the timely provision of health care items and 
                services to the patient, provided that the provision of 
                such housing is not advertised nor an incentive of 
                which the value is disproportionately large in 
                relationship to the value of the health care item or 
                service (with respect to the value of the item or 
                service itself or, for preventative items or services, 
                the future health care costs reasonably expected to be 
                avoided); or
                  ``(iii) are for the purpose of paying premiums or 
                cost sharing on behalf of such a patient, provided that 
                the making of such payment is not subject to conditions 
                other than conditions agreed to under a contract for 
                the delivery of contract health services.
          ``(C) Contract health services.--A transfer of anything of 
        value negotiated as part of a contract entered into between an 
        Indian Health Program, Indian Tribe, Tribal Organization, Urban 
        Indian Organization, or the Indian Health Service and a 
        contract care provider for the delivery of contract health 
        services authorized by the Indian Health Service, provided 
        that--
                  ``(i) such a transfer is not tied to volume or value 
                of referrals or other business generated by the 
                parties; and
                  ``(ii) any such transfer is limited to the fair 
                market value of the health care items or services 
                provided or, in the case of a transfer of items or 
                services related to preventative care, the value of the 
                future health care costs reasonably expected to be 
                avoided.
          ``(D) Other transfers.--Any other transfer of anything of 
        value involving an Indian Health Program, Indian Tribe, Tribal 
        Organization, or Urban Indian Organization, or a patient served 
        or eligible for service from an Indian Health Program, Indian 
        Tribe, Tribal Organization, or Urban Indian Organization, that 
        the Secretary, in consultation with the Attorney General, 
        determines is appropriate, taking into account the special 
        circumstances of such Indian Health Programs, Indian Tribes, 
        Tribal Organizations, and Urban Indian Organizations, and of 
        patients served by such Programs, Tribes, and Organizations.''.

SEC. 208. RULES APPLICABLE UNDER MEDICAID AND SCHIP TO MANAGED CARE 
                    ENTITIES WITH RESPECT TO INDIAN ENROLLEES AND 
                    INDIAN HEALTH CARE PROVIDERS AND INDIAN MANAGED 
                    CARE ENTITIES.

  (a) In General.--Section 1932 of the Social Security Act (42 U.S.C. 
1396u-2) is amended by adding at the end the following new subsection:
  ``(h) Special Rules With Respect to Indian Enrollees, Indian Health 
Care Providers, and Indian Managed Care Entities.--
          ``(1) Enrollee option to select an indian health care 
        provider as primary care provider.--In the case of a non-Indian 
        Medicaid managed care entity that--
                  ``(A) has an Indian enrolled with the entity; and
                  ``(B) has an Indian health care provider that is 
                participating as a primary care provider within the 
                network of the entity,
        insofar as the Indian is otherwise eligible to receive services 
        from such Indian health care provider and the Indian health 
        care provider has the capacity to provide primary care services 
        to such Indian, the contract with the entity under section 
        1903(m) or under section 1905(t)(3) shall require, as a 
        condition of receiving payment under such contract, that the 
        Indian shall be allowed to choose such Indian health care 
        provider as the Indian's primary care provider under the 
        entity.
          ``(2) Assurance of payment to indian health care providers 
        for provision of covered services.--Each contract with a 
        managed care entity under section 1903(m) or under section 
        1905(t)(3) shall require any such entity that has a significant 
        percentage of Indian enrollees (as determined by the 
        Secretary), as a condition of receiving payment under such 
        contract to satisfy the following requirements:
                  ``(A) Demonstration of participating indian health 
                care providers or application of alternative payment 
                arrangements.--Subject to subparagraph (E), to--
                          ``(i) demonstrate that the number of Indian 
                        health care providers that are participating 
                        providers with respect to such entity are 
                        sufficient to ensure timely access to covered 
                        Medicaid managed care services for those 
                        enrollees who are eligible to receive services 
                        from such providers; or
                          ``(ii) agree to pay Indian health care 
                        providers who are not participating providers 
                        with the entity for covered Medicaid managed 
                        care services provided to those enrollees who 
                        are eligible to receive services from such 
                        providers at a rate equal to the rate 
                        negotiated between such entity and the provider 
                        involved or, if such a rate has not been 
                        negotiated, at a rate that is not less than the 
                        level and amount of payment which the entity 
                        would make for the services if the services 
                        were furnished by a participating provider 
                        which is not an Indian health care provider.
                  ``(B) Prompt payment.--To agree to make prompt 
                payment (in accordance with rules applicable to managed 
                care entities) to Indian health care providers that are 
                participating providers with respect to such entity or, 
                in the case of an entity to which subparagraph (A)(ii) 
                or (E) applies, that the entity is required to pay in 
                accordance with that subparagraph.
                  ``(C) Satisfaction of claim requirement.--To deem any 
                requirement for the submission of a claim or other 
                documentation for services covered under subparagraph 
                (A) by the enrollee to be satisfied through the 
                submission of a claim or other documentation by an 
                Indian health care provider that is consistent with 
                section 403(h) of the Indian Health Care Improvement 
                Act.
                  ``(D) Compliance with generally applicable 
                requirements.--
                          ``(i) In general.--Subject to clause (ii), as 
                        a condition of payment under subparagraph (A), 
                        an Indian health care provider shall comply 
                        with the generally applicable requirements of 
                        this title, the State plan, and such entity 
                        with respect to covered Medicaid managed care 
                        services provided by the Indian health care 
                        provider to the same extent that non-Indian 
                        providers participating with the entity must 
                        comply with such requirements.
                          ``(ii) Limitations on compliance with managed 
                        care entity generally applicable 
                        requirements.--An Indian health care provider--
                                  ``(I) shall not be required to comply 
                                with a generally applicable requirement 
                                of a managed care entity described in 
                                clause (i) as a condition of payment 
                                under subparagraph (A) if such 
                                compliance would conflict with any 
                                other statutory or regulatory 
                                requirements applicable to the Indian 
                                health care provider; and
                                  ``(II) shall only need to comply with 
                                those generally applicable requirements 
                                of a managed care entity described in 
                                clause (i) as a condition of payment 
                                under subparagraph (A) that are 
                                necessary for the entity's compliance 
                                with the State plan, such as those 
                                related to care management, quality 
                                assurance, and utilization management.
                  ``(E) Application of special payment requirements for 
                federally-qualified health centers and encounter rate 
                for services provided by certain indian health care 
                providers.--
                          ``(i) Federally-qualified health centers.--
                                  ``(I) Managed care entity payment 
                                requirement.--To agree to pay any 
                                Indian health care provider that is a 
                                federally-qualified health center but 
                                not a participating provider with 
                                respect to the entity, for the 
                                provision of covered Medicaid managed 
                                care services by such provider to an 
                                Indian enrollee of the entity at a rate 
                                equal to the amount of payment that the 
                                entity would pay a federally-qualified 
                                health center that is a participating 
                                provider with respect to the entity but 
                                is not an Indian health care provider 
                                for such services.
                                  ``(II) Continued application of state 
                                requirement to make supplemental 
                                payment.--Nothing in subclause (I) or 
                                subparagraph (A) or (B) shall be 
                                construed as waiving the application of 
                                section 1902(bb)(5) regarding the State 
                                plan requirement to make any 
                                supplemental payment due under such 
                                section to a federally-qualified health 
                                center for services furnished by such 
                                center to an enrollee of a managed care 
                                entity (regardless of whether the 
                                federally-qualified health center is or 
                                is not a participating provider with 
                                the entity).
                          ``(ii) Continued application of encounter 
                        rate for services provided by certain indian 
                        health care providers.--If the amount paid by a 
                        managed care entity to an Indian health care 
                        provider that is not a federally-qualified 
                        health center and that has elected to receive 
                        payment under this title as an Indian Health 
                        Service provider under the July 11, 1996, 
                        Memorandum of Agreement between the Health Care 
                        Financing Administration (now the Centers for 
                        Medicare & Medicaid Services) and the Indian 
                        Health Service for services provided by such 
                        provider to an Indian enrollee with the managed 
                        care entity is less than the encounter rate 
                        that applies to the provision of such services 
                        under such memorandum, the State plan shall 
                        provide for payment to the Indian health care 
                        provider of the difference between the 
                        applicable encounter rate under such memorandum 
                        and the amount paid by the managed care entity 
                        to the provider for such services.
                  ``(F) Construction.--Nothing in this paragraph shall 
                be construed as waiving the application of section 
                1902(a)(30)(A) (relating to application of standards to 
                assure that payments are consistent with efficiency, 
                economy, and quality of care).
          ``(3) Offering of managed care through indian medicaid 
        managed care entities.--If--
                  ``(A) a State elects to provide services through 
                Medicaid managed care entities under its Medicaid 
                managed care program; and
                  ``(B) an Indian health care provider that is funded 
                in whole or in part by the Indian Health Service, or a 
                consortium composed of 1 or more Tribes, Tribal 
                Organizations, or Urban Indian Organizations, and which 
                also may include the Indian Health Service, has 
                established an Indian Medicaid managed care entity in 
                the State that meets generally applicable standards 
                required of such an entity under such Medicaid managed 
                care program,
        the State shall offer to enter into an agreement with the 
        entity to serve as a Medicaid managed care entity with respect 
        to eligible Indians served by such entity under such program.
          ``(4) Special rules for indian managed care entities.--The 
        following are special rules regarding the application of a 
        Medicaid managed care program to Indian Medicaid managed care 
        entities:
                  ``(A) Enrollment.--
                          ``(i) Limitation to indians.--An Indian 
                        Medicaid managed care entity may restrict 
                        enrollment under such program to Indians and to 
                        members of specific Tribes in the same manner 
                        as Indian Health Programs may restrict the 
                        delivery of services to such Indians and tribal 
                        members.
                          ``(ii) No less choice of plans.--Under such 
                        program the State may not limit the choice of 
                        an Indian among Medicaid managed care entities 
                        only to Indian Medicaid managed care entities 
                        or to be more restrictive than the choice of 
                        managed care entities offered to individuals 
                        who are not Indians.
                          ``(iii) Default enrollment.--
                                  ``(I) In general.--If such program of 
                                a State requires the enrollment of 
                                Indians in a Medicaid managed care 
                                entity in order to receive benefits, 
                                the State, taking into consideration 
                                the criteria specified in subsection 
                                (a)(4)(D)(ii)(I), shall provide for the 
                                enrollment of Indians described in 
                                subclause (II) who are not otherwise 
                                enrolled with such an entity in an 
                                Indian Medicaid managed care entity 
                                described in such clause.
                                  ``(II) Indian described.--An Indian 
                                described in this subclause, with 
                                respect to an Indian Medicaid managed 
                                care entity, is an Indian who, based 
                                upon the service area and capacity of 
                                the entity, is eligible to be enrolled 
                                with the entity consistent with 
                                subparagraph (A).
                          ``(iv) Exception to state lock-in.--A request 
                        by an Indian who is enrolled under such program 
                        with a non-Indian Medicaid managed care entity 
                        to change enrollment with that entity to 
                        enrollment with an Indian Medicaid managed care 
                        entity shall be considered cause for granting 
                        such request under procedures specified by the 
                        Secretary.
                  ``(B) Flexibility in application of solvency.--In 
                applying section 1903(m)(1) to an Indian Medicaid 
                managed care entity--
                          ``(i) any reference to a `State' in 
                        subparagraph (A)(ii) of that section shall be 
                        deemed to be a reference to the `Secretary'; 
                        and
                          ``(ii) the entity shall be deemed to be a 
                        public entity described in subparagraph (C)(ii) 
                        of that section.
                  ``(C) Exceptions to advance directives.--The 
                Secretary may modify or waive the requirements of 
                section 1902(w) (relating to provision of written 
                materials on advance directives) insofar as the 
                Secretary finds that the requirements otherwise imposed 
                are not an appropriate or effective way of 
                communicating the information to Indians.
                  ``(D) Flexibility in information and marketing.--
                          ``(i) Materials.--The Secretary may modify 
                        requirements under subsection (a)(5) to ensure 
                        that information described in that subsection 
                        is provided to enrollees and potential 
                        enrollees of Indian Medicaid managed care 
                        entities in a culturally appropriate and 
                        understandable manner that clearly communicates 
                        to such enrollees and potential enrollees their 
                        rights, protections, and benefits.
                          ``(ii) Distribution of marketing materials.--
                        The provisions of subsection (d)(2)(B) 
                        requiring the distribution of marketing 
                        materials to an entire service area shall be 
                        deemed satisfied in the case of an Indian 
                        Medicaid managed care entity that distributes 
                        appropriate materials only to those Indians who 
                        are potentially eligible to enroll with the 
                        entity in the service area.
          ``(5) Malpractice insurance.--Insofar as, under a Medicaid 
        managed care program, a health care provider is required to 
        have medical malpractice insurance coverage as a condition of 
        contracting as a provider with a Medicaid managed care entity, 
        an Indian health care provider that is--
                  ``(A) a federally-qualified health center that is 
                covered under the Federal Tort Claims Act (28 U.S.C. 
                1346(b), 2671 et seq.);
                  ``(B) providing health care services pursuant to a 
                contract or compact under the Indian Self-Determination 
                and Education Assistance Act (25 U.S.C. 450 et seq.) 
                that are covered under the Federal Tort Claims Act (28 
                U.S.C. 1346(b), 2671 et seq.); or
                  ``(C) the Indian Health Service providing health care 
                services that are covered under the Federal Tort Claims 
                Act (28 U.S.C. 1346(b), 2671 et seq.);
        are deemed to satisfy such requirement.
          ``(6) Definitions.--For purposes of this subsection:
                  ``(A) Indian health care provider.--The term `Indian 
                health care provider' means an Indian Health Program or 
                an Urban Indian Organization.
                  ``(B) Indian; indian health program; service; tribe; 
                tribal organization; urban indian organization.--The 
                terms `Indian', `Indian Health Program', `Service', 
                `Tribe', `tribal organization', `Urban Indian 
                Organization' have the meanings given such terms in 
                section 4 of the Indian Health Care Improvement Act.
                  ``(C) Indian medicaid managed care entity.--The term 
                `Indian Medicaid managed care entity' means a managed 
                care entity that is controlled (within the meaning of 
                the last sentence of section 1903(m)(1)(C)) by the 
                Indian Health Service, a Tribe, Tribal Organization, or 
                Urban Indian Organization, or a consortium, which may 
                be composed of 1 or more Tribes, Tribal Organizations, 
                or Urban Indian Organizations, and which also may 
                include the Service.
                  ``(D) Non-indian medicaid managed care entity.--The 
                term `non-Indian Medicaid managed care entity' means a 
                managed care entity that is not an Indian Medicaid 
                managed care entity.
                  ``(E) Covered medicaid managed care services.--The 
                term `covered Medicaid managed care services' means, 
                with respect to an individual enrolled with a managed 
                care entity, items and services that are within the 
                scope of items and services for which benefits are 
                available with respect to the individual under the 
                contract between the entity and the State involved.
                  ``(F) Medicaid managed care program.--The term 
                `Medicaid managed care program' means a program under 
                sections 1903(m) and 1932 and includes a managed care 
                program operating under a waiver under section 1915(b) 
                or 1115 or otherwise.''.
  (b) Application to SCHIP.--Section 2107(e)(1) of such Act (42 U.S.C. 
1397gg(1)), as amended by section 206(b)(2), is amended by adding at 
the end the following new subparagraph:
                  ``(H) Subsections (a)(2)(C) and (h) of section 
                1932.''.

SEC. 209. ANNUAL REPORT ON INDIANS SERVED BY SOCIAL SECURITY ACT HEALTH 
                    BENEFIT PROGRAMS.

  Section 1139 of the Social Security Act (42 U.S.C. 1320b-9), as 
amended by the sections 202, 205, and 206, is amended by redesignating 
subsection (e) as subsection (f), and inserting after subsection (d) 
the following new subsection:
  ``(e) Annual Report on Indians Served by Health Benefit Programs 
Funded Under This Act.--Beginning January 1, 2007, and annually 
thereafter, the Secretary, acting through the Administrator of the 
Centers for Medicare & Medicaid Services and the Director of the Indian 
Health Service, shall submit a report to Congress regarding the 
enrollment and health status of Indians receiving items or services 
under health benefit programs funded under this Act during the 
preceding year. Each such report shall include the following:
          ``(1) The total number of Indians enrolled in, or receiving 
        items or services under, such programs, disaggregated with 
        respect to each such program.
          ``(2) The number of Indians described in paragraph (1) that 
        also received health benefits under programs funded by the 
        Indian Health Service.
          ``(3) General information regarding the health status of the 
        Indians described in paragraph (1), disaggregated with respect 
        to specific diseases or conditions and presented in a manner 
        that is consistent with protections for privacy of individually 
        identifiable health information under section 264(c) of the 
        Health Insurance Portability and Accountability Act of 1996.
          ``(4) A detailed statement of the status of facilities of the 
        Indian Health Service or an Indian Tribe, Tribal Organization, 
        or an Urban Indian Organization with respect to such 
        facilities' compliance with the applicable conditions and 
        requirements of titles XVIII, XIX, and XXI, and, in the case of 
        title XIX or XXI, under a State plan under such title or under 
        waiver authority, and of the progress being made by such 
        facilities (under plans submitted under section 1880(b), 
        1911(b) or otherwise) toward the achievement and maintenance of 
        such compliance.
          ``(5) Such other information as the Secretary determines is 
        appropriate.''.

                          Purpose of the Bill

    The purpose of H.R. 1328 is to amend the Indian Health Care 
Improvement Act to revise and extend that Act.

                  Background and Need for Legislation

    According to Indian Health Service (IHS) figures, the 
mortality rates for Native Americans from tuberculosis and 
alcoholism are more than six times the U.S. general population 
rate and mortality rates from diabetes are nearly three times 
as high as in the rest of the United States population. 
American Indian and Alaska Native death rates for unintentional 
injuries and motor vehicle crashes are two and one-half to 
three times higher than the national rates. Suicide and 
homicide rates are nearly twice as high in the Indian 
population.
    In addition, a new report from the Substance Abuse and 
Mental Health Services Administration (SAMHSA)\1\ found that 
American Indians and Alaska Natives continue to have higher 
rates of substance use disorders than other racial groups 
within the United States. Almost 11% percent of American 
Indians and Alaska Natives reported having a past-year alcohol 
use disorder compared with 7.6% of other racial groups, and 5% 
of American Indians and Alaska Natives had a past-year illicit 
drug use disorder compared with 2.9% of other racial groups.\2\ 
American Indians and Alaska Natives also had higher rates than 
members of other racial groups for past-year marijuana use 
(13.5% versus 10.6%), cocaine use (3.5% versus 2.4%), and 
disorders involving hallucinogen use (2.7% versus 1.7%).\3\ IHS 
reported that the number of patient services related to 
amphetamine abuse went from about 3,000 contacts in 2000 to 
over 7,000 contacts in 2005, an increase of almost 250% over 5 
years.\4\ Modernizing and improving the health care system that 
serves these communities is essential. This legislation does 
that by upgrading and updating health care for Native 
Americans.
---------------------------------------------------------------------------
    \1\National Survey on Drug Use and Health: Substance Use and 
Substance Use Disorders Among American Indians and Alaska Natives, 
Office of Applied Studies, Substance Abuse and Mental Health Services 
Administration, January, 2007.
    \2\Id.
    \3\Id.
    \4\Testimony of Robert McSwain, Deputy Director, Indian Health 
Service to the Senate Committee on Indian Affairs, April 5, 2006 (109th 
Congress).
---------------------------------------------------------------------------

         INDIAN HEALTH CARE IMPROVEMENT ACT--PUBLIC LAW 94-437

    The Indian Health Care Improvement Act (IHCIA) is the 
keystone federal law that directs the delivery of health 
services to American Indian and Alaska Native people. The 
Indian health care network--comprised of reservation and 
traditional homeland-based hospitals, clinics, school health 
centers; health stations in very remote areas; and urban Indian 
health programs in major cities--is the primary source of 
medical care for over 1.9 million American Indians and Alaska 
Natives. IHS administers this comprehensive health care network 
largely in partnership with Indian tribes, which have assumed 
an increasingly greater role in operating health programs vital 
to the well-being of their members.
    First enacted in 1976, the IHCIA presented a more organized 
and comprehensive approach to the delivery of medical care to 
Indian people, many of whom live in isolated, sparsely-
populated and under-served areas of our country. Subsequent 
reauthorizations--the IHCIA has been reauthorized three times 
with substantial amendments, the last occurring in 1992--
amended the Act to reflect advancements in health care 
delivery, enabled tribes to exercise greater responsibility 
over programs, and targeted the high incidence of certain 
diseases that have plagued the Native American population.
    The National Steering Committee on the Reauthorization of 
the IHCIA was established by tribal and health care 
representatives in the summer of 1999 to review and reconcile 
differences in recommendations from various areas of Indian 
country. The Steering Committee then drafted legislation that 
reflected the final recommendations and has remained involved 
throughout the process.

                             URBAN INDIANS

    For 40 years, the United States has provided health care to 
Urban Indians. Although appropriations for specific urban 
health care programs began in 1967, Congress formally 
authorized urban Indian health programs in 1976.
    In April 2004, the Supreme Court reaffirmed Congress' 
plenary power to legislate over matters relating to Indians.\5\ 
The Court acknowledged that Congress' plenary authority 
includes the power to recognize, terminate and restore the 
tribal status of Indian tribes.\6\ While Congress cannot 
arbitrarily call a community of people an Indian tribe,\7\ the 
Supreme Court has acknowledged that ``in respect of distinctly 
Indian communities, whether, to what extent and, for what time 
they shall be recognized and dealt with as dependent tribes 
requiring the guardianship and protection of the United States 
is to be determined by Congress''\8\ Congress' plenary 
authority over Indian tribes also includes the power to define 
who is an Indian.\9\
---------------------------------------------------------------------------
    \5\United States v. Lara, 541 U.S. 193 (2004) (noting that the 
power of Congress in Indian affairs derives not only from the Indian 
Commerce Clause, U.S. Const., Art. I, Sec. 8, cl. 3, and the Treaty 
Clause, Art II, Sec. 2, cl. 2, but rests also ``upon the Constitution's 
adoption of preconstitutional powers necessarily inherent in any 
Federal Government, namely powers that [the U.S. Supreme] Court has 
described as `necessary concomitants of nationality.''')
    \6\Id. See, also the court's observations in U.S. v. John, 437 U.S. 
634 (1978): (stating ``[n]either the fact that the Choctaws in 
Mississippi are merely a remnant of a larger group of Indians, long ago 
removed from Mississippi, nor the fact that federal supervision over 
them has not been continuous, destroys the federal power to deal with 
them.'' Id., at 652-3.
    \7\United States v. Sandoval, 231 U.S. 28, 46 (1913).
    \8\Id.
    \9\U.S. Const. Art. I, Sec. 8, cl. 3; Cohen, Felix, Handbook of 
Federal Indian Law, at 23, 1982 ed.; United States v. Holliday, 70 U.S. 
407, 417 (1865) (Congress' broad power includes dealings with 
individual Indians).
---------------------------------------------------------------------------
    As noted, this is not the first time that Congress has 
exercised its authority over individual urban Indians. The 
Supreme Court has stated that ``[t]he overriding duty of our 
federal government to deal fairly with Indians wherever located 
has been recognized by this Court many times.''\10\ As early as 
1921, Congress enacted the Snyder Act to authorize health care 
funding for Indians throughout the United States.\11\ The 
Snyder Act has never been held to be limited to Indians who are 
members of federally recognized tribes or limited to 
reservation Indians.\12\
---------------------------------------------------------------------------
    \10\Morton v. Ruiz, (415 U.S. 199, 236, (1974).
    \11\25 U.S.C. Sec. 13 (emphasis added).
    \12\See, e.g., Morton v. Ruiz, 415 U.S. 199 (1974) (upholding 
general assistance benefits authorized under the Snyder Act for 
individual Indians located off the reservation).
---------------------------------------------------------------------------
    Historically, the United States treated tribes 
differently--entering into treaties with some tribes while 
ignoring others. Various federal policies also impacted Indian 
tribes differently. For instance, the former federal policy of 
``termination'' was intended to assimilate individual Indians 
by ending the government-to-government relationship with some 
Indian tribes but not others. Terminating the political 
relationship, however, did not result in the individual Indians 
no longer being Indian. To the contrary, the Supreme Court has 
upheld the exercise of treaty rights by individual Indians 
despite the fact that Congress has terminated the federal 
relationship.\13\ Consequently, Congress has recognized the 
need to continue providing health care and certain other 
federal services to such individuals.\14\
---------------------------------------------------------------------------
    \13\Menominee Tribe of Indians v. U.S., 391 U.S. 404 (1968).
    \14\See, e.g., No Child Left Behind Act, Pub. L. 107-110.
---------------------------------------------------------------------------
    Another former federal policy--relocation\15\--is largely 
responsible for Indians moving to urban locations. Depressed 
reservation economies have also contributed to urban migration. 
Even though urban Indians no longer reside on reservations, 
they suffer from high rates of diseases and have health 
statistics similar to reservation Indians.\16\ To address this 
situation, Congress began providing health care services for 
urban Indians in 1967.
---------------------------------------------------------------------------
    \15\Many Indians were relocated to urban areas as a result of 
federal policy that began in 1931 as an attempt to assimilate Indians. 
Although the initial purpose of the relocation programs was to end 
Federal services, Congress has always indicated that health care 
programs for Indians does not stop at reservation borders.
    \16\For instance, the sudden infant death syndrome is 157% higher, 
alcoholism is 178%, chronic liver disease and cirrhosis is 126% higher. 
Without urban Indian health programs urban Indians are less likely to 
seek medical attention causing higher costs later.
---------------------------------------------------------------------------
    The history and various policies of the United States also 
resulted in some tribes entering into treaties with state 
governments. Many of these tribes continue to have political 
relationships with state governments.
    In short, Congress' plenary authority over Indians is more 
than broad enough to encompass the provisions of this Act. 
Providing health care to urban Indians is consistent with 
federal policy and with Congress' moral obligations to Indians.

                   TRADITIONAL HEALTH CARE PRACTICES

    For centuries, the United States employed various policies, 
such as assimilation and termination, to prevent Native 
Americans from using traditional health care practices. In 
furtherance of the current policy of self-governance, Congress 
recognized the importance and continued practice of traditional 
health care for Native Americans in the enactment of the Indian 
Health Care Improvement Act in 1976. Current law continues to 
recognize this importance and authorizes Federal funds to be 
used for traditional health care purposes, thus ensuring that 
health care for Native Americans is culturally appropriate.
    In 1990, Congress extended the Federal Tort Claims Act 
(FTCA) coverage to tribes and tribal organizations providing 
health care services under a contract or compact pursuant to 
the Indian Self-Determination and Education Assistance Act. 
While some concern has been expressed about FTCA's 
applicability to traditional health care practices, these 
concerns are unfounded for several reasons.
    First, a traditional healer is used when requested by an 
individual under the care of an IHS facility. In most 
instances, the traditional healer is not a Federal or tribal 
employee nor even paid with Federal funds. In fact, the 
traditional healer often does not accept any payment.
    Second, under the FTCA, liability is determined ``in 
accordance with the law of the place where the act or omission 
occurred.''\17\ In order for a claim to proceed then, state or 
tribal law must specify a standard of care for the traditional 
healing act performed. If no such standard is defined, there is 
no cause of action on which a claim for relief may be granted. 
Without such cause of action, the United States cannot be held 
liable under the FTCA.
---------------------------------------------------------------------------
    \17\28 U.S.C. Sec. Sec. 1346(b) & 2672.
---------------------------------------------------------------------------
    Finally, it should be noted that there is no record of a 
FTCA claim arising from traditional health care practices ever 
being filed.\18\
---------------------------------------------------------------------------
    \18\S. Hrg. 100-53 at 14 (March 8, 2007) (Statement of C. Frederick 
Beckner III, Deputy Assistant Attorney General, Civil Division, 
Department of Justice).
---------------------------------------------------------------------------

                               H.R. 1328

    This legislation's primary objective is to improve access 
to quality medical care for American Indians and Alaska 
Natives. Currently, over half of the IHS budget is distributed 
directly to Indian tribes who provide health care delivery 
services pursuant to Indian Self-Determination and Education 
Assistance Act (ISDEAA) contracts or compacts. In many areas of 
Indian country, IHS programs are the only source of available 
health care.
    The basic framework of the IHCIA has been retained in H.R. 
1328, including provisions that target diseases for which 
Indian Country reflects astonishingly high rates, such as 
diabetes, tuberculosis, infant mortality, alcoholism, 
accidents, homicide and substance abuse. H.R. 1328 would 
reauthorize the IHCIA through 2017 and provide funding for the 
recruitment and retention of Indian health professionals 
through scholarships, extern programs, continuing education 
programs, and retention bonuses. It would make permanent 
current programs for diabetes, andestablish a Catastrophic 
Health Emergency Fund administered for victims of disasters or 
catastrophic illness. In addition, the bill would require the Secretary 
to provide for mammography and other cancer screening consistent with 
national standards.
    Additionally, this legislation would authorize the 
Secretary to establish an Indian youth program for the purpose 
of providing innovative mental and physical disease prevention 
programs. Funding would also be authorized for activities such 
as assisted living, hospice care, long-term health care, home 
and community-based services, and traditional healing 
practices. H.R. 1328 would replace the current Urban Health 
Programs Branch with a Division of Urban Health that would 
continue to service urban Indian clinics.
    The bill would require agreements be made with Indian 
health care organizations to assist in enrolling qualified 
Indians into Medicare, Medicaid, and State Children's Health 
Insurance Program (SCHIP). It would further promote taking 
steps to provide for Medicaid enrollment on Indian reservations 
and seek input from Indian tribes on impacts encountered 
through changes in State plans.
    In addition, the bill would reorganize current substance 
abuse programs under a new Behavioral Health program to combine 
and integrate substance abuse, mental health, and social 
service programs. It would elevate the current position of 
Director of Indian Health Service to that of Assistant 
Secretary. This initiative would provide the Assistant 
Secretary with greater control over budget issues.
    Finally, this legislation would place greater emphasis on 
negotiated rulemaking with Indian tribes in order to provide 
the service population with ongoing input into how the IHCIA 
would be implemented.

                          LEGISLATIVE HISTORY

    Similar legislation was introduced in the 106th (by Rep. 
George Miller), 107th (by Rep. Rahall), 108th and 109th 
Congresses (both by Rep. Don Young). The Committee reported 
H.R. 2440 in the 108th Congress (House Report 108-791--Part I) 
and H.R. 5312 the 109th Congress (House Report 109-661--Part 
I). Also in the 109th Congress, the Senate companion bill (S. 
1057) was reported by the Senate Committee on Indian Affairs on 
March 16, 2006 (Senate Report 109-222).

                            Committee Action

    H.R. 1328 was introduced on March 6, 2007 by Representative 
Frank Pallone (D-NJ), along with thirty-four original 
cosponsors, including both Chairman Rahall and Ranking Member 
Don Young. The bill was referred to the Committee on Natural 
Resources. On March 14, 2007, the Committee on Natural 
Resources held a hearing on the bill. On April 25, 2007, the 
Full Natural Resources Committee met to consider the bill.
    Representative Abercrombie (D-HI) offered an en bloc 
amendment to include ``Urban Indians'' in the goals of the 
bill, correct typographical errors, reinsert provisions in 
existing law that were inadvertently omitted, add naturopathic 
medicine within the definition of ``health profession,'' and 
make other clarifying changes. It was adopted by voice vote.
    Rep. Pearce (R-NM) offered an amendment to distribute funds 
based on actual population needs rather than historic funding 
levels. It was withdrawn after discussion.
    Rep. Pearce (R-NM) offered an amendment requiring the 
Secretary of Health and Human Services to conduct a study of 
the third-party payment collections system for items and 
services furnished through the Indian Health Service and 
requires the Secretary to submit such report to Congress within 
6 months after date of enactment of the Act. It was adopted by 
voice vote.
    Rep. Boren (D-OK) offered an amendment to correct an 
alleged criminal jurisdiction void at the Claremore Indian 
Hospital. It was withdrawn by unanimous consent.
    Rep. Inslee (D-WA) offered an amendment to create an Area 
Distribution Fund formula to distribute health care 
construction facilities funds. It was withdrawn after 
discussion.
    Rep. Pearce (R-NM) offered an amendment requiring a report 
on the movement of patients between Service Units. It was 
adopted by voice vote.
    The bill, as amended, was then ordered favorably reported 
to the House of Representatives by voice vote.

                      Section-by-Section Analysis

Section 1. Short title; Table of contents

    Section 1 provides the short title of the bill as the 
``Indian Health Care Improvement Act Amendments of 2007'' and 
sets forth the Table of Contents.

Section 2. Report on third-party payment collections

    Section 2 requires the Secretary of Health and Human 
Services to conduct a study of the third-party payment 
collections system for items and services furnished through the 
Indian Health Service and requires the Secretary to submit such 
report to Congress within 6 months after date of enactment of 
the Act.

                   Title I--Amendments to Indian Laws

Section 101. Indian Health Care Improvement Act amended

    Section 101 amends the Indian Health Care Improvement Act 
to read as follows:

Section 1. Short title; Table of contents

    Section 1 provides that this Act may be cited as the 
``Indian Health Care Improvement Act'' and sets forth an 
amended Table of Contents.

Section 2. Findings

    Section 2 sets forth findings indicating that federal 
health services are required by the historical and unique legal 
relationship between the United States and Indians; that 
improving the quantity and quality of health services for 
Indians is a goal of the United States; that federal health 
services to Indians have resulted in a reduction in the 
prevalence and incidence of preventable illness and premature 
deaths of Indians; and that despite such services, the health 
status of Indians is still far below the general United States 
population.

Section 3. Declaration of national Indian health policy

    Section 3 sets forth a national policy of the United 
States, in fulfillment of its trust responsibility and legal 
obligations, to assure the highest possible health status of 
Indians and Urban Indians; to raise the health status of 
Indians and Urban Indians; to allow Indians to set their own 
health care priorities; to increase the number of degrees in 
health professions awarded to Indians; to require consultation 
with tribes, tribal organizations and urban Indian 
organizations; and to fund programs and facilities operated by 
tribes and tribal organizations at the same level as Indian 
Health Service (Service) programs and facilities are funded.

Section 4. Definitions

    Section 4 defines terms used in this Act, including 
definitions for the following new terms: ``accredited and 
accessible,'' ``Assistant Secretary,'' ``behavioral health,'' 
``California Indians,'' ``community college,'' ``contract 
health service,'' ``Department,'' ``disease prevention,'' 
``Indian Health Program,'' ``junior or community college,'' 
``reservation,'' ``telehealth,'' ``telemedicine,'' ``tribal 
college or university,'' and ``Tribal Health Program.'' ``Urban 
Indian'' includes members of federally-recognized Indian 
tribes, members of State-recognized Indian tribes, members of 
tribes whose relationship with the federal government has been 
terminated, and individuals who are descendants in the first or 
second degree of any such member. The Committee believes that 
there is adequate authority and precedent for this definition, 
especially since Congress has already done so for other 
purposes.\19\
---------------------------------------------------------------------------
    \19\See e.g. Indian Arts and Crafts Act, Pub. L. 101-644.
---------------------------------------------------------------------------

        Title I--Indian Health, Human Resources, and Development

Section 101. Purpose

    Section 101 provides that the purpose of this title is to 
increase the number of Indians entering health professions and 
providing health services as well as to assure a supply of 
health professions to provide health services to Indians.

Section 102. Health professions recruitment program for Indians

    Section 102 requires the Secretary to award grants to 
specified entities to assist with various activities associated 
with recruiting Indians for health professions. Terms 
addressing the application process, amount of grants, and 
payments are also set forth in this section.

Section 103. Health professions preparatory scholarship program for 
        Indians

    Section 103 requires the Secretary to provide scholarships 
to Indians for compensatory pre-professional education and pre-
graduate education. This section also specifies the uses of the 
scholarships and prohibits denial based solely on the 
applicant's scholastic achievement if the applicant has been 
admitted to or maintained good standing at an accredited 
institution or based solely on the applicant's eligibility for 
other federal assistance or benefits.

Section 104. Indian health professions scholarships

    Section 104 requires the Secretary to award Indian Health 
Scholarships to Indians pursuing courses of study in the health 
professions. The section specifies how the scholarships shall 
be distributed, how the scholarship program shall be 
administered, as well as active duty service requirements for 
recipients. Terms covering breach of contract are specified as 
are the right of recovery and the recovery terms used by the 
United States in the event of a breach of contract. The 
Secretary shall provide a partial or total waiver of the 
obligation of service or the repayment in certain specified 
conditions. A repayment obligation may not be discharged in 
bankruptcy.

Section 105. American Indians into psychology program

    Section 105 requires the Secretary to award competitive 
grants of no more than $300,000 to nine colleges and 
universities to develop and maintain Indian psychology career 
recruitment programs. One of these grants shall be provided to 
develop and maintain the Quentin N. Burdick American Indians 
into Psychology Program at the University of North Dakota. 
Grant conditions are also set forth. Each graduate who receives 
a stipend from this program is required to meet the active duty 
service requirement.

Section 106. Scholarship programs for Indian tribes

    Section 106 requires the Secretary to make grants to Tribal 
Health Programs for the purpose of providing scholarships for 
Indians to serve as health professionals in Indian communities. 
Grant amounts and requirements, contract terms, breach of 
contract terms, the relationship of the scholarship to the 
Social Security Act and continuance of funding terms are also 
set forth.

Section 107. Indian Health Service extern programs

    Section 107 grants an employment preference at the Indian 
Health Service during the nonacademic period of the year for 
Section 104 and Section 106 scholarship recipients. Scholarship 
recipients may also be employed by a Tribal Health Program or 
an Urban Indian Organization during the nonacademic period of 
the year. Employment during this period does not count towards 
the recipient's active duty service obligation and may not 
exceed 120 days during any calendar year. The recipient shall 
be compensated for his or her services and shall be employed in 
a health profession in which he or she is studying. Such 
employment shall not be counted against any employment ceiling 
affecting the Service or the Department.

Section 108. Continuing education allowances

    Section 108 authorizes the Secretary to provide programs or 
allowances to participants under Section 104, 105, 106, and 115 
in order to transition into an Indian Health Program or to take 
leave, in accordance with regulations, for professional 
consultation, management, leadership, and refresher training 
courses.

Section 109. Community Health Representative Program

    Section 109 directs the Secretary to maintain a Community 
Health Representative Program to provide training to Indians as 
community health representatives and to use community health 
representatives in the provision of health care, health 
promotion and disease prevention services to Indian 
communities. Program requirements are also set forth.

Section 110. Indian Health Service Loan Repayment Program

    Section 110 requires the Secretary to establish and 
administer a Service Loan Repayment Program in which to pay an 
individual's student loans in return for the individual 
providing health care services to Indians. Eligibility, 
application information, decision deadlines, priorities, 
contract requirements, and loan payment terms are set forth. 
Individuals with written contracts under this section shall not 
count towards any employment ceiling affecting the Department. 
The Secretary shall conduct recruiting programs and section 214 
of the Public Health Service Act shall not apply to individuals 
during their obligated service period. Terms governing 
assignment of individuals, breach of contract, and waiver or 
suspension of obligation are specified. The Secretary must 
submit a report to Congress providing data on program 
implementation on an annual basis.

Section 111. Scholarship and Loan Repayment Recovery Fund

    Section 111 establishes an Indian Health Scholarship and 
Loan Repayment Recovery Fund in the United States Treasury. The 
Fund shall consist of amounts collected under sections 104(d), 
106(e), and 110(l), any funds appropriated to the Fund, and 
interest earned on amounts in the Fund. Amounts in the Fund may 
be used to make payments to specified Indian Health Programs, 
may only be invested in interest bearing obligations of the 
United States, and such obligations may be sold by the 
Secretary of the Treasury at market price.

Section 112. Recruitment activities

    Section 112 allows the Secretary to reimburse health 
professionals seeking positions with Indian Health Programs or 
Urban Indian Organizations for certain travel expenses. 
Individuals considering entering into a contract under section 
110 and their spouses may also be reimbursed for such expenses. 
One individual from each Area Office shall be assigned by the 
Secretary to be responsible on a full-time basis for 
recruitment activities.

Section 113. Indian recruitment and retention program

    Section 113 requires the Secretary to fund, on a 
competitive basis, innovative demonstration projects to enable 
Tribal Health Programs and Urban Indian Organizations to 
recruit, place, and retain health professionals to meet their 
staffing needs.

Section 114. Advanced training and research

    Section 114 requires the Secretary to establish a 
demonstration project to enable health professionals who have 
worked in an Indian Health Program or Urban Indian Organization 
to pursue advanced training or research areas of study for 
which there is a need. Participating individuals must perform 
an active duty service obligation in an Indian Health Program 
or Urban Indian Organization and shall be liable to the United 
States for failure to complete such service obligation.

Section 115. Quentin N. Burdick American Indians Into Nursing Program

    Section 115 requires the Secretary to provide grants to 
public or private schools of nursing, tribal colleges or 
universities, nurse midwife programs and advanced practice 
nurse programs to increase the number of nurses, nurse 
midwives, and nurse practitioners who deliver health care 
services to Indians. Use of grants and grant recipient 
priorities are specified. One grant shall be provided to the 
Quentin N. Burdick American Indians Into Nursing Program at the 
University of North Dakota. Individuals receiving training 
pursuant to this section shall incur an active duty service 
obligation.

Section 116. Tribal cultural orientation

    Section 116 requires the Secretary to mandate that 
employees of the Service serving Indian Tribes in each Service 
Area receive educational instruction in the history and culture 
of Indian Tribes and their relationship to the Service. Details 
of the program are also set forth.

Section 117. Inmed Program

    Section 117 authorizes the Secretary to provide grants to 
colleges and universities to maintain and expand the Indian 
health careers recruitment program known as the ``Indians Into 
Medicine Program'' to encourage Indians to enter the health 
professions. One grant shall be provided to the University of 
North Dakota. The Secretary shall develop regulations governing 
grants and applicants must meet specified criteria.

Section 118. Health training programs of community colleges

    Section 118 requires the Secretary to award grants to 
community colleges to assist such colleges in establishing or 
maintaining programs leading to a degree or diploma in a health 
profession for individuals who desire to practice such 
profession on or near a reservation or in an Indian Health 
Program. The Secretary shall enter into agreements with the 
community colleges to provide qualified Service personnel to 
teach in the colleges and to provide technical assistance and 
support to such colleges. Any program receiving funding under 
this section must offer advanced training for certain health 
professionals. Tribal colleges and universities in the Service 
Areas shall be given priority.

Section 119. Retention bonus

    Section 119 authorizes the Secretary to pay a retention 
bonus to certain health professionals employed by, or assigned 
to, and serving in, an Indian Health Program or Urban Indian 
Organization either as a civilian employee or as a commissioned 
officer in the Regular or Reserve Corps of the Public Health 
Service. The Secretary may establish retention bonus rates for 
multiyear agreements. In the event of default, the retention 
bonus plus interest must be repaid.

Section 120. Nursing residency program

    Section 120 requires the Secretary to establish a program 
to enable Indian nurses working in an Indian Health Program or 
Urban Indian Organization to pursue advanced training. Program 
participants are obligated to serve in an Indian Health Program 
or Urban Indian Organization.

Section 121. Community Health Aide Program

    Section 121 requires the Secretary to develop and operate a 
Community Health Aide Program in Alaska. Specific program 
requirements are set forth. A neutral panel, established by the 
Secretary, shall conduct a study of the dental health aide 
therapist services provided by the Community Health Aide 
Program to ensure that the quality of care provided through 
those services is adequate and appropriate. If the Secretary 
determines it is appropriate, the Secretary may establish a 
national Community Health Aide Program. The report shall be 
submitted to the specified Congressional committees.
    The Community Health Aide Program (CHAP), except for dental 
health aide therapists' certification, may expand nationally. 
The Dental Health Aide Therapist program will be limited to 
Alaska only and the therapists' scope of practice will be 
limited to the procedures as stated in the January 31, 2005, 
Community Health Aide Program Certification Board's Standards 
and Procedures. The Committee believes the importance of the 
dental health aide program as part of a comprehensive oral 
health care delivery system led by licensed dentists should not 
be understated. This program provides an important extension of 
the community health aide program because dental health aides 
will work and live in the villages helping to establish disease 
prevention and health education programs that can break the 
dental disease cycle affecting many American Indians and Alaska 
Natives. With the emphasis on prevention, the amount of new 
active disease can be reduced and treatment of any new active 
disease can be more easily managed.
    The Committee crafted this language with input from other 
concerned Members, after consideration of the endorsement of 
the dental health aide therapist program by national Indian 
organizations and public health organizations, and with the 
assistance of the American Dental Association to ensure safety 
and continued quality care in the larger CHAP program by 
imposing certain limitations on the practice of dental health 
aide therapists found in paragraph (b)(7). To help ensure the 
continued quality of the dental health aides certified by the 
Federal Community Health Aide Program Certification Board in 
Alaska, the board should include at least one dentist from 
outside the tribal community, who has actively practiced 
dentistry and who has expertise in setting quality standards 
for evaluating competence in education and practice. In 
paragraph (b)(7), ``medical emergency'' is defined as an injury 
or illness, including infection, that poses an immediate threat 
to a person's well being, health or life. Also in paragraph 
(b)(7), deciduous teeth are defined as primary teeth and adult 
teeth are defined as permanent teeth. The amended provision 
also provides for the Secretary to establish a neutral panel to 
conduct a study of the dental health aide therapist services 
and the services of other mid-level providers, such as the 
Community Dental Health Coordinator, as developed by the 
American Dental Association.

Section 122. Tribal Health Program administration

    Section 122 requires the Secretary to provide training for 
Indians in the administration and planning of Tribal Health 
Programs.

Section 123. Health professional chronic shortage demonstration 
        programs

    Section 123 authorizes the Secretary to fund demonstration 
programs for Tribal Health Programs to address the chronic 
shortages of health professionals. Demonstration programs must 
be established for the purposes identified and must incorporate 
a program advisory board composed of representatives from 
Indian tribes and Indian communities in the area to be served.

Section 124. National Health Service Corps

    Section 124 prohibits the Secretary from removing a member 
of the National Health Service Corps from an Indian Health 
Program or Urban Indian Organization or withdrawing funding 
used to support such member unless the Secretary has ensured 
that the Indians receiving services from such member will 
experience no reduction in services. Certain National Health 
Service Corps scholars are exempt from the full-time equivalent 
limitations of the National Health Service Corps and the 
Service when serving as a commissioned corps officer in a 
Tribal Health Program or an Urban Indian Organization.

Section 125. Substance abuse counselor educational curricula 
        demonstration programs

    Section 125 permits the Secretary to enter into three year 
contracts with, or make three year grants to, tribal colleges 
and universities and community colleges to establish 
demonstration programs to develop educational curricula for 
substance abuse counseling. The Secretary is required to 
develop and issue criteria for the review and approval of 
funding applications and must submit a report to the President 
on the findings and conclusions from the demonstration 
programs. Terms for use of funds, duration of grants and 
renewal are set forth.

Section 126. Behavioral health training and community education 
        programs

    Section 126 requires the Secretary, and the Secretary of 
the Interior, to consult with Indian tribes and tribal 
organizations in conducting a study and compiling a list of the 
types of staff positions within the Indian Health Service, 
Bureau of Indian Affairs and Indian tribes, Tribal 
Organizations and Urban Indian Organizations whose 
qualifications include, or should include, training in the 
identification, prevention, education, referral, or treatment 
of mental illness, or dysfunctional and self destructive 
behavior. The appropriate Secretary is required to provide 
training, or ensure that training is provided, appropriate to 
the staff position. Upon request of an Indian Tribe, Tribal 
Organization, or Urban Indian Organization, the Indian Health 
Service is required to develop and implement, or assist in the 
development and implementation of, a community education 
program on mental illness. No later than 90 days after date of 
enactment of this measure, the Secretary is required to develop 
a plan to increase the health care staff providing behavioral 
health services by at least 500 positions within five years.

Section 127. Authorization of appropriations

    Section 127 authorizes such sums as may be necessary to 
carry out Title I.

                       Title II--Health Services

Section 201. Indian health care improvement funds

    Section 201 authorizes the Secretary to expend funds to 
fulfill the purposes specified in this section, such as 
eliminating the deficiencies in the health status and health 
resources of all Indian tribes, meeting the health needs of 
Indians, and training of traditional health care practitioners. 
Funds appropriated under this section may not be used to offset 
or limit any other appropriated funds. Funds appropriated 
pursuant to this section shall be used to improve the health 
status and reduce the resource deficiency of each Indian Tribe. 
The term ``health status and resource deficiency'' is 
definedfor purposes of this section and the health resources available 
to an Indian Tribe or Tribal Organization is clarified. The Secretary 
is also required to establish procedures for a review of any 
determination of the extent of the health status and resource 
deficiency of an Indian Tribe or Tribal Organization. The Secretary 
must submit a report to Congress on the current health status and 
resource deficiency of the Service for each Service Unit. Funds 
appropriated pursuant to this section shall be designated as the 
``Indian Health Care Improvement Fund.'' The funds shall be included in 
the base budget of the Service.
    While the Administration has raised concerns about 
extending FTCA liability for services provided by traditional 
health care practitioners, this provision, as well as many of 
the other provisions, are existing law. The Committee believes 
that the policy of self-governance should be furthered and that 
there should be no regression from existing law. The Committee 
also believes that the Administration's concern is unfounded 
and that the federal government is adequately protected.

Section 202. Catastrophic Health Emergency Fund

    Section 202 establishes an Indian Catastrophic Health 
Emergency Fund to be administered by the Secretary 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 Service's 
responsibility. Neither these funds nor their administration 
shall be subject to a contract or grant, nor shall such funds 
be allocated, apportioned, or delegated to an Area Office, 
Service Unit, or other similar basis. The Secretary is required 
to promulgate regulations in accordance with this section. 
Funds under this section may not be used to offset or limit 
appropriations made under any other law. All reimbursements 
from any other source by reason of treatment rendered to any 
victim of a disaster or catastrophic illness shall be deposited 
to this Fund.

Section 203. Health promotion and disease prevention services

    Section 203 finds that health promotion and disease 
prevention activities improve the health and well-being of 
Indians and reduces health care expenses of Indians. The 
Secretary is required to provide health promotion and disease 
prevention services to Indians. After receiving input from the 
affected Tribal Health Programs, the Secretary shall submit a 
report to Congress on the health promotion and disease 
prevention needs of Indians and the best activities to meet 
such needs.

Section 204. Diabetes prevention, treatment, and control

    Section 204 requires the Secretary, in consultation with 
Indian Tribes and Tribal Organizations, to determine the 
incidence of, and the type of complications resulting from 
diabetes among Indians and the measures required to reduce the 
incidence of diabetes. To the extent medically indicated and 
with informed consent, the Secretary must screen each Indian 
who receives diabetes services from the Service. The Secretary 
shall also maintain any model diabetes project and other 
specified projects in existence on the date of enactment of 
this Act. The Secretary may provide dialysis programs. To the 
extent funding is available, the Secretary shall undertake 
other specified duties related to diabetes.

Section 205. Shared services for long-term care

    Section 205 authorizes the Secretary to provide, either 
directly or through grants or contracts, long-term care 
services to Indians. Agreements between the Service and Tribal 
Health Programs, Indian Tribes or Tribal Organizations must 
provide for the sharing of staff or other services. Nursing 
facilities must meet the requirements of Section 1919 of the 
Social Security Act. The Secretary is required to provide 
technical assistance to enable applicants to comply with the 
provisions of this section and shall encourage the use of 
existing underused facilities.

Section 206. Health services research

    Section 206 requires the Secretary to fund research to 
further the performance of the health service responsibilities 
of Indian Health Programs. To the extent practicable, the 
Secretary must coordinate departmental research resources and 
activities to address relevant Indian Health Program research 
needs. Tribal Health Programs shall have an equal opportunity 
to compete for, and receive research funds under this section. 
Use of funds are specified. The Secretary shall evaluate the 
research and disseminate to the Tribal Health Programs 
information regarding the research under this section.

Section 207. Mammography and other cancer screening

    Section 207 requires the Secretary to provide mammography 
and other cancer screening as recommended by the United States 
Preventive Services Task Force.

Section 208. Patient travel costs

    Section 208 defines the term ``qualified escort'' for 
purposes of this section and authorizes the Secretary to fund 
certain patient travel costs, including qualified escorts, 
associated with receiving health care services.

Section 209. Epidemiology centers

    Section 209 requires the Secretary to establish an 
epidemiology center in each Service Area to carry out specified 
functions. The Director of the Centers for Disease Control and 
Prevention shall provide technical assistance to the centers. 
Grants may be made by the Secretary to tribes, tribal 
organizations, eligible intertribal consortia, and Urban Indian 
Organizations to conduct epidemiological studies of Indian 
communities. Epidemiology centers operated under such grants 
shall be treated as public health authorities for purposes of 
the Health Insurance Portability and Accountability Act of 
1968. Eligible intertribal consortia is defined for purposes of 
this section.

Section 210. Comprehensive school health education programs

    Section 210 authorizes the Secretary to award grants to 
Indian Tribes, Tribal Organizations, and Urban Indian 
Organizations to develop comprehensive school health education 
programs for children from pre-school through grade 12 in 
schools for the benefit of Indian and Urban Indian children. 
Upon request, the Secretary shall provide technical assistance 
to a Tribe, Tribal Organization or Urban Indian Organization. 
The Secretary shall also establish criteria for the review and 
approval of grant applications under this section and shall 
develop a comprehensive school health education program in 
schools funded by the Bureau of Indian Affairs.

Section 211. Indian youth program

    Section 211 authorizes the Secretary to establish and 
administer a grant program to be awarded to Indian Tribes, 
Tribal Organizations, and Urban Indian Organizations for 
innovative mental and physical disease prevention and health 
promotion and treatment programs for Indian and Urban Indian 
preadolescent and adolescent youth. The allowable and 
prohibited uses of the funds as well as the Secretary's duties 
are set forth.

Section 212. Prevention, control, and elimination of communicable and 
        infectious diseases

    Section 212 authorizes the Secretary to make grants 
available to Indian Tribes, Tribal Organizations, and Urban 
Indian Organizations for the prevention, control, and 
elimination of communicable and infectious diseases, and other 
specified related activities. Grant recipients are encouraged 
to coordinate their activities with the Centers for Disease 
Control and Prevention and State and local health agencies. 
Upon request of an Indian Tribe, Tribal Organization, or Urban 
Indian Organization, the Secretary may provide technical 
assistance. The Secretary must prepare and submit a report to 
Congress on the use of funds and the progress made toward 
preventing, controlling, and eliminating communicable and 
infectious diseases amongst Indians.

Section 213. Authority for provision of other services

    Section 213 allows the Secretary to provide funding to meet 
the Declaration of National Indian Health Policy objectives set 
forth in Section 3 through health care-related services and 
programs not otherwise described in this bill. Any service 
provided shall meet the terms and conditions set forth. This 
section also provides definitions for ``home- and community-
based services'' and ``hospice care'' for purposes of this 
section.

Section 214. Indian women's health care

    Section 214 requires the Secretary to monitor and improve 
the quality of Indian women's health care through the planning 
and delivery of programs.

Section 215. Environmental and nuclear health hazards

    Section 215 requires the Secretary, along with other 
federal agencies, to conduct studies and ongoing monitoring 
programs to determine trends in the health hazards to Indian 
miners and to other Indians as a result of environmental 
hazards which may result in chronic or life threatening health 
problems. Upon completion of such studies, the Secretary shall 
develop health care plans to address the studied health 
problems. The studies shall be submitted to Congress. An 
Intergovernmental Task Force, composed of various federal 
agencies, is established to identify existing and potential 
operations related to nuclear resource development or other 
environmental hazards that affect or may affect the health of 
Indians and to undertake activities to correct existing health 
hazards and ensure that current and future health problems are 
minimized or reduced. The Indian Health Service shall provide 
appropriate medical care to Indians who suffer from a work-
related illness as a result of employment in or near an 
environmental hazard.

Section 216. Arizona as a contract health service delivery area

    Section 216 designates the State of Arizona as a contract 
health service delivery area through the fiscal year ending 
September 30, 2016 for the purpose of providing contract health 
care services to members of federally recognized Indian Tribes 
of Arizona. The Service may not curtail any health care 
services as a result of this provision.

Section 216A. North Dakota and South Dakota as contract health service 
        delivery area

    Section 216A provides that beginning in fiscal year 2003, 
the States of North Dakota and South Dakota are designated as a 
contract health service delivery area for the purpose of 
providing contract health care services to members of federally 
recognized Indian Tribes of North Dakota and South Dakota.

Section 217. California contract health services program

    Section 217 authorizes the Secretary to fund a program 
using the California Rural Indian Health Board as a contract 
care intermediary to improve the accessibility of health 
services to California Indians. The Board shall be reimbursed 
for costs incurred pursuant to this section, however, not more 
than five percent of the reimbursed amounts may be used for 
administrative expenses. Payment shall not be made for 
treatment that may be paid for under the Indian Catastrophic 
Health Emergency Fund. An advisory board, consisting of not 
less than eight Tribal Health Programs serving California 
Indians, shall advise the California Rural Indian Health Board.

Section 218. California as a contract health service delivery area

    Section 218 designates the State of California, excluding 
specified counties, as a contract health service delivery area 
for the purpose of providing contract health care services to 
California Indians. Excluded counties may only be included in 
the contract health services delivery area if funding is 
specifically provided by the Service for such services in those 
counties.

Section 219. Contract health services for the Trenton Service Area

    Section 219 directs the Secretary to provide contract 
health care services to Turtle Mountain Band members residing 
in specified counties of the Trenton Service Area. Nothing in 
this section expands the eligibility of Band members for health 
services beyond the scope of eligibility for such health 
services that applied on May 1, 1986.

Section 220. Programs operated by Indian tribes and tribal 
        organizations

    Section 220 requires the Indian Health Service to provide 
funding to Tribal Health Programs on the same basis as funding 
is provided to programs and facilities operated directly by the 
Service.

Section 221. Licensing

    Section 221 exempts Tribal Health Program health care 
professionals from State licensing requirements for the State 
in which the Tribal Health Program performs its services 
pursuant to its contract or compact.

Section 222. Notification of provision of emergency contract health 
        services

    Section 222 provides that elderly or disabled Indians 
receiving emergency medical care or services from a non-Service 
provider or in a non-Service facility shall have 30 days to 
notify the Service of such treatment or admission.

Section 223. Prompt action on payment of claims

    Section 223 establishes a time frame for the Service to 
respond to a notification of a claim by a contract care service 
provider. Failure to respond within the time established 
requires the Service to accept the claim as valid. Payment on 
valid contract care service claims shall be made within 30 days 
after completion of the claim.

Section 224. Liability for payment

    Section 224 exempts patients receiving authorized contract 
health care services from liability for payment of such costs 
associated with the provision of such services. The Secretary 
shall notify the contract care provider and the patient that 
the patient is not liable for payment. Upon receipt of a notice 
that the claim is accepted or that the patient is not liable, 
the provider shall have no further recourse against the 
patient.

Section 225. Office of Indian Men's Health

    Section 225 permits the Secretary to establish an Office of 
Indian Men's Health within the Service. A Director, appointed 
by the Secretary, shall head the Office and shall coordinate 
and promote the health status of Indian men. Not later than two 
years after enactment of this bill, the Secretary shall submit 
a report to Congress describing the activities carried out by 
the Director and any findings by the Director with respect to 
the health of Indian men.

Section 226. Authorization of appropriations

    Section 226 authorizes appropriations in such sums as 
necessary for each fiscal year through fiscal year 2017.

                         Title III--Facilities

Section 301. Consultation; Construction and renovation of facilities; 
        Reports

    Section 301 requires the Secretary to take certain actions 
before expending or committing appropriated funds for 
facilities planning, design, construction, or renovation. 
Notwithstanding any other provision of law, the Secretary may 
not close a facility if the Secretary has not submitted an 
evaluation report to Congress that addresses the impact of the 
proposed closure and other specified considerations. The 
Secretary must maintain a health care priority system. Not 
later than one year after establishing the priority system, the 
Comptroller General of the United States shall prepare and 
finalize a report reviewing the methodologies applied, and the 
processes followed, by the Service in assessing the needs and 
developing the priority system. All funds appropriated for the 
planning, design, construction, or renovation of health care 
facilities shall be subject to the provisions of the Indian 
Self-Determination and Education Assistance Act. The Secretary 
shall consult and cooperate with Indian Tribes, Tribal 
Organizations, and Urban Indian Organizations in developing 
innovative approaches to address all or part of the total unmet 
need for construction of health facilities.

Section 302. Sanitation facilities

    Section 302 sets forth findings relating to the need for 
sanitation facilities and reaffirms that the Service has 
primary responsibility and authority to provide necessary 
sanitation facilities and services. Funding sources and terms 
and conditions on the use of such funding are set forth. The 
financial and technical capability of an Indian Tribe, Tribal 
Organization, or Indian community to safely operate, manage, 
and maintain a sanitation facility shall not be a prerequisite 
to the provision or construction of sanitation facilities. 
Financial assistance may be provided to tribes, tribal 
organizations, and Indian communities for the operation, 
management, and maintenance of their sanitation facility. 
Reasonable user fees shall be established, collected, and used 
as determined by the Tribe. Tribal Health Programs shall be 
eligible for funding on an equal basis as programs administered 
by the Service. A report, in accordance with this section, 
shall be submitted by the Secretary as part of the reporting 
requirements under section 801. The terms ``Indian community,'' 
``Sanitation facility,'' and ``Sanitation facilities'' are 
defined for purposes of this section.

Section 303. Preference to Indians and Indian firms

    Section 303 authorizes the Secretary to utilize the Buy 
Indian Act, 25 U.S.C. Sec. 47, in the construction and 
renovation of Service facilities pursuant to Section 301, and 
in the construction of sanitation facilities pursuant to 
Section 302. With regard to subchapter IV of chapter 31 of 
title 40 of the Act commonly known as the ``Davis-Bacon Act,'' 
it is the intention of the Committee to maintain current law. 
When Indian health facilities are constructed or renovated, 
Davis-Bacon prevailing wage rates apply. However, pursuant to 
current federal law and longstanding policy of the Department 
of Labor, Indian Health Service, and Bureau of Indian Affairs, 
when Indian tribes and tribal organization construct or 
renovate federally-funded Indian health facilities using their 
own employees, Davis-Bacon prevailing wage rates do not apply. 
The intention of the Committee is to maintain the status quo of 
current law and policy pursuant to the Davis-Bacon Act and the 
Indian Self-Determination and Education Assistance Act in this 
regard.

Section 304. Expenditure of non-service funds for renovation

    Section 304 permits the Secretary, if specified 
requirements are met, to accept any major expansion, 
renovation, or modernization by any Indian Tribe or Tribal 
Organization of any Service facility or of any other Indian 
health facility operated pursuant to a contract or compact. A 
separate priority list to address the increased operating 
expenses of expanded, renovated or modernized facilities shall 
be developed and maintained by the Secretary. The report shall 
be transmitted to Congress under section 801.

Section 305. Funding for the construction, expansion, and modernization 
        of small ambulatory care facilities

    Section 305 requires the Secretary to make grants to Indian 
Tribes and Tribal Organizations for the construction, 
expansion, and modernization of small ambulatory care 
facilities. Funds may be used as specified in this section. 
Grants must be approved by the Secretary in accordance with 
regulations. If grant funds are used on a facility that later 
is no longer used for the delivery of such health care 
services, all right, title, and interest in and to the facility 
shall transfer to the United States unless otherwise 
negotiated. Grant funds are nonrecurring and may not be 
included in an ISDEAA award.

Section 306. Indian Health Care delivery demonstration project

    Section 306 authorizes the Secretary to enter into ISDEAA 
contracts for the purpose of carrying out health care delivery 
demonstration projects to test alternative means of delivering 
health care and services to Indians. Funds may be used for the 
construction and renovation of hospitals, health centers, 
health stations, and other facilities to deliver health care 
services. Regulations shall be developed for the review and 
approval of applications. Projects meeting specified criteria 
may be approved. Peer review panels may be used to review and 
evaluate applications. The Secretary may provide technical and 
other assistance to enable applicants to comply with this 
section. Priority shall be given to demonstration projects in 
the following Service Units: Cass Lake, Minnesota; Mescalero, 
New Mexico; Owyhee, Nevada; Schurz, Nevada; and Fort Yuma, 
California. The authority to provide services to otherwise 
ineligible persons and to extend hospital privileges in Service 
facilities to non-Service health practitioners may be included 
in a demonstration project. Facilities operated under a 
contract or compact shall be evaluated under the same criteria 
that the Secretary uses in evaluating facilities operated 
directly by the Service. Facilities subject to a contract or 
compact shall be fully and equitably integrated into the 
implementation of the health care delivery demonstration 
projects.

Section 307. Land transfer

    Section 307 authorizes the Bureau of Indian Affairs and all 
federal agencies and departments to transfer, at no cost, land 
and improvements to the Service for the provision of health 
care services.

Section 308. Leases, contracts, and other agreements

    Section 308 authorizes the Secretary to enter into leases, 
contracts, and other agreements with Indian tribes and Tribal 
Organizations for facilities used or to be used in the 
administration and delivery of health services by an Indian 
Health Program.

Section 309. Study on loans, loan guarantees, and loan repayment

    Section 309 requires the Secretary to study feasibility of 
establishing a loan fund to provide direct loans and loan 
guarantees to Indian Tribes and Tribal Organizations for the 
construction of health care facilities. The study must include 
certain specified information and be submitted to Congress no 
later than September 30, 2009.

Section 310. Tribal leasing

    Section 310 authorizes a Tribal Health Program to lease 
permanent structures for the purpose of providing health care 
services without obtaining advance approval in appropriations 
acts.

Section 311. Indian Health Service/Tribal Facilities Joint Venture 
        Program

    Section 311 requires the Secretary to make arrangements 
with Indian Tribes and Tribal Organizations to establish joint 
venture demonstration projects, under which an Indian Tribe or 
Tribal Organization must expend tribal, private, or other 
available funds to acquire or construct a health facility for a 
minimum of 10 years, under a no-cost lease. In exchange, the 
Service would provide the equipment, supplies, and staffing for 
the operation and maintenance of such health facility. The 
Secretary is required to make such an arrangement in specified 
instances and to continue the agreement at the end of the lease 
period. The Indian Tribe or Tribal Organization shall be liable 
to the United States for breach of the agreement and the Indian 
Tribe or Tribal Organization may recover from the United States 
if the Service breaches the agreement. The terms ``health 
facility'' or ``health facilities'' are defined for purposes of 
this section.

Section 312. Location of facilities

    Section 312 requires the Bureau of Indian Affairs and the 
Service to give priority to locating Service facilities and 
projects on Indian lands or certain lands in Alaska. The term 
``Indian lands'' is defined for purposes of this section.

Section 313. Maintenance and improvement of health care facilities

    Section 313 requires the Secretary to submit to the 
President, for inclusion in the report required to be 
transmitted to Congress under section 801, a report on the 
backlog of maintenance and repair work required at Service and 
tribal health care facilities and the need for renovation and 
expansion at existing facilities. The Secretary may provide 
funds to support maintenance of newly constructed space. An 
Indian Tribe or Tribal Organization may use maintenance and 
improvement funds to construct a replacement facility if the 
costs of renovation exceed a maximum renovation cost threshold.

Section 314. Tribal management of Federally-owned quarters

    Section 314 authorizes a Tribal Health Program operating a 
health facility and the federally-owned quarters associated 
with it pursuant to a contract or compact to establish the 
rental rates charged to the occupants of the such quarters. A 
Tribal Health Program shall endeavor to achieve specified 
objectives, and may collect rents directly from federal 
employees occupying such quarters. Specific provisions govern 
rental rates for federal employees in Alaska.

Section 315. Applicability of Buy American Act requirements

    Section 315 requires the Secretary to comply with the Buy 
American Act on all procurements made under section 317. Indian 
Tribes and Tribal Organizations, however, are exempt from this 
requirement. Any person who violates the Buy American Act shall 
be subject to the penalties specified in this section.

Section 316. Other funding for facilities

    Section 316 authorizes the Secretary to accept health care 
facilities construction funds from any source and to use such 
funds to plan, design, and construct health care facilities for 
Indians. In addition, the Secretary may enter into interagency 
agreements with other federal or state agencies, or other 
entities and to accept funds to the planning, design, and 
construction of health care facilities. Standards for the 
planning, design, and construction of health care facilities 
serving Indians shall be established by regulation.

Section 317. Authorization of appropriations

    Section 317 authorizes such sums as may be necessary to be 
appropriated through fiscal year 2017.

                  Title IV--Access to Health Services

Section 401. Treatment of payments under Social Security Act health 
        benefits programs

    Section 401 provides that payments received by an Indian 
Health Program or by an Urban Indian Organization under title 
XVIII, XIX, and XXI of the Social Security Act for services 
provided to Indians shall not be considered in determining 
appropriations for the provision of health care and services to 
Indians. Nothing in this Act authorizes the Secretary to 
provide services to an Indian with coverage under title XVIII, 
XIX, or XXI of the Social Security Act in preference to an 
Indian without such coverage. Social Security payments to which 
a Service facility is entitled shall be placed in a special 
fund held by the Secretary and used as specified. A Tribal 
Health Program may elect to directly bill for, and receive 
Social Security payments for, health care items and services 
provided. This section cross-references other provisions of the 
Social Security Act.

Section 402. Grants to and contracts with the Service, Indian Tribes, 
        Tribal Organizations, and Urban Indian Organizations to 
        facilitate outreach, enrollment, and coverage of Indians under 
        Social Security Act health benefit programs and other health 
        benefits programs

    Section 402 requires the Secretary to make grants to or 
enter into contracts with Indian Tribes and Tribal 
Organizations to assist such entities in establishing and 
administering programs on or near reservations and trust lands 
to assist individual Indians with activities specified in this 
section. The Secretary shall place any necessary conditions and 
requirements on the grants or contracts. Urban Indian 
Organizations may also receive grants and other funding as 
specified. The Secretary is directed to take such steps as are 
necessary to facilitate cooperation with, and agreements 
between, States and the Service, Indian tribes, tribal 
organizations and Urban Indian Organizations. This section 
cross-references to other provisions of the Social Security 
Act. The terms ``Premium'' and ``Cost Sharing'' are defined for 
purposes of this section.

Section 403. Reimbursement from certain third parties of costs of 
        health services

    Section 403 provides the United States, an Indian Tribe, or 
Tribal Organization with the right to recovery, in accordance 
with this section, from an insurance company, health 
maintenance organization, employee benefit plan, third-party 
tortfeasor, or any other responsible or liable third party the 
reasonable charges billed by the Secretary, an Indian Tribe, or 
Tribal Organization for the provision of health services to any 
individual to the same extent that such individual would be 
eligible to receive damages, reimbursement or indemnification 
for such charges or expenses.
    With respect to the right of recovery against a State, this 
section only applies if the injury, illness, or disability is 
covered under workers' compensation laws or a no-fault 
automobile accident insurance plan. No state law and no 
contract provision, insurance policy, or other health care plan 
or program entered into or renewed after the date of enactment 
of this Act shall prevent or hinder the right of recovery under 
this section. Any right of recovery exercised pursuant to this 
section shall not deny the injured person the right of recovery 
for that portion of the person's damages not covered under this 
section. Provisions governing enforcement of the right of 
recovery are provided.
    Absent specific written authorization by a Tribal 
government, the United States shall not have a right of 
recovery under this section for an injury, illness, or 
disability covered by a self-insurance plan funded by an Indian 
Tribe, Tribal Organization, or Urban Indian Organization. A 
prevailing plaintiff shall be awarded reasonable attorney's 
fees and costs of litigation.
    A claim for benefits from specified entities may not be 
denied based on the format in which the claim is submitted. 
This section also applies to Urban Indian Organizations. 
Section 2415 of title 18, United States Code, applies to all 
actions commenced under this section. Nothing in this section 
shall be construed to limit any right of recovery available to 
the United States, an Indian Tribe, or Tribal Organization 
under the provisions of any applicable federal, state or tribal 
law.

Section 404. Crediting of reimbursements

    Section 404 provides that, except as provided in section 
202(f) and section 807, all reimbursements received or 
recovered under specified programs shall be credited to the 
Service, Indian tribe, Tribal Organization or Urban Indian 
Organization and used as provided in section 401. The Service 
may not offset or limit any amount obligated to any Service 
Unit or entity because of reimbursements under this section.

Section 405. Purchasing health care coverage

    Section 405 authorizes Indian Tribes, Tribal Organizations, 
and Urban Indian Organizations to use funds provided for health 
benefits under any provision of law, other than those made 
available under section 402, to purchase health benefits 
coverages for beneficiaries. The amounts may also be used for 
the expenses of operating a self-insured plan.

Section 406. Sharing arrangements with Federal agencies

    Section 406 authorizes the Secretary to enter into or 
expand arrangements for the sharing of medical facilities and 
services between the Service, Indian Tribes, and Tribal 
Organizations and the Department of Veterans Affairs and the 
Department of Defense. The Secretary is prohibited from taking 
certain actions that would: (1) Impair the priority access of 
any Indian to health care services provided through the Service 
and the eligibility of any Indian to receive health services 
through the Service; (2) the quality of health care services 
provided to any Indian through the Service; (3) the priority 
access of any veteran to health care services provided by the 
Department of Veterans Affairs; (4) the quality of health care 
services provided by the Department of Veterans Affairs or the 
Department of Defense; or (5) the eligibility of any Indian who 
is a veteran to receive health services through the Department 
of Veterans Affairs. The Department of Defense or the 
Department of Veterans Affairs shall reimburse the Service, 
Indian tribe, or Tribal Organization for services provided to 
beneficiaries eligible for services from either Department.

Section 407. Payor of last resort

    Section 407 mandates that, notwithstanding any federal, 
state, or local law to the contrary, the Indian Health Programs 
and health care programs operated by Urban Indian Organizations 
are the payor of last resort for services provided to eligible 
persons.

Section 408. Nondiscrimination under Federal health care programs in 
        qualifications for reimbursement for services

    Section 408 requires a federal health care program to 
accept an entity operated by the Service, an Indian Tribe, 
Tribal Organization, or Urban Indian Organization as an 
eligible provider for payment under the program for health care 
services furnished to an Indian on the same basis as any other 
provider qualified to participate as a health care services 
provider under the program. A health care services entity 
operated by the Service, an Indian Tribe, Tribal Organization, 
or Urban Indian Organization shall be deemed to have met any 
State or local licensure or recognition requirements for 
purposes of participating as a health care services provider in 
specified circumstances. Certain entities that have been 
excluded from participating in a federal health care program 
and certain entities and individuals who have had their license 
suspended or revoked by a State may not receive payment or 
reimbursement under the federal health care program. The term 
``federal health care program'' is defined for purposes of this 
section. This section cross-references certain provisions of 
the Social Security Act.

Section 409. Consultation

    Section 409 cross-references section 1139(d) of the Social 
Security Act for provisions related to consultation with 
representatives of Indian Health Programs and Urban Indian 
Organizations with respect to the health care programs 
established under Titles XVIII, XIX, and XXI of the Social 
Security Act.

Section 410. State Children's Health Insurance Program (SCHIP)

    Section 410 cross-references sections of the Social 
Security Act related to outreach to families of Indian children 
likely to be eligible for child health assistance under SCHIP 
and related to ensuring that child health assistance is 
provided under such program and that payments are made to 
Indian Health Programs and Urban Indian Organizations.

Section 411. Exclusion waiver authority for affected Indian health 
        programs and safe harbor transactions under the Social Security 
        Act

    Section 411 cross-references the Social Security Act for 
provisions relating to exclusion waiver authority for affected 
Indian Health Programs and relating to certain transactions 
involving Indian Health Programs deemed to be in safe harbors.

Section 412. Premium and cost sharing protections and eligibility 
        determinations under Medicaid and SCHIP and protection of 
        certain Indian property from Medicaid estate recovery

    Section 412 cross-references the Social Security Act for 
provisions relating to premiums or cost sharing protections for 
Indians furnished items or services directly by Indian Health 
Programs or through referral under the contract health service 
under the Medicaid program; relating rules regarding the 
treatment of certain property for purposes of determining 
eligibility; and relating to the protection of certain property 
from estate recovery provisions under the Medicaid program.

Section 413. Treatment under Medicaid and SCHIP managed care

    Section 413 cross-references the Social Security Act for 
provisions relating to the treatment of Indians enrolled in a 
managed care entity under the Medicaid program and Indian 
Health Programs and Urban Indian Organizations that are 
providers of items or services to such Indian enrollees.

Section 414. Navajo Nation Medicaid Agency feasibility study

    Section 414 requires the Secretary to study the feasibility 
of treating the Navajo Nation as a State for purposes of title 
XIX of the Social Security Act. The study must include certain 
considerations. A report of the feasibility study must be 
provided to Congress.

Section 415. General exceptions

    Section 415 provides that the requirements of this Title 
shall not apply to any excepted benefits described in certain 
paragraphs of the Public Health Service Act.

Section 416. Authorization of appropriations

    Section 416 authorizes appropriations of such sums as may 
be necessary for each fiscal year through fiscal year 2017.

                Title--Health Services for Urban Indians

Section 501. Purpose

    Section 501 states that the purpose of this title is to 
establish and maintain programs in Urban Centers to make health 
services more accessible and available to Urban Indians.

Section 502. Contracts with, and grants to, urban Indian organizations

    Section 502 requires the Secretary to enter into contracts 
with, or make grants to, Urban Indian Organizations to assist 
in the establishment and administration of programs in Urban 
Centers that meet the requirements specified in this Title.

Section 503. Contracts and grants for the provision of health care and 
        referral services

    Section 503 requires the Secretary to enter into contracts 
with, and make grants to, Urban Indian Organizations for the 
provision of health care and referral services for Urban 
Indians. Urban Indian Organizations will be selected using 
criteria prescribed by regulations and that includes certain 
specified factors. The Secretary shall facilitate access to or 
provide health promotion, disease prevention services, 
immunization services, behavioral health services, and child 
abuse prevention and treatment programs for Urban Indians. 
Other grants or contracts may be entered into between the 
Secretary and Urban Indian Organizations to provide or arrange 
for health care services to Urban Indians.

Section 504. Contracts and grants for the determination of unmet health 
        care needs

    Section 504 authorizes the Secretary to enter into 
contracts with, or make grants to, Urban Indian Organizations 
for which there were no contracts or grants entered into under 
section 503. The purpose of the grants or contracts shall be to 
assist the Secretary in assessing the health status and health 
care needs of Urban Indians. Any grant or contract entered into 
shall include certain requirements. Grants and contracts under 
this section may not be renewed.

Section 505. Evaluations; renewals

    Section 505 requires the Secretary to develop procedures to 
evaluate compliance with contract and grant requirements 
entered into under this Title. Compliance evaluations shall be 
conducted by the Secretary as set forth in this section. In the 
event of noncompliance with the requirements, the Secretary 
shall attempt to resolve with the organization any areas of 
noncompliance or unsatisfactory performance. If the 
noncompliance or unsatisfactory performance cannot be resolved 
and prevented in the future, the Secretary shall not renew the 
contract or grant with the organization.

Section 506. Other contract and grant requirements

    Section 506 requires that contracts with Urban Indian 
Organizations entered into pursuant to this title comply with 
all federal contracting laws and regulations relating to 
procurement except that in the discretion of the Secretary, 
contracts may be negotiated without advertising and need not 
conform to other specified provisions of law. The Secretary is 
authorized to make contract or grant payments in a single 
advance payment, in a semiannual or quarterly payment or by 
reimbursement. Contract provisions may be amended by the 
Secretary at the request of an Urban Indian Organization. 
Contracts or grants must assure the fair and uniform provision 
of services and assistance to Urban Indians.

Section 507. Reports and records

    Section 507 requires each Urban Indian Organization to 
submit to the Secretary a report containing specified 
information for each fiscal year that funds are received. Not 
later than 18 months after the date of enactment of this Act, 
the Secretary shall submit a report to Congress regarding the 
health status of, and services provided to, Urban Indians. The 
contract and grant reports and records of Urban Indian 
Organizations shall be subject to audit by the Secretary and 
the Comptroller General of the United States. Annual 
independent financial audits shall be an allowable cost of any 
contract or grant under sections 502 and 503.

Section 508. Limitation on contract authority

    Section 508 limits the Secretary's authority to enter into 
contracts with or award grants to the extent, and in the 
amount, provided for in appropriations acts.

Section 509. Facilities

    Section 509 authorizes the Secretary to make grants to 
contractors or grant recipients under this title for the lease, 
purchase, renovation, construction or expansion of facilities 
in order to assist contractors or grant recipients in complying 
with applicable licensure or certification requirements. The 
Secretary may conduct a study to determine the feasibility of 
establishing a loan fund to provide direct loans or loan 
guarantees to Urban Indian Organizations.

Section 510. Division of Urban Indian Health

    Section 510 establishes the Division of Urban Indian Health 
within the Service to carry out the provisions of this title, 
provide central oversight of the programs and services 
authorized under this title, and provide technical assistance 
to Urban Indian Organizations.

Section. 511. Grants for alcohol and substance abuse related services

    Section 511 authorizes the Secretary to make grants for the 
provision of health-related services in prevention of, 
treatment of, rehabilitation of, or school- and community-based 
education regarding alcohol and substance abuse in urban 
centers. Each grant shall have specific goals which must be set 
forth in the grant. The Secretary shall establish the grant 
criteria and develop a methodology for distributing grants.

Section 512. Treatment of certain demonstration projects

    Section 512 provides that the Tulsa Clinic and Oklahoma 
City Clinic demonstration projects shall be permanent programs, 
continue to be treated as Service Units and Operating Units 
with respect to resource allocation and coordination of care, 
continue to meet the requirements and definitions of an Urban 
Indian Organization, and shall not be subject to the ISDEAA.

Section 513. Urban NIAAA transferred programs

    Section 513 requires the Secretary to make grants to, or 
enter into contracts with, Urban Indian Organizations for the 
administration of Urban Indian alcohol programs originally 
established under the National Institute on Alcoholism and 
Alcohol Abuse. Contracts and grants shall be used to provide 
support for the continuation of alcohol prevention and 
treatment services for Urban Indians. The Secretary must 
evaluate and report to Congress on the activities of these 
programs not less than every five years.

Section 514. Consultation with Urban Indian Organizations

    Section 514 requires the Secretary to ensure that the 
Service consults with Urban Indian Organizations. 
``Consultation'' is defined for purposes of this section.

Section 515. Urban youth treatment center demonstration

    Section 515 authorizes the Secretary to fund the 
construction and operation of at least two residential 
treatment centers in each State meeting specified criteria.

Section 516. Grants for diabetes prevention, treatment, and control

    Section 516 permits the Secretary to make grants to certain 
Urban Indian Organizations for the provision of services for 
the prevention and treatment of, and control of the 
complications resulting from, diabetes among Urban Indians. 
Each grant must specify the goals to be accomplished under the 
grant. The Secretary must establish criteria for the grants. 
Any funds received by an Urban Indian Organization under this 
Act for the prevention, treatment, and control of diabetes 
shall be subject to these criteria.

Section 517. Community health representatives

    This section authorizes the Secretary to enter into 
contracts with, or award grants to, Urban Indian Organizations 
to employ Indians trained as health service providers through 
the Community Health Representatives Program.

Section 518. Effective date

    This section mandates that the amendments made pursuant to 
this title shall become effective on the date of enactment of 
this Act regardless of whether the Secretary has promulgated 
implementing regulations.

Section 519. Eligibility for services

    This section mandates that Urban Indians are eligible for, 
and the ultimate beneficiaries of, health care and referral 
services provided pursuant to this title.

Section 520. Authorization of appropriations

    This section authorizes appropriations of such sums as may 
be necessary through fiscal year 2017.

                 Title VI--Organizational Improvements

Section 601. Establishment of the Indian Health Service as an Agency of 
        the Public Health Service

    This section establishes the Indian Health Service within 
the Public Health Service of the Department of Health and Human 
Services. An Assistant Secretary of Indian Health shall be 
appointed by the President, by and with the advice and consent 
of the Senate, to administer the Service. The duties and 
authorities of the Assistant Secretary are set forth. Any 
reference to the Director of the Service in any other federal 
law, Executive Order, rule, regulation, or delegation of 
authority or in any document of or relating to the Director of 
the Service, shall be deemed to refer to the Assistant 
Secretary.

Section 602. Automated management information system

    This section requires the Secretary to establish an 
automated management information system for the Service that 
meets specified requirements. Each Tribal Health Program must 
be provided with an automated management information system 
that meets the management information needs of each Program and 
the Service. Each patient shall have reasonable access to his 
or her medical or health records held by or on behalf of the 
Service. The Secretary may enter into contracts, agreements, or 
joint ventures to enhance information technology in Indian 
Health Programs and facilities.

Section 603. Authorization of appropriations

    This section authorizes appropriations of such sums as may 
be necessary through fiscal year 2017.

                 Title VII--Behavioral Health Programs

Section 701. Behavioral health prevention and treatment services

    This section sets forth a number of purposes, plans, and 
programs for behavioral health prevention and treatment 
services. The Secretary must encourage Indian Tribes, Tribal 
Organizations, and Urban Indian Organizations to develop tribal 
or local plans for Indian Behavioral Health Services. To the 
extent feasible and if funding is available, the Secretary must 
provide a comprehensive continuum of behavioral health care and 
behavioral health services for Indians with services varying by 
the age of the Indian. An Indian tribe, Tribal Organization, or 
Urban Indian Organization may establish a community behavioral 
health plan to identify and coordinate resources and programs. 
The Secretary shall coordinate behavioral health planning with 
state and federal agencies. Not later than one year after the 
date of enactment of the bill, the Secretary shall assess the 
need for inpatient mental health care among Indians and the 
availability and cost of such inpatient mental health 
facilities.

Section 702. Memoranda of agreement with the Department of the Interior

    This section requires the Secretary and the Secretary of 
the Interior to enter into a memoranda of agreement or to 
update any existing memoranda of agreement required by the 
Indian Alcohol and Substance Abuse Prevention and Treatment Act 
of 1986 to address specified issues. The agreement must also 
contain specified provisions. Each memoranda of agreement must 
be published in the Federal Register.

Section 703. Comprehensive behavioral health prevention and treatment 
        program

    This section requires the Secretary to provide 
comprehensive behavioral health, prevention, treatment and 
aftercare programs. Such programs may be provided pursuant to 
contracts with public and private behavioral health treatment 
programs.

Section 704. Mental health technician program

    This section requires the Secretary to establish and 
maintain a mental health technician program to train Indians as 
mental health technicians and to employ such technicians in the 
provision of community-based mental health care. High-standard 
training in mental health care shall be provided to 
paraprofessionals based on a curriculum developed or approved 
by the Secretary. The Secretary shall supervise and evaluate 
the mental health technicians in the training program and shall 
ensure that the program uses and promotes traditional health 
care practices of the Indian tribes being served.

Section 705. Licensing requirement for mental health care workers

    This section requires any psychologist, social worker, or 
marriage and family therapist providing mental health care 
services to Indians in a clinical setting be licensed in the 
respective field. In specified situations, a trainee in 
psychology, social work, or marriage and family therapy may 
provide mental health care services.

Section 706. Indian women treatment programs

    This section allows the Secretary to make grants to Indian 
tribes, Tribal Organizations, and Urban Indian Organizations to 
develop and implement a comprehensive behavioral health 
prevention, intervention, treatment, and relapse prevention 
program that specifically addresses the cultural, historical, 
social, and child care needs of Indian women. Terms governing 
use of funds are specified. The Secretary shall establish 
criteria for the review and approval of applications and 
proposals for funding under this section. Twenty percent of the 
funds appropriated under this section shall be for grants to 
Urban Indian Organizations.

Section 707. Indian youth program

    This section requires the Secretary to develop and 
implement a program for acute detoxification and treatment for 
Indian youths. The Secretary must construct, renovate, or, as 
necessary, purchase and appropriately staff and operate at 
least one youth regional treatment center or treatment network 
in each area under the jurisdiction of an Area Office. The 
Secretary may provide intermediate technical behavioral health 
services to Indian children and adolescents. Federally-owned 
structures suitable for local residential or regional 
behavioral health treatment for Indian youths shall be 
identified and used by the Secretary for such purposes. 
Guidelines must be established by the Secretary for determining 
the suitability of any such federally-owned structure for such 
purposes.
    The Secretary, Indian Tribes, or Tribal Organizations, in 
cooperation with the Secretary of the Interior, shall develop 
and implement in each Service Unit, community-based 
rehabilitation and follow-up services for Indian youths who are 
having significant behavioral problems and need long-term 
treatment after their return to their home community. If 
appropriate, family members shall be included in the treatment 
programs provided to Indian youths. The Secretary shall provide 
programs and services to prevent and treat substance abuse 
among Indian youths. Data shall be collected by the Secretary 
with respect to mental health services provided to Indian 
youth.

Section 708. Indian youth telemental health demonstration project

    This section sets forth the purpose of this section and 
definitions specific to this section. The Secretary may award 
grants through demonstration projects to provide telemental 
health services to Indian youth. The use of funds and priority 
for awarding funds and eligibility criteria are set forth. The 
Secretary shall encourage grant recipients to collaborate to 
enable comparisons about best practices across projects and to 
submit relevant, declassified project information to the 
national clearinghouse. Each grant recipient must submit an 
annual report to the Secretary. At the termination of a 
demonstration project, the Secretary must submit to Congress a 
final report containing specified information. This section 
authorizes $1,500,000 for each of fiscal years 2008 through 
2011.

Section 709. Inpatient and community-based mental health facilities 
        design, construction, and staffing

    This section authorizes the Secretary to provide in each 
Service area, no less than one inpatient mental health care 
facility, or the equivalent, for Indians with behavioral health 
problems. The Secretary shall consider the possible conversion 
of existing, underused Service hospital beds into psychiatric 
units to meet such need.

Section 710. Training and community education

    This section requires the Secretary to develop and 
implement or assist Indian Tribes and Tribal Organizations to 
develop and implement, with each Service Unit or tribal 
program, a program of community education and behavioral health 
issues. The Secretary must provide instruction in the area of 
behavioral health issues to appropriate Bureau of Indian 
Affairs and Indian Health Service employees and personnel in 
schools or programs operated under any contract with either the 
Bureau of Indian Affairs or the Service. In carrying out the 
education and training programs, the Secretary must develop and 
provide community-based training models.

Section 711. Behavioral health program

    This section authorizes the Secretary to plan, develop, 
implement, and carry out programs to deliver innovative 
community-based behavioral health services to Indians. A grant 
may be awarded by the Secretary to an Indian Tribe or Tribal 
Organization to carry out the program. The Secretary may 
consider specified criteria and shall use the same criteria in 
evaluating the applications or proposals as used to evaluate 
other applications or proposals for funding.

Section 712. Fetal alcohol disorder programs

    This section authorizes the Secretary to establish and 
operate fetal alcohol disorder programs. The Secretary must 
develop and provide specified services. A Fetal Alcohol 
Disorder Task Force, consisting of specified entities must be 
established by the Secretary to advise the Secretary in 
developing and providing specified services. The Secretary must 
make grants to Indian Tribes, Tribal Organizations, and Urban 
Indian Organizations for applied research projects, which 
propose to elevate the understanding of methods to prevent, 
intervene, treat, or provide rehabilitation and behavioral 
health aftercare for Indians affected by fetal alcohol 
disorder. Ten percent of the appropriated funds under this 
section shall be used for grants to Urban Indian Organizations.

Section 713. Child sexual abuse and prevention treatment programs

    This section requires the Secretary to establish treatment 
programs for victims of sexual abuse who are Indian children or 
children in an Indian household, and perpetrators of child 
sexual abuse who are Indian or members of an Indian household. 
Funding under this section shall be used for specified 
purposes. Programs established under this section shall be 
carried out in coordination with programs and services 
authorized under the Indian Child Protection and Family 
Violence Prevention Act.

Section 714. Behavioral health research

    This section requires the Secretary to make grants to, or 
enter into contracts with, Indian Tribes, Tribal Organizations, 
Urban Indian Organizations, or appropriate institutions to 
conduct research on the incidence and prevalence of behavioral 
health problems among Indians. Research priorities are 
specified.

Section 715. Definitions

    This section sets forth definitions for purposes of this 
title.

Section 716. Authorization of appropriations

    This section authorizes such sums as may be necessary to 
carry out this title.

                       Title VIII--Miscellaneous

Section 801. Reports

    This section requires the Secretary to submit to Congress 
21 different reports on specified topics for each fiscal year 
following enactment of this measure.

Section 802. Regulations

    This section requires the Secretary to initiate procedures 
to negotiate and promulgate regulations or amendments to 
regulations necessary to carry out specified titles of this 
Act. A negotiated rulemaking committee to carry out this 
section may only include representatives of the United States, 
Indian Tribes, and Tribal Organizations, a majority of whom 
shall be nominated by and be representatives of Indian Tribes 
and Tribal Organizations from each Service Area. The negotiated 
rulemaking procedures shall be adapted to the unique context of 
self-governance and the government-to-government relationship 
between the United States and Indian Tribes. The lack of 
regulations shall not limit the effect of this Act. The 
Secretary may repeal any inconsistent regulations. The 
provisions of this Act shall supersede any conflicting 
provisions of law in effect on the day before the date of 
enactment of this Act.
    The Committee understands the importance of negotiated 
rulemaking for these titles and sections. Negotiated rulemaking 
was authorized in 1990 and is now part of the Administrative 
Procedures Act. Many federal agencies use negotiated rulemaking 
and one agency has noted several advantages of using negotiated 
rulemaking.\20\ Negotiated rulemaking will enable Tribal 
leaders to provide advice and input in the development of 
regulations throughout the process, which, under the general 
regulations process, is limited. Given that the regulations 
will impact the daily lives of tribal members directly, it is 
important that Indian tribes have input in developing 
regulations during the entire process. This will result in 
regulations that are less costly, less burdensome, more 
efficient to implement, and more likely to address tribal 
concerns.
---------------------------------------------------------------------------
    \20\http://www.epa.gov/brownfields/aai/negregfs.html (as of 
December 18, 2007).
---------------------------------------------------------------------------

Section 803. Plan of implementation

    This section requires the Secretary to submit to Congress a 
plan explaining the manner and schedule by which the Secretary 
will implement this Act.

Section 804. Availability of funds

    This section provides that funds made available pursuant to 
this Act shall remain available until expended.

Section 805. Limitation on use of funds appropriated to Indian Health 
        Service

    This section provides that any limitation on the use of 
funds contained in an Appropriations bill for the Department 
for a period with respect to the performance of abortions shall 
apply for that period contained in the Appropriations bill for 
the Service.

Section 806. Eligibility of California Indians

    This section sets forth the eligibility criteria for 
California Indians for health services provided by the Service. 
Nothing in this section expands the eligibility of California 
Indians for health services provided by the Service beyond the 
scope of eligibility for such health services that applied on 
May 1, 1986.

Section 807. Health services for ineligible persons

    This section sets forth the eligibility criteria for health 
services provided by the Service for individuals who would 
otherwise be ineligible for such services. For purposes of this 
section, the term ``eligible Indian'' means any Indian who is 
eligible for health services provided by the Service without 
regard to the provisions of this section.

Section 808. Reallocation of base resources

    This section provides that any allocation of Service funds 
for a fiscal year that reduces by five percent or more from the 
previous fiscal year the funding for any recurring program, 
project, or activity of a Service Unit may be implemented only 
after the Secretary has submitted to Congress a report on the 
proposed changes in allocation of funding. This provision does 
not apply if the amount appropriated to the Service for a 
fiscal year is at least five percent less than the amount 
appropriated to the Service for the previous fiscal year.

Section 809. Results of demonstration projects

    This section requires that the Secretary disseminate to 
Indian Tribes, Tribal Organizations, and Urban Indian 
Organizations the findings and results of demonstration 
projects conducted under this Act.

Section 810. Provision of services in Montana

    This section provides that the Secretary shall provide 
services and benefits for Indians in Montana in a manner 
consistent with the decision of the United States Court of 
Appeals for the Ninth Circuit in a case titled McNabb for 
McNabb v. Bowen, 829 F.2d 787 (9th Cir. 1987). Application of 
this decision in Montana shall not be construed as expressing 
Congress' intent to require the provision of services 
consistent with that case in any other State.

Section 811. Moratorium

    This section requires the Indian Health Service to provide 
services during the period of the moratorium imposed on the 
implementation of the final rule published in the Federal 
Register on September 16, 1987 by the Department of Health and 
Human Services pursuant to the eligibility criteria in effect 
on September 15, 1987 until the Service has submitted to 
Congress a budget request reflecting the increased costs 
associated with the proposed final rule and the request is 
included in an appropriations act.

Section 812. Severability provisions

    This section provides that if any provision of this Act, 
any amendment made by the Act, or the application of such 
provision or amendment to any person or circumstances is held 
to be invalid, the remainder of this Act shall remain and the 
application of such provisions to persons or circumstances 
other than those to which it is held invalid, shall not be 
affected thereby.

Section 813. Establishment of National Bipartisan Commission on Indian 
        Health Care

    This section establishes the National Bipartisan Indian 
Health Care Commission. Composition, staffing, meeting and 
hearing requirements, duties, and compensation of the 
Commission are set forth. Appropriations are authorized to 
carry out this section. The Federal Advisory Committee Act 
shall not apply to the Commission.

Section 814. Confidentiality of medical quality assurance records; 
        Qualified immunity for participants

    This section declares that the medical quality assurance 
records created by or for any Indian Health Program or a health 
program of an Urban Indian Organization as part of a medical 
quality assurance program are confidential and privileged and 
may not be disclosed to any person or entity, except as 
provided in this section. The civil liability of a person who 
releases such records in good faith is limited. The Secretary 
must promulgate regulations. Definitions for purposes of this 
section are set forth.

Section 815. Appropriations; availability

    This section provides that any new spending authority, 
which is provided under this Act shall be effective for any 
fiscal year only to such extent or in such amounts as are 
provided in appropriation Acts.

Section 816. Authorization of appropriations

    This section authorizes such sums as may be necessary to be 
appropriated for each fiscal year though fiscal year 2017 to 
carry out this title. Conforming amendments are made to other 
laws.

Section 102. Soboba sanitation facilities

    This section amends the Act of December 17, 1970 to provide 
that nothing in this Act precludes the Soboba Indian 
Reservation from being provided with sanitation facilities and 
services.

Section 103

    This section amends the Indian Self-Determination and 
Education Assistance Act to add a new Title VIII--Native 
American Health and Wellness Foundation. This new Title VIII 
provides definitions specific to that title and requires the 
Secretary to establish a Native American Health and Wellness 
Foundation. The organic structure of the Foundation is set 
forth as are the powers and duties of the Foundation. A 
Committee for the Establishment of Native American Health and 
Wellness Foundation shall be established by the Secretary to 
assist the Secretary in establishing the Foundation. The duties 
of the Committee are set forth in this section. There are 
authorized to be appropriated $500,000 for each fiscal year and 
the Secretary is required to transfer to the Foundation funds 
held by the Department of Health and Human Services under the 
Act of August 5, 1954, if the transfer or use of the funds is 
not prohibited by any term under which the funds were donated.

 Title II--Improvement of Indian Health Care Provided Under the Social 
                              Security Act

    Title II amends specified provisions of the Social Security 
Act.

Section 201. Expansion of payments under Medicare, Medicaid, and SCHIP 
        for all covered services furnished by Indian health programs

    This section authorizes the Indian Health Service and an 
Indian Tribe, Tribal Organization, or an Urban Indian 
Organization to be reimbursed for Medicaid, if applicable 
conditions and requirements are met. Indian Health Services, 
tribes, and Tribal and Urban Indian Organizations, which do not 
meet all applicable conditions and requirements, must make 
necessary improvements to achieve or maintain compliance with 
applicable conditions and requirements. The Secretary may enter 
into an agreement with a State to reimburse a State for 
Medicaid services provided by the Service, tribal or Urban 
Indian Organizations. Medicare payments may be made to the 
Service, Indian tribes, Tribal Organizations, or Urban Indian 
Organizations, if applicable conditions and requirements are 
met. If a Service, tribal, or urban Indian organization 
facility does not meet applicable conditions and requirements, 
such facility shall make necessary improvements to achieve or 
maintain compliance. Definitions for terms used in this section 
are provided. This section cross-references certain provisions 
of the Social Security Act relating to a special fund and 
direct billing for both Medicare and Medicaid by a Tribal 
Health Program or an Urban Indian Organization.

Section 202. Increased outreach to Indians under Medicaid and SCHIP and 
        improved cooperation in the provision of items and services to 
        Indians under Social Security Act health benefit programs

    This section requires the Secretary to encourage States to 
enroll Indians in the Medicaid and SCHIP programs. The 
Secretary is also required to take such steps as are necessary 
to facilitate cooperation with, and agreements between, States 
and the Service, Indian Tribes, Tribal Organizations, and Urban 
Indian Organizations with respect to the provision of health 
care items and services. Definitions for terms used in this 
section are provided.

Section 203. Additional provisions to increase outreach to, and 
        enrollments of, Indians in SCHIP and Medicaid

    This section exempts outreach activities and enrollment 
assistance to families of Indian children from the cap on SCHIP 
payments.

Section 204. Premiums and cost sharing protections under Medicaid, 
        eligibility determinations under Medicaid and SCHIP, and 
        protection of certain Indian property from Medicaid estate 
        recovery

    Section 204 prohibits enrollment fees, premiums, and cost-
sharing from being imposed on Indians served at Service, 
tribal, or Urban Indian health programs or through the 
referrals to contract health. It also prohibits the reduction 
of the reimbursement of the Service, tribal, or Urban Indian 
health program for the fees or cost-sharing. Certain Indian 
property is exempted from Medicaid estate recovery.

Section 205. Nondiscrimination in qualifications for payment for 
        services under Federal health care programs

    Section 205 permits the Service, an Indian Tribe, Tribal 
Organization or Urban Indian Organization to be eligible on the 
same basis as other qualified providers for reimbursement. 
Payments may not be made to programs excluded from any other 
federal health care program and if any state licenses were 
suspended or revoked.

Section 206. Consultation on Medicaid, SCHIP, and other health care 
        programs funded under the Social Security Act involving Indian 
        health programs and urban Indian organizations

    Section 206 maintains the Tribal Technical Advisory Group 
within the Centers for Medicaid and Medicare Services to 
provide the Centers with technical assistance and advice. 
States must establish a process for consultation with tribal 
and urban health programs on matters relating to Medicaid which 
are likely to have a direct effect on Indians or Indian health 
programs.

Section 207. Exclusion waiver authority for affected Indian health 
        programs and safe harbor transactions under the Social Security 
        Act

    Section 207 authorizes the Secretary to waive an exclusion 
under the Social Security Act for an Indian health program upon 
the request of the Indian health program. Certain transactions 
between the Indian health programs or patients may not be 
considered remuneration under Section 1128B of the Social 
Security Act.

Section 208. Rules applicable under Medicaid and SCHIP to managed care 
        entities with respect to Indian enrollees and Indian health 
        care providers and Indian managed care entities

    Section 208 permits Indians, enrolled in a non-Indian 
managed care entity with an Indian health program participating 
in the network, to choose the Indian health program as the 
primary care provider. Non-Indian managed care entities with 
significant Indian enrollees must meet certain requirements. 
The Indian health programs are required to comply with all 
generally applicable Medicaid requirements to the extent the 
requirements do not conflict with other federal statutes 
applicable to the Indian health programs. Special rules are 
applicable to Indian managed care entities. In regard to 
Medicaid managed care program, if a health care provider is 
required to have medical malpractice insurance as a condition 
of contracting with a Medicaid managed care entity, an Indian 
health care provider would be deemed to satisfy such a 
requirement in specified instances.

Section 209. Annual Report on Indians served by Social Security Act 
        health benefit programs

    Section 209 requires the Secretary to submit annual reports 
to Congress regarding the enrollment and health status of 
Indians receiving items or services under health benefit 
programs funded under this Act.

            Committee Oversight Findings and Recommendations

    Regarding clause 2(b)(1) of rule X and clause 3(c)(1) of 
rule XIII of the Rules of the House of Representatives, the 
Committee on Natural Resources' oversight findings and 
recommendations are reflected in the body of this report.

                   Constitutional Authority Statement

    Article I, section 8, clause 3 of the Constitution of the 
United States grants Congress the authority to enact this bill.

                    Compliance With House Rule XIII

    1. Cost of Legislation. Clause 3(d)(2) of rule XIII of the 
Rules of the House of Representatives requires an estimate and 
a comparison by the Committee of the costs which would be 
incurred in carrying out this bill. However, clause 3(d)(3)(B) 
of that rule provides that this requirement does not apply when 
the Committee has included in its report a timely submitted 
cost estimate of the bill prepared by the Director of the 
Congressional Budget Office under section 402 of the 
Congressional Budget Act of 1974.
    2. Congressional Budget Act. As required by clause 3(c)(2) 
of rule XIII of the Rules of the House of Representatives and 
section 308(a) of the Congressional Budget Act of 1974, this 
bill contains several provisions, primarily related to the 
Medicaid program, that would increase direct spending.
    3. General Performance Goals and Objectives. As required by 
clause 3(c)(4) of rule XIII, the general performance goal or 
objective of this bill is to amend the Indian Health Care 
Improvement Act to revise and extend that Act.
    4. Congressional Budget Office Cost Estimate. Under clause 
3(c)(3) of rule XIII of the Rules of the House of 
Representatives and section 403 of the Congressional Budget Act 
of 1974, the Committee has received the following cost estimate 
for this bill from the Director of the Congressional Budget 
Office:

H.R. 1328--Indian Health Care Improvement Act Amendments of 2007

    Summary: H.R. 1328 would authorize the appropriation of 
such sums as necessary through 2017 for activities under the 
Indian Health Care Improvement Act, the primary authorizing 
legislation for the Indian Health Service (IHS). The bill also 
contains specific authorizations for a program to encourage 
Indians to pursue careers related to behavioral health, a 
demonstration project to provide suicide prevention services, a 
commission on Indian health care, and administrative costs for 
a new nonprofit corporation. Enacting the bill also would 
affect direct spending, primarily through provisions affecting 
the Medicaid program.
    CBO estimates that implementing H.R. 1328 would cost $2.7 
billion in 2008, about $16 billion over the 2008-2012 period, 
and about $35 billion over the 2008-2017 period, assuming 
appropriation of the necessary amounts. We also estimate that 
enacting the bill would increase direct spending by $10 million 
in 2008, $57 million over the 2008-2012 period, and $137 
million over the 2008-2017 period.
    H.R. 1328 would preempt state licensing laws in certain 
cases, and this preemption would be an intergovernmental 
mandate as defined in the Unfunded Mandates Reform Act (UMRA); 
however, CBO estimates that the costs of that mandate would be 
small and would not approach the threshold established in UMRA 
($66 million in 2007, adjusted annually for inflation). The 
bill also would place new requirements on Medicaid and the 
State Children's Health Insurance Program (SCHIP) that would 
result in additional spending of about $85 million over the 
2008-2017 period. Those requirements, however, would not be 
intergovernmental mandates as defined by UMRA. Other provisions 
of the bill would benefit tribal governments by establishing 
new or expanding existing programs for Indian health care. This 
bill contains no private-sector mandates as defined in UMRA.
    Estimated Cost to the Federal Government: The estimated 
budgetary impact of H.R. 1328 is summarized in Table 1. The 
costs of this legislation fall within budget function 550 
(health).

           TABLE 1.--ESTIMATED BUDGETARY EFFECTS OF H.R. 1328
------------------------------------------------------------------------
                                      By fiscal year, in millions of
                                                 dollars--
                                 ---------------------------------------
                                   2008    2009    2010    2011    2012
------------------------------------------------------------------------
              CHANGES IN SPENDING SUBJECT TO APPROPRIATION

Estimated Authorization Level...   3,257   3,326   3,402   3,481   3,558
Estimated Outlays...............   2,682   3,141   3,310   3,449   3,534

                      CHANGES IN DIRECT SPENDING\1\

Estimated Budget Authority......       9      10      12      12      13
Estimated Outlays...............      10      10      12      12      13
------------------------------------------------------------------------
\1\Direct spending changes through 2017 are shown in Table 3.

    Basis of estimate: For the purpose of this estimate, CBO 
assumes that H.R. 1328 will be enacted near the start of fiscal 
year 2008 and that the necessary amounts will be appropriated 
for each year.

Spending Subject to Appropriation

    The estimated effects of H.R. 1328 on spending subject to 
appropriation for the next five years are detailed in Table 2. 
Implementing the legislation would result in discretionary 
costs of about $16 billion over the 2008-2012 period. Because 
the bill would authorize funding through 2017, such 
discretionary cost would continue, with an estimated cost of 
about $35 billion over the 2008-2017 period.

                       TABLE 2.--ESTIMATED EFFECTS OF H.R. 1328 ON DISCRETIONARY SPENDING
----------------------------------------------------------------------------------------------------------------
                                                                     By fiscal year, in millions of dollars--
                                                                 -----------------------------------------------
                                                                   2007    2008    2009    2010    2011    2012
----------------------------------------------------------------------------------------------------------------
                                        SPENDING SUBJECT TO APPROPRIATION
IHS Spending Under Current Law:\1\
    Budget Authority............................................   3,169       0       0       0       0       0
    Estimated Outlays...........................................   3,203     553     164      72      12       2
Proposed Changes:
    Existing Indian Health Service Activities:
        Estimated Authorization Level...........................       0   3,247   3,320   3,396   3,475   3,554
        Estimated Outlays.......................................       0   2,679   3,134   3,303   3,443   3,529
    Recruitment Program for Behavioral Health Careers:
        Authorization Level.....................................       0       3       3       3       3       3
        Estimated Outlays.......................................       0       2       3       3       3       3
    Mental Health Demonstration Project:
        Authorization Level.....................................       0       2       2       2       2       0
        Estimated Outlays.......................................       0       *       1       2       2       1
    Commission on Indian Health Care:
        Authorization Level.....................................       0       4       0       0       0       0
        Estimated Outlays.......................................       0       1       2       1       0       0
    Native American Health and Wellness Foundation:
        Authorization Level.....................................       0       1       1       1       1       1
        Estimated Outlays.......................................       0       *       1       1       1       1
    Total Changes:
        Estimated Authorization Level...........................       0    3257   3,326   3,402   3,481   3,558
        Estimated Outlays.......................................       0   2,682   3,141   3,310   3,449   3,534
Spending Under S. 1200:
    Estimated Authorization Level\1\............................   3,169   3,257   3,326   3,402   3,481   3,558
    Estimated Outlays...........................................   3,203   3,235   3,305   3,382   3,461   3,536
----------------------------------------------------------------------------------------------------------------
Note: * = less than $500,000.
\1\The 2007 level is the amount appropriated for that year for IHS.

    Existing Indian Health Service Activities. H.R. 1328 would 
authorize the appropriation of such sums as necessary for the 
Indian Health Service through 2017. The agency's 
responsibilities under the bill would be broadly similar to 
those in current law. In 2007, the agency received an 
appropriation of $3.2 billion. CBO's estimate of the authorized 
level for IHS programs is the appropriated amount for 2007 
adjusted for inflation in later years. (That level would grow 
to nearly $4 billion by 2017.) The estimated outlays reflect 
historical spending patterns for IHS activities.
    Recruitment Program for Behavioral Health Careers. Section 
105 of the bill would authorize the appropriation of $2.7 
million annually through 2017 for grants to develop and 
maintain programs that encourage Indians to pursue careers in a 
field related to behavioral health. Assuming the appropriation 
of the authorized amounts, CBO estimates that implementing this 
provision would cost $2 million in 2008, $13 million over the 
2008-2012 period, and $26 million over the 2008-2017 period.
    Mental Health Demonstration Project. Section 708 would 
authorize the appropriation of $1.5 million annually for fiscal 
years 2008 through 2011 for grants to examine the feasibility 
of using telecommunication technology to provide suicide 
prevention services to Indians. Assuming the appropriation of 
the authorized amounts, CBO estimates that implementing this 
provision would cost less than $500,000 in 2008 and about $6 
million over the 2008-2012 period.
    Commission on Indian Health Care. Section 813 would 
authorize the appropriation of $4 million for a commission that 
would examine how the federal government provides health care 
services to Indians. The members of the commission would have 
to be appointed within eight months of the bill's enactment and 
would be required to submit a final report to the Congress no 
later than 18 months after that. Assuming the appropriation of 
the authorized amount, CBO estimates that implementing this 
provision would cost $1 million in 2008, $2 million in 2009, 
and $1 million in 2010.
    Native American Health and Wellness Foundation. H.R. 1328 
would establish a charitable and nonprofit corporation called 
the Native American Health and Wellness Foundation to assist 
federal, state, tribal, and other entities in efforts to 
further health and wellness activities and opportunities for 
Indians. The bill would authorize the appropriation of $500,000 
annually for the foundation's administrative expenses; this 
amount would be adjusted in later years for inflation. Assuming 
the appropriation of the authorized amounts, CBO estimates that 
implementing this provision would cost less than $500,000 in 
2008 and about $2 million over the 2008-2012 period.

Direct spending

    H.R. 1328 contains several provisions, primarily related to 
the Medicaid program, that would affect direct spending. The 
bill's estimated effects on direct spending are shown in Table 
3. Overall, CBO estimates that enacting the bill would increase 
direct spending by $10 million in 2008 and $137 million over 
the 2008-2017 period.

                                               TABLE 3.--ESTIMATED EFFECTS OF H.R. 1328 ON DIRECT SPENDING
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                       By fiscal year, in millions of dollars--
                                                             -------------------------------------------------------------------------------------------
                                                               2008   2009   2010   2011   2012   2013   2014   2015   2016   2017  2008-2012  2008-2017
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                               CHANGES IN DIRECT SPENDING

Exemption from Cost Sharing and Premiums:
    Medicaid:
        Estimated Budget Authority..........................      6      6      7      7      8      9      9      9     10     11        34         82
        Estimated Outlays...................................      6      6      7      7      8      9      9      9     10     11        34         82
    SCHIP:
        Budget Authority....................................      0      0      0      0      0      0      0      0      0      0         0          0
        Estimated Outlays...................................      1      *      *      *      *     -1      *      *      *      *         2          *
Consultation with Indian Health Programs:
    Estimated Budget Authority..............................      *      *      1      1      1      1      1      1      1      1         3          7
    Estimated Outlays.......................................      *      *      1      1      1      1      1      1      1      1         3          7
Medicaid Managed Care Provisions:
    Estimated Budget Authority..............................      3      3      4      4      4      5      5      5      6      6        18         45
    Estimated Outlays.......................................      3      3      4      4      4      5      5      5      6      6        18         45
Scholarship and Loan Repayment Recovery Fund:
    Estimated Budget Authority..............................      *      *      *      *      *      *      *      *      *      *         2          4
    Estimated Outlays.......................................      *      *      *      *      *      *      *      *      *      *         2          4
Total Changes:
    Estimated Budget Authority..............................      9     10     12     12     13     15     15     16     17     18        56        137
    Estimated Outlays.......................................     10     10     12     12     13     14     15     16     17     18        57        137
--------------------------------------------------------------------------------------------------------------------------------------------------------
Notes: Components may not sum to totals because of rounding. SCHIP is the State Children's Health Insurance Program.
*= costs or savings of less than $500,000.

    IHS-funded health programs are commonly divided into three 
groups: Those operated directly by the Indian Health Service, 
those operated by tribes and tribal organizations under self-
governance agreements, and those operated by urban Indian 
organizations. For this estimate, they are referred to 
collectively as Indian health programs.
    Exemption from Cost Sharing and Premiums. Section 204 would 
prohibit Medicaid and SCHIP programs from charging premiums or 
other cost-sharing payments to Indians for services that are 
provided directly or upon referral by Indian health programs. 
The provision also would prohibit states from reducing payments 
to providers for those services by the amount of cost sharing 
that Indians otherwise would pay.
    Medicaid. CBO anticipates that this provision's budgetary 
effect would stem largely from eliminating cost sharing for 
referral services. Current law already prohibits Indian health 
programs from charging cost sharing to Indians who use their 
services. In addition, Medicaid pays almost all facilities 
operated by IHS and tribes based on an all-inclusive rate that 
is not reduced to account for any cost sharing that Indians 
would otherwise have to pay. Finally, very few states charge 
premiums to their Medicaid enrollees.
    Using Medicaid administrative data, CBO estimates that 
about 280,000 Indians are Medicaid recipients who also use IHS, 
and that federal Medicaid spending on affected services would 
be about $225 per person annually in 2008. The amount of 
affected spending would be relatively low because Medicaid 
already prohibits cost sharing in many instances, such as long-
term care services, emergency services, and services for many 
children and pregnant women. For the affected spending, CBO 
assumes that cost-sharing payments by individuals equal 2 
percent of total spending--Medicaid law limits the extent to 
which states can impose cost sharing--and that eliminating cost 
sharing would increase total spending by about 5 percent as 
individuals consume more services. Overall, CBO estimates that 
the provision would increase federal Medicaid spending by $6 
million in 2008 and by $82 million over the 2008-2017 period.
    State Children's Health Insurance Program. SCHIP 
regulations already prohibit states from charging cost sharing 
or premiums to Indian children enrolled in the program. As a 
result, the provision's impact on SCHIP spending largely 
reflects higher payments to Indian health programs and the use 
of additional services by adult enrollees that a handful of 
states cover in waiver programs. The provision's effects would 
be limited in later years because total funding for the program 
is capped. On balance, CBO estimates that the additional 
spending would total less than $500,000 over the 2008-2017 
period.
    Consultation with Indian Health Programs. Section 206 would 
encourage state Medicaid programs to consult regularly with 
Indian health programs on outstanding Medicaid issues by 
allowing states to receive federal matching funds for the cost 
of those consultations. Those costs would be treated as an 
administrative expense under Medicaid and divided equally 
between the federal government and the states. CBO anticipates 
that a small number of states would take advantage of this 
provision, increasing federal Medicaid spending by less than 
$500,000 in 2008 and by $7 million over the 2008-2017 period.
    Medicaid Managed Care Provisions. Section 208 would make 
several changes to improve the ability of Indian health 
programs to receive payments for Indians who receive Medicaid 
benefits through managed care arrangements. Those changes 
include:
     Managed care organizations (MCOs) would have to 
pay Indian health programs at least the rates used for non-
preferred providers. States also would have the option of 
making those payments directly to Indian health programs.
     MCOs would have to accept claims submitted by 
Indian health programs instead of requiring enrollees to submit 
claims personally.
     Some requirements that MCOs must now meet to 
participate in Medicaid would be waived or modified for Indian 
health programs that seek to operate as MCOs. (For example, 
MCOs run by Indian health programs would be able to limit 
enrollment to Indians only.)
     States would be required to offer contracts to 
Indian health programs seeking to operate their own MCOs.
    Based on administrative data on Medicaid enrollment and 
spending for Indians who receive benefits via managed care, CBO 
estimates that those provisions would increase federal Medicaid 
spending by $3 million in 2008 and $45 million over the 2008-
2017 period. We anticipate that the additional costs would be 
relatively modest because some states already use similar rules 
in their Medicaid managed care programs and Indian health 
programs would have a limited interest in participating as 
MCOs.
    Scholarship and Loan Repayment Recovery Fund. H.R. 1328 
would allow the Secretary of Health and Human Services to spend 
amounts collected for breach of contract from recipients of 
certain IHS scholarships. Under current law, those funds are 
deposited in the Treasury and not spent. Because the 
Secretary's ability to spend those funds would not be subject 
to appropriation, the provision would increase direct spending. 
Based on historical information from IHS, CBO estimates that 
the provision would increase spending by less than $500,000 a 
year, but would total about $4 million over the 2008-2017 
period.
    Estimated impact on state, local, and tribal governments:

Intergovernmental mandates

    H.R. 1328 would preempt state licensing laws in cases where 
a health care professional is licensed in one state but is 
performing services in another state under a contract or 
compact with a tribal health program. This preemption would be 
an intergovernmental mandate as defined in the UMRA; however, 
CBO estimates that the loss of any licensing fees resulting 
from the mandate would be small and would not approach the 
threshold established in UMRA ($66 million in 2007, adjusted 
annually for inflation).

Other impacts

    H.R. 1328 would reauthorize and expand grant and assistance 
programs available to Indian tribes, tribal organizations, and 
urban Indian organizations for a range of health care programs, 
including prevention, treatment, and ongoing care. The bill 
also would allow IHS and tribal entities to share facilities, 
and it would authorize joint ventures between IHS and Indian 
tribes or tribal organizations for the construction and 
operation of health facilities. The bill would authorize 
funding for a variety of health services including hospice 
care, long-term care, public health services, and home and 
community-based services.
    The bill would prohibit states from charging cost sharing 
or premiums in the Medicaid or SCHIP programs to Indians who 
receive services or benefits through an Indian health program. 
CBO estimates that the new requirements in the bill would 
result in additional spending by states of about $85 million 
over the 2008-2017 period. Those requirements, however, would 
not be intergovernmental mandates as defined by UMRA because 
Medicaid and SCHIP provide states with significant flexibility 
to make programmatic adjustments to accommodate the changes. 
Some tribal entities, particularly those operating managed care 
systems, may realize some savings as a result of these 
provisions.
    Estimated impact on the private sector: This bill contains 
no private-sector mandates as defined in UMRA.
    Previous CBO estimate: On June 8, 2007, CBO issued an 
estimate for H.R. 1328, the Indian Health Care Improvement Act 
Amendments of 2007, as ordered reported by the Senate Committee 
on Indian Affairs on May 10, 2007. There are only minor 
differences between the two bills, and CBO's estimates for them 
are identical.
    Estimate prepared by: Federal Costs: Eric Rollins, Impact 
on State, Local, and Tribal Governments: Leo Lex, Impact on the 
Private Sector: Paige Shevlin.
    Estimate approved by: Peter H. Fontaine, Deputy Assistant 
Director for Budget Analysis.

                    Compliance With Public Law 104-4

    This bill would preempt state licensing laws in certain 
cases, which would be an intergovernmental mandate, however the 
Congressional Budget Office estimates that the costs of this 
mandate would be small and would not approach the threshold 
established in the Unfunded Mandates Reform Act.

                           Earmark Statement

    H.R. 1328 does not contain any congressional earmarks, 
limited tax benefits, or limited tariff benefits as defined in 
clause 9(d), 9(e) or 9(f) of rule XXI.

                Preemption of State, Local or Tribal Law

    This bill would preempt state licensing laws where a health 
care professional is licensed in one state but is performing 
services in another state under a contract or compact with a 
tribal health program. This bill does not preempt local or 
tribal law.

         Changes in Existing Law Made by the Bill, as Reported

  In compliance with clause 3(e) of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (existing law 
proposed to be omitted is enclosed in black brackets, new 
matter is printed in italic, existing law in which no change is 
proposed is shown in roman):

                   INDIAN HEALTH CARE IMPROVEMENT ACT

    AN ACT To implement the Federal responsibility for the care and 
education of the Indian people by improving the services and facilities 
of Federal Indian health programs and encouraging maximum participation 
          of Indians in such programs, and for other purposes.

  Be it enacted by the Senate and House of Representatives of 
the United States of America in Congress assembled, [That this 
Act may be cited as the ``Indian Health Care Improvement Act''.
                               [findings
  [Sec. 2. The Congress finds the following:
  [(a) Federal health services to maintain and improve the 
health of the Indians are consonant with and required by the 
Federal Government's historical and unique legal relationship 
with, and resulting responsibility to, the American Indian 
people.
  [(b) A major national goal of the United States is to provide 
the quantity and quality of health services which will permit 
the health status of Indians to be raised to the highest 
possible level and to encourage the maximum participation of 
Indians in the planning and management of those services.
  [(c) Federal health services to Indians have resulted in a 
reduction in the prevalence and incidence of preventable 
illnesses among, and unnecessary and premature deaths of, 
Indians.
  [(d) Despite such services, the unmet health needs of the 
American Indian people are severe and the health status of the 
Indians is far below that of the general population of the 
United States.
                   [declaration of health objectives
  [Sec. 3. (a) The Congress hereby declares that it is the 
policy of this Nation, in fulfillment of its special 
responsibilities and legal obligation to the American Indian 
people, to assure the highest possible health status for 
Indians and urban Indians and to provide all resources 
necessary to effect that policy.
  [(b) It is the intent of the Congress that the Nation meet 
the following health status objectives with respect to Indians 
and urban Indians by the year 2000:
          [(1) Reduce coronary heart disease deaths to a level 
        of no more than 100 per 100,000.
          [(2) Reduce the prevalence of overweight individuals 
        to no more than 30 percent.
          [(3) Reduce the prevalence of anemia to less than 10 
        percent among children aged 1 through 5.
          [(4) Reduce the level of cancer deaths to a rate of 
        no more than 130 per 100,000.
          [(5) Reduce the level of lung cancer deaths to a rate 
        of no more than 42 per 100,000.
          [(6) Reduce the level of chronic obstructive 
        pulmonary disease related deaths to a rate of no more 
        than 25 per 100,000.
          [(7) Reduce deaths among men caused by alcohol-
        related motor vehicle crashes to no more than 44.8 per 
        100,000.
          [(8) Reduce cirrhosis deaths to no more than 13 per 
        100,000.
          [(9) Reduce drug-related deaths to no more than 3 per 
        100,000.
          [(10) Reduce pregnancies among girls aged 17 and 
        younger to no more than 50 per 1,000 adolescents.
          [(11) Reduce suicide among men to no more than 12.8 
        per 100,000.
          [(12) Reduce by 15 percent the incidence of injurious 
        suicide attempts among adolescents aged 14 through 17.
          [(13) Reduce to less than 10 percent the prevalence 
        of mental disorders among children and adolescents.
          [(14) Reduce the incidence of child abuse or neglect 
        to less than 25.2 per 1,000 children under age 18.
          [(15) Reduce physical abuse directed at women by male 
        partners to no more than 27 per 1,000 couples.
          [(16) Increase years of healthy life to at least 65 
        years.
          [(17) Reduce deaths caused by unintentional injuries 
        to no more than 66.1 per 100,000.
          [(18) Reduce deaths caused by motor vehicle crashes 
        to no more than 39.2 per 100,000.
          [(19) Among children aged 6 months through 5 years, 
        reduce the prevalence of blood lead levels 
        exceeding15ug/dl and reduce to zero the prevalence of 
        blood lead levels exceeding 25 ug/dl.
          [(20) Reduce dental caries (cavities) so that the 
        proportion of children with one or more caries (in 
        permanent or primary teeth) is no more than 45 percent 
        among children aged 6 through 8 and no more than 60 
        percent among adolescents aged 15.
          [(21) Reduce untreated dental caries so that the 
        proportion of children with untreated caries (in 
        permanent or primary teeth) is no more than 20 percent 
        among children aged 6 through 8 and no more than 40 
        percent among adolescents aged 15.
          [(22) Reduce to no more than 20 percent the 
        proportion of individuals aged 65 and older who have 
        lost all of their natural teeth.
          [(23) Increase to at least 45 percent the proportion 
        of individuals aged 35 to 44 who have never lost a 
        permanent tooth due to dental caries or periodontal 
        disease.
          [(24) Reduce destructive periodontal disease to a 
        prevalence of no more than 15 percent among individuals 
        aged 35 to 44.
          [(25) Increase to at least 50 percent the proportion 
        of children who have received protective sealants on 
        the occlusal (chewing) surfaces of permanent molar 
        teeth.
          [(26) Reduce the prevalence of gingivitis among 
        individuals aged 35 to 44 to no more than 50 percent.
          [(27) Reduce the infant mortality rate to no more 
        than 8.5 per 1,000 live births.
          [(28) Reduce the fetal death rate (20 or more weeks 
        of gestation) to no more than 4 per 1,000 live births 
        plus fetal deaths.
          [(29) Reduce the maternal mortality rate to no more 
        than 3.3 per 100,000 live births.
          [(30) Reduce the incidence of fetal alcohol syndrome 
        to no more than 2 per 1,000 live births.
          [(31) Reduce stroke deaths to no more than 20 per 
        100,000.
          [(32) Reverse the increase in end-stage renal disease 
        (requiring maintenance dialysis or transplantation) to 
        attain an incidence of no more than 13 per 100,000.
          [(33) Reduce breast cancer deaths to no more than 
        20.6 per 100,000 women.
          [(34) Reduce deaths from cancer of the uterine cervix 
        to no more than 1.3 per 100,000 women.
          [(35) Reduce colorectal cancer deaths to no more than 
        13.2 per 100,000.
          [(36) Reduce to no more than 11 percent the 
        proportion of individuals who experience a limitation 
        in major activity due to chronic conditions.
          [(37) Reduce significant hearing impairment to a 
        prevalence of no more than 82 per 1,000.
          [(38) Reduce significant visual impairment to a 
        prevalence of no more than 30 per 1,000.
          [(39) Reduce diabetes-related deaths to no more than 
        48 per 100,000.
          [(40) Reduce diabetes to an incidence of no more than 
        2.5 per 1,000 and a prevalence of no more than 62 per 
        1,000.
          [(41) Reduce the most severe complications of 
        diabetes as follows:
                  [(A) End-stage renal disease, 1.9 per 1,000.
                  [(B) Blindness, 1.4 per 1,000.
                  [(C) Lower extremity amputation, 4.9 per 
                1,000.
                  [(D) Perinatal mortality, 2 percent.
                  [(E) Major congenital malformations, 4 
                percent.
          [(42) Confine annual incidence of diagnosed AIDS 
        cases to no more than 1,000 cases.
          [(43) Confine the prevalence of HIV infection to no 
        more than 100 per 100,000.
          [(44) Reduce gonorrhea to an incidence of no more 
        than 225 cases per 100,000.
          [(45) Reduce chlamydia trachomatis infections, as 
        measured by a decrease in the incidence of 
        nongonococcal urethritis to no more than 170 cases per 
        100,000.
          [(46) Reduce primary and secondary syphilis to an 
        incidence of no more than 10 cases per 100,000.
          [(47) Reduce the incidence of pelvic inflammatory 
        disease, as measured by a reduction in hospitalization 
        for pelvic inflammatory disease to no more than 250 per 
        100,000 women aged 15 through 44.
          [(48) Reduce viral hepatitis B infection to no more 
        than 40 per 100,000 cases.
          [(49) Reduce indigenous cases of vaccine-preventable 
        diseases as follows:
                  [(A) Diphtheria among individuals aged 25 and 
                younger, 0.
                  [(B) Tetanus among individuals aged 25 and 
                younger, 0.
                  [(C) Polio (wild-type virus), 0.
                  [(D) Measles, 0.
                  [(E) Rubella, 0.
                  [(F) Congenital Rubella Syndrome, 0.
                  [(G) Mumps, 500.
                  [(H) Pertussis, 1,000.
          [(50) Reduce epidemic-related pneumonia and influenza 
        deaths among individuals aged 65 and older to no more 
        than 7.3 per 100,000.
          [(51) Reduce the number of new carriers of viral 
        hepatitis B among Alaska Natives to no more than 1 
        case.
          [(52) Reduce tuberculosis to an incidence of no more 
        than 5 cases per 100,000.
          [(53) Reduce bacterial meningitis to no more than 8 
        cases per 100,000.
          [(54) Reduce infectious diarrhea by at least 25 
        percent among children.
          [(55) Reduce acute middle ear infections among 
        children aged 4 and younger, as measured by days of 
        restricted activity or school absenteeism, to no more 
        than 105 days per 100 children.
          [(56) Reduce cigarette smoking to a prevalence of no 
        more than 20 percent.
          [(57) Reduce smokeless tobacco use by youth to a 
        prevalence of no more than 10 percent.
          [(58) Increase to at least 65 percent the proportion 
        of parents and caregivers who use feeding practices 
        that prevent baby bottle tooth decay.
          [(59) Increase to at least 75 percent the proportion 
        of mothers who breast feed their babies in the early 
        postpartum period, and to at least 50 percent the 
        proportion who continue breast feeding until their 
        babies are 5 to 6 months old.
          [(60) Increase to at least 90 percent the proportion 
        of pregnant women who receive prenatal care in the 
        first trimester of pregnancy.
          [(61) Increase to at least 70 percent the proportion 
        of individuals who have received, as a minimum within 
        the appropriate interval, all of the screening and 
        immunization services and at least one of the 
        counseling services appropriate for their age and 
        gender as recommended by the United States Preventive 
        Services Task Force.
  [(c) It is the intent of the Congress that the Nation 
increase the proportion of all degrees in the health 
professions and allied and associated health profession fields 
awarded to Indians to 0.6 percent.
  [(d) The Secretary shall submit to the President, for 
inclusion in each report required to be transmitted to the 
Congress under section 801, a report on the progress made in 
each area of the Service toward meeting each of the objectives 
described in subsection (b).
                              [definitions
  [Sec. 4. For purposes of this Act--
  [(a) ``Secretary'', unless otherwise designated, means the 
Secretary of Health and Human Services.
  [(b) ``Service'' means the Indian Health Service.
  [(c) ``Indians'' or ``Indian'', unless otherwise designated, 
means any person who is a member of an Indian tribe, as defined 
in subsection (d) hereof, except that, for the purpose of 
sections 102 and 103, such terms shall mean any individual who 
(1), irrespective of whether he or she lives on or near a 
reservation, is a member of a tribe, band, or other organized 
group of Indians, including those tribes, bands, or groups 
terminated since 1940 and those recognized now or in the future 
by the State in which they reside, or who is a descendant, in 
the first or second degree, of any such member, or (2) is an 
Eskimo or Aleut or other Alaska Native, or (3) is considered by 
the Secretary of the Interior to be an Indian for any purpose, 
or (4) is determined to be an Indian under regulations 
promulgated by the Secretary.
  [(d) ``Indian tribe'' means any Indian tribe, band, nation, 
or other organized group or community, including any Alaska 
Native village or group or regional or village corporation as 
defined in or established pursuant to the Alaska Native Claims 
Settlement Act (85 Stat. 688), which is recognized as eligible 
for the special programs and services provided by the United 
States to Indians because of their status as Indians.
  [(e) ``Tribal organization'' means the elected governing body 
of any Indian tribe or any legally established organization of 
Indians which is controlled by one or more such bodies or by a 
board of directors elected or selected by one or more such 
bodies (or elected by the Indian population to be served by 
such organization) and which includes the maximum participation 
of Indians in all phases of its activities.
  [(f) ``Urban Indian'' means any individual who resides in an 
urban center, as defined in subsection (g) hereof, and who 
meets one or more of the four criteria in subsection (c)(1) 
through (4) of this section.
  [(g) ``Urban center'' means any community which has a 
sufficient urban Indian population with unmet health needs to 
warrant assistance under title V, as determined by the 
Secretary.
  [(h) ``Urban Indian organization'' means a nonprofit 
corporate body situated in an urban center, governed by an 
urban Indian controlled board of directors and providing for 
the maximum participation of all interested Indian groups and 
individuals, which body is capable of legally cooperating with 
other public and private entities for the purpose of performing 
the activities described in section 503(a).
  [(i) ``Area office'' means an administrative entity including 
a program office, within the Indian Health Service through 
which services and funds are provided to the service units 
within a defined geographic area.
  [(j) ``Service unit'' means--
          [(1) an administrative entity within the Indian 
        Health Service, or
          [(2) a tribe or tribal organization operating health 
        care programs or facilities with funds from the Service 
        under the Indian Self-Determination Act,
through which services are provided, directly or by contract, 
to the eligible Indian population within a defined geographic 
area.
  [(k) ``Health promotion'' includes--
          [(1) cessation of tobacco smoking,
          [(2) reduction in the misuse of alcohol and drugs,
          [(3) improvement of nutrition,
          [(4) improvement in physical fitness,
          [(5) family planning,
          [(6) control of stress, and
          [(7) pregnancy and infant care (including prevention 
        of fetal alcohol syndrome).
  [(l) ``Disease prevention'' includes--
          [(1) immunizations,
          [(2) control of high blood pressure,
          [(3) control of sexually transmittable diseases,
          [(4) prevention and control of diabetes,
          [(5) control of toxic agents,
          [(6) occupational safety and health,
          [(7) accident prevention,
          [(8) fluoridation of water, and
          [(9) control of infectious agents.
  [(m) ``Service area'' means the geographical area served by 
each area office.
  [(n) ``Health profession'' means allopathic medicine, family 
medicine, internal medicine, pediatrics, geriatric medicine, 
obstetrics and gynecology, podiatric medicine, nursing, public 
health nursing, dentistry, psychiatry, osteopathy, optometry, 
pharmacy, psychology, public health, social work, marriage and 
family therapy, chiropractic medicine, environmental health and 
engineering, an allied health profession, or any other health 
profession.
  [(o) ``Substance abuse'' includes inhalant abuse.
  [(p) ``FAE'' means fetal alcohol effect.
  [(q) ``FAS'' means fetal alcohol syndrome.

                    TITLE I--INDIAN HEALTH MANPOWER

                                [purpose
  [Sec. 101. The purpose of this title is to increase the 
number of Indians entering the health professions and to assure 
an adequate supply of health professionals to the Service, 
Indian tribes, tribal organizations, and urban Indian 
organizations involved in the provision of health care to 
Indian people.
          [health professions recruitment program for indians
  [Sec. 102. (a) The Secretary, acting through the Service, 
shall make grants to public or nonprofit private health, or 
educational entities, or Indian tribes or tribal organizations 
to assist such entities in meeting the costs of--
          [(1) identifying Indians with a potential for 
        education or training in the health professions and 
        encouraging and assisting them--
                  [(A) to enroll in courses of study in such 
                health professions; or
                  [(B) if they are not qualified to enroll in 
                any such courses of study, to undertake such 
                postsecondary education or training as may be 
                required to qualify them for enrollment;
          [(2) publicizing existing sources of financial aid 
        available to Indians enrolled in any course of study 
        referred to in paragraph (1) of this subsection or who 
        are undertaking training necessary to quality them to 
        enroll in any such course of study; or
          [(3) establishing other programs which the Secretary 
        determines will enhance and facilitate the enrollment 
        of Indians in, and the subsequent pursuit and 
        completion by them of, courses of study referred to in 
        paragraph (1) of this subsection.
  [(b)(1) No grant may be made under this section unless an 
application therefor has been submitted to, and approved by, 
the Secretary. Such application shall be in such form, 
submitted in such manner, and contain such information, as the 
Secretary shall by regulation prescribe. The Secretary shall 
give a preference to applications submitted by Indian tribes or 
tribal organizations.
  [(2) The amount of any grant under this section shall be 
determined by the Secretary. Payments pursuant to grants under 
this section may be made in advance or by way of reimbursement, 
and at such intervals and on such conditions as the Secretary 
finds necessary.
    [health professions preparatory scholarship program for indians
  [Sec. 103. (a) The Secretary, acting through the Service, 
shall make scholarship grants to Indians who--
          [(1) have successfully completed their high school 
        education or high school equivalency; and
          [(2) have demonstrated the capability to successfully 
        complete courses of study in the health professions.
  [(b) Scholarship grants made pursuant to this section shall 
be for the following purposes:
          [(1) Compensatory preprofessional education of any 
        grantee, such scholarship not to exceed two years on a 
        full-time basis (or the part-time equivalent thereof, 
        as determined by the Secretary).
          [(2) Pregraduate education of any grantee leading to 
        a baccalaureate degree in an approved course of study 
        preparatory to a field of study in a health profession, 
        such scholarship not to exceed 4 years (or the part-
        time equivalent thereof, as determined by the 
        Secretary).
  [(c) Scholarship grants made under this section may cover 
costs of tuition, books, transportation, board, and other 
necessary related expenses of a grantee while attending school.
  [(d) The Secretary shall not deny scholarship assistance to 
an eligible applicant under this section solely on the basis of 
the applicant's scholastic achievement if such applicant has 
been admitted to, or maintained good standing at, an accredited 
institution.
  [(e) The Secretary shall not deny scholarship assistance to 
an eligible applicant under this section solely by reason of 
such applicant's eligibility for assistance or benefits under 
any other Federal program.
                [indian health professions scholarships
  [Sec. 104. (a) In order to provide health professionals to 
Indians, Indian tribes, tribal organizations, and urban Indian 
organizations, the Secretary, acting through the Service and in 
accordance with this section, shall make scholarship grants to 
Indians who are enrolled full or part time in appropriately 
accredited schools and pursuing courses of study in the health 
professions. Such scholarships shall be designated Indian 
Health Scholarships and shall be made in accordance with 
section 338A of the Public Health Service Act (42 U.S.C. 254l), 
except as provided in subsection (b) of this section.
  [(b)(1) The Secretary, acting through the Service, shall 
determine who shall receive scholarships under subsection (a) 
and shall determine the distribution of such scholarships among 
such health professions on the basis of the relative needs of 
Indians for additional service in such health professions.
  [(2) An individual shall be eligible for a scholarship under 
subsection (a) in any year in which such individual is enrolled 
full or part time in a course of study referred to in 
subsection (a).
  [(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--
          [(i) in the Indian Health Service;
          [(ii) in a program conducted under a contract entered 
        into under the Indian Self-Determination Act;
          [(iii) in a program assisted under title V of this 
        Act;
          [(iv) in the private practice of the applicable 
        profession if, as determined by the Secretary, in 
        accordance with guidelines promulgated by the 
        Secretary, such practice is situated in a physician or 
        other health professional shortage area and addresses 
        the health care needs of a substantial number of 
        Indians; or
  [(B) At the request of any individual who has entered into a 
contract referred to in subparagraph (A) and who receives a 
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).
  [(C) A recipient of an Indian Health Scholarship may, at the 
election of the recipient, meet the active duty service 
obligation described in subparagraph (A) by service in a 
program specified in that subparagraph that--
          [(i) is located on the reservation of the tribe in 
        which the recipient is enrolled; or
          [(ii) serves the tribe in which the recipient is 
        enrolled.
  [(D) Subject to subparagraph (C), the Secretary, in making 
assignments of Indian Health Scholarship recipients required to 
meet the active duty service obligation described in 
subparagraph (A), shall give priority to assigning individuals 
to service in those programs specified in subparagraph (A) that 
have a need for health professionals to provide health care 
services as a result of individuals having breached contracts 
entered into under this section.
  [(4) In the case of an individual receiving a scholarship 
under this section who is enrolled part time in an approved 
course of study--
          [(A) such scholarship shall be for a period of years 
        not to exceed the part-time equivalent of 4 years, as 
        determined by the Secretary;
          [(B) the period of obligated service described in 
        paragraph (3)(A) shall be equal to the greater of--
                  [(i) the part-time equivalent of one year for 
                each year for which the individual was provided 
                a scholarship (as determined by the Secretary); 
                or
                  [(ii) two years; and
          [(C) the amount of the monthly stipend specified in 
        section 338A(g)(1)(B) of the Public Health Service Act 
        (42 U.S.C. 254l(g)(1)(B)) shall be reduced pro rata (as 
        determined by the Secretary) based on the number of 
        hours such student is enrolled.
  [(5)(A) An individual who has, on or after the date of the 
enactment of this paragraph, entered into a written contract 
with the Secretary under this section and who--
          [(i) fails to maintain an acceptable level of 
        academic standing in the educational institution in 
        which he is enrolled (such level determined by the 
        educational institution under regulations of the 
        Secretary),
          [(ii) is dismissed from such educational institution 
        for disciplinary reasons,
          [(iii) voluntarily terminates the training in such an 
        educational institution for which he is provided a 
        scholarship under such contract before the completion 
        of such training, or
          [(iv) fails to accept payment, or instructs the 
        educational institution in which he is enrolled not to 
        accept payment, in whole or in part, of a scholarship 
        under such contract,
in lieu of any service obligation arising under such contract, 
shall be liable to the United States for the amount which has 
been paid to him, or on his behalf, under the contract.
  [(B) If for any reason not specified in subparagraph (A) an 
individual breaches his written contract by failing either to 
begin such individual's service obligation under this section 
or to complete such service obligation, the United States shall 
be entitled to recover from the individual an amount determined 
in accordance with the formula specified in subsection (l) of 
section 108 in the manner provided for in such subsection.
  [(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.
  [(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) The Secretary shall, acting through the Service, 
establish a Placement Office to develop and implement a 
national policy for the placement, to available vacancies 
within the Service, of Indian Health Scholarship recipients 
required to meet the active duty service obligation prescribed 
under section 338C of the Public Health Service Act (42 U.S.C. 
254m) without regard to any competitive personnel system, 
agency personnel limitation, or Indian preference policy.
                 [indian health service extern programs
  [Sec. 105. (a) Any individual who receives a scholarship 
grant pursuant to section 104 shall be entitled to employment 
in the service during any nonacademic period of the year. 
Periods of employment pursuant to this subsection shall not be 
counted in determining the fulfillment of the service 
obligation incurred as a condition of the scholarship grant.
  [(b) Any individual enrolled in a course of study in the 
health professions may be employed by the Service during any 
nonacademic period of the year. Any such employment shall not 
exceed one hundred and twenty days during any calendar year.
  [(c) Any employment pursuant to this section shall be made 
without regard to any competitive personnel system or agency 
personnel limitation and to a position which will enable the 
individual so employed to receive practical experience in the 
health profession in which he or she is engaged in study. Any 
individual so employed shall receive payment for his or her 
services comparable to the salary he or she would receive if he 
or she were employed in the competitive system. Any individual 
so employed shall not be counted against any employment ceiling 
affecting the Service or the Department of Health and Human 
Services.
                    [continuing education allowances
  [Sec. 106. (a) In order to encourage physicians, dentists, 
nurses, and other health professionals to join or continue in 
the Service and to provide their services in the rural and 
remote areas where a significant portion of the Indian people 
resides, the Secretary, acting through the Service, may provide 
allowances to health professionals employed in the Service to 
enable them for a period of time each year prescribed by 
regulation of the Secretary to take leave of their duty 
stations for professional consultation and refresher training 
courses.
  [(b) Of amounts appropriated under the authority of this 
title for each fiscal year to be used to carry out this 
section, not more than $1,000,000 may be used to establish 
postdoctoral training programs for health professionals.
                [community health representative program
  [Sec. 107. (a) Under the authority of the Act of November 2, 
1921 (25 U.S.C. 13), popularly known as the Snyder Act, the 
Secretary shall maintain a Community Health Representative 
Program under which the Service--
          [(1) provides for the training of Indians as health 
        paraprofessionals, and
          [(2) uses such paraprofessionals in the provision of 
        health care, health promotion, and disease prevention 
        services to Indian communities.
  [(b) The Secretary, acting through the Community Health 
Representative Program of the Service, shall--
          [(1) provide a high standard of training for 
        paraprofessionals to Community Health Representatives 
        to ensure that the Community Health Representatives 
        provide quality health care, health promotion, and 
        disease prevention services to the Indian communities 
        served by such Program,
          [(2) in order to provide such training, develop and 
        maintain a curriculum that--
                  [(A) combines education in the theory of 
                health care with supervised practical 
                experience in the provision of health care, and
                  [(B) provides instruction and practical 
                experience in health promotion and disease 
                prevention activities, with appropriate 
                consideration given to lifestyle factors that 
                have an impact on Indian health status, such as 
                alcoholism, family dysfunction, and poverty,
          [(3) maintain a system which identifies the needs of 
        Community Health Representatives for continuing 
        education in health care, health promotion, and disease 
        prevention and maintain programs that meet the needs 
        for such continuing education,
          [(4) maintain a system that provides close 
        supervision of Community Health Representatives,
          [(5) maintain a system under which the work of 
        Community Health Representatives is reviewed and 
        evaluated, and
          [(6) promote traditional health care practices of the 
        Indian tribes served consistent with the Service 
        standards for the provision of health care, health 
        promotion, and disease prevention.
             [indian health service loan repayment program
  [Sec. 108. (a)(1) The Secretary, acting through the Service, 
shall establish a program to be known as the Indian Health 
Service Loan Repayment Program (hereinafter referred to as the 
``Loan Repayment Program'') in order to assure an adequate 
supply of trained health professionals necessary to maintain 
accreditation of, and provide health care services to Indians 
through, Indian health programs.
  [(2) For the purposes of this section--
          [(A) the term ``Indian health program'' means any 
        health program or facility funded, in whole or part, by 
        the Service for the benefit of Indians and 
        administered--
                  [(i) directly by the Service;
                  [(ii) by any Indian tribe or tribal or Indian 
                organization pursuant to a contract under--
                          [(I) the Indian Self-Determination 
                        Act, or
                          [(II) section 23 of the Act of April 
                        30, 1908 (25 U.S.C. 47), popularly 
                        known as the ``Buy-Indian'' Act; or
                  [(iii) by an urban Indian organization 
                pursuant to title V of this Act; and
          [(B) the term ``State'' has the same meaning given 
        such term in section 331(i)(4) of the Public Health 
        Service Act.
  [(b) To be eligible to participate in the Loan Repayment 
Program, an individual must--
          [(1)(A) be enrolled--
                  [(i) in a course of study or program in an 
                accredited institution, as determined by the 
                Secretary, within any State and be scheduled to 
                complete such course of study in the same year 
                such individual applies to participate in such 
                program; or
                  [(ii) in an approved graduate training 
                program in a health profession; or
          [(B) have--
                  [(i) a degree in a health profession; and
                  [(ii) a license to practice a health 
                profession in a State;
          [(2)(A) be eligible for, or hold, an appointment as a 
        commissioned officer in the Regular or Reserve Corps of 
        the Public Health Service;
          [(B) be eligible for selection for civilian service 
        in the Regular or Reserve Corps of the Public Health 
        Service;
          [(C) meet the professional standards for civil 
        service employment in the Indian Health Service; or
          [(D) be employed in an Indian health program without 
        a service obligation; and
          [(3) submit to the Secretary an application for a 
        contract described in subsection (f).
  [(c)(1) In disseminating application forms and contract forms 
to individuals desiring to participate in the Loan Repayment 
Program, the Secretary shall include with such forms a fair 
summary of the rights and liabilities of an individual whose 
application is approved (and whose contract is accepted) by the 
Secretary, including in the summary a clear explanation of the 
damages to which the United States is entitled under subsection 
(l) in the case of the individual's breach of the contract. The 
Secretary shall provide such individuals with sufficient 
information regarding the advantages and disadvantages of 
service as a commissioned officer in the Regular or Reserve 
Corps of the Public Health Service or a civilian employee of 
the Indian Health Service to enable the individual to make a 
decision on an informed basis.
  [(2) The application form, contract form, and all other 
information furnished by the Secretary under this section shall 
be written in a manner calculated to be understood by the 
average individual applying to participate in the Loan 
Repayment Program.
  [(3) The Secretary shall make such application forms, 
contract forms, and other information available to individuals 
desiring to participate in the Loan Repayment Program on a date 
sufficiently early to ensure that such individuals have 
adequate time to carefully review and evaluate such forms and 
information.
  [(d)(1) Consistent with paragraph (3), the Secretary, acting 
through the Service and in accordance with subsection (k), 
shall annually--
          [(A) identify the positions in each Indian health 
        program for which there is a need or a vacancy, and
          [(B) rank those positions in order of priority.
  [(2) Consistent with the priority determined under paragraph 
(1), the Secretary, in determining which applications under the 
Loan Repayment Program to approve (and which contracts to 
accept), shall give priority to applications made by--
          [(A) Indians; and
          [(B) individuals recruited through the efforts of 
        Indian tribes or tribal or Indian organizations.
          [(3)(A) Subject to subparagraph (B), of the total 
        amounts appropriated for each of the fiscal years 1993, 
        1994, and 1995 for loan repayment contracts under this 
        section, the Secretary shall provide that--
                  [(i) not less than 25 percent be provided to 
                applicants who are nurses, nurse practitioners, 
                or nurse midwives; and
                  [(ii) not less than 10 percent be provided to 
                applicants who are mental health professionals 
                (other than applicants described in clause 
                (i)).
          [(B) The requirements specified in clause (i) or 
        clause (ii) of subparagraph (A) shall not apply if the 
        Secretary does not receive the number of applications 
        from the individuals described in clause (i) or clause 
        (ii), respectively, necessary to meet such 
        requirements.
  [(e)(1) An individual becomes a participant in the Loan 
Repayment Program only upon the Secretary and the individual 
entering into a written contract described in subsection (f).
  [(2) The Secretary shall provide written notice to an 
individual promptly on--
          [(A) the Secretary's approving, under paragraph (1), 
        of the individual's participation in the Loan Repayment 
        Program, including extensions resulting in an aggregate 
        period of obligated service in excess of 4 years; or
          [(B) the Secretary's disapproving an individual's 
        participation in such Program.
  [(f) The written contract referred to in this section between 
the Secretary and an individual shall contain--
          [(1) an agreement under which--
                  [(A) subject to paragraph (3), the Secretary 
                agrees--
                          [(i) to pay loans on behalf of the 
                        individual in accordance with the 
                        provisions of this section, and
                          [(ii) to accept (subject to the 
                        availability of appropriated funds for 
                        carrying out this section) the 
                        individual into the Service or place 
                        the individual with a tribe or Indian 
                        organization as provided in 
                        subparagraph (B)(iii), and
                  [(B) subject to paragraph (3), the individual 
                agrees--
                          [(i) to accept loan payments on 
                        behalf of the individual;
                          [(ii) in the case of an individual 
                        described in subsection (b)(1)--
                                  [(I) to maintain enrollment 
                                in a course of study or 
                                training described in 
                                subsection (b)(1)(A) until the 
                                individual completes the course 
                                of study or training, and
                                  [(II) while enrolled in such 
                                course of study or training, to 
                                maintain an acceptable level of 
                                academic standing (as 
                                determined under regulations of 
                                the Secretary by the 
                                educational institution 
                                offering such course of study 
                                or training);
                          [(iii) to serve for a time period 
                        (hereinafter in this section referred 
                        to as the ``period of obligated 
                        service'') equal to 2 years or such 
                        longer period as the individual may 
                        agree to serve in the full-time 
                        clinical practice of such individual's 
                        profession in an Indian health program 
                        to which the individual may be assigned 
                        by the Secretary;
          [(2) a provision permitting the Secretary to extend 
        for such longer additional periods, as the individual 
        may agree to, the period of obligated service agreed to 
        by the individual under paragraph (1)(B)(iii);
          [(3) a provision that any financial obligation of the 
        United States arising out of a contract entered into 
        under this section and any obligation of the individual 
        which is conditioned thereon is contingent upon funds 
        being appropriated for loan repayments under this 
        section;
          [(4) a statement of the damages to which the United 
        States is entitled under subsection (l) for the 
        individual's breach of the contract; and
          [(5) such other statements of the rights and 
        liabilities of the Secretary and of the individual, not 
        inconsistent with this section.
  [(g)(1) A loan repayment provided for an individual under a 
written contract under the Loan Repayment Program shall consist 
of payment, in accordance with paragraph (2), on behalf of the 
individual of the principal, interest, and related expenses on 
government and commercial loans received by the individual 
regarding the undergraduate or graduate education of the 
individual (or both), which loans were made for--
          [(A) tuition expenses;
          [(B) all other reasonable educational expenses, 
        including fees, books, and laboratory expenses, 
        incurred by the individual; and
          [(C) reasonable living expenses as determined by the 
        Secretary.
  [(2)(A) For each year of obligated service that an individual 
contracts to serve under subsection (f) the Secretary may pay 
up to $35,000 (or an amount equal to the amount specified in 
section 338B(g)(2)(A) of the Public Health Service Act) on 
behalf of the individual for loans described in paragraph (1). 
In making a determination of the amount to pay for a year of 
such service by an individual, the Secretary shall consider the 
extent to which each such determination--
          [(i) affects the ability of the Secretary to maximize 
        the number of contracts that can be provided under the 
        Loan Repayment Program from the amounts appropriated 
        for such contracts;
          [(ii) provides an incentive to serve in Indian health 
        programs with the greatest shortages of health 
        professionals; and
          [(iii) provides an incentive with respect to the 
        health professional involved remaining in an Indian 
        health program with such a health professional 
        shortage, and continuing to provide primary health 
        services, after the completion of the period of 
        obligated service under the Loan Repayment Program.
  [(B) Any arrangement made by the Secretary for the making of 
loan repayments in accordance with this subsection shall 
provide that any repayments for a year of obligated service 
shall be made no later than the end of the fiscal year in which 
the individual completes such year of service.
  [(3) For the purpose of providing reimbursements for tax 
liability resulting from payments under paragraph (2) on behalf 
of an individual, the Secretary--
          [(A) in addition to such payments, may make payments 
        to the individual in an amount not less than 20 percent 
        and not more than 39 percent of the total amount of 
        loan repayments made for the taxable year involved; and
          [(B) may make such additional payments as the 
        Secretary determines to be appropriate with respect to 
        such purpose.
  [(4) The Secretary may enter into an agreement with the 
holder of any loan for which payments are made under the Loan 
Repayment Program to establish a schedule for the making of 
such payments.
  [(h) Notwithstanding any other provision of law, individuals 
who have entered into written contracts with the Secretary 
under this section, while undergoing academic training, shall 
not be counted against any employment ceiling affecting the 
Department of Health and Human Services.
  [(i) The Secretary shall conduct recruiting programs for the 
Loan Repayment Program and other health professional programs 
of the Service at educational institutions training health 
professionals or specialists identified in subsection (a).
  [(j) Section 214 of the Public Health Service Act (42 U.S.C. 
215) shall not apply to individuals during their period of 
obligated service under the Loan Repayment Program.
  [(k) The Secretary, in assigning individuals to serve in 
Indian health programs pursuant to contracts entered into under 
this section, shall--
          [(1) ensure that the staffing needs of Indian health 
        programs administered by an Indian tribe or tribal or 
        health organization receive consideration on an equal 
        basis with programs that are administered directly by 
        the Service; and
          [(2) give priority to assigning individuals to Indian 
        health programs that have a need for health 
        professionals to provide health care services as a 
        result of individuals having breached contracts entered 
        into under this section.
  [(l)(1) An individual who has entered into a written contract 
with the Secretary under this section and who--
          [(A) is enrolled in the final year of a course of 
        study and who--
                  [(i) fails to maintain an acceptable level of 
                academic standing in the educational 
                institution in which he is enrolled (such level 
                determined by the educational institution under 
                regulations of the Secretary);
                  [(ii) voluntarily terminates such enrollment; 
                or
                  [(iii) is dismissed from such educational 
                institution before completion of such course of 
                study; or
          [(B) is enrolled in a graduate training program, 
        fails to complete such training program, and does not 
        receive a waiver from the Secretary under subsection 
        (b)(1)(B)(ii),
shall be liable, in lieu of any service obligation arising 
under such contract, to the United States for the amount which 
has been paid on such individual's behalf under the contract.
  [(2) If, for any reason not specified in paragraph (1), an 
individual breaches his written contract under this section by 
failing either to begin, or complete, such individual's period 
of obligated service in accordance with subsection (f), the 
United States shall be entitled to recover from such individual 
an amount to be determined in accordance with the following 
formula:

                              [A=3Z(t-s/t)

in which--
          [(A) ``A'' is the amount the United States is 
        entitled to recover;
          [(B) ``Z'' is the sum of the amounts paid under this 
        section to, or on behalf of, the individual and the 
        interest on such amounts which would be payable if, at 
        the time the amounts were paid, they were loans bearing 
        interest at the maximum legal prevailing rate, as 
        determined by the Treasurer of the United States;
          [(C) ``t'' is the total number of months in the 
        individual's period of obligated service in accordance 
        with subsection (f); and
          [(D) ``s'' is the number of months of such period 
        served by such individual in accordance with this 
        section.
Amounts not paid within such period shall be subject to 
collection through deductions in Medicare payments pursuant to 
section 1892 of the Social Security Act.
  [(3)(A) Any amount of damages which the United States is 
entitled to recover under this subsection shall be paid to the 
United States within the 1-year period beginning on the date of 
the breach or such longer period beginning on such date as 
shall be specified by the Secretary.
  [(B) If damages described in subparagraph (A) are delinquent 
for 3 months, the Secretary shall, for the purpose of 
recovering such damages--
          [(i) utilize collection agencies contracted with by 
        the Administrator of the General Services 
        Administration; or
          [(ii) enter into contracts for the recovery of such 
        damages with collection agencies selected by the 
        Secretary.
  [(C) Each contract for recovering damages pursuant to this 
subsection shall provide that the contractor will, not less 
than once each 6 months, submit to the Secretary a status 
report on the success of the contractor in collecting such 
damages. Section 3718 of title 31, United States Code, shall 
apply to any such contract to the extent not inconsistent with 
this subsection.
  [(m)(1) Any obligation of an individual under the Loan 
Repayment Program for service or payment of damages shall be 
canceled upon the death of the individual.
  [(2) The Secretary shall by regulation provide for the 
partial or total waiver or suspension of any obligation of 
service or payment by an individual under the Loan Repayment 
Program whenever compliance by the individual is impossible or 
would involve extreme hardship to the individual and if 
enforcement of such obligation with respect to any individual 
would be unconscionable.
  [(3) The Secretary may waive, in whole or in part, the rights 
of the United States to recover amounts under this section in 
any case of extreme hardship or other good cause shown, as 
determined by the Secretary.
  [(4) Any obligation of an individual under the Loan Repayment 
Program for payment of damages may be released by a discharge 
in bankruptcy under title 11 of the United States Code only if 
such discharge is granted after the expiration of the 5-year 
period beginning on the first date that payment of such damages 
is required, and only if the bankruptcy court finds that 
nondischarge of the obligation would be unconscionable.
  [(n) The Secretary shall submit to the President, for 
inclusion in each report required to be submitted to the 
Congress under section 801, a report concerning the previous 
fiscal year which sets forth--
          [(1) the health professional positions maintained by 
        the Service or by tribal or Indian organizations for 
        which recruitment or retention is difficult;
          [(2) the number of Loan Repayment Program 
        applications filed with respect to each type of health 
        profession;
          [(3) the number of contracts described in subsection 
        (f) that are entered into with respect to each health 
        profession;
          [(4) the amount of loan payments made under this 
        section, in total and by health profession;
          [(5) the number of scholarship grants that are 
        provided under section 104 with respect to each health 
        profession;
          [(6) the amount of scholarship grants provided under 
        section 104, in total and by health profession;
          [(7) the number of providers of health care that will 
        be needed by Indian health programs, by location and 
        profession, during the three fiscal years beginning 
        after the date the report is filed; and
          [(8) the measures the Secretary plans to take to fill 
        the health professional positions maintained by the 
        Service or by tribes or tribal or Indian organizations 
        for which recruitment or retention is difficult.
             [scholarship and loan repayment recovery fund
  [Sec. 108A. (a) There is established in the Treasury of the 
United States a fund to be known as the Indian Health 
Scholarship and Loan Repayment Recovery Fund (hereafter in this 
section referred to as the ``Fund''). The Fund shall consist of 
such amounts as may be appropriated to the Fund under 
subsection (b). Amounts appropriated for the Fund shall remain 
available until expended.
  [(b) For each fiscal year, there is authorized to be 
appropriated to the Fund an amount equal to the sum of--
          [(1) the amount collected during the preceding fiscal 
        year by the Federal Government pursuant to--
                  [(A) the liability of individuals under 
                subparagraph (A) or (B) of section 104(b)(5) 
                for the breach of contracts entered into under 
                section 104; and
                  [(B) the liability of individuals under 
                section 108(l) for the breach of contracts 
                entered into under section 108; and
          [(2) the aggregate amount of interest accruing during 
        the preceding fiscal year on obligations held in the 
        Fund pursuant to subsection (d) and the amount of 
        proceeds from the sale or redemption of such 
        obligations during such fiscal year.
  [(c)(1) Amounts in the Fund and available pursuant to 
appropriation Acts may be expended by the Secretary, acting 
through the Service, to make payments to an Indian tribe or 
tribal organization administering a health care program 
pursuant to a contract entered into under the Indian Self-
Determination Act--
          [(A) to which a scholarship recipient under section 
        104 or a loan repayment program participant under 
        section 108 has been assigned to meet the obligated 
        service requirements pursuant to sections; and
          [(B) that has a need for a health professional to 
        provide health care services as a result of such 
        recipient or participant having breached the contract 
        entered into under section 104 or section 108.
  [(2) An Indian tribe or tribal organization receiving 
payments pursuant to paragraph (1) may expend the payments to 
recruit and employ, directly or by contract, health 
professionals to provide health care services.
  [(d)(1) The Secretary of the Treasury shall invest such 
amounts of the Fund as such Secretary determines are not 
required to meet current withdrawals from the Fund. Such 
investments may be made only in interest-bearing obligations of 
the United States. For such purpose, such obligations may be 
acquired on original issue at the issue price, or by purchase 
of outstanding obligations at the market price.
  [(2) Any obligation acquired by the Fund may be sold by the 
Secretary of the Treasury at the market price.
                        [recruitment activities
  [Sec. 109. (a) The Secretary may reimburse health 
professionals seeking positions in the Service, including 
individuals considering entering into a contract under section 
108, and their spouses, for actual and reasonable expenses 
incurred in traveling to and from their places of residence to 
an area in which they may be assigned for the purpose of 
evaluating such area with respect to such assignment.
  [(b) The Secretary, acting through the Service, shall assign 
one individual in each area office to be responsible on a full-
time basis for recruitment activities.
               [tribal recruitment and retention program
  [Sec. 110. (a) The Secretary, acting through the Service, 
shall fund, on a competitive basis, projects to enable Indian 
tribes and tribal and Indian organizations to recruit, place, 
and retain health professionals to meet the staffing needs of 
Indian health programs (as defined in section 108(a)(2)).
  [(b)(1) Any Indian tribe or tribal or Indian organization may 
submit an application for funding of a project pursuant to this 
section.
  [(2) Indian tribes and tribal and Indian organizations under 
the authority of the Indian Self-Determination Act shall be 
given an equal opportunity with programs that are administered 
directly by the Service to compete for, and receive, grants 
under subsection (a) for such projects.
                    [advanced training and research
  [Sec. 111. (a) The Secretary, acting through the Service, 
shall establish a program to enable health professionals to 
pursue advanced training or research in areas of study for 
which the Secretary determines a need exists. In selecting 
participants for a program established under this subsection, 
the Secretary, acting through the Service, shall give priority 
to applicants who are employed by the Indian Health Service, 
Indian tribes, tribal organizations, and urban Indian 
organizations, at the time of the submission of the 
applications.
  [(b) An individual who participates in a program under 
subsection (a), where the educational costs are borne by the 
Service, shall incur an obligation to serve in an Indian health 
program (as defined in section 108(a)(2)) for a period of 
obligated service equal to at least the period of time during 
which the individual participates in such program. In the event 
that the individual fails to complete such obligated service, 
the individual shall be liable to the United States for the 
period of service remaining. In such event, with respect to 
individuals entering the program after the date of the 
enactment of the Indian Health Amendments of 1992, the United 
States shall be entitled to recover from such individual an 
amount to be determined in accordance with the formula 
specified in subsection (l) of section 108 in the manner 
provided for in such subsection.
  [(c) Health professionals from Indian tribes and tribal and 
Indian organizations under the authority of the Indian Self-
Determination Act shall be given an equal opportunity to 
participate in the program under subsection (a).
                            [nursing program
  [Sec. 112. (a) The Secretary, acting through the Service, 
shall provide grants to--
          [(1) public or private schools of nursing,
          [(2) tribally controlled community colleges and 
        tribally controlled postsecondary vocational 
        institutions (as defined in section 390(2) of the 
        Tribally Controlled Vocational Institutions Support Act 
        of 1990 (20 U.S.C. 2397h(2)), and
          [(3) nurse midwife programs, and nurse practitioner 
        programs, that are provided by any public or private 
        institution,
for the purpose of increasing the number of nurses, nurse 
midwives, and nurse practitioners who deliver health care 
services to Indians.
  [(b) Grants provided under subsection (a) may be used to--
          [(1) recruit individuals for programs which train 
        individuals to be nurses, nurse midwives, or nurse 
        practitioners,
          [(2) provide scholarships to individuals enrolled in 
        such programs that may pay the tuition charged for such 
        program and other expenses incurred in connection with 
        such program, including books, fees, room and board, 
        and stipends for living expenses,
          [(3) provide a program that encourages nurses, nurse 
        midwives, and nurse practitioners to provide, or 
        continue to provide, health care services to Indians,
          [(4) provide a program that increases the skills of, 
        and provides continuing education to, nurses, nurse 
        midwives, and nurse practitioners, or
          [(5) provide any program that is designed to achieve 
        the purpose described in subsection (a).
  [(c) Each application for a grant under subsection (a) shall 
include such information as the Secretary may require to 
establish the connection between the program of the applicant 
and a health care facility that primarily serves Indians.
  [(d) In providing grants under subsection (a), the Secretary 
shall extend a preference to--
          [(1) programs that provide a preference to Indians,
          [(2) programs that train nurse midwives or nurse 
        practitioners,
          [(3) programs that are interdisciplinary, and
          [(4) programs that are conducted in cooperation with 
        a center for gifted and talented Indian students 
        established under section 5324(a) of the Indian 
        Education Act of 1988.
  [(e) The Secretary shall provide one of the grants authorized 
under subsection (a) to establish and maintain a program at the 
University of North Dakota to be known as the ``Quentin N. 
Burdick American Indians Into Nursing Program''. Such program 
shall, to the maximum extent feasible, coordinate with the 
Quentin N. Burdick Indian Health Programs established under 
section 114(b) and the Quentin N. Burdick American Indians Into 
Psychology Program established under section 217(b).
  [(f) The active duty service obligation prescribed under 
section 338C of the Public Health Service Act (42 U.S.C. 254m) 
shall be met by each individual who receives training or 
assistance described in paragraph (1) or (2) of subsection (b) 
that is funded by a grant provided under subsection (a). Such 
obligation shall be met by service--
          [(A) in the Indian Health Service;
          [(B) in a program conducted under a contract entered 
        into under the Indian Self-Determination Act;
          [(C) in a program assisted under title V of this Act; 
        or
          [(D) in the private practice of nursing if, as 
        determined by the Secretary, in accordance with 
        guidelines promulgated by the Secretary, such practice 
        is situated in a physician or other health professional 
        shortage area and addresses the health care needs of a 
        substantial number of Indians.
  [(g) Beginning with fiscal year 1993, of the amounts 
appropriated under the authority of this title for each fiscal 
year to be used to carry out this section, not less than 
$1,000,000 shall be used to provide grants under subsection (a) 
for the training of nurse midwives, nurse anesthetists, and 
nurse practitioners.
                        [nursing school clinics
  [Sec. 112A. (a) Grants.--In addition to the authority of the 
Secretary under section 112(a)(1), the Secretary, acting 
through the Service, is authorized to provide grants to public 
or private schools of nursing for the purpose of establishing, 
developing, operating, and administering clinics to address the 
health care needs of Indians, and to provide primary health 
care services to Indians who reside on or within 50 miles of 
Indian country, as defined in section 1151 of title 18, United 
States Code.
  [(b) Purposes.--Grants provided under subsection (a) may be 
used to--
          [(1) establish clinics, to be run and staffed by the 
        faculty and students of a grantee school, to provide 
        primary care services in areas in or within 50 miles of 
        Indian country (as defined in section 1151 of title 18, 
        United States Code);
          [(2) provide clinical training, program development, 
        faculty enhancement, and student scholarships in a 
        manner that would benefit such clinics; and
          [(3) carry out any other activities determined 
        appropriate by the Secretary.
  [(c) Amount and Conditions.--The Secretary may award grants 
under this section in such amounts and subject to such 
conditions as the Secretary deems appropriate.
  [(d) Design.--The clinics established under this section 
shall be designed to provide nursing students with a structured 
clinical experience that is similar in nature to that provided 
by residency training programs for physicians.
  [(e) Regulations.--The Secretary shall prescribe such 
regulations as may be necessary to carry out the provisions of 
this section.
  [(f) Authorization To Use Amounts.--Out of amounts 
appropriated to carry out this title for each of the fiscal 
years 1993 through 2000 not more than $5,000,000 may be used to 
carry out this section.
                      [tribal culture and history
  [Sec. 113. (a) The Secretary, acting through the Service, 
shall establish a program under which appropriate employees of 
the Service who serve particular Indian tribes shall receive 
educational instruction in the history and culture of such 
tribes and in the history of the Service.
  [(b) To the extent feasible, the program established under 
subsection (a) shall--
          [(1) be carried out through tribally-controlled 
        community colleges (within the meaning of section 2(4) 
        of the Tribally Controlled Community College Assistance 
        Act of 1978) and tribally controlled postsecondary 
        vocational institutions (as defined in section 390(2) 
        of the Tribally Controlled Vocational Institutions 
        Support Act of 1990 (20 U.S.C. 2397h(2)),
          [(2) be developed in consultation with the affected 
        tribal government, and
          [(3) include instruction in Native American studies.
                             [inmed program
  [Sec. 114. (a) The Secretary is authorized to provide grants 
to at least 3 colleges and universities for the purpose of 
maintaining and expanding the Native American health careers 
recruitment program known as the ``Indians into Medicine 
Program'' (hereinafter in this section referred to as 
``INMED'') as a means of encouraging Indians to enter the 
health professions.
  [(b) The Secretary shall provide one of the grants authorized 
under subsection (a) to maintain the INMED program at the 
University of North Dakota, to be known as the ``Quentin N. 
Burdick Indian Health Programs'', unless the Secretary makes a 
determination, based upon program reviews, that the program is 
not meeting the purposes of this section. Such program shall, 
to the maximum extent feasible, coordinate with the Quentin N. 
Burdick American Indians Into Psychology Program established 
under section 217(b) and the Quentin N. Burdick American 
Indians Into Nursing Program established under section 112(e).
  [(c)(1) The Secretary shall develop regulations for the 
competitive awarding of the grants provided under this section.
  [(2) Applicants for grants provided under this section shall 
agree to provide a program which--
          [(A) provides outreach and recruitment for health 
        professions to Indian communities including elementary, 
        secondary and community colleges located on Indian 
        reservations which will be served by the program,
          [(B) incorporates a program advisory board comprised 
        of representatives from the tribes and communities 
        which will be served by the program,
          [(C) provides summer preparatory programs for Indian 
        students who need enrichment in the subjects of math 
        and science in order to pursue training in the health 
        professions,
          [(D) provides tutoring, counseling and support to 
        students who are enrolled in a health career program of 
        study at the respective college or university, and
          [(E) to the maximum extent feasible, employs 
        qualified Indians in the program.
  [(d) By no later than the date that is 3 years after the date 
of enactment of the Indian Health Care Amendments of 1988, the 
Secretary shall submit a report to the Congress on the program 
established under this section including recommendations for 
expansion or changes to the program.
            [health training programs of community colleges
  [Sec. 115. (a)(1) The Secretary, acting through the Service, 
shall award grants to community colleges for the purpose of 
assisting the community college in the establishment of 
programs which provide education in a health profession leading 
to a degree or diploma in a health profession for individuals 
who desire to practice such profession on an Indian reservation 
or in a tribal clinic.
  [(2) The amount of any grant awarded to a community college 
under paragraph (1) for the first year in which such a grant is 
provided to the community college shall not exceed $100,000.
  [(b)(1) The Secretary, acting through the Service, shall 
award grants to community colleges that have established a 
program described in subsection (a)(1) for the purpose of 
maintaining the program and recruiting students for the 
program.
  [(2) Grants may only be made under this section to a 
community college which--
          [(A) is accredited,
          [(B) has access to a hospital facility, Service 
        facility, or hospital that could provide training of 
        nurses or health professionals,
          [(C) has entered into an agreement with an accredited 
        college or university medical school, the terms of 
        which--
                  [(i) provide a program that enhances the 
                transition and recruitment of students into 
                advanced baccalaureate or graduate programs 
                which train health professionals, and
                  [(ii) stipulate certifications necessary to 
                approve internship and field placement 
                opportunities at service unit facilities of the 
                Service or at tribal health facilities,
          [(D) has a qualified staff which has the appropriate 
        certifications, and
          [(E) is capable of obtaining State or regional 
        accreditation of the program described in subsection 
        (a)(1).
  [(c) The Secretary shall encourage community colleges 
described in subsection (b)(2) to establish and maintain 
programs described in subsection (a)(1) by--
          [(1) entering into agreements with such colleges for 
        the provision of qualified personnel of the Service to 
        teach courses of study in such programs, and
          [(2) providing technical assistance and support to 
        such colleges.
  [(d) Any program receiving assistance under this section that 
is conducted with respect to a health profession shall also 
offer courses of study which provide advanced training for any 
health professional who--
          [(1) has already received a degree or diploma in such 
        health profession, and
          [(2) provides clinical services on an Indian 
        reservation, at a Service facility, or at a tribal 
        clinic.
Such courses of study may be offered in conjunction with the 
college or university with which the community college has 
entered into the agreement required under subsection (b)(2)(C).
  [(e) For purposes of this section--
          [(1) The term ``community college'' means--
                  [(A) a tribally controlled community college, 
                or
                  [(B) a junior or community college.
          [(2) The term ``tribally controlled community 
        college'' has the meaning given to such term by section 
        2(4) of the Tribally Controlled Community College 
        Assistance Act of 1978.
          [(3) The term ``junior or community college'' has the 
        meaning given to such term by section 312(e) of the 
        Higher Education Act of 1965 (20 U.S.C. 1058(e)).
            [additional incentives for health professionals
  [Sec. 116. (a) The Secretary may provide the incentive 
special pay authorized under section 302(b) of title 37, United 
States Code, to civilian medical officers of the Indian Health 
Service who are assigned to, and serving in, positions included 
in the list established under subsection (b)(1) for which 
recruitment or retention of personnel is difficult.
  [(b)(1) The Secretary shall establish and update on an annual 
basis a list of positions of health care professionals employed 
by, or assigned to, the Service for which recruitment or 
retention is difficult.
  [(2)(A) The Secretary may pay a bonus to any commissioned 
officer or civil service employee, other than a commissioned 
medical officer, dental officer, optometrist, and veterinarian, 
who is employed in or assigned to, and serving in, a position 
in the Service included in the list established by the 
Secretary under paragraph (1).
  [(B) The total amount of bonus payments made by the Secretary 
under this paragraph to any employee during any 1-year period 
shall not exceed $2,000.
  [(c) The Secretary may establish programs to allow the use of 
flexible work schedules, and compressed work schedules, in 
accordance with the provisions of subchapter II of chapter 61 
of title 5, United States Code, for health professionals 
employed by, or assigned to, the Service.
                            [retention bonus
  [Sec. 117. (a) The Secretary may pay a retention bonus to any 
physician or nurse employed by, or assigned to, and serving in, 
the Service either as a civilian employee or as a commissioned 
officer in the Regular or Reserve Corps of the Public Health 
Service who--
          [(1) is assigned to, and serving in, a position 
        included in the list established under section 
        116(b)(1) for which recruitment or retention of 
        personnel is difficult,
          [(2) the Secretary determines is needed by the 
        Service,
          [(3) has--
                  [(A) completed 3 years of employment with the 
                Service, or
                  [(B) completed any service obligations 
                incurred as a requirement of--
                          [(i) any Federal scholarship program, 
                        or
                          [(ii) any Federal education loan 
                        repayment program, and
          [(4) enters into an agreement with the Service for 
        continued employment for a period of not less than 1 
        year.
  [(b) Beginning with fiscal year 1993, not less than 25 
percent of the retention bonuses awarded each year under 
subsection (a) shall be awarded to nurses.
  [(c) The Secretary may establish rates for the retention 
bonus which shall provide for a higher annual rate for 
multiyear agreements than for single year agreements referred 
to in subsection (a)(4), but in no event shall the annual rate 
be more than $25,000 per annum.
  [(d) The retention bonus for the entire period covered by the 
agreement described in subsection (a)(4) shall be paid at the 
beginning of the agreed upon term of service.
  [(e) Any physician or nurse failing to complete the agreed 
upon term of service, except where such failure is through no 
fault of the individual, shall be obligated to refund to the 
Government the full amount of the retention bonus for the 
period covered by the agreement, plus interest as determined by 
the Secretary in accordance with section 108(l)(2)(B).
  [(f) The Secretary may pay a retention bonus to any physician 
or nurse employed by an organization providing health care 
services to Indians pursuant to a contract under the Indian 
Self-Determination Act if such physician or nurse is serving in 
a position which the Secretary determines is--
          [(1) a position for which recruitment or retention is 
        difficult; and
          [(2) necessary for providing health care services to 
        Indians.
                       [nursing residency program
  [Sec. 118. (a) The Secretary, acting through the Service, 
shall establish a program to enable licensed practical nurses, 
licensed vocational nurses, and registered nurses who are 
working in an Indian health program (as defined in section 
108(a)(2)(A)), and have done so for a period of not less than 
one year, to pursue advanced training.
  [(b) Such program shall include a combination of education 
and work study in an Indian health program (as defined in 
section 108(a)(2)(A)) leading to an associate or bachelor's 
degree (in the case of a licensed practical nurse or licensed 
vocational nurse) or a bachelor's degree (in the case of a 
registered nurse) or a Master's degree.
  [(c) An individual who participates in a program under 
subsection (a), where the educational costs are paid by the 
Service, shall incur an obligation to serve in an Indian health 
program for a period of obligated service equal to at least 
three times the period of time during which the individual 
participates in such program. In the event that the individual 
fails to complete such obligated service, the United States 
shall be entitled to recover from such individual an amount 
determined in accordance with the formula specified in 
subsection (l) of section 108 in the manner provided for in 
such subsection.
               [community health aide program for alaska
  [Sec. 119. (a) Under the authority of the Act of November 2, 
1921 (25 U.S.C. 13; popularly known as the Snyder Act), the 
Secretary shall maintain a Community Health Aide Program in 
Alaska under which the Service--
          [(1) provides for the training of Alaska Natives as 
        health aides or community health practitioners;
          [(2) uses such aides or practitioners in the 
        provision of health care, health promotion, and disease 
        prevention services to Alaska Natives living in 
        villages in rural Alaska; and
          [(3) provides for the establishment of 
        teleconferencing capacity in health clinics located in 
        or near such villages for use by community health aides 
        or community health practitioners.
  [(b) The Secretary, acting through the Community Health Aide 
Program of the Service, shall--
          [(1) using trainers accredited by the Program, 
        provide a high standard of training to community health 
        aides and community health practitioners to ensure that 
        such aides and practitioners provide quality health 
        care, health promotion, and disease prevention services 
        to the villages served by the Program;
          [(2) in order to provide such training, develop a 
        curriculum that--
                  [(A) combines education in the theory of 
                health care with supervised practical 
                experience in the provision of health care;
                  [(B) provides instruction and practical 
                experience in the provision of acute care, 
                emergency care, health promotion, disease 
                prevention, and the efficient and effective 
                management of clinic pharmacies, supplies, 
                equipment, and facilities; and
                  [(C) promotes the achievement of the health 
                status objectives specified in section 3(b);
          [(3) establish and maintain a Community Health Aide 
        Certification Board to certify as community health 
        aides or community health practitioners individuals who 
        have successfully completed the training described in 
        paragraph (1) or can demonstrate equivalent experience;
          [(4) develop and maintain a system which identifies 
        the needs of community health aides and community 
        health practitioners for continuing education in the 
        provision of health care, including the areas described 
        in paragraph (2)(B), and develop programs that meet the 
        needs for such continuing education;
          [(5) develop and maintain a system that provides 
        close supervision of community health aides and 
        community health practitioners; and
          [(6) develop a system under which the work of 
        community health aides and community health 
        practitioners is reviewed and evaluated to assure the 
        provision of quality health care, health promotion, and 
        disease prevention services.
          [matching grants to tribes for scholarship programs
  [Sec. 120. (a)(1) The Secretary shall make grants to Indian 
tribes and tribal organizations for the purpose of assisting 
such tribes and tribal organizations in educating Indians to 
serve as health professionals in Indian communities.
  [(2) Amounts available for grants under paragraph (1) for any 
fiscal year shall not exceed 5 percent of amounts available for 
such fiscal year for Indian Health Scholarships under section 
104.
  [(3) An application for a grant under paragraph (1) shall be 
in such form and contain such agreements, assurances, and 
information as the Secretary determines are necessary to carry 
out this section.
  [(b)(1) An Indian tribe or tribal organization receiving a 
grant under subsection (a) shall agree to provide scholarships 
to Indians pursuing education in the health professions in 
accordance with the requirements of this section.
  [(2) With respect to the costs of providing any scholarship 
pursuant to paragraph (1)--
          [(A) 80 percent of the costs of the scholarship shall 
        be paid from the grant made under subsection (a) to the 
        Indian tribe or tribal organization; and
          [(B) 20 percent of such costs shall be paid from non-
        Federal contributions by the Indian tribe or tribal 
        organization through which the scholarship is provided.
  [(3) In determining the amount of non-Federal contributions 
that have been provided for purposes of subparagraph (B) of 
paragraph (2), any amounts provided by the Federal Government 
to the Indian tribe or tribal organization involved or to any 
other entity shall not be included.
  [(4) Non-Federal contributions required by subparagraph (B) 
of paragraph (2) may be provided directly by the Indian tribe 
or tribal organization involved or through donations from 
public and private entities.
  [(c) An Indian tribe or tribal organization shall provide 
scholarships under subsection (b) only to Indians enrolled or 
accepted for enrollment in a course of study (approved by the 
Secretary) in one of the health professions described in 
section 104(a).
  [(d) In providing scholarships under subsection (b), the 
Secretary and the Indian tribe or tribal organization shall 
enter into a written contract with each recipient of such 
scholarship. Such contract shall--
          [(1) obligate such recipient to provide service in an 
        Indian health program (as defined in section 
        108(a)(2)(A)), in the same service area where the 
        Indian tribe or tribal organization providing the 
        scholarship is located, for--
                  [(A) a number of years equal to the number of 
                years for which the scholarship is provided (or 
                the part-time equivalent thereof, as determined 
                by the Secretary), or for a period of 2 years, 
                whichever period is greater; or
                  [(B) such greater period of time as the 
                recipient and the Indian tribe or tribal 
                organization may agree;
          [(2) provide that the amount of such scholarship--
                  [(A) may be expended only for--
                          [(i) tuition expenses, other 
                        reasonable educational expenses, and 
                        reasonable living expenses incurred in 
                        attendance at the educational 
                        institution; and
                          [(ii) payment to the recipient of a 
                        monthly stipend of not more than the 
                        amount authorized by section 
                        338A(g)(1)(B) of the Public Health 
                        Service Act (42 U.S.C. 254m(g)(1)(B)), 
                        such amount to be reduced pro rata (as 
                        determined by the Secretary) based on 
                        the number of hours such student is 
                        enrolled; and
                  [(B) may not exceed, for any year of 
                attendance for which the scholarship is 
                provided, the total amount required for the 
                year for the purposes authorized in 
                subparagraph (A);
          [(3) require the recipient of such scholarship to 
        maintain an acceptable level of academic standing (as 
        determined by the educational institution in accordance 
        with regulations issued by the Secretary); and
          [(4) require the recipient of such scholarship to 
        meet the educational and licensure requirements 
        necessary to be a physician, certified nurse 
        practitioner, certified nurse midwife, or physician 
        assistant.
  [(e)(1) An individual who has entered into a written contract 
with the Secretary and an Indian tribe or tribal organization 
under subsection (d) and who--
          [(A) fails to maintain an acceptable level of 
        academic standing in the educational institution in 
        which he is enrolled (such level determined by the 
        educational institution under regulations of the 
        Secretary),
          [(B) is dismissed from such educational institution 
        for disciplinary reasons,
          [(C) voluntarily terminates the training in such an 
        educational institution for which he is provided a 
        scholarship under such contract before the completion 
        of such training, or
          [(D) fails to accept payment, or instructs the 
        educational institution in which he is enrolled not to 
        accept payment, in whole or in part, of a scholarship 
        under such contract,
in lieu of any service obligation arising under such contract, 
shall be liable to the United States for the Federal share of 
the amount which has been paid to him, or on his behalf, under 
the contract.
  [(2) If for any reason not specified in paragraph (1), an 
individual breaches his written contract by failing either to 
begin such individual's service obligation required under such 
contract or to complete such service obligation, the United 
States shall be entitled to recover from the individual an 
amount determined in accordance with the formula specified in 
subsection (l) of section 108 in the manner provided for in 
such subsection.
  [(3) The Secretary may carry out this subsection on the basis 
of information submitted by the tribes or tribal organizations 
involved, or on the basis of information collected through such 
other means as the Secretary determines to be appropriate.
  [(f) The recipient of a scholarship under subsection (b) 
shall agree, in providing health care pursuant to the 
requirements of subsection (d)(1)--
          [(1) not to discriminate against an individual 
        seeking such care on the basis of the ability of the 
        individual to pay for such care or on the basis that 
        payment for such care will be made pursuant to the 
        program established in title XVIII of the Social 
        Security Act or pursuant to the program established in 
        title XIX of such Act; and
          [(2) to accept assignment under section 
        1842(b)(3)(B)(ii) of the Social Security Act for all 
        services for which payment may be made under part B of 
        title XVIII of such Act, and to enter into an 
        appropriate agreement with the State agency that 
        administers the State plan for medical assistance under 
        title XIX of such Act to provide service to individuals 
        entitled to medical assistance under the plan.
  [(g) The Secretary may not make any payments under subsection 
(a) to an Indian tribe or tribal organization for any fiscal 
year subsequent to the first fiscal year of such payments 
unless the Secretary determines that, for the immediately 
preceding fiscal year, the Indian tribe or tribal organization 
has complied with requirements of this section.
                 [tribal health program administration
  [Sec. 121. The Secretary shall, by contract or otherwise, 
provide training for individuals in the administration and 
planning of tribal health programs.
               [university of south dakota pilot program
  [Sec. 122. (a) The Secretary may make a grant to the School 
of Medicine of the University of South Dakota (hereafter in 
this section referred to as ``USDSM'') to establish a pilot 
program on an Indian reservation at one or more service units 
in South Dakota to address the chronic manpower shortage in the 
Aberdeen Area of the Service.
  [(b) The purposes of the program established pursuant to a 
grant provided under subsection (a) are--
          [(1) to provide direct clinical and practical 
        experience at a service unit to medical students and 
        residents from USDSM and other medical schools;
          [(2) to improve the quality of health care for 
        Indians by assuring access to qualified health care 
        professionals; and
          [(3) to provide academic and scholarly opportunities 
        for physicians, physician assistants, nurse 
        practitioners, nurses, and other allied health 
        professionals serving Indian people by identifying and 
        utilizing all academic and scholarly resources of the 
        region.
  [(c) The pilot program established pursuant to a grant 
provided under subsection (a) shall--
          [(1) incorporate a program advisory board composed of 
        representatives from the tribes and communities in the 
        area which will be served by the program; and
          [(2) shall be designated as an extension of the USDSM 
        campus and program participants shall be under the 
        direct supervision and instruction of qualified medical 
        staff serving at the service unit who shall be members 
        of the USDSM faculty.
  [(d) The USDSM shall coordinate the program established 
pursuant to a grant provided under subsection (a) with other 
medical schools in the region, nursing schools, tribal 
community colleges, and other health professional schools.
  [(e) The USDSM, in cooperation with the Service, shall 
develop additional professional opportunities for program 
participants on Indian reservations in order to improve the 
recruitment and retention of qualified health professionals in 
the Aberdeen Area of the Service.
                    [authorization of appropriations
  [Sec. 123. There are authorized to be appropriated such sums 
as may be necessary for each fiscal year through fiscal year 
2000 to carry out this title.

                       [TITLE II--HEALTH SERVICES

                  [indian health care improvement fund
  [Sec. 201. (a) The Secretary is authorized to expend funds 
which are appropriated under the authority of this section, 
through the Service, for the purposes of--
          [(1) eliminating the deficiencies in health status 
        and resources of all Indian tribes,
          [(2) eliminating backlogs in the provision of health 
        care services to Indians,
          [(3) meeting the health needs of Indians in an 
        efficient and equitable manner, and
          [(4) augmenting the ability of the Service to meet 
        the following health service responsibilities, either 
        through direct or contract care or through contracts 
        entered into pursuant to the Indian Self-Determination 
        Act, with respect to those Indian tribes with the 
        highest levels of health status and resource 
        deficiencies:
                  [(A) clinical care (direct and indirect) 
                including clinical eye and vision care;
                  [(B) preventive health;
                  [(C) dental care (direct and indirect);
                  [(D) mental health, including community 
                mental health services, inpatient mental health 
                services, dormitory mental health services, 
                therapeutic and residential treatment centers, 
                and training of traditional Indian 
                practitioners;
                  [(E) emergency medical services;
                  [(F) treatment and control of, and 
                rehabilitative care related to, alcoholism and 
                drug abuse (including fetal alcohol syndrome) 
                among Indians;
                  [(G) accident prevention programs;
                  [(H) home health care;
                  [(I) community health representatives; and
                  [(J) maintenance and repair.
  [(b)(1) Any funds appropriated under the authority of this 
section shall not be used to offset or limit any appropriations 
made to the Service under the Act of November 2, 1921 (25 
U.S.C. 13), popularly known as the Snyder Act, or any other 
provision of law.
  [(2)(A) Funds appropriated under the authority of this 
section may be allocated on a service unit basis. The funds 
allocated to each service unit under this subparagraph shall be 
used by the service unit to reduce the health status and 
resource deficiency of each tribe served by such service unit.
  [(B) The apportionment of funds allocated to a service unit 
under subparagraph (A) among the health service 
responsibilities described in subsection (a)(4) shall be 
determined by the Service in consultation with, and with the 
active participation of, the affected Indian tribes.
  [(c) For purposes of this section--
          [(1) The term ``health status and resource 
        deficiency'' means the extent to which--
                  [(A) the health status objectives set forth 
                in section 3(b) are not being achieved; and
                  [(B) the Indian tribe does not have available 
                to it the health resources it needs, taking 
                into account the actual cost of providing 
                health care services given local geographic, 
                climatic, rural, or other circumstances.
          [(2) The health resources available to an Indian 
        tribe include health resources provided by the Service 
        as well as health resources used by the Indian tribe, 
        including services and financing systems provided by 
        any Federal programs, private insurance, and programs 
        of State or local governments.
          [(3) The Secretary shall establish procedures which 
        allow any Indian tribe to petition the Secretary for a 
        review of any determination of the extent of the health 
        status and resource deficiency of such tribe.
  [(d)(1) Programs administered by any Indian tribe or tribal 
organization under the authority of the Indian Self-
Determination Act shall be eligible for funds appropriated 
under the authority of this section on an equal basis with 
programs that are administered directly by the Service.
  [(2) If any funds allocated to a tribe or service unit under 
the authority of this section are used for a contract entered 
into under the Indian Self-Determination Act, a reasonable 
portion of such funds may be used for health planning, 
training, technical assistance, and other administrative 
support functions.
  [(e) By no later than the date that is 3 years after the date 
of enactment of the Indian Health Amendments of 1992, the 
Secretary shall submit to the Congress the current health 
status and resource deficiency report of the Service for each 
Indian tribe or service unit, including newly recognized or 
acknowledged tribes. Such report shall set out--
          [(1) the methodology then in use by the Service for 
        determining tribal health status and resource 
        deficiencies, as well as the most recent application of 
        that methodology;
          [(2) the extent of the health status and resource 
        deficiency of each Indian tribe served by the Service;
          [(3) the amount of funds necessary to eliminate the 
        health status and resource deficiencies of all Indian 
        tribes served by the Service; and
          [(4) an estimate of--
                  [(A) the amount of health service funds 
                appropriated under the authority of this Act, 
                or any other Act, including the amount of any 
                funds transferred to the Service, for the 
                preceding fiscal year which is allocated to 
                each service unit, Indian tribe, or comparable 
                entity;
                  [(B) the number of Indians eligible for 
                health services in each service unit or Indian 
                tribe; and
                  [(C) the number of Indians using the Service 
                resources made available to each service unit 
                or Indian tribe.
  [(f) Funds appropriated under authority of this section for 
any fiscal year shall be included in the base budget of the 
Service for the purpose of determining appropriations under 
this section in subsequent fiscal years.
  [(g) Nothing in this section is intended to diminish the 
primary responsibility of the Service to eliminate existing 
backlogs in unmet health care needs, nor are the provisions of 
this section intended to discourage the Service from 
undertaking additional efforts to achieve parity among Indian 
tribes.
  [(h) Any funds appropriated under the authority of this 
section shall be designated as the ``Indian Health Care 
Improvement Fund''.
                  [catastrophic health emergency fund
  [Sec. 202. (a)(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), 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.
  [(b) 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
                  [(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) Amounts appropriated to the Fund under this section 
shall not be used to offset or limit appropriations made to the 
Service under authority of the Act of November 2, 1921 (25 
U.S.C. 13), popularly known as the Snyder Act, or any other 
law.
  [(d) 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.
           [health promotion and disease prevention services
  [Sec. 203. (a) 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 3(b).
  [(b) The Secretary shall submit to the President for 
inclusion in each statement which is required to be submitted 
to the Congress under section 801 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.
              [diabetes prevention, treatment, and control
  [Sec. 204. (a) 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
          [(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) 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.
  [(c)(1) The Secretary shall continue to maintain through 
fiscal year 2000 each model diabetes project in existence on 
the date of the enactment of the Indian Health Amendments of 
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) 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) Funds appropriated under this section in any fiscal year 
shall be in addition to base resources appropriated to the 
Service for that year.
                    [hospice care feasibility study
  [Sec. 205. (a) 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.
  [(b) 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) Not later than the date which is 12 months after the 
date of the enactment of this section, 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) 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 1861(dd)(2) 
        of the Social Security Act (42 U.S.C. 1395x(dd)(2)); 
        and
          [(3) the term ``hospice care'' means the items and 
        services specified in subparagraphs (A) through (H) of 
        section 1861(dd)(1) of the Social Security Act (42 
        U.S.C. 1395x(dd)(1)).
 [reimbursement from certain third parties of costs of health services
  [Sec. 206. (a) Except as provided in subsection (f), 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) Subsection (a) 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) No law of any State, or of any political subdivision of 
a State, and no provision of any contract entered into or 
renewed after the date of enactment of the Indian Health Care 
Amendments of 1988, shall prevent or hinder the right of 
recovery of the United States, an Indian tribe, or a tribal 
organization under subsection (a).
  [(d) No action taken by the United States, an Indian tribe, 
or a tribal organization to enforce the right of recovery 
provided under subsection (a) 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) The United States, an Indian tribe, or a tribal 
organization may enforce the right of recovery provided under 
subsection (a) 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) 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.
                      [crediting of reimbursements
  [Sec. 207. (a) Except as provided in section 202(d), title 
IV, and section 813 of this Act, all reimbursements received or 
recovered, under authority of this Act, Public Law 87-693 (42 
U.S.C. 2651, et seq.), or any other provision of law, by reason 
of the provision of health services by the Service or by a 
tribe or tribal organization under a contract pursuant to the 
Indian Self-Determination Act shall be retained by the Service 
or that tribe or tribal organization and shall be available for 
the facilities, and to carry out the programs, of the Service 
or that tribe or tribal organization to provide health care 
services to Indians.
  [(b) The Service may not offset or limit the amount of funds 
obligated to any service unit or any entity under contract with 
the Service because of the receipt of reimbursements under 
subsection (a).
                       [health services research
  [Sec. 208. Of the amounts appropriated for the Service in any 
fiscal year, other than amounts made available for the Indian 
Health Care Improvement Fund, not less than $200,000 shall be 
available only for research to further the performance of the 
health service responsibilities of the Service. Indian tribes 
and tribal organizations contracting with the Service under the 
authority of the Indian Self-Determination Act shall be given 
an equal opportunity to compete for, and receive, research 
funds under this section.
            [mental health prevention and treatment services
  [Sec. 209. (a) National Plan for Indian Mental Health 
Services.--(1) Not later than 120 days after the date of 
enactment of this section, the Secretary, acting through the 
Service, shall develop and publish in the Federal Register a 
final national plan for Indian Mental Health Services. The plan 
shall include--
          [(A) an assessment of the scope of the problem of 
        mental illness and dysfunctional and self-destructive 
        behavior, including child abuse and family violence, 
        among Indians, including--
                  [(i) the number of Indians served by the 
                Service who are directly or indirectly affected 
                by such illness or behavior, and
                  [(ii) an estimate of the financial and human 
                cost attributable to such illness or behavior;
          [(B) an assessment of the existing and additional 
        resources necessary for the prevention and treatment of 
        such illness and behavior; and
          [(C) an estimate of the additional funding needed by 
        the Service to meet its responsibilities under the 
        plan.
  [(2) The Secretary shall submit a copy of the national plan 
to the Congress.
  [(b) Memorandum of Agreement.--Not later than 180 days after 
the date of enactment of this section, the Secretary and the 
Secretary of the Interior shall develop and enter into a 
memorandum of agreement under which the Secretaries shall, 
among other things--
          [(1) determine and define the scope and nature of 
        mental illness and dysfunctional and self-destructive 
        behavior, including child abuse and family violence, 
        among Indians;
          [(2) make an assessment of the existing Federal, 
        tribal, State, local, and private services, resources, 
        and programs available to provide mental health 
        services for Indians;
          [(3) make an initial determination of the unmet need 
        for additional services, resources, and programs 
        necessary to meet the needs identified pursuant to 
        paragraph (1);
          [(4)(A) ensure that Indians, as citizens of the 
        United States and of the States in which they reside, 
        have access to mental health services to which all 
        citizens have access;
          [(B) determine the right of Indians to participate 
        in, and receive the benefit of, such services; and
          [(C) take actions necessary to protect the exercise 
        of such right;
          [(5) delineate the responsibilities of the Bureau of 
        Indian Affairs and the Service, including mental health 
        identification, prevention, education, referral, and 
        treatment services (including services through 
        multidisciplinary resource teams), at the central, 
        area, and agency and service unit levels to address the 
        problems identified in paragraph (1);
          [(6) provide a strategy for the comprehensive 
        coordination of the mental health services provided by 
        the Bureau of Indian Affairs and the Service to meet 
        the needs identified pursuant to paragraph (1), 
        including--
                  [(A) the coordination of alcohol and 
                substance abuse programs of the Service, the 
                Bureau of Indian Affairs, and the various 
                tribes (developed under the Indian Alcohol and 
                Substance Abuse Prevention and Treatment Act of 
                1986) with the mental health initiatives 
                pursuant to this Act, particularly with respect 
                to the referral and treatment of dually-
                diagnosed individuals requiring mental health 
                and substance abuse treatment; and
                  [(B) ensuring that Bureau of Indian Affairs 
                and Service programs and services (including 
                multidisciplinary resource teams) addressing 
                child abuse and family violence are coordinated 
                with such non-Federal programs and services;
          [(7) direct appropriate officials of the Bureau of 
        Indian Affairs and the Service, particularly at the 
        agency and service unit levels, to cooperate fully with 
        tribal requests made pursuant to subsection (d); and
          [(8) provide for an annual review of such agreement 
        by the two Secretaries.
  [(c) Community Mental Health Plan.--(1) The governing body of 
any Indian tribe may, at its discretion, adopt a resolution for 
the establishment of a community mental health plan providing 
for the identification and coordination of available resources 
and programs to identify, prevent, or treat mental illness or 
dysfunctional and self-destructive behavior, including child 
abuse and family violence, among its members.
  [(2) In furtherance of a plan established pursuant to 
paragraph (1) and at the request of a tribe, the appropriate 
agency, service unit, or other officials of the Bureau of 
Indian Affairs and the Service shall cooperate with, and 
provide technical assistance to, the tribe in the development 
of such plan. Upon the establishment of such a plan and at the 
request of the tribe, such officials, as directed by the 
memorandum of agreement developed pursuant to subsection (c), 
shall cooperate with the tribe in the implementation of such 
plan.
  [(3) Two or more Indian tribes may form a coalition for the 
adoption of resolutions and the establishment and development 
of a joint community mental health plan under this subsection.
  [(4) The Secretary, acting through the Service, may make 
grants to Indian tribes adopting a resolution pursuant to 
paragraph (1) to obtain technical assistance for the 
development of a community mental health plan and to provide 
administrative support in the implementation of such plan.
  [(d) Mental Health Training and Community Education 
Programs.--(1) The Secretary and the Secretary of the Interior, 
in consultation with representatives of Indian tribes, shall 
conduct a study and compile a list, of the types of staff 
positions specified in paragraph (2) whose qualifications 
include, or should include, training in the identification, 
prevention, education, referral, or treatment of mental illness 
or dysfunctional and self-destructive behavior.
  [(2) The positions referred to in paragraph (1) are--
          [(A) staff positions within the Bureau of Indian 
        Affairs, including existing positions, in the fields 
        of--
                  [(i) elementary and secondary education;
                  [(ii) social services and family and child 
                welfare;
                  [(iii) law enforcement and judicial services; 
                and
                  [(iv) alcohol and substance abuse;
          [(B) staff positions with the Service; and
          [(C) staff positions similar to those identified in 
        subparagraphs (A) and (B) established and maintained by 
        Indian tribes, including positions established in 
        contracts entered into under the Indian Self-
        Determination Act.
  [(3)(A) The appropriate Secretary shall provide training 
criteria appropriate to each type of position identified in 
paragraph (2)(A) and ensure that appropriate training has been, 
or will be, provided to any individual in any such position. 
With respect to any such individual in a position identified 
pursuant to paragraph (2)(C), the respective Secretaries shall 
provide appropriate training to, or provide funds to an Indian 
tribe for the training of, such individual. In the case of 
positions funded under a contract entered into under the Indian 
Self-Determination Act, the appropriate Secretary shall ensure 
that such training costs are included in the contract, if 
necessary.
  [(B) Funds authorized to be appropriated pursuant to this 
section may be used to provide training authorized by this 
paragraph for community education programs described in 
paragraph (5) if a plan adopted pursuant to subsection (d) 
identifies individuals or employment categories, other than 
those identified pursuant to paragraph (1), for which such 
training or community education is deemed necessary or 
desirable.
  [(4) Position-specific training criteria described in 
paragraph (3) shall be culturally relevant to Indians and 
Indian tribes and shall ensure that appropriate information 
regarding traditional Indian healing and treatment practices is 
provided.
  [(5) The Service shall develop and implement or, upon the 
request of an Indian tribe, assist such tribe to develop and 
implement, a program of community education on mental illness 
and dysfunctional and self-destructive behavior for 
individuals, as determined in a plan adopted pursuant to 
subsection (d). In carrying out this paragraph, the Service 
shall provide, upon the request of an Indian tribe, technical 
assistance to the Indian tribe to obtain or develop community 
education and training materials on the identification, 
prevention, referral, and treatment of mental illness and 
dysfunctional and self-destructive behavior.
  [(e) Staffing.--(1) Within 90 days after the date of 
enactment of this section, the Secretary shall develop a plan 
under which the Service will increase the health care staff 
providing mental health services by at least 500 positions 
within five years after the date of enactment of this section, 
with at least 200 of such positions devoted to child, 
adolescent, and family services. Such additional staff shall be 
primarily assigned to the service unit level for services which 
shall include outpatient, emergency, aftercare and follow-up, 
and prevention and education services.
  [(2) The plan developed under paragraph (1) shall be 
implemented under the Act of November 2, 1921 (25 U.S.C. 13) 
popularly known as the ``Snyder Act''.
  [(f) Staff Recruitment and Retention.--(1) The Secretary 
shall provide for the recruitment of the additional personnel 
required by subsection (f) and the retention of all Service 
personnel providing mental health services. In carrying out 
this subsection, the Secretary shall give priority to 
practitioners providing mental health services to children and 
adolescents with mental health problems.
  [(2) In carrying out paragraph (1), the Secretary shall 
develop a program providing for--
          [(A) the payment of bonuses (which shall not be more 
        favorable than those provided for under sections 116 
        and 117) for service in hardship posts;
          [(B) the repayment of loans (for which the provisions 
        of repayment contracts shall not be more favorable than 
        the repayment contracts under section 108) for health 
        professions education as a recruitment incentive; and
          [(C) a system of postgraduate rotations as a 
        retention incentive.
  [(3) This subsection shall be carried out in coordination 
with the recruitment and retention programs under title I.
  [(g) Mental Health Technician Program.--(1) Under the 
authority of the Snyder Act of November 2, 1921 (25 U.S.C. 13), 
the Secretary shall establish and maintain a Mental Health 
Technician program within the Service which--
          [(A) provides for the training of Indians as mental 
        health technicians; and
          [(B) employs such technicians in the provision of 
        community-based mental health care that includes 
        identification, prevention, education, referral, and 
        treatment services.
  [(2) In carrying out paragraph (1)(A), the Secretary shall 
provide high standard paraprofessional training in mental 
health care necessary to provide quality care to the Indian 
communities to be served. Such training shall be based upon a 
curriculum developed or approved by the Secretary which 
combines education in the theory of mental health care with 
supervised practical experience in the provision of such care.
  [(3) The Secretary shall supervise and evaluate the mental 
health technicians in the training program.
  [(4) The Secretary shall ensure that the program established 
pursuant to this subsection involves the utilization and 
promotion of the traditional Indian health care and treatment 
practices of the Indian tribes to be served.
  [(h) Mental Health Research.--The Secretary, acting through 
the Service and in consultation with the National Institute of 
Mental Health, shall enter into contracts with, or make grants 
to, appropriate institutions for the conduct of research on the 
incidence and prevalence of mental disorders among Indians on 
Indian reservations and in urban areas. Research priorities 
under this subsection shall include--
          [(1) the inter-relationship and inter-dependence of 
        mental disorders with alcoholism, suicide, homicides, 
        accidents, and the incidence of family violence, and
          [(2) the development of models of prevention 
        techniques.
The effect of the inter-relationships and interdependencies 
referred to in paragraph (1) on children, and the development 
of prevention techniques under paragraph (2) applicable to 
children, shall be emphasized.
  [(i) Facilities Assessment.--Within one year after the date 
of enactment of this section, the Secretary, acting through the 
Service, shall make an assessment of the need for inpatient 
mental health care among Indians and the availability and cost 
of inpatient mental health facilities which can meet such need. 
In making such assessment, the Secretary shall consider the 
possible conversion of existing, under-utilized service 
hospital beds into psychiatric units to meet such need.
  [(j) Annual Report.--The Service shall develop methods for 
analyzing and evaluating the overall status of mental health 
programs and services for Indians and shall submit to the 
President, for inclusion in each report required to be 
transmitted to the Congress under section 801, a report on the 
mental health status of Indians which shall describe the 
progress being made to address mental health problems of Indian 
communities.
  [(k) Mental Health Demonstration Grant Program.--(1) The 
Secretary, acting through the Service, is authorized to make 
grants to Indian tribes and inter-tribal consortia to pay 75 
percent of the cost of planning, developing, and implementing 
programs to deliver innovative community-based mental health 
services to Indians. The 25 percent tribal share of such cost 
may be provided in cash or through the provision of property or 
services.
  [(2) The Secretary may award a grant for a project under 
paragraph (1) to an Indian tribe or inter-tribal consortium 
which meets the following criteria:
          [(A) The project will address significant unmet 
        mental health needs among Indians.
          [(B) The project will serve a significant number of 
        Indians.
          [(C) The project has the potential to deliver 
        services in an efficient and effective manner.
          [(D) The tribe or consortium has the administrative 
        and financial capability to administer the project.
          [(E) The project will deliver services in a manner 
        consistent with traditional Indian healing and 
        treatment practices.
          [(F) The project is coordinated with, and avoids 
        duplication of, existing services.
  [(3) For purposes of this subsection, the Secretary shall, in 
evaluating applications for grants for projects to be operated 
under any contract entered into with the Service under the 
Indian Self-Determination Act, use the same criteria that the 
Secretary uses in evaluating any other application for such a 
grant.
  [(4) The Secretary may only award one grant under this 
subsection with respect to a service area until the Secretary 
has awarded grants for all service areas with respect to which 
the Secretary receives applications during the application 
period, as determined by the Secretary, which meet the criteria 
specified in paragraph (2).
  [(5) Not later than 180 days after the close of the term of 
the last grant awarded pursuant to this subsection, the 
Secretary shall submit to the Congress a report evaluating the 
effectiveness of the innovative community-based projects 
demonstrated pursuant to this subsection. Such report shall 
include findings and recommendations, if any, relating to the 
reorganization of the programs of the Service for delivery of 
mental health services to Indians.
  [(6) Grants made pursuant to this section may be expended 
over a period of three years and no grant may exceed $1,000,000 
for the fiscal years involved.
  [(l) Licensing Requirement for Mental Health Care Workers.--
Any person employed as a psychologist, social worker, or 
marriage and family therapist for the purpose of providing 
mental health care services to Indians in a clinical setting 
under the authority of this Act or through a contract pursuant 
to the Indian Self-Determination Act shall--
          [(1) in the case of a person employed as a 
        psychologist, be licensed as a clinical psychologist or 
        working under the direct supervision of a licensed 
        clinical psychologist;
          [(2) in the case of a person employed as a social 
        worker, be licensed as a social worker or working under 
        the direct supervision of a licensed social worker; or
          [(3) in the case of a person employed as a marriage 
        and family therapist, be licensed as a marriage and 
        family therapist or working under the direct 
        supervision of a licensed marriage and family 
        therapist.
  [(m) Intermediate Adolescent Mental Health Services.--(1) The 
Secretary, acting through the Service, may make grants to 
Indian tribes and tribal organizations to provide intermediate 
mental health services to Indian children and adolescents, 
including--
          [(A) inpatient and outpatient services;
          [(B) emergency care;
          [(C) suicide prevention and crisis intervention; and
          [(D) prevention and treatment of mental illness, and 
        dysfunctional and self-destructive behavior, including 
        child abuse and family violence.
  [(2) Funds provided under this subsection may be used--
          [(A) to construct or renovate an existing health 
        facility to provide intermediate mental health 
        services;
          [(B) to hire mental health professionals;
          [(C) to staff, operate, and maintain an intermediate 
        mental health facility, group home, or youth shelter 
        where intermediate mental health services are being 
        provided; and
          [(D) to make renovations and hire appropriate staff 
        to convert existing hospital beds into adolescent 
        psychiatric units.
  [(3) Funds provided under this subsection may not be used for 
the purposes described in section 216(b)(1).
  [(4) An Indian tribe or tribal organization receiving a grant 
under this subsection shall ensure that intermediate adolescent 
mental health services are coordinated with other tribal, 
Service, and Bureau of Indian Affairs mental health, alcohol 
and substance abuse, and social services programs on the 
reservation of such tribe or tribal organization.
  [(5) The Secretary shall establish criteria for the review 
and approval of applications for grants made pursuant to this 
subsection.
  [(6) There are authorized to be appropriated to carry out 
this section $10,000,000 for fiscal year 1993 and such sums as 
may be necessary for each of the fiscal years 1994, 1995, 1996, 
1997, 1998, 1999, and 2000.
                    [managed care feasibility study
  [Sec. 210. (a) The Secretary, acting through the Service, 
shall conduct a study to assess the feasibility of allowing an 
Indian tribe to purchase, directly or through the Service, 
managed care coverage for all members of the tribe from--
          [(1) a tribally owned and operated managed care plan; 
        or
          [(2) a State licensed managed care plan.
  [(b) Not later than the date which is 12 months after the 
date of the enactment of this section, 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.
       [california contract health services demonstration program
  [Sec. 211. (a) The Secretary shall establish a demonstration 
program to evaluate the use of a contract care intermediary to 
improve the accessibility of health services to California 
Indians.
  [(b)(1) In establishing such program, the Secretary shall 
enter into an agreement with the California Rural Indian Health 
Board to reimburse the Board for costs (including reasonable 
administrative costs) incurred, during the period of the 
demonstration program, in providing medical treatment under 
contract to California Indians described in section 809(b) 
throughout the California contract health services delivery 
area described in section 810 with respect to high-cost 
contract care cases.
  [(2) Not more than 5 percent of the amounts provided to the 
Board under this section for any fiscal year may be for 
reimbursement for administrative expenses incurred by the Board 
during such fiscal year.
  [(3) No payment may be made for treatment provided under the 
demonstration program to the extent payment may be made for 
such treatment under the Catastrophic Health Emergency Fund 
described in section 202 or from amounts appropriated or 
otherwise made available to the California contract health 
service delivery area for a fiscal year.
  [(c) There is hereby established an advisory board which 
shall advise the California Rural Indian Health Board in 
carrying out the demonstration pursuant to this section. The 
advisory board shall be composed of representatives, selected 
by the California Rural Indian Health Board, from not less than 
8 tribal health programs serving California Indians covered 
under such demonstration, at least one half of whom are not 
affiliated with the California Rural Indian Health Board.
  [(d) The demonstration program described in this section 
shall begin on January 1, 1993, and shall terminate on 
September 30, 1997.
  [(e) Not later than July 1, 1998, the California Rural Indian 
Health Board shall submit to the Secretary a report on the 
demonstration program carried out under this section, including 
a statement of its findings regarding the impact of using a 
contract care intermediary on--
          [(1) access to needed health services;
          [(2) waiting periods for receiving such services; and
          [(3) the efficient management of high-cost contract 
        care cases.
  [(f) For the purposes of this section, the term ``high-cost 
contract care cases'' means those cases in which the cost of 
the medical treatment provided to an individual--
          [(1) would otherwise be eligible for reimbursement 
        from the Catastrophic Health Emergency Fund established 
        under section 202, except that the cost of such 
        treatment does not meet the threshold cost requirement 
        established pursuant to section 202(b)(2); and
          [(2) exceeds $1,000.
  [(g) There are authorized to be appropriated for each of the 
fiscal years 1996 through 2000, such sums as may be necessary 
to carry out the purposes of this section.
                   [coverage of screening mammography
  [Sec. 212. The Secretary, through the Service, shall provide 
for screening mammography (as defined in section 1861(jj) of 
the Social Security Act) for Indian and urban Indian women 35 
years of age or older at a frequency, determined by the 
Secretary (in consultation with the Director of the National 
Cancer Institute), appropriate to such women, and under such 
terms and conditions as are consistent with standards 
established by the Secretary to assure the safety and accuracy 
of screening mammography under part B of title XVIII of the 
Social Security Act.
                         [patient travel costs
  [Sec. 213. (a) The Secretary, acting through the Service, 
shall provide funds for the following patient travel costs 
associated with receiving health care services provided (either 
through direct or contract care or through contracts entered 
into pursuant to the Indian Self-Determination Act) under this 
Act--
          [(1) emergency air transportation; and
          [(2) nonemergency air transportation where ground 
        transportation is infeasible.
  [(b) There are authorized to be appropriated to carry out 
this section $15,000,000 for fiscal year 1993 and such sums as 
may be necessary for each of the fiscal years 1994, 1995, 1996, 
1997, 1998, 1999, and 2000.
                         [epidemiology centers
  [Sec. 214. (a)(1) The Secretary shall establish an 
epidemiology center in each Service area to carry out the 
functions described in paragraph (3).
  [(2) To assist such centers in carrying out such functions, 
the Secretary shall perform the following:
          [(A) In consultation with the Centers for Disease 
        Control and Indian tribes, develop sets of data (which 
        to the extent practicable, shall be consistent with the 
        uniform data sets used by the States with respect to 
        the year 2000 health objectives) for uniformly defining 
        health status for purposes of the objectives specified 
        in section 3(b). Such sets shall consist of one or more 
        categories of information. The Secretary shall develop 
        formats for the uniform collecting and reporting of 
        information on such categories.
          [(B) Establish and maintain a system for monitoring 
        the progress made toward meeting each of the health 
        status objectives described in section 3(b).
  [(3) In consultation with Indian tribes and urban Indian 
communities, each area epidemiology center established under 
this subsection shall, with respect to such area--
          [(A) collect data relating to, and monitor progress 
        made toward meeting, each of the health status 
        objectives described in section 3(b) using the data 
        sets and monitoring system developed by the Secretary 
        pursuant to paragraph (2);
          [(B) evaluate existing delivery systems, data 
        systems, and other systems that impact the improvement 
        of Indian health;
          [(C) assist tribes and urban Indian communities in 
        identifying their highest priority health status 
        objectives and the services needed to achieve such 
        objectives, based on epidemiological data;
          [(D) make recommendations for the targeting of 
        services needed by tribal, urban, and other Indian 
        communities;
          [(E) make recommendations to improve health care 
        delivery systems for Indians and urban Indians;
          [(F) work cooperatively with tribal providers of 
        health and social services in order to avoid 
        duplication of existing services; and
          [(G) provide technical assistance to Indian tribes 
        and urban Indian organizations in the development of 
        local health service priorities and incidence and 
        prevalence rates of disease and other illness in the 
        community.
  [(4) Epidemiology centers established under this subsection 
shall be subject to the provisions of the Indian Self-
Determination Act (25 U.S.C. 450f et seq.).
  [(5) The director of the Centers for Disease Control shall 
provide technical assistance to the centers in carrying out the 
requirements of this subsection.
  [(6) The Service shall assign one epidemiologist from each of 
its area offices to each area epidemiology center to provide 
such center with technical assistance necessary to carry out 
this subsection.
  [(b)(1) The Secretary may make grants to Indian tribes, 
tribal organizations, and eligible intertribal consortia or 
Indian organizations to conduct epidemiological studies of 
Indian communities.
  [(2) An intertribal consortia or Indian organization is 
eligible to receive a grant under this subsection if--
          [(A) it is incorporated for the primary purpose of 
        improving Indian health; and
          [(B) it is representative of the tribes or urban 
        Indian communities in which it is located.
  [(3) An application for a grant under this subsection shall 
be submitted in such manner and at such time as the Secretary 
shall prescribe.
  [(4) Applicants for grants under this subsection shall--
          [(A) demonstrate the technical, administrative, and 
        financial expertise necessary to carry out the 
        functions described in paragraph (5);
          [(B) consult and cooperate with providers of related 
        health and social services in order to avoid 
        duplication of existing services; and
          [(C) demonstrate cooperation from Indian tribes or 
        urban Indian organizations in the area to be served.
  [(5) A grant awarded under paragraph (1) may be used to--
          [(A) carry out the functions described in subsection 
        (a)(3);
          [(B) provide information to and consult with tribal 
        leaders, urban Indian community leaders, and related 
        health staff, on health care and health services 
        management issues; and
          [(C) provide, in collaboration with tribes and urban 
        Indian communities, the Service with information 
        regarding ways to improve the health status of Indian 
        people.
  [(6) There are authorized to be appropriated to carry out the 
purposes of this subsection not more than $12,000,000 for 
fiscal year 1993 and such sums as may be necessary for each of 
the fiscal years 1994, 1995, 1996, 1997, 1998, 1999, and 2000.
            [comprehensive school health education programs
  [Sec. 215. (a) The Secretary, acting through the Service and 
in consultation with the Secretary of the Interior, may award 
grants to Indian tribes to develop comprehensive school health 
education programs for children from preschool through grade 12 
in schools located on Indian reservations.
  [(b) Grants awarded under this section may be used to--
          [(1) develop health education curricula;
          [(2) train teachers in comprehensive school health 
        education curricula;
          [(3) integrate school-based, community-based, and 
        other public and private health promotion efforts;
          [(4) encourage healthy, tobacco-free school 
        environments;
          [(5) coordinate school-based health programs with 
        existing services and programs available in the 
        community;
          [(6) develop school programs on nutrition education, 
        personal health, and fitness;
          [(7) develop mental health wellness programs;
          [(8) develop chronic disease prevention programs;
          [(9) develop substance abuse prevention programs;
          [(10) develop accident prevention and safety 
        education programs;
          [(11) develop activities for the prevention and 
        control of communicable diseases; and
          [(12) develop community and environmental health 
        education programs.
  [(c) The Secretary shall provide technical assistance to 
Indian tribes in the development of health education plans, and 
the dissemination of health education materials and information 
on existing health programs and resources.
  [(d) The Secretary shall establish criteria for the review 
and approval of applications for grants made pursuant to this 
section.
  [(e) Recipients of grants under this section shall submit to 
the Secretary an annual report on activities undertaken with 
funds provided under this section. Such reports shall include a 
statement of--
          [(1) the number of preschools, elementary schools, 
        and secondary schools served;
          [(2) the number of students served;
          [(3) any new curricula established with funds 
        provided under this section;
          [(4) the number of teachers trained in the health 
        curricula; and
          [(5) the involvement of parents, members of the 
        community, and community health workers in programs 
        established with funds provided under this section.
  [(f)(1) The Secretary of the Interior, acting through the 
Bureau of Indian Affairs and in cooperation with the Secretary, 
shall develop a comprehensive school health education program 
for children from preschool through grade 12 in schools 
operated by the Bureau of Indian Affairs.
  [(2) Such program shall include--
          [(A) school programs on nutrition education, personal 
        health, and fitness;
          [(B) mental health wellness programs;
          [(C) chronic disease prevention programs;
          [(D) substance abuse prevention programs;
          [(E) accident prevention and safety education 
        programs; and
          [(F) activities for the prevention and control of 
        communicable diseases.
  [(3) The Secretary of the Interior shall--
          [(A) provide training to teachers in comprehensive 
        school health education curricula;
          [(B) ensure the integration and coordination of 
        school-based programs with existing services and health 
        programs available in the community; and
          [(C) encourage healthy, tobacco-free school 
        environments.
  [(g) There are authorized to be appropriated to carry out 
this section $15,000,000 for fiscal year 1993 and such sums as 
may be necessary for each of the fiscal years 1994, 1995, 1996, 
1997, 1998, 1999, and 2000.
                      [indian youth grant program
  [Sec. 216. (a) The Secretary, acting through the Service, is 
authorized to make grants to Indian tribes, tribal 
organizations, and urban Indian organizations for innovative 
mental and physical disease prevention and health promotion and 
treatment programs for Indian preadolescent and adolescent 
youths.
  [(b)(1) Funds made available under this section may be used 
to--
          [(A) develop prevention and treatment programs for 
        Indian youth which promote mental and physical health 
        and incorporate cultural values, community and family 
        involvement, and traditional healers; and
          [(B) develop and provide community training and 
        education.
  [(2) Funds made available under this section may not be used 
to provide services described in section 209(m).
  [(c) The Secretary shall--
          [(1) disseminate to Indian tribes information 
        regarding models for the delivery of comprehensive 
        health care services to Indian and urban Indian 
        adolescents;
          [(2) encourage the implementation of such models; and
          [(3) at the request of an Indian tribe, provide 
        technical assistance in the implementation of such 
        models.
  [(d) The Secretary shall establish criteria for the review 
and approval of applications under this section.
  [(e) There are authorized to be appropriated to carry out 
this section $5,000,000 for fiscal year 1993 and such sums as 
may be necessary for each of the fiscal years 1994, 1995, 1996, 
1997, 1998, 1999, and 2000.
               [american indians into psychology program
  [Sec. 217. (a) The Secretary may provide grants to at least 3 
colleges and universities for the purpose of developing and 
maintaining American Indian psychology career recruitment 
programs as a means of encouraging Indians to enter the mental 
health field.
  [(b) The Secretary shall provide one of the grants authorized 
under subsection (a) to develop and maintain a program at the 
University of North Dakota to be known as the ``Quentin N. 
Burdick American Indians Into Psychology Program''. Such 
program shall, to the maximum extent feasible, coordinate with 
the Quentin N. Burdick Indian Health Programs authorized under 
section 114(b), the Quentin N. Burdick American Indians Into 
Nursing Program authorized under section 112(e), and existing 
university research and communications networks.
  [(c)(1) The Secretary shall issue regulations for the 
competitive awarding of the grants provided under this section.
  [(2) Applicants for grants under this section shall agree to 
provide a program which, at a minimum--
          [(A) provides outreach and recruitment for health 
        professions to Indian communities including elementary, 
        secondary and community colleges located on Indian 
        reservations that will be served by the program;
          [(B) incorporates a program advisory board comprised 
        of representatives from the tribes and communities that 
        will be served by the program;
          [(C) provides summer enrichment programs to expose 
        Indian students to the varied fields of psychology 
        through research, clinical, and experiential 
        activities;
          [(D) provides stipends to undergraduate and graduate 
        students to pursue a career in psychology;
          [(E) develops affiliation agreements with tribal 
        community colleges, the Service, university affiliated 
        programs, and other appropriate entities to enhance the 
        education of Indian students;
          [(F) to the maximum extent feasible, utilizes 
        existing university tutoring, counseling and student 
        support services; and
          [(G) to the maximum extent feasible, employs 
        qualified Indians in the program.
  [(d) The active duty service obligation prescribed under 
section 338C of the Public Health Service Act (42 U.S.C. 254m) 
shall be met by each graduate student who receives a stipend 
described in subsection (c)(2)(D) that is funded by a grant 
provided under this section. Such obligation shall be met by 
service--
          [(1) in the Indian Health Service;
          [(2) in a program conducted under a contract entered 
        into under the Indian Self-Determination Act;
          [(3) in a program assisted under title V of this Act; 
        or
          [(4) in the private practice of psychology if, as 
        determined by the Secretary, in accordance with 
        guidelines promulgated by the Secretary, such practice 
        is situated in a physician or other health professional 
        shortage area and addresses the health care needs of a 
        substantial number of Indians.
         [prevention, control, and elimination of tuberculosis
  [Sec. 218. (a) The Secretary, acting through the Service 
after consultation with the Centers for Disease Control, may 
make grants to Indian tribes and tribal organizations for--
          [(1) projects for the prevention, control, and 
        elimination of tuberculosis;
          [(2) public information and education programs for 
        the prevention, control, and elimination of 
        tuberculosis; and
          [(3) education, training, and clinical skills 
        improvement activities in the prevention, control, and 
        elimination of tuberculosis for health professionals, 
        including allied health professionals.
  [(b) The Secretary may make a grant under subsection (a) only 
if an application for the grant is submitted to the Secretary 
and the application is in such form, is made in such manner, 
and contains the assurances required by subsection (c) and such 
other agreements, assurances, and information as the Secretary 
may require.
  [(c) To be eligible for a grant under subsection (a), an 
applicant must provide assurances satisfactory to the Secretary 
that--
          [(1) the applicant will coordinate its activities for 
        the prevention, control, and elimination of 
        tuberculosis with activities of the Centers for Disease 
        Control\1\, and State and local health agencies; and
          [(2) the applicant will submit to the Secretary an 
        annual report on its activities for the prevention, 
        control, and elimination of tuberculosis.
  [(d) In carrying out this section, the Secretary--
          [(1) shall establish criteria for the review and 
        approval of applications for grants under subsection 
        (a), including requirement of public health 
        qualifications of applicants;
          [(2) shall, subject to available appropriations, make 
        at least one grant under subsection (a) within each 
        area office;
          [(3) may, at the request of an Indian tribe or tribal 
        organization, provide technical assistance; and
          [(4) shall prepare and submit a report to the 
        Committee on Energy and Commerce and the Committee on 
        Natural Resources of the House and the Committee on 
        Indian Affairs of the Senate not later than February 1, 
        1994, and biennially thereafter, on the use of funds 
        under this section and on the progress made toward the 
        prevention, control, and elimination of tuberculosis 
        among Indian tribes and tribal organizations.
  [(e) The Secretary may, at the request of a recipient of a 
grant under subsection (a), reduce the amount of such grant 
by--
          [(1) the fair market value of any supplies or 
        equipment furnished the grant recipient; and
          [(2) the amount of the pay, allowances, and travel 
        expenses of any officer or employee of the Government 
        when detailed to the grant recipient and the amount of 
        any other costs incurred in connection with the detail 
        of such officer or employee,
when the furnishing of such supplies or equipment or the detail 
of such an officer or employee is for the convenience of and at 
the request of such grant recipient and for the purpose of 
carrying out a program with respect to which the grant under 
subsection (a) is made. The amount by which any such grant is 
so reduced shall be available for payment by the Secretary of 
the costs incurred in furnishing the supplies or equipment, or 
in detailing the personnel, on which the reduction of such 
grant is based, and such amount shall be deemed as part of the 
grant and shall be deemed to have been paid to the grant 
recipient.
                [contract health services payment study
  [Sec. 219. (a) The Secretary, acting through the Service and 
in consultation with representatives of Indian tribes and 
tribal organizations operating contract health care programs 
under the Indian Self-Determination Act (25 U.S.C. 450f et 
seq.) or under self-governance compacts, Service personnel, 
private contract health services providers, the Indian Health 
Service Fiscal Intermediary, and other appropriate experts, 
shall conduct a study--
          [(1) to assess and identify administrative barriers 
        that hinder the timely payment for services delivered 
        by private contract health services providers to 
        individual Indians by the Service and the Indian Health 
        Service Fiscal Intermediary;
          [(2) to assess and identify the impact of such 
        delayed payments upon the personal credit histories of 
        individual Indians who have been treated by such 
        providers; and
          [(3) to determine the most efficient and effective 
        means of improving the Service's contract health 
        services payment system and ensuring the development of 
        appropriate consumer protection policies to protect 
        individual Indians who receive authorized services from 
        private contract health services providers from billing 
        and collection practices, including the development of 
        materials and programs explaining patients' rights and 
        responsibilities.
  [(b) The study required by subsection (a) shall--
          [(1) assess the impact of the existing contract 
        health services regulations and policies upon the 
        ability of the Service and the Indian Health Service 
        Fiscal Intermediary to process, on a timely and 
        efficient basis, the payment of bills submitted by 
        private contract health services providers;
          [(2) assess the financial and any other burdens 
        imposed upon individual Indians and private contract 
        health services providers by delayed payments;
          [(3) survey the policies and practices of collection 
        agencies used by contract health services providers to 
        collect payments for services rendered to individual 
        Indians;
          [(4) identify appropriate changes in Federal 
        policies, administrative procedures, and regulations, 
        to eliminate the problems experienced by private 
        contract health services providers and individual 
        Indians as a result of delayed payments; and
          [(5) compare the Service's payment processing 
        requirements with private insurance claims processing 
        requirements to evaluate the systemic differences or 
        similarities employed by the Service and private 
        insurers.
  [(c) Not later than 12 months after the date of the enactment 
of this section, the Secretary shall transmit to the Congress a 
report that includes--
          [(1) a detailed description of the study conducted 
        pursuant to this section; and
          [(2) a discussion of the findings and conclusions of 
        such study.
                  [prompt action on payment of claims
  [Sec. 220. (a) The Service shall respond to a notification of 
a claim by a provider of a contract care service with either an 
individual purchase order or a denial of the claim within 5 
working days after the receipt of such notification.
  [(b) If the Service fails to respond to a notification of a 
claim in accordance with subsection (a), the Service shall 
accept as valid the claim submitted by the provider of a 
contract care service.
  [(c) The Service shall pay a completed contract care service 
claim within 30 days after completion of the claim.
             [demonstration of electronic claims processing
  [Sec. 221. (a) Not later than June 15, 1993, the Secretary 
shall develop and implement, directly or by contract, 2 
projects to demonstrate in a pilot setting the use of claims 
processing technology to improve the accuracy and timeliness of 
the billing for, and payment of, contract health services.
  [(b) The Secretary shall conduct one of the projects 
authorized in subsection (a) in the Service area served by the 
area office located in Phoenix, Arizona.
                         [liability for payment
  [Sec. 222. (a) A patient who receives contract health care 
services that are authorized by the Service shall not be liable 
for the payment of any charges or costs associated with the 
provision of such services.
  [(b) The Secretary shall notify a contract care provider and 
any patient who receives contract health care services 
authorized by the Service that such patient is not liable for 
the payment of any charges or costs associated with the 
provision of such services.
                 [office of indian women's health care
  [Sec. 223. There is established within the Service an Office 
of Indian Women's Health Care to oversee efforts of the Service 
to monitor and improve the quality of health care for Indian 
women of all ages through the planning and delivery of programs 
administered by the Service, in order to improve and enhance 
the treatment models of care for Indian women.
                    [authorization of appropriations
  [Sec. 224. Except as provided in sections 209(m), 211, 213, 
214(b)(5), 215, and 216, there are authorized to be 
appropriated such sums as may be necessary for each fiscal year 
through fiscal year 2000 to carry out this title.
                      [limitation on use of funds
  [Sec. 225. Amounts appropriated to carry out this title may 
not be used in a manner inconsistent with the Assisted Suicide 
Funding Restriction Act of 1997.

                     [TITLE III--HEALTH FACILITIES

             [consultation; closure of facilities; reports
  [Sec. 301. (a) Prior to the expenditure of, or the making of 
any firm commitment to expend, any funds appropriated for the 
planning, design, construction, or renovation of facilities 
pursuant to the Act of November 2, 1921 (25 U.S.C. 13), 
popularly known as the Snyder Act, the Secretary, acting 
through the Service, shall--
          [(1) consult with any Indian tribe that would be 
        significantly affected by such expenditure for the 
        purpose of determining and, whenever practicable, 
        honoring tribal preferences concerning size, location, 
        type, and other characteristics of any facility on 
        which such expenditure is to be made, and
          [(2) ensure, whenever practicable, that such facility 
        meets the standards of the Joint Commission on 
        Accreditation of Health Care Organizations by not later 
        than 1 year after the date on which the construction or 
        renovation of such facility is completed.
  [(b)(1) Notwithstanding any provision of law other than this 
subsection, no Service hospital or outpatient health care 
facility of the Service, or any portion of such a hospital or 
facility, may be closed if the Secretary has not submitted to 
the Congress at least 1 year prior to the date such hospital or 
facility (or portion thereof) is proposed to be closed an 
evaluation of the impact of such proposed closure which 
specifies, in addition to other considerations--
          [(A) the accessibility of alternative health care 
        resources for the population served by such hospital or 
        facility;
          [(B) the cost effectiveness of such closure;
          [(C) the quality of health care to be provided to the 
        population served by such hospital or facility after 
        such closure;
          [(D) the availability of contract health care funds 
        to maintain existing levels of service;
          [(E) the views of the Indian tribes served by such 
        hospital or facility concerning such closure;
          [(F) the level of utilization of such hospital or 
        facility by all eligible Indians; and
          [(G) the distance between such hospital or facility 
        and the nearest operating Service hospital.
  [(2) Paragraph (1) shall not apply to any temporary closure 
of a facility or of any portion of a facility if such closure 
is necessary for medical, environmental, or safety reasons.
  [(c)(1) The Secretary shall submit to the President, for 
inclusion in each report required to be transmitted to the 
Congress under section 801, a report which sets forth--
          [(A) the current health facility priority system of 
        the Service,
          [(B) the planning, design, construction, and 
        renovation needs for the 10 top-priority inpatient care 
        facilities and the 10 top-priority ambulatory care 
        facilities (together with required staff quarters),
          [(C) the justification for such order of priority,
          [(D) the projected cost of such projects, and
          [(E) the methodology adopted by the Service in 
        establishing priorities under its health facility 
        priority system.
  [(2) In preparing each report required under paragraph (1) 
(other than the initial report), the Secretary shall--
          [(A) consult with Indian tribes and tribal 
        organizations including those tribes or tribal 
        organizations operating health programs or facilities 
        under any contract entered into with the Service under 
        the Indian Self-Determination Act, and
          [(B) review the needs of such tribes and tribal 
        organizations for inpatient and outpatient facilities, 
        including their needs for renovation and expansion of 
        existing facilities.
  [(3) For purposes of this subsection, the Secretary shall, in 
evaluating the needs of facilities operated under any contract 
entered into with the Service under the Indian Self-
Determination Act, use the same criteria that the Secretary 
uses in evaluating the needs of facilities operated directly by 
the Service.
  [(4) The Secretary shall ensure that the planning, design, 
construction, and renovation needs of Service and non-Service 
facilities which are the subject of a contract for health 
services entered into with the Service under the Indian Self-
Determination Act are fully and equitably integrated into the 
development of the health facility priority system.
  [(d) All funds appropriated under the Act of November 2, 1921 
(25 U.S.C. 13), for the planning, design, construction, or 
renovation of health facilities for the benefit of an Indian 
tribe or tribes shall be subject to the provisions of section 
102 of the Indian Self-Determination Act.
           [safe water and sanitary waste disposal facilities
  [Sec. 302. (a) The Congress hereby finds and declares that--
          [(1) the provision of safe water supply systems and 
        sanitary sewage and solid waste disposal systems is 
        primarily a health consideration and function;
          [(2) Indian people suffer an inordinately high 
        incidence of disease, injury, and illness directly 
        attributable to the absence or inadequacy of such 
        systems;
          [(3) the long-term cost to the United States of 
        treating and curing such disease, injury, and illness 
        is substantially greater than the short-term cost of 
        providing such systems and other preventive health 
        measures;
          [(4) many Indian homes and communities still lack 
        safe water supply systems and sanitary sewage and solid 
        waste disposal systems; and
          [(5) it is in the interest of the United States, and 
        it is the policy of the United States, that all Indian 
        communities and Indian homes, new and existing, be 
        provided with safe and adequate water supply systems 
        and sanitary sewage waste disposal systems as soon as 
        possible.
  [(b)(1) In furtherance of the findings and declarations made 
in subsection (a), Congress reaffirms the primary 
responsibility and authority of the Service to provide the 
necessary sanitation facilities and services as provided in 
section 7 of the Act of August 5, 1954 (42 U.S.C. 2004a).
  [(2) The Secretary, acting through the Service, is authorized 
to provide under section 7 of the Act of August 5, 1954\1\ (42 
U.S.C. 2004a)--
          [(A) financial and technical assistance to Indian 
        tribes and communities in the establishment, training, 
        and equipping of utility organizations to operate and 
        maintain Indian sanitation facilities;
          [(B) ongoing technical assistance and training in the 
        management of utility organizations which operate and 
        maintain sanitation facilities; and
          [(C) operation and maintenance assistance for, and 
        emergency repairs to, tribal sanitation facilities when 
        necessary to avoid a health hazard or to protect the 
        Federal investment in sanitation facilities.
  [(3) Notwithstanding any other provision of law--
          [(A) the Secretary of Housing and Urban Affairs is 
        authorized to transfer funds appropriated under the 
        Housing and Community Development Act of 1974 (42 
        U.S.C. 5301, et seq.) to the Secretary of Health and 
        Human Services, and
          [(B) the Secretary of Health and Human Services is 
        authorized to accept and use such funds for the purpose 
        of providing sanitation facilities and services for 
        Indians under section 7 of the Act of August 5, 1954 
        (42 U.S.C. 2004a).
  [(c) Beginning in fiscal year 1990, the Secretary, acting 
through the Service, shall develop and begin implementation of 
a 10-year plan to provide safe water supply and sanitation 
sewage and solid waste disposal facilities to existing Indian 
homes and communities and to new and renovated Indian homes.
  [(d) The financial and technical capability of an Indian 
tribe or community to safely operate and maintain a sanitation 
facility shall not be a prerequisite to the provision or 
construction of sanitation facilities by the Secretary.
  [(e)(1) The Secretary is authorized to provide financial 
assistance to Indian tribes and communities in an amount equal 
to the Federal share of the costs of operating, managing, and 
maintaining the facilities provided under the plan described in 
subsection (c).
  [(2) For the purposes of paragraph (1), the term ``Federal 
share'' means 80 percent of the costs described in paragraph 
(1).
  [(3) With respect to Indian tribes with fewer than 1,000 
enrolled members, the non-Federal portion of the costs of 
operating, managing, and maintaining such facilities may be 
provided, in part, through cash donations or in kind property, 
fairly evaluated.
  [(f) Programs administered by Indian tribes or tribal 
organizations under the authority of the Indian Self-
Determination Act shall be eligible for--
          [(1) any funds appropriated pursuant to this section, 
        and
          [(2) any funds appropriated for the purpose of 
        providing water supply or sewage disposal services,
on an equal basis with programs that are administered directly 
by the Service.
  [(g)(1) The Secretary shall submit to the President, for 
inclusion in each report required to be transmitted to the 
Congress under section 801, a report which sets forth--
          [(A) the current Indian sanitation facility priority 
        system of the Service;
          [(B) the methodology for determining sanitation 
        deficiencies;
          [(C) the level of sanitation deficiency for each 
        sanitation facilities project of each Indian tribe or 
        community;
          [(D) the amount of funds necessary to raise all 
        Indian tribes and communities to a level I sanitation 
        deficiency; and
          [(E) the amount of funds necessary to raise all 
        Indian tribes and communities to zero sanitation 
        deficiency.
  [(2) In preparing each report required under paragraph (1) 
(other than the initial report), the Secretary shall consult 
with Indian tribes and tribal organizations (including those 
tribes or tribal organizations operating health care programs 
or facilities under any contract entered into with the Service 
under the Indian Self-Determination Act) to determine the 
sanitation needs of each tribe.
  [(3) The methodology used by the Secretary in determining 
sanitation deficiencies for purposes of paragraph (1) shall be 
applied uniformly to all Indian tribes and communities.
  [(4) For purposes of this subsection, the sanitation 
deficiency levels for an Indian tribe or community are as 
follows:
          [(A) level I is an Indian tribe or community with a 
        sanitation system--
                  [(i) which complies with all applicable water 
                supply and pollution control laws, and
                  [(ii) in which the deficiencies relate to 
                routine replacement, repair, or maintenance 
                needs;
          [(B) level II is an Indian tribe or community with a 
        sanitation system--
                  [(i) which complies with all applicable water 
                supply and pollution control laws, and
                  [(ii) in which the deficiencies relate to 
                capital improvements that are necessary to 
                improve the facilities in order to meet the 
                needs of such tribe or community for domestic 
                sanitation facilities;
          [(C) level III is an Indian tribe or community with a 
        sanitation system which--
                  [(i) has an inadequate or partial water 
                supply and a sewage disposal facility that does 
                not comply with applicable water supply and 
                pollution control laws, or
                  [(ii) has no solid waste disposal facility;
          [(D) level IV is an Indian tribe or community with a 
        sanitation system which lacks either a safe water 
        supply system or a sewage disposal system; and
          [(E) level V is an Indian tribe or community that 
        lacks a safe water supply and a sewage disposal system.
  [(5) For purposes of this subsection, any Indian tribe or 
community that lacks the operation and maintenance capability 
to enable its sanitation system to meet pollution control laws 
may not be treated as having a level I or II sanitation 
deficiency.
                [preference to indians and indian firms
  [Sec. 303. (a) The Secretary, acting through the Service, may 
utilize the negotiating authority of the Act of June 25, 1910 
(25 U.S.C. 47), to give preference to any Indian or any 
enterprise, partnership, corporation, or other type of business 
organization owned and controlled by an Indian or Indians 
including former or currently federally recognized Indian 
tribes in the State of New York (hereinafter referred to as an 
``Indian firm'') in the construction and renovation of Service 
facilities pursuant to section 301 and in the construction of 
safe water and sanitary waste disposal facilities pursuant to 
section 302. Such preference may be accorded by the Secretary 
unless he finds, pursuant to rules and regulations promulgated 
by him, that the project or function to be contracted for will 
not be satisfactory or such project or function cannot be 
properly completed or maintained under the proposed contract. 
The Secretary, in arriving at his finding, shall consider 
whether the Indian or Indian firm will be deficient with 
respect to (1) ownership and control by Indians, (2) equipment, 
(3) bookkeeping and accounting procedures, (4) substantive 
knowledge of the project or function to be contracted for, (5) 
adequately trained personnel, or (6) other necessary components 
of contract performance.
  [(b) For the purpose of implementing the provisions of this 
title, the Secretary shall assure that the rates of pay for 
personnel engaged in the construction or renovation of 
facilities constructed or renovated in whole or in part by 
funds made available pursuant to this title are not less than 
the prevailing local wage rates for similar work as determined 
in accordance with the Act of March 3, 1931 (40 U.S.C. 276a--
276a-5, known as the Davis-Bacon Act).
                     [soboba sanitation facilities
  [Sec. 304. The Act of December 17, 1970 (84 Stat. 1465), is 
hereby amended by adding the following new section 9 at the end 
thereof:
  [``Sec. 9. Nothing in this Act shall preclude the Soboba Band 
of Mission Indians and the Soboba Indian Reservation from being 
provided with sanitation facilities and services under the 
authority of section 7 of the Act of August 5, 1954 (68 Stat 
674), as amended by the Act of July 31, 1959 (73 Stat. 267).''.
            [expenditure of nonservice funds for renovation
  [Sec. 305. (a)(1) Notwithstanding any other provision of law, 
the Secretary is authorized to accept any major renovation or 
modernization by any Indian tribe of any Service facility, or 
of any other Indian health facility operated pursuant to a 
contract entered into under the Indian Self-Determination Act, 
including--
          [(A) any plans or designs for such renovation or 
        modernization; and
          [(B) any renovation or modernization for which funds 
        appropriated under any Federal law were lawfully 
        expended,
but only if the requirements of subsection (b) are met.
  [(2) The Secretary shall maintain a separate priority list to 
address the needs of such facilities for personnel or 
equipment.
  [(3) The Secretary shall submit to the President, for 
inclusion in each report required to be transmitted to the 
Congress under section 801, the priority list maintained 
pursuant to paragraph (2).
  [(b) The requirements of this subsection are met with respect 
to any renovation or modernization if--
          [(1) the tribe or tribal organization--
                  [(A) provides notice to the Secretary of its 
                intent to renovate or modernize; and
                  [(B) applies to the Secretary to be placed on 
                a separate priority list to address the needs 
                of such new facilities for personnel or 
                equipment; and
          [(2) the renovation or modernization--
                  [(A) is approved by the appropriate area 
                director of the Service; and
                  [(B) is administered by the tribe in 
                accordance with the rules and regulations 
                prescribed by the Secretary with respect to 
                construction or renovation of Service 
                facilities.
  [(c) If any Service facility which has been renovated or 
modernized by an Indian tribe under this section ceases to be 
used as a Service facility during the 20-year period beginning 
on the date such renovation or modernization is completed, such 
Indian tribe shall be entitled to recover from the United 
States an amount which bears the same ratio to the value of 
such facility at the time of such cessation as the value of 
such renovation or modernization (less the total amount of any 
funds provided specifically for such facility under any Federal 
program that were expended for such renovation or 
modernization) bore to the value of such facility at the time 
of the completion of such renovation or modernization.
 [grant program for the construction, expansion, and modernization of 
                    small ambulatory care facilities
  [Sec. 306. (a)(1) The Secretary, acting through the Service, 
shall make grants to tribes and tribal organizations for the 
construction, expansion, or modernization of facilities for the 
provision of ambulatory care services to eligible Indians (and 
noneligible persons as provided in subsection (c)(1)(C)). A 
grant made under this section may cover up to 100 percent of 
the costs of such construction, expansion, or modernization. 
For the purposes of this section, the term ``construction'' 
includes the replacement of an existing facility.
  [(2) A grant under paragraph (1) may only be made to a tribe 
or tribal organization operating an Indian health facility 
(other than a facility owned or constructed by the Service, 
including a facility originally owned or constructed by the 
Service and transferred to a tribe or tribal organization) 
pursuant to a contract entered into under the Indian Self-
Determination Act.
  [(b)(1) A grant provided under this section may be used only 
for the construction, expansion, or modernization (including 
the planning and design of such construction, expansion, or 
modernization) of an ambulatory care facility--
          [(A) located apart from a hospital;
          [(B) not funded under section 301 or section 307; and
          [(C) which, upon completion of such construction, 
        expansion, or modernization will--
                  [(i) have a total capacity appropriate to its 
                projected service population;
                  [(ii) serve no less than 500 eligible Indians 
                annually; and
                  [(iii) provide ambulatory care in a service 
                area (specified in the contract entered into 
                under the Indian Self-Determination Act) with a 
                population of not less than 2,000 eligible 
                Indians.
  [(2) The requirements of clauses (ii) and (iii) of paragraph 
(1)(C) shall not apply to a tribe or tribal organization 
applying for a grant under this section whose tribal government 
offices are located on an island.
  [(c)(1) No grant may be made under this section unless an 
application for such a grant has been submitted to and approved 
by the Secretary. An application for a grant under this section 
shall be submitted in such form and manner as the Secretary 
shall by regulation prescribe and shall set forth reasonable 
assurance by the applicant that, at all times after the 
construction, expansion, or modernization of a facility carried 
out pursuant to a grant received under this section--
          [(A) adequate financial support will be available for 
        the provision of services at such facility;
          [(B) such facility will be available to eligible 
        Indians without regard to ability to pay or source of 
        payment; and
          [(C) such facility will, as feasible without 
        diminishing the quality or quantity of services 
        provided to eligible Indians, serve noneligible persons 
        on a cost basis.
  [(2) In awarding grants under this section, the Secretary 
shall give priority to tribes and tribal organizations that 
demonstrate--
          [(A) a need for increased ambulatory care services; 
        and
          [(B) insufficient capacity to deliver such services.
  [(d) If any facility (or portion thereof) with respect to 
which funds have been paid under this section, ceases, at any 
time after completion of the construction, expansion, or 
modernization carried out with such funds, to be utilized for 
the purposes of providing ambulatory care services to eligible 
Indians, all of the right, title, and interest in and to such 
facility (or portion thereof) shall transfer to the United 
States.
           [indian health care delivery demonstration project
  [Sec. 307. (a) Health Care Delivery Demonstration Projects.--
The Secretary, acting through the Service, is authorized to 
enter into contracts with, or make grants to, Indian tribes or 
tribal organizations for the purpose of carrying out a health 
care delivery demonstration project to test alternative means 
of delivering health care and services through health 
facilities to Indians.
  [(b) Use of Funds.--The Secretary, in approving projects 
pursuant to this section, may authorize funding for the 
construction and renovation of hospitals, health centers, 
health stations, and other facilities to deliver health care 
services and is authorized to--
          [(1) waive any leasing prohibition;
          [(2) permit carryover of funds appropriated for the 
        provision of health care services;
          [(3) permit the use of non-Service Federal funds and 
        non-Federal funds;
          [(4) permit the use of funds or property donated from 
        any source for project purposes; and
          [(5) provide for the reversion of donated real or 
        personal property to the donor.
  [(c) Criteria.--(1) Within 180 days after the date of 
enactment of this section, the Secretary, after consultation 
with Indian tribes and tribal organizations, shall develop and 
publish in the Federal Register criteria for the review and 
approval of applications submitted under this section. The 
Secretary may enter into a contract or award a grant under this 
section for projects which meet the following criteria:
          [(A) There is a need for a new facility or program or 
        the reorientation of an existing facility or program.
          [(B) A significant number of Indians, including those 
        with low health status, will be served by the project.
          [(C) The project has the potential to address the 
        health needs of Indians in an innovative manner.
          [(D) The project has the potential to deliver 
        services in an efficient and effective manner.
          [(E) The project is economically viable.
          [(F) The Indian tribe or tribal organization has the 
        administrative and financial capability to administer 
        the project.
          [(G) The project is integrated with providers of 
        related health and social services and is coordinated 
        with, and avoids duplication of, existing services.
  [(2) The Secretary may provide for the establishment of peer 
review panels, as necessary, to review and evaluate 
applications and to advise the Secretary regarding such 
applications using the criteria developed pursuant to paragraph 
(1).
  [(3)(A) On or before September 30, 1995, the Secretary shall 
enter into contracts or award grants under this section for a 
demonstration project in each of the following service units 
which meets the criteria specified in paragraph (1) and for 
which a completed application has been received by the 
Secretary:
          [(i) Cass Lake, Minnesota.
          [(ii) Clinton, Oklahoma.
          [(iii) Harlem, Montana.
          [(iv) Mescalero, New Mexico.
          [(v) Owyhee, Nevada.
          [(vi) Parker, Arizona.
          [(vii) Schurz, Nevada.
          [(viii) Winnebago, Nebraska.
          [(ix) Ft. Yuma, California.
  [(B) The Secretary may also enter into contracts or award 
grants under this section taking into consideration 
applications received under this section from all service 
areas. The Secretary may not award a greater number of such 
contracts or grants in one service area than in any other 
service area until there is an equal number of such contracts 
or grants awarded with respect to all service areas from which 
the Secretary receives applications during the application 
period (as determined by the Secretary) which meet the criteria 
specified in paragraph (1).
  [(d) Technical Assistance.--The Secretary shall provide such 
technical and other assistance as may be necessary to enable 
applicants to comply with the provisions of this section.
  [(e) Service to Ineligible Persons.--The authority to provide 
services to persons otherwise ineligible for the health care 
benefits of the Service and the authority to extend hospital 
privileges in service facilities to non-Service health care 
practitioners as provided in section 813 may be included, 
subject to the terms of such section, in any demonstration 
project approved pursuant to this section.
  [(f) Equitable Treatment.--For purposes of subsection 
(c)(1)(A), the Secretary shall, in evaluating facilities 
operated under any contract entered into with the Service under 
the Indian Self-Determination Act, use the same criteria that 
the Secretary uses in evaluating facilities operated directly 
by the Service.
  [(g) Equitable Integration of Facilities.--The Secretary 
shall ensure that the planning, design, construction, and 
renovation needs of Service and non-Service facilities which 
are the subject of a contract for health services entered into 
with the Service under the Indian Self-Determination Act, are 
fully and equitably integrated into the implementation of the 
health care delivery demonstration projects under this section.
  [(h)(1) The Secretary shall submit to the President, for 
inclusion in the report which is required to be submitted to 
the Congress under section 801 for fiscal year 1997, an interim 
report on the findings and conclusions derived from the 
demonstration projects established under this section.
  [(2) The Secretary shall submit to the President, for 
inclusion in the report which is required to be submitted to 
the Congress under section 801 for fiscal year 1999, a final 
report on the findings and conclusions derived from the 
demonstration projects established under this section, together 
with legislative recommendations.
                             [land transfer
  [Sec. 308. The Bureau of Indian Affairs is authorized to 
transfer, at no cost, up to 5 acres of land at the Chemawa 
Indian School, Salem, Oregon, to the Service for the provision 
of health care services. The land authorized to be transferred 
by this section is that land adjacent to land under the 
jurisdiction of the Service and occupied by the Chemawa Indian 
Health Center.
                    [authorization of appropriations
  [Sec. 309. There are authorized to be appropriated such sums 
as may be necessary for each fiscal year through fiscal year 
2000 to carry out this title.
               [applicability of buy american requirement
  [Sec. 310. (a) The Secretary shall ensure that the 
requirements of the Buy American Act apply to all procurements 
made with funds provided pursuant to the authorization 
contained in section 309.
  [(b) The Secretary shall submit to the Congress a report on 
the amount of procurements from foreign entities made in fiscal 
years 1993 and 1994 with funds provided pursuant to the 
authorization contained in section 309. Such report shall 
separately indicate the dollar value of items procured with 
such funds for which the Buy American Act was waived pursuant 
to the Trade Agreement Act of 1979 or any international 
agreement to which the United States is a party.
  [(c) If it has been finally determined by a court or Federal 
agency that any person intentionally affixed a label bearing a 
``Made in America'' inscription, or any inscription with the 
same meaning, to any product sold in or shipped to the United 
States that is not made in the United States, such person shall 
be ineligible to receive any contract or subcontract made with 
funds provided pursuant to the authorization contained in 
section 309, pursuant to the debarment, suspension, and 
ineligibility procedures described in sections 9.400 through 
9.409 of title 48, Code of Federal Regulations.
  [(d) For purposes of this section, the term ``Buy American 
Act'' means title III of the Act entitled ``An Act making 
appropriations for the Treasury and Post Office Departments for 
the fiscal year ending June 30, 1934, and for other purposes'', 
approved March 3, 1933 (41 U.S.C. 10a et seq.).

                  [TITLE IV--ACCESS TO HEALTH SERVICES

             [treatment of payments under medicare program
  [Sec. 401. (a) Any payments received by a hospital or skilled 
nursing facility of the Service (whether operated by the 
Service or by an Indian tribe or tribal organization pursuant 
to a contract under the Indian Self-Determination Act) for 
services provided to Indians eligible for benefits under title 
XVIII of the Social Security Act shall not be considered in 
determining appropriations for health care and services to 
Indians.
  [(b) Nothing in this Act authorizes the Secretary to provide 
services to an Indian beneficiary with coverage under title 
XVIII of the Social Security Act, as amended, in preference to 
an Indian beneficiary without such coverage.
             [treatment of payments under medicaid program
  [Sec. 402. (a) Notwithstanding any other provision of law, 
payments to which any facility of the Service (including a 
hospital, nursing facility, intermediate care facility for the 
mentally retarded, or any other type of facility which provides 
services for which payment is available under title XIX of the 
Social Security Act) is entitled under a State plan by reason 
of section 1911 of such Act shall be placed in a special fund 
to be held by the Secretary and used by him (to such extent or 
in such amounts as are provided in appropriation Acts) 
exclusively for the purpose of making any improvements in the 
facilities of such Service which may be necessary to achieve 
compliance with the applicable conditions and requirements of 
such title. In making payments from such fund, the Secretary 
shall ensure that each service unit of the Service receives at 
least 80 percent of the amounts to which the facilities of the 
Service, for which such service unit makes collections, are 
entitled by reason of section 1911 of the Social Security Act.
  [(b) Any payments received by such facility for services 
provided to Indians eligible for benefits under title XIX of 
the Social Security Act shall not be considered in determining 
appropriations for the provision of health care and services to 
Indians.
                                [report
  [Sec. 403. The Secretary shall submit to the President, for 
inclusion in the report required to be transmitted to the 
Congress under section 801, an accounting on the amount and use 
of funds made available to the Service pursuant to this title 
as a result of reimbursements through title XVIII and XIX of 
the Social Security Act, as amended.
           [grants to and contracts with tribal organizations
  [Sec. 404. (a) The Secretary, acting through the Service, 
shall make grants to or enter into contracts with tribal 
organizations to assist such organizations in establishing and 
administering programs on or near Federal Indian reservations 
and trust areas and in or near Alaska Native villages to assist 
individual Indians to--
          [(1) enroll under section 1818 of part A and sections 
        1836 and 1837 of part B of title XVIII of the Social 
        Security Act;
          [(2) pay monthly premiums for coverage due to 
        financial need of such individual; and
          [(3) apply for medical assistance provided pursuant 
        to title XIX of the Social Security Act.
  [(b) The Secretary, acting through the Service, shall place 
conditions as deemed necessary to effect the purpose of this 
section in any contract or grant which the Secretary makes with 
any tribal organization pursuant to this section. Such 
conditions shall include, but are not limited to, requirements 
that the organization successfully undertake to--
          [(1) determine the population of Indians to be served 
        that are or could be recipients of benefits under 
        titles XVIII and XIX of the Social Security Act;
          [(2) assist individual Indians in becoming familiar 
        with and utilizing such benefits;
          [(3) provide transportation to such individual 
        Indians to the appropriate offices for enrollment or 
        application for medical assistance;
          [(4) develop and implement--
                  [(A) a schedule of income levels to determine 
                the extent of payments of premiums by such 
                organizations for coverage of needy 
                individuals; and
                  [(B) methods of improving the participation 
                of Indians in receiving the benefits provided 
                under titles XVIII and XIX of the Social 
                Security Act.
  [(c) The Secretary, acting through the Service, may enter 
into an agreement with an Indian tribe, tribal organization, or 
urban Indian organization which provides for the receipt and 
processing of applications for medical assistance under title 
XIX of the Social Security Act and benefits under title XVIII 
of the Social Security Act at a Service facility or a health 
care facility administered by such tribe or organization 
pursuant to a contract under the Indian Self-Determination Act.

 [demonstration program for direct billing of medicare, medicaid, and 
                 other third party payorsi20  sec. 405.
  [(a) Establishment of Direct Billing Program.--
          [(1) In general.--The Secretary shall establish a 
        program under which Indian tribes, tribal 
        organizations, and Alaska Native health organizations 
        that contract or compact for the operation of a 
        hospital or clinic of the Service under the Indian 
        Self-Determination and Education Assistance Act may 
        elect to directly bill for, and receive payment for, 
        health care services provided by such hospital or 
        clinic for which payment is made under title XVIII of 
        the Social Security Act (42 U.S.C. 1395 et seq.) (in 
        this section referred to as the ``medicare program''), 
        under a State plan for medical assistance approved 
        under title XIX of the Social Security Act (42 U.S.C. 
        1396 et seq.) (in this section referred to as the 
        ``medicaid program''), or from any other third party 
        payor.
          [(2) Application of 100 percent fmap.--The third 
        sentence of section 1905(b) of the Social Security Act 
        (42 U.S.C. 1396d(b)) shall apply for purposes of 
        reimbursement under the medicaid program for health 
        care services directly billed under the program 
        established under this section.
  [(b) Direct Reimbursement.--
          [(1) Use of funds.--Each hospital or clinic 
        participating in the program described in subsection 
        (a) of this section shall be reimbursed directly under 
        the medicare and medicaid programs for services 
        furnished, without regard to the provisions of section 
        1880(c) of the Social Security Act (42 U.S.C. 
        1395qq(c)) and sections 402(a) and 813(b)(2)(A), but 
        all funds so reimbursed shall first be used by the 
        hospital or clinic for the purpose of making any 
        improvements in the hospital or clinic that may be 
        necessary to achieve or maintain compliance with the 
        conditions and requirements applicable generally to 
        facilities of such type under the medicare or medicaid 
        programs. Any funds so reimbursed which are in excess 
        of the amount necessary to achieve or maintain such 
        conditions shall be used--
                  [(A) solely for improving the health 
                resources deficiency level of the Indian tribe; 
                and
                  [(B) in accordance with the regulations of 
                the Service applicable to funds provided by the 
                Service under any contract entered into under 
                the Indian Self-Determination Act (25 U.S.C. 
                450f et seq.).
          [(2) Audits.--The amounts paid to the hospitals and 
        clinics participating in the program established under 
        this section shall be subject to all auditing 
        requirements applicable to programs administered 
        directly by the Service and to facilities participating 
        in the medicare and medicaid programs.
          [(3) Secretarial oversight.--The Secretary shall 
        monitor the performance of hospitals and clinics 
        participating in the program established under this 
        section, and shall require such hospitals and clinics 
        to submit reports on the program to the Secretary on an 
        annual basis.
          [(4) No payments from special funds.--Notwithstanding 
        section 1880(c) of the Social Security Act (42 U.S.C. 
        1395qq(c)) or section 402(a), no payment may be made 
        out of the special funds described in such sections for 
        the benefit of any hospital or clinic during the period 
        that the hospital or clinic participates in the program 
        established under this section.
  [(c) Requirements for Participation.--
          [(1) Application.--Except as provided in paragraph 
        (2)(B), in order to be eligible for participation in 
        the program established under this section, an Indian 
        tribe, tribal organization, or Alaska Native health 
        organization shall submit an application to the 
        Secretary that establishes to the satisfaction of the 
        Secretary that--
                  [(A) the Indian tribe, tribal organization, 
                or Alaska Native health organization contracts 
                or compacts for the operation of a facility of 
                the Service;
                  [(B) the facility is eligible to participate 
                in the medicare or medicaid programs under 
                section 1880 or 1911 of the Social Security Act 
                (42 U.S.C. 1395qq; 1396j);
                  [(C) the facility meets the requirements that 
                apply to programs operated directly by the 
                Service; and
                  [(D) the facility--
                          [(i) is accredited by an accrediting 
                        body as eligible for reimbursement 
                        under the medicare or medicaid 
                        programs; or
                          [(ii) has submitted a plan, which has 
                        been approved by the Secretary, for 
                        achieving such accreditation.
          [(2) Approval.--
                  [(A) In general.--The Secretary shall review 
                and approve a qualified application not later 
                than 90 days after the date the application is 
                submitted to the Secretary unless the Secretary 
                determines that any of the criteria set forth 
                in paragraph (1) are not met.
                  [(B) Grandfather of demonstration program 
                participants.--Any participant in the 
                demonstration program authorized under this 
                section as in effect on the day before the date 
                of enactment of the Alaska Native and American 
                Indian Direct Reimbursement Act of 1999 shall 
                be deemed approved for participation in the 
                program established under this section and 
                shall not be required to submit an application 
                in order to participate in the program.
                  [(C) Duration.--An approval by the Secretary 
                of a qualified application under subparagraph 
                (A), or a deemed approval of a demonstration 
                program under subparagraph (B), shall continue 
                in effect as long as the approved applicant or 
                the deemed approved demonstration program meets 
                the requirements of this section.
  [(d) Examination and Implementation of Changes.--
          [(1) In general.--The Secretary, acting through the 
        Service, and with the assistance of the Administrator 
        of the Centers for Medicare & Medicaid Services, shall 
        examine on an ongoing basis and implement--
                  [(A) any administrative changes that may be 
                necessary to facilitate direct billing and 
                reimbursement under the program established 
                under this section, including any agreements 
                with States that may be necessary to provide 
                for direct billing under the medicaid program; 
                and
                  [(B) any changes that may be necessary to 
                enable participants in the program established 
                under this section to provide to the Service 
                medical records information on patients served 
                under the program that is consistent with the 
                medical records information system of the 
                Service.
          [(2) Accounting information.--The accounting 
        information that a participant in the program 
        established under this section shall be required to 
        report shall be the same as the information required to 
        be reported by participants in the demonstration 
        program authorized under this section as in effect on 
        the day before the date of enactment of the Alaska 
        Native and American Indian Direct Reimbursement Act of 
        1999. The Secretary may from time to time, after 
        consultation with the program participants, change the 
        accounting information submission requirements.
  [(e) Withdrawal From Program.--A participant in the program 
established under this section may withdraw from participation 
in the same manner and under the same conditions that a tribe 
or tribal organization may retrocede a contracted program to 
the Secretary under authority of the Indian Self-Determination 
Act (25 U.S.C. 450 et seq.). All cost accounting and billing 
authority under the program established under this section 
shall be returned to the Secretary upon the Secretary's 
acceptance of the withdrawal of participation in this program.
         [authorization for emergency contract health services
  [Sec. 406. With respect to an elderly or disabled Indian 
receiving emergency medical care or services from a non-Service 
provider or in a non-Service facility under the authority of 
this Act, the time limitation (as a condition of payment) for 
notifying the Service of such treatment or admission shall be 
30 days.
                    [authorization of appropriations
  [Sec. 407. There are authorized to be appropriated such sums 
as may be necessary for each fiscal year through fiscal year 
2000 to carry out this title.

              [TITLE V--HEALTH SERVICES FOR URBAN INDIANS

                                [purpose
  [Sec. 501. The purpose of this title is to establish programs 
in urban centers to make health services more accessible to 
urban Indians.
       [contracts with, and grants to, urban indian organizations
  [Sec. 502. Under authority of the Act of November 2, 1921 (25 
U.S.C. 13), popularly known as the Snyder Act, the Secretary, 
through the Service, shall enter into contracts with, or make 
grants to, urban Indian organizations to assist such 
organizations in the establishment and administration, within 
the urban centers in which such organizations are situated, of 
programs which meet the requirements set forth in this title. 
The Secretary, through the Service, shall include such 
conditions as the Secretary considers necessary to effect the 
purpose of this title in any contract which the Secretary 
enters into with, or in any grant the Secretary makes to, any 
urban Indian organization pursuant to this title.
  [contracts and grants for the provision of health care and referral 
                                services
  [Sec. 503. (a) Under authority of the Act of November 2, 1921 
(25 U.S.C. 13), popularly known as the Snyder Act, the 
Secretary, through the Service, shall enter into contracts 
with, or make grants to, urban Indian organizations for the 
provision of health care and referral services for urban 
Indians residing in the urban centers in which such 
organizations are situated. Any such contract or grant shall 
include requirements that the urban Indian organization 
successfully undertake to--
          [(1) estimate the population of urban Indians 
        residing in the urban center in which such organization 
        is situated who are or could be recipients of health 
        care or referral services;
          [(2) estimate the current health status of urban 
        Indians residing in such urban center;
          [(3) estimate the current health care needs of urban 
        Indians residing in such urban center;
          [(4) identify all public and private health services 
        resources within such urban center which are or may be 
        available to urban Indians;
          [(5) determine the use of public and health services 
        resources by the urban Indians residing in such urban 
        center;
          [(6) assist such health services resources in 
        providing services to urban Indians;
          [(7) assist urban Indians in becoming familiar with 
        and utilizing such health services resources;
          [(8) provide basic health education, including health 
        promotion and disease prevention education, to urban 
        Indians;
          [(9) establish and implement training programs to 
        accomplish the referral and education tasks set forth 
        in paragraphs (6) through (8) of this subsection;
          [(10) identify gaps between unmet health needs of 
        urban Indians and the resources available to meet such 
        needs;
          [(11) make recommendations to the Secretary and 
        Federal, State, local, and other resource agencies on 
        methods of improving health service programs to meet 
        the needs of urban Indians; and
          [(12) where necessary, provide, or enter into 
        contracts for the provision of, health care services 
        for urban Indians.
  [(b) The Secretary, through the Service, shall by regulation 
prescribe the criteria for selecting urban Indian organizations 
to enter into contracts or receive grants under this section. 
Such criteria shall, among other factors, include--
          [(1) the extent of unmet health care needs of urban 
        Indians in the urban center involved;
          [(2) the size of the urban Indian population in the 
        urban center involved;
          [(3) the accessibility to, and utilization of, health 
        care services (other than services provided under this 
        title) by urban Indians in the urban center involved;
          [(4) the extent, if any, to which the activities set 
        forth in subsection (a) would duplicate--
                  [(A) any previous or current public or 
                private health services project in an urban 
                center that was or is funded in a manner other 
                than pursuant to this title; or
                  [(B) any project funded under this title;
          [(5) the capability of an urban Indian organization 
        to perform the activities set forth in subsection (a) 
        and to enter into a contract with the Secretary or to 
        meet the requirements for receiving a grant under this 
        section;
          [(6) the satisfactory performance and successful 
        completion by an urban Indian organization of other 
        contracts with the Secretary under this title;
          [(7) the appropriateness and likely effectiveness of 
        conducting the activities set forth in subsection (a) 
        in an urban center; and
          [(8) the extent of existing or likely future 
        participation in the activities set forth in subsection 
        (a) by appropriate health and health-related Federal, 
        State, local, and other agencies.
  [(c) The Secretary, acting through the Service, shall 
facilitate access to, or provide, health promotion and disease 
prevention services for urban Indians through grants made to 
urban Indian organizations administering contracts entered into 
pursuant to this section or receiving grants under subsection 
(a).
  [(d)(1) The Secretary, acting through the Service, shall 
facilitate access to, or provide, immunization services for 
urban Indians through grants made to urban Indian organizations 
administering contracts entered into pursuant to this section 
or receiving grants under subsection (a).
  [(2) In making any grant to carry out this subsection, the 
Secretary shall take into consideration--
          [(A) the size of the urban Indian population to be 
        served;
          [(B) the immunization levels of the urban Indian 
        population, particularly the immunization levels of 
        infants, children, and the elderly;
          [(C) the utilization by the urban Indians of 
        alternative resources from State and local governments 
        for no-cost or low-cost immunization services to the 
        general population; and
          [(D) the capability of the urban Indian organization 
        to carry out services pursuant to this subsection.
  [(3) For purposes of this subsection, the term ``immunization 
services'' means services to provide without charge 
immunizations against vaccine-preventable diseases.
  [(e)(1) The Secretary, acting through the Service, shall 
facilitate access to, or provide, mental health services for 
urban Indians through grants made to urban Indian organizations 
administering contracts entered into pursuant to this section 
or receiving grants under subsection (a).
  [(2) A grant may not be made under this subsection to an 
urban Indian organization until that organization has prepared, 
and the Service has approved, an assessment of the mental 
health needs of the urban Indian population concerned, the 
mental health services and other related resources available to 
that population, the barriers to obtaining those services and 
resources, and the needs that are unmet by such services and 
resources.
  [(3) Grants may be made under this subsection--
          [(A) to prepare assessments required under paragraph 
        (2);
          [(B) to provide outreach, educational, and referral 
        services to urban Indians regarding the availability of 
        direct mental health services, to educate urban Indians 
        about mental health issues and services, and effect 
        coordination with existing mental health providers in 
        order to improve services to urban Indians;
          [(C) to provide outpatient mental health services to 
        urban Indians, including the identification and 
        assessment of illness, therapeutic treatments, case 
        management, support groups, family treatment, and other 
        treatment; and
          [(D) to develop innovative mental health service 
        delivery models which incorporate Indian cultural 
        support systems and resources.
  [(f)(1) The Secretary, acting through the Service, shall 
facilitate access to, or provide, services for urban Indians 
through grants to urban Indian organizations administering 
contracts entered into pursuant to this section or receiving 
grants under subsection (a) to prevent and treat child abuse 
(including sexual abuse) among urban Indians.
  [(2) A grant may not be made under this subsection to an 
urban Indian organization until that organization has prepared, 
and the Service has approved, an assessment that documents the 
prevalence of child abuse in the urban Indian population 
concerned and specifies the services and programs (which may 
not duplicate existing services and programs) for which the 
grant is requested.
  [(3) Grants may be made under this subsection--
          [(A) to prepare assessments required under paragraph 
        (2);
          [(B) for the development of prevention, training, and 
        education programs for urban Indian populations, 
        including child education, parent education, provider 
        training on identification and intervention, education 
        on reporting requirements, prevention campaigns, and 
        establishing service networks of all those involved in 
        Indian child protection; and
          [(C) to provide direct outpatient treatment services 
        (including individual treatment, family treatment, 
        group therapy, and support groups) to urban Indians who 
        are child victims of abuse (including sexual abuse) or 
        adult survivors of child sexual abuse, to the families 
        of such child victims, and to urban Indian perpetrators 
        of child abuse (including sexual abuse).
  [(4) In making grants to carry out this subsection, the 
Secretary shall take into consideration--
          [(A) the support for the urban Indian organization 
        demonstrated by the child protection authorities in the 
        area, including committees or other services funded 
        under the Indian Child Welfare Act of 1978 (25 U.S.C. 
        1901 et seq.), if any;
          [(B) the capability and expertise demonstrated by the 
        urban Indian organization to address the complex 
        problem of child sexual abuse in the community; and
          [(C) the assessment required under paragraph (2).
 [contracts and grants for the determination of unmet health care needs
  [Sec. 504. (a) Under authority of the Act of November 2, 1921 
(25 U.S.C. 13), popularly known as the Snyder Act, the 
Secretary, through the Service, may enter into contracts with, 
or make grants to, urban Indian organizations situated in urban 
centers for which contracts have not been entered into, or 
grants have not been made, under section 503. The purpose of a 
contract or grant made under this section shall be the 
determination of the matters described in subsection (b)(1) in 
order to assist the Secretary in assessing the health status 
and health care needs of urban Indians in the urban center 
involved and determining whether the Secretary should enter 
into a contract or make a grant under section 503 with respect 
to the urban Indian organization which the Secretary has 
entered into a contract with, or made a grant to, under this 
section.
  [(b) Any contract entered into, or grant made, by the 
Secretary under this section shall include requirements that--
          [(1) the urban Indian organization successfully 
        undertake to--
                  [(A) document the health care status and 
                unmet health care needs of urban Indians in the 
                urban center involved; and
                  [(B) with respect to urban Indians in the 
                urban center involved, determine the matters 
                described in clauses (2), (3), (4), and (8) of 
                section 503(b); and
          [(2) the urban Indian organization complete 
        performance of the contract, or carry out the 
        requirements of the grant, within one year after the 
        date on which the Secretary and such organization enter 
        into such contract, or within one year after such 
        organization receives such grant, whichever is 
        applicable.
  [(c) The Secretary may not renew any contract entered into, 
or grant made, under this section.
                         [evaluations; renewals
  [Sec. 505. (a) The Secretary, through the Service, shall 
develop procedures to evaluate compliance with grant 
requirements under this title and compliance with, and 
performance of contracts entered into by urban Indian 
organizations under this title. Such procedures shall include 
provisions for carrying out the requirements of this section.
  [(b) The Secretary, through the Service, shall conduct an 
annual onsite evaluation of each urban Indian organization 
which has entered into a contract or received a grant under 
section 503 for purposes of determining the compliance of such 
organization with, and evaluating the performance of such 
organization under, such contract or the terms of such grant.
  [(c) If, as a result of the evaluations conducted under this 
section, the Secretary determines that an urban Indian 
organization has not complied with the requirements of a grant 
or complied with or satisfactorily performed a contract under 
section 503, the Secretary shall, prior to renewing such 
contract or grant, attempt to resolve with such organization 
the areas of noncompliance or unsatisfactory performance and 
modify such contract or grant to prevent future occurrences of 
such noncompliance or unsatisfactory performance. If the 
Secretary determines that such noncompliance or unsatisfactory 
performance cannot be resolved and prevented in the future, the 
Secretary shall not renew such contract or grant with such 
organization and is authorized to enter into a contract or make 
a grant under section 503 with another urban Indian 
organization which is situated in the same urban center as the 
urban Indian organization whose contract or grant is not 
renewed under this section.
  [(d) In determining whether to renew a contract or grant with 
an urban Indian organization under section 503 which has 
completed performance of a contract or grant under section 504, 
the Secretary shall review the records of the urban Indian 
organization, the reports submitted under section 507, and, in 
the case of a renewal of a contract or grant under section 503, 
shall consider the results of the onsite evaluations conducted 
under subsection (b).
                 [other contract and grant requirements
  [Sec. 506. (a) Contracts with urban Indian organizations 
entered into pursuant to this title shall be in accordance with 
all Federal contracting laws and regulations except that, in 
the discretion of the Secretary, such contracts may be 
negotiated without advertising and need not conform to the 
provisions of the Act of August 24, 1935 (40 U.S.C. 270a, et 
seq.).
  [(b) Payments under any contracts or grants pursuant to this 
title may be made in advance or by way of reimbursement and in 
such installments and on such conditions as the Secretary deems 
necessary to carry out the purposes of this title.
  [(c) Notwithstanding any provision of law to the contrary, 
the Secretary may, at the request or consent of an urban Indian 
organization, revise or amend any contract entered into by the 
Secretary with such organization under this title as necessary 
to carry out the purposes of this title.
  [(d) In connection with any contract or grant entered into 
pursuant to this title, the Secretary may permit an urban 
Indian organization to utilize, in carrying out such contract 
or grant, existing facilities owned by the Federal Government 
within the Secretary's jurisdiction under such terms and 
conditions as may be agreed upon for the use and maintenance of 
such facilities.
  [(e) Contracts with, or grants to, urban Indian organizations 
and regulations adopted pursuant to this title shall include 
provisions to assure the fair and uniform provision to urban 
Indians of services and assistance under such contracts or 
grants by such organizations.
  [(f) Urban Indians, as defined in section 4(f) of this Act, 
shall be eligible for health care or referral services provided 
pursuant to this title.
                          [reports and records
  [Sec. 507. (a) For each fiscal year during which an urban 
Indian organization receives or expends funds pursuant to a 
contract entered into, or a grant received, pursuant to this 
title, such organization shall submit to the Secretary a 
quarterly report including--
          [(1) in the case of a contract or grant under section 
        503, information gathered pursuant to clauses (10) and 
        (11) of subsection (a) of such section;
          [(2) information on activities conducted by the 
        organization pursuant to the contract or grant;
          [(3) an accounting of the amounts and purposes for 
        which Federal funds were expended; and
          [(4) such other information as the Secretary may 
        request.
  [(b) The reports and records of the urban Indian organization 
with respect to a contract or grant under this title shall be 
subject to audit by the Secretary and the Comptroller General 
of the United States.
  [(c) The Secretary shall allow as a cost of any contract or 
grant entered into under section 503 the cost of an annual 
private audit conducted by a certified public accountant.
  [(d)(1) The Secretary, acting through the Service, shall 
submit a report to the Congress not later than March 31, 1992, 
evaluating--
          [(A) the health status of urban Indians;
          [(B) the services provided to Indians through this 
        title;
          [(C) areas of unmet needs in urban areas served under 
        this title; and
          [(D) areas of unmet needs in urban areas not served 
        under this title.
  [(2) In preparing the report under paragraph (1), the 
Secretary shall consult with urban Indian health providers and 
may contract with a national organization representing urban 
Indian health concerns to conduct any aspect of the report.
  [(3) The Secretary and the Secretary of the Interior shall--
          [(A) assess the status of the welfare of urban Indian 
        children, including the volume of child protection 
        cases, the prevalence of child sexual abuse, and the 
        extent of urban Indian coordination with tribal 
        authorities with respect to child sexual abuse; and
          [(B) submit a report on the assessment required under 
        subparagraph (A), together with recommended legislation 
        to improve Indian child protection in urban Indian 
        populations, to the Congress no later than March 31, 
        1992.
                   [limitation on contract authority
  [Sec. 508. The authority of the Secretary to enter into 
contracts under this title shall be to the extent, and in an 
amount, provided for in appropriation Acts.

                         [facilities renovation
  [Sec. 509. The Secretary may make funds available to 
contractors or grant recipients under this title for minor 
renovations to facilities, including leased facilities, to 
assist such contractors or grant recipients in meeting or 
maintaining the Joint Commission for Accreditation of Health 
Care Organizations (JCAHO) standards.

                     [urban health programs branch
  [Sec. 510. (a) Establishment.--There is hereby established 
within the Service a Branch of Urban Health Programs which 
shall be responsible for carrying out the provisions of this 
title and for providing central oversight of the programs and 
services authorized under this title.
  [(b) Staff, Services, and Equipment.--The Secretary shall 
appoint such employees to work in the branch, including a 
program director, and shall provide such services and 
equipment, as may be necessary for it to carry out its 
responsibilities. The Secretary shall also analyze the need to 
provide at least one urban health program analyst for each area 
office of the Indian Health Service and shall submit his 
findings to the Congress as a part of the Department's fiscal 
year 1993 budget request.
        [grants for alcohol and substance abuse related services
  [Sec. 511. (a) Grants.--The Secretary may make grants for the 
provision of health-related services in prevention of, 
treatment of, rehabilitation of, or school and community-based 
education in, alcohol and substance abuse in urban centers to 
those urban Indian organizations with whom the Secretary has 
entered into a contract under this title or under section 201.
  [(b) Goals of Grant.--Each grant made pursuant to subsection 
(a) shall set forth the goals to be accomplished pursuant to 
the grant. The goals shall be specific to each grant as agreed 
to between the Secretary and the grantee.
  [(c) Criteria.--The Secretary shall establish criteria for 
the grants made under subsection (a), including criteria 
relating to the--
          [(1) size of the urban Indian population;
          [(2) accessibility to, and utilization of, other 
        health resources available to such population;
          [(3) duplication of existing Service or other Federal 
        grants or contracts;
          [(4) capability of the organization to adequately 
        perform the activities required under the grant;
          [(5) satisfactory performance standards for the 
        organization in meeting the goals set forth in such 
        grant, which standards shall be negotiated and agreed 
        to between the Secretary and the grantee on a grant-by-
        grant basis; and
          [(6) identification of need for services.
The Secretary shall develop a methodology for allocating grants 
made pursuant to this section based on such criteria.
  [(d) Treatment of Funds Received by Urban Indian 
Organizations.--Any funds received by an urban Indian 
organization under this Act for substance abuse prevention, 
treatment, and rehabilitation shall be subject to the criteria 
set forth in subsection (c).
              [treatment of certain demonstration projects
  [Sec. 512. (a) Notwithstanding any other provision of law, 
the Oklahoma City Clinic demonstration project and the Tulsa 
Clinic demonstration project shall be treated as service units 
in the allocation of resources and coordination of care and 
shall not be subject to the provisions of the Indian Self-
Determination Act for the term of such projects. The Secretary 
shall provide assistance to such projects in the development of 
resources and equipment and facility needs.
  [(b) The Secretary shall submit to the President, for 
inclusion in the report required to be submitted to the 
Congress under section 801 for fiscal year 1999, a report on 
the findings and conclusions derived from the demonstration 
projects specified in subsection (a).
  [(c) In addition to the amounts made available under section 
514 to carry out this section through fiscal year 2000, there 
are authorized to be appropriated such sums as may be necessary 
to carry out this section for each of fiscal years 2001 and 
2002.
                   [urban niaaa transferred programs
  [Sec. 513. (a) The Secretary shall, within the Branch of 
Urban Health Programs of the Service, make grants or enter into 
contracts for the administration of urban Indian alcohol 
programs that were originally established under the National 
Institute on Alcoholism and Alcohol Abuse (hereafter in this 
section referred to as ``NIAAA'') and transferred to the 
Service.
  [(b) Grants provided or contracts entered into under this 
section shall be used to provide support for the continuation 
of alcohol prevention and treatment services for urban Indian 
populations and such other objectives as are agreed upon 
between the Service and a recipient of a grant or contract 
under this section.
  [(c) Urban Indian organizations that operate Indian alcohol 
programs originally funded under NIAAA and subsequently 
transferred to the Service are eligible for grants or contracts 
under this section.
  [(d) For the purpose of carrying out this section, the 
Secretary may combine NIAAA alcohol funds with other substance 
abuse funds currently administered through the Branch of Urban 
Health Programs of the Service.
  [(e) The Secretary shall evaluate and report to the Congress 
on the activities of programs funded under this section at 
least every 5 years.
                    [authorization of appropriations
  [Sec. 514. There are authorized to be appropriated such sums 
as may be necessary for each fiscal year through fiscal year 
2000 to carry out this title.

                 [TITLE VI--ORGANIZATIONAL IMPROVEMENTS

[establishment of the indian health service as an agency of the public 
                             health service
  [Sec. 601. (a) In order to more effectively and efficiently 
carry out the responsibilities, authorities, and functions of 
the United States to provide health care services to Indians 
and Indian tribes, as are or may be hereafter provided by 
Federal statute or treaties, there is established within the 
Public Health Service of the Department of Health and Human 
Services the Indian Health Service. The Indian Health Service 
shall be administered by a Director, who shall be appointed by 
the President, by and with the advice and consent of the 
Senate. The Director of the Indian Health Service shall report 
to the Secretary through the Assistant Secretary for Health of 
the Department of Health and Human Services. Effective with 
respect to an individual appointed by the President, by and 
with the advice and consent of the Senate, after January 1, 
1993, the term of service of the Director shall be 4 years. A 
Director may serve more than 1 term.
  [(b) The Indian Health Service shall be an agency within the 
Public Health Service of the Department of Health and Human 
Services, and shall not be an office, component, or unit of any 
other agency of the Department.
  [(c) The Secretary shall carry out through the Director of 
the Indian Health Service--
          [(1) all functions which were, on the day before the 
        date of enactment of the Indian Health Care Amendments 
        of 1988, carried out by or under the direction of the 
        individual serving as Director of the Indian Health 
        Service on such day;
          [(2) all functions of the Secretary relating to the 
        maintenance and operation of hospital and health 
        facilities for Indians and the planning for, and 
        provision and utilization of, health services for 
        Indians;
          [(3) all health programs under which health care is 
        provided to Indians based upon their status as Indians 
        which are administered by the Secretary, including (but 
        not limited to) programs under--
                  [(A) this Act;
                  [(B) the Act of November 2, 1921 (25 U.S.C. 
                13);
                  [(C) the Act of August 5, 1954 (42 U.S.C. 
                2001, et seq.);
                  [(D) the Act of August 16, 1957 (42 U.S.C. 
                2005 et seq.); and
                  [(E) the Indian Self-Determination Act (25 
                U.S.C. 450f, et seq.); and
          [(4) all scholarship and loan functions carried out 
        under title I.
  [(d)(1) The Secretary, acting through the Director of the 
Indian Health Service, shall have the authority--
          [(A) except to the extent provided in paragraph (2), 
        to appoint and compensate employees for the Service in 
        accordance with title 5, United States Code;
          [(B) to enter into contracts for the procurement of 
        goods and services to carry out the functions of the 
        Service; and
          [(C) to manage, expend, and obligate all funds 
        appropriated for the Service.
  [(2) Notwithstanding any other law, the provisions of section 
12 of the Act of June 18, 1934 (48 Stat. 986; 25 U.S.C. 472), 
shall apply to all personnel actions taken with respect to new 
positions created within the Service as a result of its 
establishment under subsection (a).
                [automated management information system
  [Sec. 602. (a)(1) The Secretary shall establish an automated 
management information system for the Service.
  [(2) The information system established under paragraph (1) 
shall include--
          [(A) a financial management system,
          [(B) a patient care information system for each area 
        served by the Service,
          [(C) a privacy component that protects the privacy of 
        patient information held by, or on behalf of, the 
        Service, and
          [(D) a services-based cost accounting component that 
        provides estimates of the costs associated with the 
        provision of specific medical treatments or services in 
        each area office of the Service.
  [(b)(1) The Secretary shall provide each Indian tribe and 
tribal organization that provides health services under a 
contract entered into with the Service under the Indian Self-
Determination Act automated management information systems 
which--
          [(A) meet the management information needs of such 
        Indian tribe or tribal organization with respect to the 
        treatment by the Indian tribe or tribal organization of 
        patients of the Service, and
          [(B) meet the management information needs of the 
        Service.
  [(2) The Secretary shall reimburse each Indian tribe or 
tribal organization for the part of the cost of the operation 
of a system provided under paragraph (1) which is attributable 
to the treatment by such Indian tribe or tribal organization of 
patients of the Service.
  [(3) The Secretary shall provide systems under paragraph (1) 
to Indian tribes and tribal organizations providing health 
services in California by no later than September 30, 1990.
  [(c) Notwithstanding any other provision of law, each patient 
shall have reasonable access to the medical or health records 
of such patient which are held by, or on behalf of, the 
Service.
                    [authorization of appropriations
  [Sec. 603. There are authorized to be appropriated such sums 
as may be necessary for each fiscal year through fiscal year 
2000 to carry out this title.

                  [TITLE VII--SUBSTANCE ABUSE PROGRAMS

                [indian health service responsibilities
  [Sec. 701. The Memorandum of Agreement entered into pursuant 
to section 4205 of the Indian Alcohol and Substance Abuse 
Prevention and Treatment Act of 1986 (25 U.S.C. 2411) shall 
include specific provisions pursuant to which the Service shall 
assume responsibility for--
          [(1) the determination of the scope of the problem of 
        alcohol and substance abuse among Indian people, 
        including the number of Indians within the jurisdiction 
        of the Service who are directly or indirectly affected 
        by alcohol and substance abuse and the financial and 
        human cost;
          [(2) an assessment of the existing and needed 
        resources necessary for the prevention of alcohol and 
        substance abuse and the treatment of Indians affected 
        by alcohol and substance abuse; and
          [(3) an estimate of the funding necessary to 
        adequately support a program of prevention of alcohol 
        and substance abuse and treatment of Indians affected 
        by alcohol and substance abuse.
                     [indian health service program
  [Sec. 702. (a) Comprehensive Prevention and Treatment 
Program.--(1) The Secretary, acting through the Service, shall 
provide a program of comprehensive alcohol and substance abuse 
prevention and treatment which shall include--
          [(A) prevention, through educational intervention, in 
        Indian communities;
          [(B) acute detoxification and treatment;
          [(C) community-based rehabilitation;
          [(D) community education and involvement, including 
        extensive training of health care, educational, and 
        community-based personnel; and
          [(E) residential treatment programs for pregnant and 
        post partum women and their children.
  [(2) The target population of such program shall be members 
of Indian tribes. Efforts to train and educate key members of 
the Indian community shall target employees of health, 
education, judicial, law enforcement, legal, and social service 
programs.
  [(b) Contract Health Services.--(1) The Secretary, acting 
through the Service, may enter into contracts with public or 
private providers of alcohol and substance abuse treatment 
services for the purpose of assisting the Service in carrying 
out the program required under subsection (a).
  [(2) In carrying out this subsection, the Secretary shall 
provide assistance to Indian tribes to develop criteria for the 
certification of alcohol and substance abuse service providers 
and accreditation of service facilities which meet minimum 
standards for such services and facilities as may be determined 
pursuant to section 4205(a)(3) of the Indian Alcohol and 
Substance Abuse Prevention and Treatment Act of 1986 (25 U.S.C. 
2411(a)(3)).
  [(c) Grants for Model Program.--(1) The Secretary, acting 
through the Service shall make a grant to the Standing Rock 
Sioux Tribe to develop a community-based demonstration project 
to reduce drug and alcohol abuse on the Standing Rock Sioux 
Reservation and to rehabilitate Indian families afflicted by 
such abuse.
  [(2) Funds shall be used by the Tribe to--
          [(A) develop and coordinate community-based alcohol 
        and substance abuse prevention and treatment services 
        for Indian families;
          [(B) develop prevention and intervention models for 
        Indian families;
          [(C) conduct community education on alcohol and 
        substance abuse; and
          [(D) coordinate with existing Federal, State, and 
        tribal services on the reservation to develop a 
        comprehensive alcohol and substance abuse program that 
        assists in the rehabilitation of Indian families that 
        have been or are afflicted by alcoholism.
  [(3) The Secretary shall submit to the President for 
inclusion in the report to be transmitted to the Congress under 
section 801 for fiscal year 1995 an evaluation of the 
demonstration project established under paragraph (1).
                    [indian women treatment programs
  [Sec. 703. (a) The Secretary may make grants to Indian tribes 
and tribal organizations to develop and implement a 
comprehensive alcohol and substance abuse program of 
prevention, intervention, treatment, and relapse prevention 
services that specifically addresses the cultural, historical, 
social, and child care needs of Indian women, regardless of 
age.
  [(b) Grants made pursuant to this section may be used to--
          [(1) develop and provide community training, 
        education, and prevention programs for Indian women 
        relating to alcohol and substance abuse issues, 
        including fetal alcohol syndrome and fetal alcohol 
        effect;
          [(2) identify and provide appropriate counseling, 
        advocacy, support, and relapse prevention to Indian 
        women and their families; and
          [(3) develop prevention and intervention models for 
        Indian women which incorporate traditional healers, 
        cultural values, and community and family involvement.
  [(c) The Secretary shall establish criteria for the review 
and approval of applications for grants under this section.
  [(d)(1) There are authorized to be appropriated to carry out 
this section $10,000,000 for fiscal year 1993 and such sums as 
are necessary for each of the fiscal years 1994, 1995, 1996, 
1997, 1998, 1999, and 2000.
  [(2) Twenty percent of the funds appropriated pursuant to 
this subsection shall be used to make grants to urban Indian 
organizations funded under title V.
                  [indian health service youth program
  [Sec. 704. (a) Detoxification and Rehabilitation.--The 
Secretary shall develop and implement a program for acute 
detoxification and treatment for Indian youth who are alcohol 
and substance abusers. The program shall include regional 
treatment centers designed to include detoxification and 
rehabilitation for both sexes on a referral basis. These 
regional centers shall be integrated with the intake and 
rehabilitation programs based in the referring Indian 
community.
  [(b) Treatment Centers or Facilities.--(1) The Secretary 
shall construct, renovate, or, as necessary, purchase, and 
appropriately staff and operate, a youth regional treatment 
center in each area under the jurisdiction of an area office. 
For the purposes of this subsection, the area offices of the 
Service in Tucson and Phoenix, Arizona, shall be considered one 
area office and the area office in California shall be 
considered to be two area offices, one office whose 
jurisdiction shall be considered to encompass the northern area 
of the State of California, and one office whose jurisdiction 
shall be considered to encompass the remainder of the State of 
California.
  [(2) For the purpose of staffing and operating such centers 
or facilities, funding shall be pursuant to the Act of November 
2, 1921 (25 U.S.C. 13).
  [(3) A youth treatment center constructed or purchased under 
this subsection shall be constructed or purchased at a location 
within the area described in paragraph (1) agreed upon (by 
appropriate tribal resolution) by a majority of the tribes to 
be served by such center.
  [(4)(A) Notwithstanding any other provision of this title, 
the Secretary may, from amounts authorized to be appropriated 
for the purposes of carrying out this section, make funds 
available to--
          [(i) the Tanana Chiefs Conference, Incorporated, for 
        the purpose of leasing, constructing, renovating, 
        operating and maintaining a residential youth treatment 
        facility in Fairbanks, Alaska; and
          [(ii) the Southeast Alaska Regional Health 
        Corporation to staff and operate a residential youth 
        treatment facility without regard to the proviso set 
        forth in section 4(l) of the Indian Self-Determination 
        and Education Assistance Act (25 U.S.C. 450b(l)).
  [(B) Until additional residential youth treatment facilities 
are established in Alaska pursuant to this section, the 
facilities specified in subparagraph (A) shall make every 
effort to provide services to all eligible Indian youth 
residing in such State.
  [(c) Federally Owned Structures.--
          [(1) The Secretary, acting through the Service, 
        shall, in consultation with Indian tribes--
                  [(A) identify and use, where appropriate, 
                federally owned structures suitable as local 
                residential or regional alcohol and substance 
                abuse treatment centers for Indian youth; and
                  [(B) establish guidelines for determining the 
                suitability of any such federally owned 
                structure to be used as a local residential or 
                regional alcohol and substance abuse treatment 
                center for Indian youth.
          [(2) Any structure described in paragraph (1) may be 
        used under such terms and conditions as may be agreed 
        upon by the Secretary and the agency having 
        responsibility for the structure.
  [(d) Rehabilitation and Aftercare Services.--
          [(1) The Secretary, in cooperation with the Secretary 
        of the Interior, shall develop and implement within 
        each Service service unit community-based 
        rehabilitation and follow-up services for Indian youth 
        who are alcohol or substance abusers which are designed 
        to integrate long-term treatment and to monitor and 
        support the Indian youth after their return to their 
        home community.
          [(2) Services under paragraph (1) shall be 
        administered within each service unit by trained staff 
        within the community who can assist the Indian youth in 
        continuing development of self-image, positive problem-
        solving skills, and nonalcohol or substance abusing 
        behaviors. Such staff shall include alcohol and 
        substance abuse counselors, mental health 
        professionals, and other health professionals and 
        paraprofessionals, including community health 
        representatives.
  [(e) Inclusion of Family in Youth Treatment Program.--In 
providing the treatment and other services to Indian youth 
authorized by this section, the Secretary shall provide for the 
inclusion of family members of such youth in the treatment 
programs or other services as may be appropriate. Not less than 
10 percent of the funds appropriated for the purposes of 
carrying out subsection (d) shall be used for outpatient care 
of adult family members related to the treatment of an Indian 
youth under that subsection.
  [(f) Multidrug Abuse Study.--(1) The Secretary shall conduct 
a study to determine the incidence and prevalence of the abuse 
of multiple forms of drugs, including alcohol, among Indian 
youth residing on Indian reservations and in urban areas and 
the interrelationship of such abuse with the incidence of 
mental illness among such youth.
  [(2) The Secretary shall submit a report detailing the 
findings of such study, together with recommendations based on 
such findings, to the Congress no later than two years after 
the date of the enactment of this section.
                   [training and community education
  [Sec. 705. (a) Community Education.--The Secretary, in 
cooperation with the Secretary of the Interior, shall develop 
and implement within each service unit a program of community 
education and involvement which shall be designed to provide 
concise and timely information to the community leadership of 
each tribal community. Such program shall include education in 
alcohol and substance abuse to political leaders, tribal 
judges, law enforcement personnel, members of tribal health and 
education boards, and other critical members of each tribal 
community.
  [(b) Training.--The Secretary shall, either directly or by 
contract, provide instruction in the area of alcohol and 
substance abuse, including instruction in crisis intervention 
and family relations in the context of alcohol and substance 
abuse, youth alcohol and substance abuse, and the causes and 
effects of fetal alcohol syndrome to appropriate employees of 
the Bureau of Indian Affairs and the Service, and to personnel 
in schools or programs operated under any contract with the 
Bureau of Indian Affairs or the Service, including supervisors 
of emergency shelters and halfway houses described in section 
4213 of the Indian Alcohol and Substance Abuse Prevention and 
Treatment Act of 1986 (25 U.S.C. 2433).
  [(c) Community-Based Training Models.--In carrying out the 
education and training programs required by this section, the 
Secretary, acting through the Service and in consultation with 
tribes and Indian alcohol and substance abuse prevention 
experts, shall develop and provide community-based training 
models. Such models shall address--
          [(1) the elevated risk of alcohol and substance abuse 
        faced by children of alcoholics;
          [(2) the cultural and multigenerational aspects of 
        alcohol and substance abuse prevention and recovery; 
        and
          [(3) community-based and multidisciplinary strategies 
        for preventing and treating alcohol and substance 
        abuse.
          [gallup alcohol and substance abuse treatment center
  [Sec. 706. (a) Grants for Residential Treatment.--The 
Secretary shall make grants to the Navajo Nation for the 
purpose of providing residential treatment for alcohol and 
substance abuse for adult and adolescent members of the Navajo 
Nation and neighboring tribes.
  [(b) Purposes of Grants.--Grants made pursuant to this 
section shall (to the extent appropriations are made available) 
be used to--
          [(1) provide at least 15 residential beds each year 
        for adult long-term treatment, including beds for 
        specialized services such as polydrug abusers, dual 
        diagnosis, and specialized services for women with 
        fetal alcohol syndrome children;
          [(2) establish clinical assessment teams consisting 
        of a clinical psychologist, a part-time 
        addictionologist, a master's level assessment 
        counselor, and a certified medical records technician 
        which shall be responsible for conducting individual 
        assessments and matching Indian clients with the 
        appropriate available treatment;
          [(3) provide at least 12 beds for an adolescent 
        shelterbed program in the city of Gallup, New Mexico, 
        which shall serve as a satellite facility to the Acoma/
        Canoncito/Laguna Hospital and the adolescent center 
        located in Shiprock, New Mexico, for emergency crisis 
        services, assessment, and family intervention;
          [(4) develop a relapse program for the purposes of 
        identifying sources of job training and job opportunity 
        in the Gallup area and providing vocational training, 
        job placement, and job retention services to recovering 
        substance abusers; and
          [(5) provide continuing education and training of 
        treatment staff in the areas of intensive outpatient 
        services, development of family support systems, and 
        case management in cooperation with regional colleges, 
        community colleges, and universities.
  [(c) Contract for Residential Treatment.--The Navajo Nation, 
in carrying out the purposes of this section, shall enter into 
a contract with an institution in the Gallup, New Mexico, area 
which is accredited by the Joint Commission of the 
Accreditation of Health Care Organizations to provide 
comprehensive alcohol and drug treatment as authorized in 
subsection (b).
  [(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).
                                [reports
  [Sec. 707. (a) Compilation of Data.--The Secretary, with 
respect to the administration of any health program by a 
service unit, directly or through contract, including a 
contract under the Indian Self-Determination Act, shall require 
the compilation of data relating to the number of cases or 
incidents in which any Service personnel or services were 
involved and which were related, either directly or indirectly, 
to alcohol or substance abuse. Such report shall include the 
type of assistance provided and the disposition of these cases.
  [(b) Referral of Data.--The data compiled under subsection 
(a) shall be provided annually to the affected Indian tribe and 
Tribal Coordinating Committee to assist them in developing or 
modifying a Tribal Action Plan under section 4206 of the Indian 
Alcohol and Substance Abuse Prevention and Treatment Act of 
1986 (25 U.S.C. 2471 et seq.).
  [(c) Comprehensive Report.--Each service unit director shall 
be responsible for assembling the data compiled under this 
section and section 4214 of the Indian Alcohol and Substance 
Abuse Prevention and Treatment Act of 1986 (25 U.S.C. 2434) 
into an annual tribal comprehensive report. Such report shall 
be provided to the affected tribe and to the Director of the 
Service who shall develop and publish a biennial national 
report based on such tribal comprehensive reports.
        [fetal alcohol syndrome and fetal alcohol effect grants
  [Sec. 708. (a)(1) The Secretary may make grants to Indian 
tribes and tribal organizations to establish fetal alcohol 
syndrome and fetal alcohol effect programs as provided in this 
section for the purposes of meeting the health status 
objectives specified in section 3(b).
  [(2) Grants made pursuant to this section shall be used to--
          [(A) develop and provide community and in-school 
        training, education, and prevention programs relating 
        to FAS and FAE;
          [(B) identify and provide alcohol and substance abuse 
        treatment to high-risk women;
          [(C) identify and provide appropriate educational and 
        vocational support, counseling, advocacy, and 
        information to FAS and FAE affected persons and their 
        families or caretakers;
          [(D) develop and implement counseling and support 
        programs in schools for FAS and FAE affected children;
          [(E) develop prevention and intervention models which 
        incorporate traditional healers, cultural values and 
        community involvement;
          [(F) develop, print, and disseminate education and 
        prevention materials on FAS and FAE; and
          [(G) develop and implement, through the tribal 
        consultation process, culturally sensitive assessment 
        and diagnostic tools for use in tribal and urban Indian 
        communities.
  [(3) The Secretary shall establish criteria for the review 
and approval of applications for grants under this section.
  [(b) The Secretary, acting through the Service, shall--
          [(1) develop an annual plan for the prevention, 
        intervention, treatment, and aftercare for those 
        affected by FAS and FAE in Indian communities;
          [(2) conduct a study, directly or by contract with 
        any organization, entity, or institution of higher 
        education with significant knowledge of FAS and FAE and 
        Indian communities, of the special educational, 
        vocational, school-to-work transition, and independent 
        living needs of adolescent and adult Indians and Alaska 
        Natives with FAS or FAE; and
          [(3) establish a national clearinghouse for 
        prevention and educational materials and other 
        information on FAS and FAE effect in Indian and Alaska 
        Native communities and ensure access to clearinghouse 
        materials by any Indian tribe or urban Indian 
        organization.
  [(c) The Secretary shall establish a task force to be known 
as the FAS/FAE Task Force to advise the Secretary in carrying 
out subsection (b). Such task force shall be composed of 
representatives from the National Institute on Drug Abuse, the 
National Institute on Alcohol and Alcoholism, the Office of 
Substance Abuse Prevention, the National Institute of Mental 
Health, the Service, the Office of Minority Health of the 
Department of Health and Human Services, the Administration for 
Native Americans, the Bureau of Indian Affairs, Indian tribes, 
tribal organizations, urban Indian communities, and Indian FAS/
FAE experts.
  [(d) The Secretary, acting through the Substance Abuse and 
Mental Health Services Administration, shall make grants to 
Indian tribes, tribal organizations, universities working with 
Indian tribes on cooperative projects, and urban Indian 
organizations for applied research projects which propose to 
elevate the understanding of methods to prevent, intervene, 
treat, or provide aftercare for Indians and urban Indians 
affected by FAS or FAE.
  [(e)(1) The Secretary shall submit to the President, for 
inclusion in each report required to be transmitted to the 
Congress under section 801, a report on the status of FAS and 
FAE in the Indian population. Such report shall include, in 
addition to the information required under section (3)(d) with 
respect to the health status objective specified in section 
(3)(b)(27), the following:
          [(A) The progress of implementing a uniform 
        assessment and diagnostic methodology in Service and 
        tribally based service delivery systems.
          [(B) The incidence of FAS and FAE babies born for all 
        births by reservation and urban-based sites.
          [(C) The prevalence of FAS and FAE affected Indian 
        persons in Indian communities, their primary means of 
        support, and recommendations to improve the support 
        system for these individuals and their families or 
        caretakers.
          [(D) The level of support received from the entities 
        specified in subsection (c) in the area of FAS and FAE.
          [(E) The number of inpatient and outpatient substance 
        abuse treatment resources which are specifically 
        designed to meet the unique needs of Indian women, and 
        the volume of care provided to Indian women through 
        these means.
          [(F) Recommendations regarding the prevention, 
        intervention, and appropriate vocational, educational 
        and other support services for FAS and FAE affected 
        individuals in Indian communities.
  [(2) The Secretary may contract the production of this report 
to a national organization specifically addressing FAS and FAE 
in Indian communities.
  [(f)(1) There are authorized to be appropriated to carry out 
this section $22,000,000 for fiscal year 1993 and such sums as 
may be necessary for each of the fiscal years 1994, 1995, 1996, 
1997, 1998, 1999, and 2000.
  [(2) Ten percent of the funds appropriated pursuant to this 
section shall be used to make grants to urban Indian 
organizations funded under title V.
  [pueblo substance abuse treatment project for san juan pueblo, new 
                                 mexico
  [Sec. 709. The Secretary, acting through the Service, shall 
continue to make grants, through fiscal year 1995, to the 8 
Northern Indian Pueblos Council, San Juan Pueblo, New Mexico, 
for the purpose of providing substance abuse treatment services 
to Indians in need of such services.
                    [thunder child treatment center
  [Sec. 710. (a) The Secretary, acting through the Service, 
shall make a grant to the Intertribal Addictions Recovery 
Organization, Inc. (commonly known as the Thunder Child 
Treatment Center) at Sheridan, Wyoming, for the completion of 
construction of a multiple approach substance abuse treatment 
center which specializes in the treatment of alcohol and drug 
abuse of Indians.
  [(b) For the purposes of carrying out subsection (a), there 
are authorized to be appropriated $2,000,000 for fiscal years 
1993 and 1994. No funding shall be available for staffing or 
operation of this facility. None of the funding appropriated to 
carry out subsection (a) shall be used for administrative 
purposes.
       [substance abuse counselor education demonstration project
  [Sec. 711. (a) The Secretary, acting through the Service, may 
enter into contracts with, or make grants to, accredited 
tribally controlled community colleges, tribally controlled 
postsecondary vocational institutions, and eligible community 
colleges to establish demonstration projects to develop 
educational curricula for substance abuse counseling.
  [(b) Funds provided under this section shall be used only for 
developing and providing educational curricula for substance 
abuse counseling (including paying salaries for instructors). 
Such curricula may be provided through satellite campus 
programs.
  [(c) A contract entered into or a grant provided under this 
section shall be for a period of one year. Such contract or 
grant may be renewed for an additional one year period upon the 
approval of the Secretary.
  [(d) Not later than 180 days after the date of the enactment 
of this section, the Secretary, after consultation with Indian 
tribes and administrators of accredited tribally controlled 
community colleges, tribally controlled postsecondary 
vocational institutions, and eligible community colleges, shall 
develop and issue criteria for the review and approval of 
applications for funding (including applications for renewals 
of funding) under this section. Such criteria shall ensure that 
demonstration projects established under this section promote 
the development of the capacity of such entities to educate 
substance abuse counselors.
  [(e) The Secretary shall provide such technical and other 
assistance as may be necessary to enable grant recipients to 
comply with the provisions of this section.
  [(f) The Secretary shall submit to the President, for 
inclusion in the report which is required to be submitted under 
section 801 for fiscal year 1999, a report on the findings and 
conclusions derived from the demonstration projects conducted 
under this section.
  [(g) For the purposes of this section, the following 
definitions apply:
          [(1) The term ``educational curriculum'' means one or 
        more of the following:
                  [(A) Classroom education.
                  [(B) Clinical work experience.
                  [(C) Continuing education workshops.
          [(2) The term ``eligible community college'' means an 
        accredited community college that--
                          [(i) is located on or near an Indian 
                        reservation;
                          [(ii) has entered into a cooperative 
                        agreement with the governing body of 
                        such Indian reservation to carry out a 
                        demonstration project under this 
                        section; and
                          [(iii) has a student enrollment of 
                        not less than 10 percent Indian.
          [(3) The term ``tribally controlled community 
        college'' has the meaning given such term in section 
        2(a)(4) of the Tribally Controlled Community College 
        Assistance Act of 1978 (25 U.S.C. 1801(a)(4)).
          [(4) The term ``tribally controlled postsecondary 
        vocational institution'' has the meaning given such 
        term in section 390(2) of the Tribally Controlled 
        Vocational Institutions Support Act of 1990 (20 U.S.C. 
        2397h(2)).
  [(h) There are authorized to be appropriated for each of 
fiscal years 1996 through 2000, such sums as may be necessary 
to carry out the purposes of this section. Such sums shall 
remain available until expended.
       [gila river alcohol and substance abuse treatment facility
  [Sec. 712. (a) The Secretary, acting through the Service, 
shall establish a regional youth alcohol and substance abuse 
prevention and treatment center in Sacaton, Arizona, on the 
Gila River Indian Reservation. The center shall be established 
within facilities leased, with the consent of the Gila River 
Indian Community, by the Service from such Community.
  [(b) The center established pursuant to this section shall be 
known as the ``Regional Youth Alcohol and Substance Abuse 
Prevention and Treatment Center''.
  [(c) The Secretary, acting through the Service, shall 
establish, as a unit of the regional center, a youth alcohol 
and substance abuse prevention and treatment facility in 
Fallon, Nevada.
      [alaska native drug and alcohol abuse demonstration project
  [Sec. 713. (a) The Secretary, acting through the Service, 
shall make grants to the Alaska Native Health Board for the 
conduct of a two-part community-based demonstration project to 
reduce drug and alcohol abuse in Alaska Native villages and to 
rehabilitate families afflicted by such abuse. Sixty percent of 
such grant funds shall be used by the Health Board to stimulate 
coordinated community development programs in villages seeking 
to organize to combat alcohol and drug use. Forty percent of 
such grant funds shall be transferred to a qualified nonprofit 
corporation providing alcohol recovery services in the village 
of St. Mary's, Alaska, to enlarge and strengthen a family life 
demonstration program of rehabilitation for families that have 
been or are afflicted by alcoholism.
  [(b) The Secretary shall submit to the President for 
inclusion in the report required to be submitted to the 
Congress under section 801 for fiscal year 1995 an evaluation 
of the demonstration project established under subsection (a).
                    [authorization of appropriations
  [Sec. 714. Except as provided in sections 703, 706, 708, 710, 
and 711, there are authorized to be appropriated such sums as 
may be necessary for each fiscal year through fiscal year 2000 
to carry out the provisions of this title.

                       [TITLE VIII--MISCELLANEOUS

                                [reports
  [Sec. 801. The President shall, at the time the budget is 
submitted under section 1105 of title 31, United States Code, 
for each fiscal year transmit to the Congress a report 
containing--
          [(1) a report on the progress made in meeting the 
        objectives of this Act, including a review of programs 
        established or assisted pursuant to this Act and an 
        assessment and recommendations of additional programs 
        or additional assistance necessary to, at a minimum, 
        provide health services to Indians, and ensure a health 
        status for Indians, which are at a parity with the 
        health services available to and the health status of, 
        the general population;
          [(2) a report on whether, and to what extent, new 
        national health care programs, benefits, initiatives, 
        or financing systems have had an impact on the purposes 
        of this Act and any steps that the Secretary may have 
        taken to consult with Indian tribes to address such 
        impact;
          [(3) a report on the use of health services by 
        Indians--
                  [(A) on a national and area or other relevant 
                geographical basis;
                  [(B) by gender and age;
                  [(C) by source of payment and type of 
                service; and
                  [(D) comparing such rates of use with rates 
                of use among comparable non-Indian populations.
          [(4) a separate statement which specifies the amount 
        of funds requested to carry out the provisions of 
        section 201;
          [(5) a separate statement of the total amount 
        obligated or expended in the most recently completed 
        fiscal year to achieve each of the objectives described 
        in section 814, relating to infant and maternal 
        mortality and fetal alcohol syndrome;
          [(6) the reports required by sections 3(d), 108(n), 
        203(b), 209(j), 301(c), 302(g), 305(a)(3), 403, 708(e), 
        and 817(a), and 822(f);
          [(7) for fiscal year 1995, the report required by 
        sections 702(c)(3) and 713(b);
          [(8) for fiscal year 1997, the interim report 
        required by section 307(h)(1); and
          [(9) for fiscal year 1999, the reports required by 
        sections 307(h)(2), 512(b), 711(f), and 821(g).
                              [regulations
  [Sec. 802. Prior to any revision of or amendment to rules or 
regulations promulgated pursuant to this Act, the Secretary 
shall consult with Indian tribes and appropriate national or 
regional Indian organizations and shall publish any proposed 
revision or amendment in the Federal Register not less than 
sixty days prior to the effective date of such revision or 
amendment in order to provide adequate notice to, and receive 
comments from, other interested parties.
                       [leases with indian tribes
  [Sec. 804. (a) Notwithstanding any other provision of law, 
the Secretary is authorized, in carrying out the purposes of 
this Act, to enter into leases with Indian tribes for periods 
not in excess of twenty years. Property leased by the Secretary 
from an Indian tribe may be reconstructed or renovated by the 
Secretary pursuant to an agreement with such Indian tribe.
  [(b) The Secretary may enter into leases, contracts, and 
other legal agreements with Indian tribes or tribal 
organizations which hold--
          [(1) title to;
          [(2) a leasehold interest in; or
          [(3) a beneficial interest in (where title is held by 
        the United States in trust for the benefit of a tribe);
facilities used for the administration and delivery of health 
services by the Service or by programs operated by Indian 
tribes or tribal organizations to compensate such Indian tribes 
or tribal organizations for costs associated with the use of 
such facilities for such purposes. Such costs include rent, 
depreciation based on the useful life of the building, 
principal and interest paid or accrued, operation and 
maintenance expenses, and other expenses determined by 
regulation to be allowable.
                         [availability of funds
  [Sec. 805. The funds appropriated pursuant to this Act shall 
remain available until expended.
 [limitation on use of funds appropriated to the indian health service
  [Sec. 806. Any limitation on the use of funds contained in an 
Act providing appropriations for the Department of Health and 
Human Services for a period with respect to the performance of 
abortions shall apply for that period with respect to the 
performance of abortions using funds contained in an Act 
providing appropriations for the Indian Health Service.
              [nuclear resource development health hazards
  [Sec. 807. (a) The Secretary and the Service shall conduct, 
in conjunction with other appropriate Federal agencies and in 
consultation with concerned Indian tribes and organizations, a 
study of the health hazards to Indian communities as a result 
of nuclear resource development. Such study shall include--
          [(1) an evaluation of the nature and extent of 
        nuclear resource development related health problems 
        currently exhibited among Indians and the causes of 
        such health problems;
          [(2) an analysis of the potential effect of ongoing 
        and future nuclear resource development on or near 
        Indian reservations and communities;
          [(3) an evaluation of the types and nature of 
        activities, practices, and conditions causing or 
        affecting such health problems, including uranium 
        mining and milling, uranium mine tailing deposits, 
        nuclear powerplant operation and construction, and 
        nuclear waste disposal;
          [(4) a summary of any findings and recommendations 
        provided in Federal and State studies, reports, 
        investigations, and inspections during the five years 
        prior to the date of the enactment of this section that 
        directly or indirectly relate to the activities, 
        practices, and conditions affecting the health or 
        safety of such Indians; and
          [(5) the efforts that have been made by Federal and 
        State agencies and mining and milling companies to 
        effectively carry out an education program for such 
        Indians regarding the health and safety hazards of such 
        nuclear resource development.
  [(b) Upon completion of such study the Secretary and the 
Service shall take into account the results of such study and 
develop a health care plan to address the health problems 
studied under subsection (a). The plan shall include--
          [(1) methods for diagnosing and treating Indians 
        currently exhibiting such health problems;
          [(2) preventive care for Indians who may be exposed 
        to such health hazards, including the monitoring of the 
        health of individuals who have or may have been exposed 
        to excessive amounts of radiations, or affected by 
        other nuclear development activities that have had or 
        could have a serious impact upon the health of such 
        individuals; and
          [(3) a program of education for Indians who, by 
        reason of their work or geographic proximity to such 
        nuclear development activities, may experience health 
        problems.
  [(c) The Secretary and the Service shall submit to Congress 
the study prepared under subsection (a) no later than the date 
eighteen months after the date of enactment of this section. 
The health care plan prepared under subsection (b) shall be 
submitted in a report no later than the date one year after the 
date that the study prepared under subsection (a) is submitted 
to Congress. Such report shall include recommended activities 
for the implementation of the plan, as well as an evaluation of 
any activities previously undertaken by the service to address 
such health problems.
  [(d)(1) There is established an Intergovernmental Task Force 
to be composed of the following individuals (or their 
designees): the Secretary of Energy, the Administrator of the 
Environmental Protection Agency, the Director of the Bureau of 
Mines, the Assistant Secretary for Occupational Safety and 
Health, and the Secretary of the Interior.
  [(2) The Task Force shall identify existing and potential 
operations related to nuclear resource development that affect 
or may affect the health of Indians on or near an Indian 
reservation or in an Indian community and enter into activities 
to correct existing health hazards and insure that current and 
future health problems resulting from nuclear resource 
development activities are minimized or reduced.
  [(3) The Secretary shall be Chairman of the Task Force. The 
Task Force shall meet at least twice each year. Each member of 
the Task Force shall furnish necessary assistance to the Task 
Force.
  [(e) In the case of any Indian who--
          [(1) as a result of employment in or near a uranium 
        mine or mill, suffers from a work related illness or 
        condition;
          [(2) is eligible to receive diagnosis and treatment 
        services from a service facility; and
          [(3) by reason of such Indian's employment, is 
        entitled to medical care at the expense of such mine or 
        mill operator; the Service shall, at the request of 
        such Indian, render appropriate medical care to such 
        Indian for such illness or condition and may recover 
        the costs of any medical care so rendered to which such 
        Indian is entitled at the expense of such operator from 
        such operator. Nothing in this subsection shall affect 
        the rights of such Indian to recover damages other than 
        such costs paid to the Service from the employer for 
        such illness or condition.
          [arizona as a contract health service delivery area
  [Sec. 808. (a) For the fiscal years beginning with the fiscal 
year ending September 30, 1982, and ending with the fiscal year 
ending September 30, 2000, the State of Arizona shall be 
designated as a contract health service delivery area by the 
Service for the purpose of providing contract health care 
services to members of federally recognized Indian tribes of 
Arizona.
  [(b) The Service shall not curtail any health care services 
provided to Indians residing on Federal reservations in the 
State of Arizona if such curtailment is due to the provision of 
contract services in such State pursuant to the designation of 
such State as a contract health service delivery area pursuant 
to subsection (a).
                   [eligibility of california indians
  [Sec. 809. (a)(1) In order to provide the Congress with 
sufficient data to determine which Indians in the State of 
California should be eligible for health services provided by 
the Service, the Secretary shall, by no later than the date 
that is 3 years after the date of enactment of the Indian 
Health Care Amendments of 1988, prepare and submit to the 
Congress a report which sets forth--
          [(A) a determination by the Secretary of the number 
        of Indians described in subsection (b)(2), and the 
        number of Indians described in subsection (b)(3), who 
        are not members of an Indian tribe recognized by the 
        Federal Government,
          [(B) the geographic location of such Indians,
          [(C) the Indian tribes of which such Indians are 
        members,
          [(D) an assessment of the current health status, and 
        health care needs, of such Indians, and
          [(E) an assessment of the actual availability and 
        accessibility of alternative resources for the health 
        care of such Indians that such Indians would have to 
        rely on if the Service did not provide for the health 
        care of such Indians.
  [(2) The report required under paragraph (1) shall be 
prepared by the Secretary--
          [(A) in consultation with the Secretary of the 
        Interior, and
          [(B) with the assistance of the tribal health 
        programs providing services to the Indians described in 
        paragraph (2) or (3) of subsection (b) who are not 
        members of any Indian tribe recognized by the Federal 
        Government.
  [(b) Until such time as any subsequent law may otherwise 
provide, the following California Indians shall be eligible for 
health services provided by the Service:
          [(1) Any member of a federally recognized Indian 
        tribe.
          [(2) Any descendant of an Indian who was residing in 
        California on June 1, 1852, but only if such 
        descendant--
                  [(A) is living in California,
                  [(B) is a member of the Indian community 
                served by a local program of the Service, and
                  [(C) is regarded as an Indian by the 
                community in which such descendant lives.
          [(3) Any Indian who holds trust interests in public 
        domain, national forest, or Indian reservation 
        allotments in California.
          [(4) Any Indian in California who is listed on the 
        plans for distribution of the assets of California 
        rancherias and reservations under the Act of August 18, 
        1958 (72 Stat. 619), and any descendant of such an 
        Indian.
  [(c) Nothing in this section may be construed as expanding 
the eligibility of California Indians for health services 
provided by the Service beyond the scope of eligibility for 
such health services that applied on May 1, 1986.
         [california as a contract health service delivery area
  [Sec. 810. The State of California, excluding the counties of 
Alameda, Contra Costa, Los Angeles, Marin, Orange, Sacramento, 
San Francisco, San Mateo, Santa Clara, Kern, Merced, Monterey, 
Napa, San Benito, San Joaquin, San Luis Obispo, Santa Cruz, 
Solano, Stanislaus, and Ventura shall be designated as a 
contract health service delivery area by the Service for the 
purpose of providing contract health services to Indians in 
such State.
                      [contract health facilities
  [Sec. 811. The Service shall provide funds for health care 
programs and facilities operated by tribes and tribal 
organizations under contracts with the Service entered into 
under the Indian Self-Determination Act--
          [(1) for the maintenance and repair of clinics owned 
        or leased by such tribes or tribal organizations,
          [(2) for employee training,
          [(3) for cost-of-living increases for employees, and
          [(4) for any other expenses relating to the provision 
        of health services,
on the same basis as such funds are provided to programs and 
facilities operated directly by the Service.
                     [national health service corps
  [Sec. 812. The Secretary of Health and Human Services shall 
not--
          [(1) remove a member of the National Health Service 
        Corps from a health facility operated by the Indian 
        Health Service or by a tribe or tribal organization 
        under contract with the Indian Health Service under the 
        Indian Self-Determination Act, or
          [(2) withdraw funding used to support such member,
unless the Secretary, acting through the Service, has ensured 
that the Indians receiving services from such member will 
experience no reduction in services.
                [health services for ineligible persons
  [Sec. 813. (a)(1) Any individual who--
          [(A) has not attained 19 years of age,
          [(B) is the natural or adopted child, step-child, 
        foster-child, legal ward, or orphan of an eligible 
        Indian, and
          [(C) is not otherwise eligible for the health 
        services provided by the Service,
shall be eligible for all health services provided by the 
Service on the same basis and subject to the same rules that 
apply to eligible Indians until such individual attains 19 
years of age. The existing and potential health needs of all 
such individuals shall be taken into consideration by the 
Service in determining the need for, or the allocation of, the 
health resources of the Service. If such an individual has been 
determined to be legally incompetent prior to attaining 19 
years of age, such individual shall remain eligible for such 
services until one year after the date such disability has been 
removed.
  [(2) Any spouse of an eligible Indian who is not an Indian, 
or who is of Indian descent but not otherwise eligible for the 
health services provided by the Service, shall be eligible for 
such health services if all of such spouses are made eligible, 
as a class, by an appropriate resolution of the governing body 
of the Indian tribe of the eligible Indian. The health needs of 
persons made eligible under this paragraph shall not be taken 
into consideration by the Service in determining the need for, 
or allocation of, its health resources.
  [(b)(1)(A) The Secretary is authorized to provide health 
services under this subsection through health facilities 
operated directly by the Service to individuals who reside 
within the service area of a service unit and who are not 
eligible for such health services under any other subsection of 
this section or under any other provision of law if--
          [(i) the Indian tribe (or, in the case of a multi-
        tribal service area, all the Indian tribes) served by 
        such service unit requests such provision of health 
        services to such individuals, and
          [(ii) the Secretary and the Indian tribe or tribes 
        have jointly determined that--
                  [(I) the provision of such health services 
                will not result in a denial or diminution of 
                health services to eligible Indians, and
                  [(II) there is no reasonable alternative 
                health facility or services, within or without 
                the service area of such service unit, 
                available to meet the health needs of such 
                individuals.
  [(B) In the case of health facilities operated under a 
contract entered into under the Indian Self-Determination Act, 
the governing body of the Indian tribe or tribal organization 
providing health services under such contract is authorized to 
determine whether health services should be provided under such 
contract to individuals who are not eligible for such health 
services under any other subsection of this section or under 
any other provision of law. In making such determinations, the 
governing body of the Indian tribe or tribal organization shall 
take into account the considerations described in subparagraph 
(A)(ii).
  [(2)(A) Persons receiving health services provided by the 
Service by reason of this subsection shall be liable for 
payment of such health services under a schedule of charges 
prescribed by the Secretary which, in the judgment of the 
Secretary, results in reimbursement in an amount not less than 
the actual cost of providing the health services. 
Notwithstanding section 1880(c) of the Social Security Act, 
section 402(a) of this Act, or any other provision of law, 
amounts collected under this subsection, including medicare or 
medicaid reimbursements under titles XVIII and XIX of the 
Social Security Act, shall be credited to the account of the 
facility providing the service and shall be used solely for the 
provision of health services within that facility. Amounts 
collected under this subsection shall be available for 
expenditure within such facility for not to exceed one fiscal 
year after the fiscal year in which collected.
  [(B) Health services may be provided by the Secretary through 
the Service under this subsection to an indigent person who 
would not be eligible for such health services but for the 
provisions of paragraph (1) only if an agreement has been 
entered into with a State or local government under which the 
State or local government agrees to reimburse the Service for 
the expenses incurred by the Service in providing such health 
services to such indigent person.
  [(3)(A) In the case of a service area which serves only one 
Indian tribe, the authority of the Secretary to provide health 
services under paragraph (1)(A) shall terminate at the end of 
the fiscal year succeeding the fiscal year in which the 
governing body of the Indian tribe revokes its concurrence to 
the provision of such health services.
  [(B) In the case of a multi-tribal service area, the 
authority of the Secretary to provide health services under 
paragraph (1)(A) shall terminate at the end of the fiscal year 
succeeding the fiscal year in which at least 51 percent of the 
number of Indian tribes in the service area revoke their 
concurrence to the provision of such health services.
  [(c) The Service may provide health services under this 
subsection to individuals who are not eligible for health 
services provided by the Service under any other subsection of 
this section or under any other provision of law in order to--
          [(1) achieve stability in a medical emergency,
          [(2) prevent the spread of a communicable disease or 
        otherwise deal with a public health hazard,
          [(3) provide care to non-Indian women pregnant with 
        an eligible Indian's child for the duration of the 
        pregnancy through post partum, or
          [(4) provide care to immediate family members of an 
        eligible person if such care is directly related to the 
        treatment of the eligible person.
  [(d) Hospital privileges in health facilities operated and 
maintained by the Service or operated under a contract entered 
into under the Indian Self-Determination Act may be extended to 
non-Service health care practitioners who provide services to 
persons described in subsection (a) or (b). Such non-Service 
health care practitioners may be regarded as employees of the 
Federal Government for purposes of section 1346(b) and chapter 
171 of title 28, United States Code (relating to Federal tort 
claims) only with respect to acts or omissions which occur in 
the course of providing services to eligible persons as a part 
of the conditions under which such hospital privileges are 
extended.
  [(e) For purposes of this section, the term ``eligible 
Indian'' means any Indian who is eligible for health services 
provided by the Service without regard to the provisions of 
this section.
         [infant and maternal mortality; fetal alcohol syndrome
  [Sec. 814. By no later than January 1, 1990, the Secretary 
shall develop and begin implementation of a plan to achieve the 
following objectives by January 1, 1994:
          [(1) reduction of the rate of Indian infant mortality 
        in each area office of the Service to the lower of--
                  [(A) twelve deaths per one thousand live 
                births, or
                  [(B) the rate of infant mortality applicable 
                to the United States population as a whole;
          [(2) reduction of the rate of maternal mortality in 
        each area office of the Service to the lower of--
                  [(A) five deaths per one hundred thousand 
                live births, or
                  [(B) the rate of maternal mortality 
                applicable to the United States population as a 
                whole; and
          [(3) reduction of the rate of fetal alcohol syndrome 
        among Indians served by, or on behalf of, the Service 
        to one per one thousand live births.
         [contract health services for the trenton service area
  [Sec. 815. (a) The Secretary, acting through the Service, is 
directed to provide contract health services to members of the 
Turtle Mountain Band of Chippewa Indians that reside in the 
Trenton Service Area of Divide, McKenzie, and Williams counties 
in the State of North Dakota and the adjoining counties of 
Richland, Roosevelt, and Sheridan in the State of Montana.
  [(b) Nothing in this section may be construed as expanding 
the eligibility of members of the Turtle Mountain Band of 
Chippewa Indians for health services provided by the Service 
beyond the scope of eligibility for such health services that 
applied on May 1, 1986.
   [indian health service and department of veterans affairs health 
                    facilities and services sharing
  [Sec. 816. (a) The Secretary shall examine the feasibility of 
entering into an arrangement for the sharing of medical 
facilities and services between the Indian Health Service and 
the Department of Veterans Affairs and shall, in accordance 
with subsection (b), prepare a report on the feasibility of 
such an arrangement and submit such report to the Congress by 
no later than September 30, 1990.
  [(b) The Secretary shall not take any action under this 
section or under subchapter IV of chapter 81 of title 38, 
United States Code, which would impair--
          [(1) the priority access of any Indian to health care 
        services provided through the Indian Health Service;
          [(2) the quality of health care services provided to 
        any Indian through the Indian Health Service;
          [(3) the priority access of any veteran to health 
        care services provided by the Department of Veterans 
        Affairs;
          [(4) the quality of health care services provided to 
        any veteran by the Department of Veterans Affairs;
          [(5) the eligibility of any Indian to receive health 
        services through the Indian Health Service; or
          [(6) the eligibility of any Indian who is a veteran 
        to receive health services through the Department of 
        Veterans Affairs.
  [(c)(1) Not later than December 23, 1988, the Director of the 
Indian Health Service and the Secretary of Veterans Affairs 
shall implement an agreement under which--
          [(A) individuals in the vicinity of Roosevelt, Utah, 
        who are eligible for health care from the Department of 
        Veterans Affairs could obtain health care services at 
        the facilities of the Indian Health Service located at 
        Fort Duchesne, Utah; and
          [(B) individuals eligible for health care from the 
        Indian Health Service at Fort Duchesne, Utah, could 
        obtain health care services at the Department of 
        Veterans Affairs medical center located in Salt Lake 
        City, Utah.
  [(2) Not later than November 23, 1990, the Secretary and the 
Secretary of Veterans Affairs shall jointly submit a report to 
the Congress on the health care services provided as a result 
of paragraph (1).
  [(d) Nothing in this section may be construed as creating any 
right of a veteran to obtain health services from the Indian 
Health Service except as provided in an agreement under 
subsection (c).
                    [reallocation of base resources
  [Sec. 817. (a) Notwithstanding any other provision of law, 
any allocation of Service funds for a fiscal year that reduces 
by 5 percent or more from the previous fiscal year the funding 
for any recurring program, project, or activity of a service 
unit may be implemented only after the Secretary has submitted 
to the President, for inclusion in the report required to be 
transmitted to the Congress under section 801, a report on the 
proposed change in allocation of funding, including the reasons 
for the change and its likely effects.
  [(b) Subsection (a) shall not apply if the total amount 
appropriated to the Service for a fiscal year is less than the 
amount appropriated to the Service for previous fiscal year.
 [demonstration projects for tribal management of health care services
  [Sec. 818. (a)(1) The Secretary, acting through the Service, 
shall make grants to Indian tribes to establish demonstration 
projects under which the Indian tribe will develop and test a 
phased approach to assumption by the Indian tribe of the health 
care delivery system of the Service for members of the Indian 
tribe living on or near the reservations of the Indian tribe 
through the use of Service, tribal, and private sector 
resources.
  [(2) A grant may be awarded to an Indian tribe under 
paragraph (1) only if the Secretary determines that the Indian 
tribe has the administrative and financial capabilities 
necessary to conduct a demonstration project described in 
paragraph (1).
  [(b) During the period in which a demonstration project 
established under subsection (a) is being conducted by an 
Indian tribe, the Secretary shall award all health care 
contracts, including community, behavioral, and preventive 
health care contracts, to the Indian tribe in the form of a 
single grant to which the regulations prescribed under part A 
of title XIX of the Public Health Service Act (as modified as 
necessary by any agreement entered into between the Secretary 
and the Indian tribe to achieve the purposes of the 
demonstration project established under subsection (a)) shall 
apply.
  [(c) The Secretary may waive such provisions of Federal 
procurement law as are necessary to enable any Indian tribe to 
develop and test administrative systems under the demonstration 
project established under subsection (a), but only if such 
waiver does not diminish or endanger the delivery of health 
care services to Indians.
  [(d)(1) The demonstration project established under 
subsection (a) shall terminate on September 30, 1993, or, in 
the case of a demonstration project for which a grant is made 
after September 30, 1990, three years after the date on which 
such grant is made.
  [(2) By no later than September 30, 1996, the Secretary shall 
evaluate the performance of each Indian tribe that has 
participated in a demonstration project established under 
subsection (a) and shall submit to the Congress a report on 
such evaluations and demonstration projects.
  [(e)(1) The Secretary, acting through the Service, shall make 
arrangements with Indian tribes to establish joint venture 
demonstration projects under which an Indian tribe shall expend 
tribal, private, or other available nontribal funds, for the 
acquisition or construction of a health facility for a minimum 
of 20 years, under a no-cost lease, in exchange for agreement 
by the Service to provide the equipment, supplies, and staffing 
for the operation and maintenance of such a health facility. A 
tribe may utilize tribal funds, private sector, or other 
available resources, including loan guarantees, to fulfill its 
commitment under this subsection.
  [(2) The Secretary shall make such an arrangement with an 
Indian tribe only if the Secretary first determines that the 
Indian tribe has the administrative and financial capabilities 
necessary to complete the timely acquisition or construction of 
the health facility described in paragraph (1).
  [(3) An Indian tribe or tribal organization that has entered 
into a written agreement with the Secretary under this 
subsection, and that breaches or terminates without cause such 
agreement, shall be liable to the United States for the amount 
that has been paid to the tribe, or paid to a third party on 
the tribe's behalf, under the agreement. The Secretary has the 
right to recover tangible property (including supplies), and 
equipment, less depreciation, and any funds expended for 
operations and maintenance under this section. The preceding 
sentence does not apply to any funds expended for the delivery 
of health care services, or for personnel or staffing, shall be 
recoverable.
                 [child sexual abuse treatment programs
  [Sec. 819. (a) The Secretary and the Secretary of the 
Interior shall, for each fiscal year through fiscal year 1995, 
continue the demonstration programs involving treatment for 
child sexual abuse provided through the Hopi Tribe and the 
Assiniboine and Sioux Tribes of the Fort Peck Reservation.
  [(b) Beginning October 1, 1995, the Secretary and the 
Secretary of the Interior may establish, in any service area, 
demonstration programs involving treatment for child sexual 
abuse, except that the Secretaries may not establish a greater 
number of such programs in one service area than in any other 
service area until there is an equal number of such programs 
established with respect to all service areas from which the 
Secretary receives qualified applications during the 
application period (as determined by the Secretary).
                            [tribal leasing
  [Sec. 820. Indian tribes providing health care services 
pursuant to a contract entered into under the Indian Self-
Determination Act may lease permanent structures for the 
purpose of providing such health care services without 
obtaining advance approval in appropriation Acts.
         [home- and community-based care demonstration project
  [Sec. 821. (a) The Secretary, acting through the Service, is 
authorized to enter into contracts with, or make grants to, 
Indian tribes or tribal organizations providing health care 
services pursuant to a contract entered into under the Indian 
Self-Determination Act, to establish demonstration projects for 
the delivery of home- and community-based services to 
functionally disabled Indians.
  [(b)(1) Funds provided for a demonstration project under this 
section shall be used only for the delivery of home- and 
community-based services (including transportation services) to 
functionally disabled Indians.
  [(2) Such funds may not be used--
          [(A) to make cash payments to functionally disabled 
        Indians;
          [(B) to provide room and board for functionally 
        disabled Indians;
          [(C) for the construction or renovation of facilities 
        or the purchase of medical equipment; or
          [(D) for the provision of nursing facility services.
  [(c) Not later than 180 days after the date of the enactment 
of this section, the Secretary, after consultation with Indian 
tribes and tribal organizations, shall develop and issue 
criteria for the approval of applications submitted under this 
section. Such criteria shall ensure that demonstration projects 
established under this section promote the development of the 
capacity of tribes and tribal organizations to deliver, or 
arrange for the delivery of, high quality, culturally 
appropriate home- and community-based services to functionally 
disabled Indians;
  [(d) The Secretary shall provide such technical and other 
assistance as may be necessary to enable applicants to comply 
with the provisions of this section.
  [(e) At the discretion of the tribe or tribal organization, 
services provided under a demonstration project established 
under this section may be provided (on a cost basis) to persons 
otherwise ineligible for the health care benefits of the 
Service.
  [(f) The Secretary shall establish not more than 24 
demonstration projects under this section. The Secretary may 
not establish a greater number of demonstration projects under 
this section in one service area than in any other service area 
until there is an equal number of such demonstration projects 
established with respect to all service areas from which the 
Secretary receives applications during the application period 
(as determined by the Secretary) which meet the criteria issued 
pursuant to subsection (c).
  [(g) The Secretary shall submit to the President, for 
inclusion in the report which is required to be submitted under 
section 801 for fiscal year 1999, a report on the findings and 
conclusions derived from the demonstration projects conducted 
under this section, together with legislative recommendations.
  [(h) For the purposes of this section, the following 
definitions shall apply:
          [(1) The term ``home- and community-based services'' 
        means one or more of the following:
                  [(A) Homemaker/home health aide services.
                  [(B) Chore services.
                  [(C) Personal care services.
                  [(D) Nursing care services provided outside 
                of a nursing facility by, or under the 
                supervision of, a registered nurse.
                  [(E) Respite care.
                  [(F) Training for family members in managing 
                a functionally disabled individual.
                  [(G) Adult day care.
                  [(H) Such other home- and community-based 
                services as the Secretary may approve.
          [(2) The term ``functionally disabled'' means an 
        individual who is determined to require home- and 
        community-based services based on an assessment that 
        uses criteria (including, at the discretion of the 
        tribe or tribal organization, activities of daily 
        living) developed by the tribe or tribal organization.
  [(i) There are authorized to be appropriated for each of the 
fiscal years 1996 through 2000 such sums as may be necessary to 
carry out this section. Such sums shall remain available until 
expended.
                 [shared services demonstration project
  [Sec. 822. (a) The Secretary, acting through the Service and 
notwithstanding any other provision of law, is authorized to 
enter into contracts with Indian tribes or tribal organizations 
to establish not more than 6 shared services demonstration 
projects for the delivery of long-term care to Indians. Such 
projects shall provide for the sharing of staff or other 
services between a Service facility and a nursing facility 
owned and operated (directly or by contract) by such Indian 
tribe or tribal organization.
  [(b) A contract entered into pursuant to subsection (a)--
          [(1) may, at the request of the Indian tribe or 
        tribal organization, delegate to such tribe or tribal 
        organization such powers of supervision and control 
        over Service employees as the Secretary deems necessary 
        to carry out the purposes of this section;
          [(2) shall provide that expenses (including salaries) 
        relating to services that are shared between the 
        Service facility and the tribal facility be allocated 
        proportionately between the Service and the tribe or 
        tribal organization; and
          [(3) may authorize such tribe or tribal organization 
        to construct, renovate, or expand a nursing facility 
        (including the construction of a facility attached to a 
        Service facility), except that no funds appropriated 
        for the Service shall be obligated or expended for such 
        purpose.
  [(c) To be eligible for a contract under this section, a 
tribe or tribal organization, shall, as of the date of the 
enactment of this Act--
          [(1) own and operate (directly or by contract) a 
        nursing facility;
          [(2) have entered into an agreement with a consultant 
        to develop a plan for meeting the long-term needs of 
        the tribe or tribal organization; or
          [(3) have adopted a tribal resolution providing for 
        the construction of a nursing facility.
  [(d) Any nursing facility for which a contract is entered 
into under this section shall meet the requirements for nursing 
facilities under section 1919 of the Social Security Act.
  [(e) The Secretary shall provide such technical and other 
assistance as may be necessary to enable applicants to comply 
with the provisions of this section.
  [(f) The Secretary shall submit to the President, for 
inclusion in each report required to be transmitted to the 
Congress under section 801, a report on the findings and 
conclusions derived from the demonstration projects conducted 
under this section.
                   [results of demonstration projects
  [Sec. 823. The Secretary shall provide for the dissemination 
to Indian tribes of the findings and results of demonstration 
projects conducted under this Act.
                   [priority for indian reservations
  [Sec. 824. (a) Beginning on the date of the enactment of this 
section, the Bureau of Indian Affairs and the Service shall, in 
all matters involving the reorganization or development of 
Service facilities, or in the establishment of related 
employment projects to address unemployment conditions in 
economically depressed areas, give priority to locating such 
facilities and projects on Indian lands if requested by the 
Indian tribe with jurisdiction over such lands.
  [(b) For purposes of this section, the term ``Indian lands'' 
means--
          [(1) all lands within the limits of any Indian 
        reservation; and
          [(2) any lands title which is held in trust by the 
        United States for the benefit of any Indian tribe or 
        individual Indian, or held by any Indian tribe or 
        individual Indian subject to restriction by the United 
        States against alienation and over which an Indian 
        tribe exercises governmental power.
                    [authorization of appropriations
  [Sec. 825. Except as provided in section 821, there are 
authorized to be appropriated such sums as may be necessary for 
each fiscal year through fiscal year 2000 to carry out this 
title.]

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

  (a) Short Title.--This Act may be cited as the ``Indian 
Health Care Improvement Act''.
  (b) Table of Contents.--The table of contents 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. Scholarship programs for Indian Tribes.
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.
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.
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. 217. North Dakota and South Dakota as contract health service 
          delivery area.
Sec. 218. California contract health services program.
Sec. 219. California as a contract health service delivery area.
Sec. 220. Contract health services for the Trenton Service Area.
Sec. 221. Programs operated by Indian Tribes and Tribal Organizations.
Sec. 222. Licensing.
Sec. 223. Notification of provision of emergency contract health 
          services.
Sec. 224. Prompt action on payment of claims.
Sec. 225. Liability for payment.
Sec. 226. Office of Indian Men's Health.
Sec. 227. 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 non-Service 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. Study on 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 
          benefits programs.
Sec. 402. Grants to and contracts with the Service, Indian Tribes, 
          Tribal Organizations, and Urban Indian Organizations to 
          facilitate outreach, enrollment, and coverage of Indians under 
          Social Security Act health benefit programs and other health 
          benefits programs.
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.
Sec. 407. Payor of last resort.
Sec. 408. Nondiscrimination under Federal health care programs in 
          qualifications for reimbursement for services.
Sec. 409. Consultation.
Sec. 410. State Children's Health Insurance Program (SCHIP).
Sec. 411. Exclusion waiver authority for affected Indian Health Programs 
          and safe harbor transactions under the Social Security Act.
Sec. 412. Premium and cost sharing protections and eligibility 
          determinations under Medicaid and SCHIP and protection of 
          certain Indian property from Medicaid estate recovery.
Sec. 413. Treatment under Medicaid and SCHIP managed care.
Sec. 414. Navajo Nation Medicaid Agency feasibility study.
Sec. 415. General exceptions.
Sec. 416. 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. Division 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. Urban youth treatment center demonstration.
Sec. 516. Grants for diabetes prevention, treatment, and control.
Sec. 517. Community health representatives.
Sec. 518. Effective date.
Sec. 519. Eligibility for services.
Sec. 520. 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.
Sec. 708. Indian youth telemental health demonstration project.
Sec. 709. Inpatient and community-based mental health facilities design, 
          construction, and staffing.
Sec. 710. Training and community education.
Sec. 711. Behavioral health program.
Sec. 712. Fetal alcohol disorder programs.
Sec. 713. Child sexual abuse and prevention treatment programs.
Sec. 714. Behavioral health research.
Sec. 715. Definitions.
Sec. 716. 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 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. Severability provisions.
Sec. 813. Establishment of National Bipartisan Commission on Indian 
          Health Care.
Sec. 814. Confidentiality of medical quality assurance records; 
          qualified immunity for participants.
Sec. 815. Appropriations; availability.
Sec. 816. Authorization of appropriations.

SEC. 2. FINDINGS.

  Congress makes the following findings:
          (1) Federal health services to maintain and improve 
        the health of the Indians are consonant with and 
        required by the Federal Government's historical and 
        unique legal relationship with, and resulting 
        responsibility to, the American Indian people.
          (2) A major national goal of the United States is to 
        provide the quantity and quality of health services 
        which will permit the health status of Indians to be 
        raised to the highest possible level and to encourage 
        the maximum participation of Indians in the planning 
        and management of those services.
          (3) Federal health services to Indians have resulted 
        in a reduction in the prevalence and incidence of 
        preventable illnesses among, and unnecessary and 
        premature deaths of, Indians.
          (4) Despite such services, the unmet health needs of 
        the American Indian people are severe and the health 
        status of the Indians is far below that of the general 
        population of the United States.

SEC. 3. DECLARATION OF NATIONAL INDIAN HEALTH POLICY.

  Congress declares that it is the policy of this Nation, in 
fulfillment of its special trust responsibilities and legal 
obligations to Indians--
          (1) to assure the highest possible health status for 
        Indians and Urban Indians and to provide all resources 
        necessary to effect that policy;
          (2) to raise the health status of Indians and Urban 
        Indians to at least the levels set forth in the goals 
        contained within the Healthy People 2010 or successor 
        objectives;
          (3) to the greatest extent possible, to allow Indians 
        to set their own health care priorities and establish 
        goals that reflect their unmet needs;
          (4) to increase the proportion of all degrees in the 
        health professions and allied and associated health 
        professions awarded to Indians so that the proportion 
        of Indian health professionals in each Service Area is 
        raised to at least the level of that of the general 
        population;
          (5) to require meaningful consultation with Indian 
        Tribes, Tribal Organizations, and Urban Indian 
        Organizations to implement this Act and the national 
        policy of Indian self-determination; and
          (6) to provide funding for programs and facilities 
        operated by Indian Tribes and Tribal Organizations in 
        amounts that are not less than the amounts provided to 
        programs and facilities operated directly by the 
        Service.

SEC. 4. DEFINITIONS.

  For purposes of this Act:
          (1) The term ``accredited and accessible'' means on 
        or near a reservation and accredited by a national or 
        regional organization with accrediting authority.
          (2) The term ``Area Office'' means an administrative 
        entity, including a program office, within the Service 
        through which services and funds are provided to the 
        Service Units within a defined geographic area.
          (3) The term ``Assistant Secretary'' means the 
        Assistant Secretary of Indian Health.
          (4)(A) The term ``behavioral health'' means the 
        blending of substance (alcohol, drugs, inhalants, and 
        tobacco) abuse and mental health prevention and 
        treatment, for the purpose of providing comprehensive 
        services.
          (B) The term ``behavioral health'' includes the joint 
        development of substance abuse and mental health 
        treatment planning and coordinated case management 
        using a multidisciplinary approach.
          (5) The term ``California Indians'' means those 
        Indians who are eligible for health services of the 
        Service pursuant to section 806.
          (6) The term ``community college'' means--
                  (A) a tribal college or university, or
                  (B) a junior or community college.
          (7) The term ``contract health service'' means health 
        services provided at the expense of the Service or a 
        Tribal Health Program by public or private medical 
        providers or hospitals, other than the Service Unit or 
        the Tribal Health Program at whose expense the services 
        are provided.
          (8) The term ``Department'' means, unless otherwise 
        designated, the Department of Health and Human 
        Services.
          (9) The term ``disease prevention'' means the 
        reduction, limitation, and prevention of disease and 
        its complications and reduction in the consequences of 
        disease, including--
                  (A) controlling--
                          (i) the development of diabetes;
                          (ii) high blood pressure;
                          (iii) infectious agents;
                          (iv) injuries;
                          (v) occupational hazards and 
                        disabilities;
                          (vi) sexually transmittable diseases; 
                        and
                          (vii) toxic agents; and
                  (B) providing--
                          (i) fluoridation of water; and
                          (ii) immunizations.
          (10) The term ``health profession'' means allopathic 
        medicine, family medicine, internal medicine, 
        pediatrics, geriatric medicine, obstetrics and 
        gynecology, podiatric medicine, nursing, public health 
        nursing, dentistry, psychiatry, osteopathy, optometry, 
        pharmacy, psychology, public health, social work, 
        marriage and family therapy, chiropractic medicine, 
        environmental health and engineering, allied health 
        professions, naturopathic medicine, and any other 
        health profession.
          (11) The term ``health promotion'' means--
                  (A) fostering social, economic, 
                environmental, and personal factors conducive 
                to health, including raising public awareness 
                about health matters and enabling the people to 
                cope with health problems by increasing their 
                knowledge and providing them with valid 
                information;
                  (B) encouraging adequate and appropriate 
                diet, exercise, and sleep;
                  (C) promoting education and work in 
                conformity with physical and mental capacity;
                  (D) making available safe water and sanitary 
                facilities;
                  (E) improving the physical, economic, 
                cultural, psychological, and social 
                environment;
                  (F) promoting culturally competent care; and
                  (G) providing adequate and appropriate 
                programs, which may include--
                          (i) abuse prevention (mental and 
                        physical);
                          (ii) community health;
                          (iii) community safety;
                          (iv) consumer health education;
                          (v) diet and nutrition;
                          (vi) immunization and other 
                        prevention of communicable diseases, 
                        including HIV/AIDS;
                          (vii) environmental health;
                          (viii) exercise and physical fitness;
                          (ix) avoidance of fetal alcohol 
                        disorders;
                          (x) first aid and CPR education;
                          (xi) human growth and development;
                          (xii) injury prevention and personal 
                        safety;
                          (xiii) behavioral health;
                          (xiv) monitoring of disease 
                        indicators between health care provider 
                        visits, through appropriate means, 
                        including Internet-based health care 
                        management systems;
                          (xv) personal health and wellness 
                        practices;
                          (xvi) personal capacity building;
                          (xvii) prenatal, pregnancy, and 
                        infant care;
                          (xviii) psychological well-being;
                          (xix) reproductive health and family 
                        planning;
                          (xx) safe and adequate water;
                          (xxi) healthy work environments;
                          (xxii) elimination, reduction, and 
                        prevention of contaminants that create 
                        unhealthy household conditions 
                        (including mold and other allergens);
                          (xxiii) stress control;
                          (xxiv) substance abuse;
                          (xxv) sanitary facilities;
                          (xxvi) sudden infant death syndrome 
                        prevention;
                          (xxvii) tobacco use cessation and 
                        reduction;
                          (xxviii) violence prevention; and
                          (xxix) such other activities 
                        identified by the Service, a Tribal 
                        Health Program, or an Urban Indian 
                        Organization, to promote achievement of 
                        any of the objectives described in 
                        section 3(2).
          (12) The term ``Indian'', unless otherwise 
        designated, means any person who is a member of an 
        Indian Tribe or is eligible for health services under 
        section 806, except that, for the purpose of sections 
        102 and 103, the term also means any individual who--
                  (A)(i) irrespective of whether the individual 
                lives on or near a reservation, is a member of 
                a tribe, band, or other organized group of 
                Indians, including those tribes, bands, or 
                groups terminated since 1940 and those 
                recognized now or in the future by the State in 
                which they reside; or
                  (ii) is a descendant, in the first or second 
                degree, of any such member;
                  (B) is an Eskimo or Aleut or other Alaska 
                Native;
                  (C) is considered by the Secretary of the 
                Interior to be an Indian for any purpose; or
                  (D) is determined to be an Indian under 
                regulations promulgated by the Secretary.
          (13) The term ``Indian Health Program'' means--
                  (A) any health program administered directly 
                by the Service;
                  (B) any Tribal Health Program; or
                  (C) any Indian Tribe or Tribal Organization 
                to which the Secretary provides funding 
                pursuant to section 23 of the Act of June 25, 
                1910 (25 U.S.C. 47) (commonly known as the 
                ``Buy Indian Act'').
          (14) The term ``Indian Tribe'' has the meaning given 
        the term in the Indian Self-Determination and Education 
        Assistance Act (25 U.S.C. 450 et seq.).
          (15) The term ``junior or community college'' has the 
        meaning given the term by section 312(e) of the Higher 
        Education Act of 1965 (20 U.S.C. 1058(e)).
          (16) The term ``reservation'' means any federally 
        recognized Indian Tribe's reservation, Pueblo, or 
        colony, including former reservations in Oklahoma, 
        Indian allotments, and Alaska Native Regions 
        established pursuant to the Alaska Native Claims 
        Settlement Act (43 U.S.C. 1601 et seq.).
          (17) The term ``Secretary'', unless otherwise 
        designated, means the Secretary of Health and Human 
        Services.
          (18) The term ``Service'' means the Indian Health 
        Service.
          (19) The term ``Service Area'' means the geographical 
        area served by each Area Office.
          (20) The term ``Service Unit'' means an 
        administrative entity of the Service, or a Tribal 
        Health Program through which services are provided, 
        directly or by contract, to eligible Indians within a 
        defined geographic area.
          (21) The term ``telehealth'' has the meaning given 
        the term in section 330K(a) of the Public Health 
        Service Act (42 U.S.C. 254c-16(a)).
          (22) The term ``telemedicine'' means a 
        telecommunications link to an end user through the use 
        of eligible equipment that electronically links health 
        professionals or patients and health professionals at 
        separate sites in order to exchange health care 
        information in audio, video, graphic, or other format 
        for the purpose of providing improved health care 
        services.
          (23) The term ``tribal college or university'' has 
        the meaning given the term in section 316(b)(3) of the 
        Higher Education Act (20 U.S.C. 1059c(b)(3)).
          (24) The term ``Tribal Health Program'' means an 
        Indian Tribe or Tribal Organization that operates any 
        health program, service, function, activity, or 
        facility funded, in whole or part, by the Service 
        through, or provided for in, a contract or compact with 
        the Service under the Indian Self-Determination and 
        Education Assistance Act (25 U.S.C. 450 et seq.).
          (25) The term ``Tribal Organization'' has the meaning 
        given the term in the Indian Self-Determination and 
        Education Assistance Act (25 U.S.C. 450 et seq.).
          (26) The term ``Urban Center'' means any community 
        which has a sufficient Urban Indian population with 
        unmet health needs to warrant assistance under title V 
        of this Act, as determined by the Secretary.
          (27) The term ``Urban Indian'' means any individual 
        who resides in an Urban Center and who meets 1 or more 
        of the following criteria:
                  (A) Irrespective of whether the individual 
                lives on or near a reservation, the individual 
                is a member of a tribe, band, or other 
                organized group of Indians, including those 
                tribes, bands, or groups terminated since 1940 
                and those tribes, bands, or groups that are 
                recognized by the States in which they reside, 
                or who is a descendant in the first or second 
                degree of any such member.
                  (B) The individual is an Eskimo, Aleut, or 
                other Alaska Native.
                  (C) The individual is considered by the 
                Secretary of the Interior to be an Indian for 
                any purpose.
                  (D) The individual is determined to be an 
                Indian under regulations promulgated by the 
                Secretary.
          (28) The term ``Urban Indian Organization'' means a 
        nonprofit corporate body that (A) is situated in an 
        Urban Center; (B) is governed by an Urban Indian-
        controlled board of directors; (C) provides for the 
        participation of all interested Indian groups and 
        individuals; and (D) is capable of legally cooperating 
        with other public and private entities for the purpose 
        of performing the activities described in section 
        503(a).

        TITLE I--INDIAN HEALTH, HUMAN RESOURCES, AND DEVELOPMENT

SEC. 101. PURPOSE.

  The purpose of this title is to increase, to the maximum 
extent feasible, the number of Indians entering the health 
professions and providing health services, and to assure an 
optimum supply of health professionals to the Indian Health 
Programs and Urban Indian Organizations involved in the 
provision of health services to Indians.

SEC. 102. HEALTH PROFESSIONS RECRUITMENT PROGRAM FOR INDIANS.

  (a) In General.--The Secretary, acting through the Service, 
shall make grants to public or nonprofit private health or 
educational entities, Tribal Health Programs, or Urban Indian 
Organizations to assist such entities in meeting the costs of--
          (1) identifying Indians with a potential for 
        education or training in the health professions and 
        encouraging and assisting them--
                  (A) to enroll in courses of study in such 
                health professions; or
                  (B) if they are not qualified to enroll in 
                any such courses of study, to undertake such 
                postsecondary education or training as may be 
                required to qualify them for enrollment;
          (2) publicizing existing sources of financial aid 
        available to Indians enrolled in any course of study 
        referred to in paragraph (1) or who are undertaking 
        training necessary to qualify them to enroll in any 
        such course of study; or
          (3) establishing other programs which the Secretary 
        determines will enhance and facilitate the enrollment 
        of Indians in, and the subsequent pursuit and 
        completion by them of, courses of study referred to in 
        paragraph (1).
  (b) Grants.--
          (1) Application.--The Secretary shall not make a 
        grant under this section unless an application has been 
        submitted to, and approved by, the Secretary. Such 
        application shall be in such form, submitted in such 
        manner, and contain such information, as the Secretary 
        shall by regulation prescribe pursuant to this Act. The 
        Secretary shall give a preference to applications 
        submitted by Tribal Health Programs or Urban Indian 
        Organizations.
          (2) Amount of grants; payment.--The amount of a grant 
        under this section shall be determined by the 
        Secretary. Payments pursuant to this section may be 
        made in advance or by way of reimbursement, and at such 
        intervals and on such conditions as provided for in 
        regulations issued pursuant to this Act. To the extent 
        not otherwise prohibited by law, grants shall be for 3 
        years, as provided in regulations issued pursuant to 
        this Act.

SEC. 103. HEALTH PROFESSIONS PREPARATORY SCHOLARSHIP PROGRAM FOR 
                    INDIANS.

  (a) Scholarships Authorized.--The Secretary, acting through 
the Service, shall provide scholarship grants to Indians who--
          (1) have successfully completed their high school 
        education or high school equivalency; and
          (2) have demonstrated the potential to successfully 
        complete courses of study in the health professions.
  (b) Purposes.--Scholarship grants provided pursuant to this 
section shall be for the following purposes:
          (1) Compensatory preprofessional education of any 
        recipient, such scholarship not to exceed 2 years on a 
        full-time basis (or the part-time equivalent thereof, 
        as determined by the Secretary pursuant to regulations 
        issued under this Act).
          (2) Pregraduate education of any recipient leading to 
        a baccalaureate degree in an approved course of study 
        preparatory to a field of study in a health profession, 
        such scholarship not to exceed 4 years. An extension of 
        up to 2 years (or the part-time equivalent thereof, as 
        determined by the Secretary pursuant to regulations 
        issued pursuant to this Act) may be approved.
  (c) Other Conditions.--Scholarships under this section--
          (1) may cover costs of tuition, books, 
        transportation, board, and other necessary related 
        expenses of a recipient while attending school;
          (2) shall not be denied solely on the basis of the 
        applicant's scholastic achievement if such applicant 
        has been admitted to, or maintained good standing at, 
        an accredited institution; and
          (3) shall not be denied solely by reason of such 
        applicant's eligibility for assistance or benefits 
        under any other Federal program.

SEC. 104. INDIAN HEALTH PROFESSIONS SCHOLARSHIPS.

  (a) In General.--
          (1) Authority.--The Secretary, acting through the 
        Service, shall make scholarship grants to Indians who 
        are enrolled full or part time in accredited schools 
        pursuing courses of study in the health professions. 
        Such scholarships shall be designated Indian Health 
        Scholarships and shall be made in accordance with 
        section 338A of the Public Health Services Act (42 
        U.S.C. 254l), except as provided in subsection (b) of 
        this section.
          (2) Determinations by secretary.--The Secretary, 
        acting through the Service, shall determine--
                  (A) who shall receive scholarship grants 
                under subsection (a); and
                  (B) the distribution of the scholarships 
                among health professions on the basis of the 
                relative needs of Indians for additional 
                service in the health professions.
          (3) Certain delegation not allowed.--The 
        administration of this section shall be a 
        responsibility of the Assistant Secretary and shall not 
        be delegated in a contract or compact under the Indian 
        Self-Determination and Education Assistance Act (25 
        U.S.C. 450 et seq.).
  (b) Active Duty Service Obligation.--
          (1) Obligation met.--The active duty service 
        obligation under a written contract with the Secretary 
        under this section that an Indian has entered into 
        shall, if that individual is a recipient of an Indian 
        Health Scholarship, be met in full-time practice equal 
        to 1 year for each school year for which the 
        participant receives a scholarship award under this 
        part, or 2 years, whichever is greater, by service in 1 
        or more of the following:
                  (A) In an Indian Health Program.
                  (B) In a program assisted under title V of 
                this Act.
                  (C) In the private practice of the applicable 
                profession if, as determined by the Secretary, 
                in accordance with guidelines promulgated by 
                the Secretary, such practice is situated in a 
                physician or other health professional shortage 
                area and addresses the health care needs of a 
                substantial number of Indians.
                  (D) In a teaching capacity in a tribal 
                college or university nursing program (or a 
                related health profession program) if, as 
                determined by the Secretary, the health service 
                provided to Indians would not decrease.
          (2) Obligation deferred.--At the request of any 
        individual who has entered into a contract referred to 
        in paragraph (1) and who receives a 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:
                  (A) No period of internship, residency, or 
                other advanced clinical training shall be 
                counted as satisfying any period of obligated 
                service under this subsection.
                  (B) 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).
                  (C) The active duty service obligation will 
                be served in the health profession of that 
                individual in a manner consistent with 
                paragraph (1).
                  (D) A recipient of a scholarship under this 
                section may, at the election of the recipient, 
                meet the active duty service obligation 
                described in paragraph (1) by service in a 
                program specified under that paragraph that--
                          (i) is located on the reservation of 
                        the Indian Tribe in which the recipient 
                        is enrolled; or
                          (ii) serves the Indian Tribe in which 
                        the recipient is enrolled.
          (3) Priority when making assignments.--Subject to 
        paragraph (2), the Secretary, in making assignments of 
        Indian Health Scholarship recipients required to meet 
        the active duty service obligation described in 
        paragraph (1), shall give priority to assigning 
        individuals to service in those programs specified in 
        paragraph (1) that have a need for health professionals 
        to provide health care services as a result of 
        individuals having breached contracts entered into 
        under this section.
  (c) Part-Time Students.--In the case of an individual 
receiving a scholarship under this section who is enrolled part 
time in an approved course of study--
          (1) such scholarship shall be for a period of years 
        not to exceed the part-time equivalent of 4 years, as 
        determined by the Secretary;
          (2) the period of obligated service described in 
        subsection (b)(1) shall be equal to the greater of--
                  (A) the part-time equivalent of 1 year for 
                each year for which the individual was provided 
                a scholarship (as determined by the Secretary); 
                or
                  (B) 2 years; and
          (3) the amount of the monthly stipend specified in 
        section 338A(g)(1)(B) of the Public Health Service Act 
        (42 U.S.C. 254l(g)(1)(B)) shall be reduced pro rata (as 
        determined by the Secretary) based on the number of 
        hours such student is enrolled.
  (d) Breach of Contract.--
          (1) Specified breaches.--An individual shall be 
        liable to the United States for the amount which has 
        been paid to the individual, or on behalf of the 
        individual, under a contract entered into with the 
        Secretary under this section on or after the date of 
        enactment of the Indian Health Care Improvement Act 
        Amendments of 2007 if that individual--
                  (A) fails to maintain an acceptable level of 
                academic standing in the educational 
                institution in which he or she is enrolled 
                (such level determined by the educational 
                institution under regulations of the 
                Secretary);
                  (B) is dismissed from such educational 
                institution for disciplinary reasons;
                  (C) voluntarily terminates the training in 
                such an educational institution for which he or 
                she is provided a scholarship under such 
                contract before the completion of such 
                training; or
                  (D) fails to accept payment, or instructs the 
                educational institution in which he or she is 
                enrolled not to accept payment, in whole or in 
                part, of a scholarship under such contract, in 
                lieu of any service obligation arising under 
                such contract.
          (2) Other breaches.--If for any reason not specified 
        in paragraph (1) an individual breaches a written 
        contract by failing either to begin such individual's 
        service obligation required under such contract or to 
        complete such service obligation, the United States 
        shall be entitled to recover from the individual an 
        amount determined in accordance with the formula 
        specified in subsection (l) of section 110 in the 
        manner provided for in such subsection.
          (3) Cancellation upon death of recipient.--Upon the 
        death of an individual who receives an Indian Health 
        Scholarship, any outstanding obligation of that 
        individual for service or payment that relates to that 
        scholarship shall be canceled.
          (4) Waivers and suspensions.--
                  (A) In general.--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.
                  (B) Factors for consideration.--Before 
                waiving or suspending an obligation of service 
                or payment under subparagraph (A), the 
                Secretary shall consult with the affected Area 
                Office, Indian Tribes, Tribal Organizations, or 
                Urban Indian Organizations, and may take into 
                consideration whether the obligation may be 
                satisfied in a teaching capacity at a tribal 
                college or university nursing program under 
                subsection (b)(1)(D).
          (5) Extreme hardship.--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.
          (6) Bankruptcy.--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.

SEC. 105. AMERICAN INDIANS INTO PSYCHOLOGY PROGRAM.

  (a) Grants Authorized.--The Secretary, acting through the 
Service, shall make grants of not more than $300,000 to each of 
9 colleges and universities for the purpose of developing and 
maintaining Indian psychology career recruitment programs as a 
means of encouraging Indians to enter the behavioral health 
field. These programs shall be located at various locations 
throughout the country to maximize their availability to Indian 
students and new programs shall be established in different 
locations from time to time.
  (b) Quentin N. Burdick Program Grant.--The Secretary shall 
provide a grant authorized under subsection (a) to develop and 
maintain a program at the University of North Dakota to be 
known as the ``Quentin N. Burdick American Indians Into 
Psychology Program'. Such program shall, to the maximum extent 
feasible, coordinate with the Quentin N. Burdick Indian Health 
Programs authorized under section 117(b), the Quentin N. 
Burdick American Indians Into Nursing Program authorized under 
section 115(e), and existing university research and 
communications networks.
  (c) Regulations.--The Secretary shall issue regulations 
pursuant to this Act for the competitive awarding of grants 
provided under this section.
  (d) Conditions of Grant.--Applicants under this section shall 
agree to provide a program which, at a minimum--
          (1) provides outreach and recruitment for health 
        professions to Indian communities including elementary, 
        secondary, and accredited and accessible community 
        colleges that will be served by the program;
          (2) incorporates a program advisory board comprised 
        of representatives from the tribes and communities that 
        will be served by the program;
          (3) provides summer enrichment programs to expose 
        Indian students to the various fields of psychology 
        through research, clinical, and experimental 
        activities;
          (4) provides stipends to undergraduate and graduate 
        students to pursue a career in psychology;
          (5) develops affiliation agreements with tribal 
        colleges and universities, the Service, university 
        affiliated programs, and other appropriate accredited 
        and accessible entities to enhance the education of 
        Indian students;
          (6) to the maximum extent feasible, uses existing 
        university tutoring, counseling, and student support 
        services; and
          (7) to the maximum extent feasible, employs qualified 
        Indians in the program.
  (e) Active Duty Service Requirement.--The active duty service 
obligation prescribed under section 338C of the Public Health 
Service Act (42 U.S.C. 254m) shall be met by each graduate who 
receives a stipend described in subsection (d)(4) that is 
funded under this section. Such obligation shall be met by 
service--
          (1) in an Indian Health Program;
          (2) in a program assisted under title V of this Act; 
        or
          (3) in the private practice of psychology if, as 
        determined by the Secretary, in accordance with 
        guidelines promulgated by the Secretary, such practice 
        is situated in a physician or other health professional 
        shortage area and addresses the health care needs of a 
        substantial number of Indians.
  (f) Authorization of Appropriations.--There is authorized to 
be appropriated to carry out this section $2,700,000 for each 
of fiscal years 2008 through 2017.

SEC. 106. SCHOLARSHIP PROGRAMS FOR INDIAN TRIBES.

  (a) In General.--
          (1) Grants authorized.--The Secretary, acting through 
        the Service, shall make grants to Tribal Health 
        Programs for the purpose of providing scholarships for 
        Indians to serve as health professionals in Indian 
        communities.
          (2) Amount.--Amounts available under paragraph (1) 
        for any fiscal year shall not exceed 5 percent of the 
        amounts available for each fiscal year for Indian 
        Health Scholarships under section 104.
          (3) Application.--An application for a grant under 
        paragraph (1) shall be in such form and contain such 
        agreements, assurances, and information as consistent 
        with this section.
  (b) Requirements.--
          (1) In general.--A Tribal Health Program receiving a 
        grant under subsection (a) shall provide scholarships 
        to Indians in accordance with the requirements of this 
        section.
          (2) Costs.--With respect to costs of providing any 
        scholarship pursuant to subsection (a)--
                  (A) 80 percent of the costs of the 
                scholarship shall be paid from the funds made 
                available pursuant to subsection (a)(1) 
                provided to the Tribal Health Program; and
                  (B) 20 percent of such costs may be paid from 
                any other source of funds.
  (c) Course of Study.--A Tribal Health Program shall provide 
scholarships under this section only to Indians enrolled or 
accepted for enrollment in a course of study (approved by the 
Secretary) in 1 of the health professions contemplated by this 
Act.
  (d) Contract.--
          (1) In general.--In providing scholarships under 
        subsection (b), the Secretary and the Tribal Health 
        Program shall enter into a written contract with each 
        recipient of such scholarship.
          (2) Requirements.--Such contract shall--
                  (A) obligate such recipient to provide 
                service in an Indian Health Program or Urban 
                Indian Organization, in the same Service Area 
                where the Tribal Health Program providing the 
                scholarship is located, for--
                          (i) a number of years for which the 
                        scholarship is provided (or the part-
                        time equivalent thereof, as determined 
                        by the Secretary), or for a period of 2 
                        years, whichever period is greater; or
                          (ii) such greater period of time as 
                        the recipient and the Tribal Health 
                        Program may agree;
                  (B) provide that the amount of the 
                scholarship--
                          (i) may only be expended for--
                                  (I) tuition expenses, other 
                                reasonable educational 
                                expenses, and reasonable living 
                                expenses incurred in attendance 
                                at the educational institution; 
                                and
                                  (II) payment to the recipient 
                                of a monthly stipend of not 
                                more than the amount authorized 
                                by section 338(g)(1)(B) of the 
                                Public Health Service Act (42 
                                U.S.C. 254m(g)(1)(B)), with 
                                such amount to be reduced pro 
                                rata (as determined by the 
                                Secretary) based on the number 
                                of hours such student is 
                                enrolled, and not to exceed, 
                                for any year of attendance for 
                                which the scholarship is 
                                provided, the total amount 
                                required for the year for the 
                                purposes authorized in this 
                                clause; and
                          (ii) may not exceed, for any year of 
                        attendance for which the scholarship is 
                        provided, the total amount required for 
                        the year for the purposes authorized in 
                        clause (i);
                  (C) require the recipient of such scholarship 
                to maintain an acceptable level of academic 
                standing as determined by the educational 
                institution in accordance with regulations 
                issued pursuant to this Act; and
                  (D) require the recipient of such scholarship 
                to meet the educational and licensure 
                requirements appropriate to each health 
                profession.
          (3) Service in other service areas.--The contract may 
        allow the recipient to serve in another Service Area, 
        provided the Tribal Health Program and Secretary 
        approve and services are not diminished to Indians in 
        the Service Area where the Tribal Health Program 
        providing the scholarship is located.
  (e) Breach of Contract.--
          (1) Specific breaches.--An individual who has entered 
        into a written contract with the Secretary and a Tribal 
        Health Program under subsection (d) shall be liable to 
        the United States for the Federal share of the amount 
        which has been paid to him or her, or on his or her 
        behalf, under the contract if that individual--
                  (A) fails to maintain an acceptable level of 
                academic standing in the educational 
                institution in which he or she is enrolled 
                (such level as determined by the educational 
                institution under regulations of the 
                Secretary);
                  (B) is dismissed from such educational 
                institution for disciplinary reasons;
                  (C) voluntarily terminates the training in 
                such an educational institution for which he or 
                she is provided a scholarship under such 
                contract before the completion of such 
                training; or
                  (D) fails to accept payment, or instructs the 
                educational institution in which he or she is 
                enrolled not to accept payment, in whole or in 
                part, of a scholarship under such contract, in 
                lieu of any service obligation arising under 
                such contract.
          (2) Other breaches.--If for any reason not specified 
        in paragraph (1), an individual breaches a written 
        contract by failing to either begin such individual's 
        service obligation required under such contract or to 
        complete such service obligation, the United States 
        shall be entitled to recover from the individual an 
        amount determined in accordance with the formula 
        specified in subsection (l) of section 110 in the 
        manner provided for in such subsection.
          (3) Cancellation upon death of recipient.--Upon the 
        death of an individual who receives an Indian Health 
        Scholarship, any outstanding obligation of that 
        individual for service or payment that relates to that 
        scholarship shall be canceled.
          (4) Information.--The Secretary may carry out this 
        subsection on the basis of information received from 
        Tribal Health Programs involved or on the basis of 
        information collected through such other means as the 
        Secretary deems appropriate.
  (f) Relation to Social Security Act.--The recipient of a 
scholarship under this section shall agree, in providing health 
care pursuant to the requirements herein--
          (1) not to discriminate against an individual seeking 
        care on the basis of the ability of the individual to 
        pay for such care or on the basis that payment for such 
        care will be made pursuant to a program established in 
        title XVIII of the Social Security Act or pursuant to 
        the programs established in title XIX or title XXI of 
        such Act; and
          (2) to accept assignment under section 
        1842(b)(3)(B)(ii) of the Social Security Act for all 
        services for which payment may be made under part B of 
        title XVIII of such Act, and to enter into an 
        appropriate agreement with the State agency that 
        administers the State plan for medical assistance under 
        title XIX, or the State child health plan under title 
        XXI, of such Act to provide service to individuals 
        entitled to medical assistance or child health 
        assistance, respectively, under the plan.
  (g) Continuance of Funding.--The Secretary shall make 
payments under this section to a Tribal Health Program for any 
fiscal year subsequent to the first fiscal year of such 
payments unless the Secretary determines that, for the 
immediately preceding fiscal year, the Tribal Health Program 
has not complied with the requirements of this section.

SEC. 107. INDIAN HEALTH SERVICE EXTERN PROGRAMS.

  (a) Employment Preference.--Any individual who receives a 
scholarship pursuant to section 104 or 106 shall be given 
preference for employment in the Service, or may be employed by 
a Tribal Health Program or an Urban Indian Organization, or 
other agencies of the Department as available, during any 
nonacademic period of the year.
  (b) Not Counted Toward Active Duty Service Obligation.--
Periods of employment pursuant to this subsection shall not be 
counted in determining fulfillment of the service obligation 
incurred as a condition of the scholarship.
  (c) Timing; Length of Employment.--Any individual enrolled in 
a program, including a high school program, authorized under 
section 102(a) may be employed by the Service or by a Tribal 
Health Program or an Urban Indian Organization during any 
nonacademic period of the year. Any such employment shall not 
exceed 120 days during any calendar year.
  (d) Nonapplicability of Competitive Personnel System.--Any 
employment pursuant to this section shall be made without 
regard to any competitive personnel system or agency personnel 
limitation and to a position which will enable the individual 
so employed to receive practical experience in the health 
profession in which he or she is engaged in study. Any 
individual so employed shall receive payment for his or her 
services comparable to the salary he or she would receive if he 
or she were employed in the competitive system. Any individual 
so employed shall not be counted against any employment ceiling 
affecting the Service or the Department.

SEC. 108. CONTINUING EDUCATION ALLOWANCES.

  In order to encourage scholarship and stipend recipients 
under sections 104, 105, 106, and 115 and health professionals, 
including community health representatives and emergency 
medical technicians, to join or continue in an Indian Health 
Program and to provide their services in the rural and remote 
areas where a significant portion of Indians reside, the 
Secretary, acting through the Service, may--
          (1) provide programs or allowances to transition into 
        an Indian Health Program, including licensing, board or 
        certification examination assistance, and technical 
        assistance in fulfilling service obligations under 
        sections 104, 105, 106, and 115; and
          (2) provide programs or allowances to health 
        professionals employed in an Indian Health Program to 
        enable them for a period of time each year prescribed 
        by regulation of the Secretary to take leave of their 
        duty stations for professional consultation, 
        management, leadership, and refresher training courses.

SEC. 109. COMMUNITY HEALTH REPRESENTATIVE PROGRAM.

  (a) In General.--Under the authority of the Act of November 
2, 1921 (25 U.S.C. 13) (commonly known as the ``Snyder Act''), 
the Secretary, acting through the Service, shall maintain a 
Community Health Representative Program under which Indian 
Health Programs--
          (1) provide for the training of Indians as community 
        health representatives; and
          (2) use such community health representatives in the 
        provision of health care, health promotion, and disease 
        prevention services to Indian communities.
  (b) Duties.--The Community Health Representative Program of 
the Service, shall--
          (1) provide a high standard of training for community 
        health representatives to ensure that the community 
        health representatives provide quality health care, 
        health promotion, and disease prevention services to 
        the Indian communities served by the Program;
          (2) in order to provide such training, develop and 
        maintain a curriculum that--
                  (A) combines education in the theory of 
                health care with supervised practical 
                experience in the provision of health care; and
                  (B) provides instruction and practical 
                experience in health promotion and disease 
                prevention activities, with appropriate 
                consideration given to lifestyle factors that 
                have an impact on Indian health status, such as 
                alcoholism, family dysfunction, and poverty;
          (3) maintain a system which identifies the needs of 
        community health representatives for continuing 
        education in health care, health promotion, and disease 
        prevention and develop programs that meet the needs for 
        continuing education;
          (4) maintain a system that provides close supervision 
        of Community Health Representatives;
          (5) maintain a system under which the work of 
        Community Health Representatives is reviewed and 
        evaluated; and
          (6) promote traditional health care practices of the 
        Indian Tribes served consistent with the Service 
        standards for the provision of health care, health 
        promotion, and disease prevention.

SEC. 110. INDIAN HEALTH SERVICE LOAN REPAYMENT PROGRAM.

  (a) Establishment.--The Secretary, acting through the 
Service, shall establish and administer a program to be known 
as the Service Loan Repayment Program (hereinafter referred to 
as the ``Loan Repayment Program'') in order to ensure an 
adequate supply of trained health professionals necessary to 
maintain accreditation of, and provide health care services to 
Indians through, Indian Health Programs and Urban Indian 
Organizations.
  (b) Eligible Individuals.--To be eligible to participate in 
the Loan Repayment Program, an individual must--
          (1)(A) be enrolled--
                  (i) in a course of study or program in an 
                accredited educational institution (as 
                determined by the Secretary under section 
                338B(b)(1)(c)(i) of the Public Health Service 
                Act (42 U.S.C. 254l-1(b)(1)(c)(i))) and be 
                scheduled to complete such course of study in 
                the same year such individual applies to 
                participate in such program; or
                  (ii) in an approved graduate training program 
                in a health profession; or
          (B) have--
                  (i) a degree in a health profession; and
                  (ii) a license to practice a health 
                profession;
          (2)(A) be eligible for, or hold, an appointment as a 
        commissioned officer in the Regular or Reserve Corps of 
        the Public Health Service;
          (B) be eligible for selection for civilian service in 
        the Regular or Reserve Corps of the Public Health 
        Service;
          (C) meet the professional standards for civil service 
        employment in the Service; or
          (D) be employed in an Indian Health Program or Urban 
        Indian Organization without a service obligation; and
          (3) submit to the Secretary an application for a 
        contract described in subsection (e).
  (c) Application.--
          (1) Information to be included with forms.--In 
        disseminating application forms and contract forms to 
        individuals desiring to participate in the Loan 
        Repayment Program, the Secretary shall include with 
        such forms a fair summary of the rights and liabilities 
        of an individual whose application is approved (and 
        whose contract is accepted) by the Secretary, including 
        in the summary a clear explanation of the damages to 
        which the United States is entitled under subsection 
        (l) in the case of the individual's breach of contract. 
        The Secretary shall provide such individuals with 
        sufficient information regarding the advantages and 
        disadvantages of service as a commissioned officer in 
        the Regular or Reserve Corps of the Public Health 
        Service or a civilian employee of the Service to enable 
        the individual to make a decision on an informed basis.
          (2) Clear language.--The application form, contract 
        form, and all other information furnished by the 
        Secretary under this section shall be written in a 
        manner calculated to be understood by the average 
        individual applying to participate in the Loan 
        Repayment Program.
          (3) Timely availability of forms.--The Secretary 
        shall make such application forms, contract forms, and 
        other information available to individuals desiring to 
        participate in the Loan Repayment Program on a date 
        sufficiently early to ensure that such individuals have 
        adequate time to carefully review and evaluate such 
        forms and information.
  (d) Priorities.--
          (1) List.--Consistent with subsection (k), the 
        Secretary shall annually--
                  (A) identify the positions in each Indian 
                Health Program or Urban Indian Organization for 
                which there is a need or a vacancy; and
                  (B) rank those positions in order of 
                priority.
          (2) Approvals.--Notwithstanding the priority 
        determined under paragraph (1), the Secretary, in 
        determining which applications under the Loan Repayment 
        Program to approve (and which contracts to accept), 
        shall--
                  (A) give first priority to applications made 
                by individual Indians; and
                  (B) after making determinations on all 
                applications submitted by individual Indians as 
                required under subparagraph (A), give priority 
                to--
                          (i) individuals recruited through the 
                        efforts of an Indian Health Program or 
                        Urban Indian Organization; and
                          (ii) other individuals based on the 
                        priority rankings under paragraph (1).
  (e) Recipient Contracts.--
          (1) Contract required.--An individual becomes a 
        participant in the Loan Repayment Program only upon the 
        Secretary and the individual entering into a written 
        contract described in paragraph (2).
          (2) Contents of contract.--The written contract 
        referred to in this section between the Secretary and 
        an individual shall contain--
                  (A) an agreement under which--
                          (i) subject to subparagraph (C), the 
                        Secretary agrees--
                                  (I) to pay loans on behalf of 
                                the individual in accordance 
                                with the provisions of this 
                                section; and
                                  (II) to accept (subject to 
                                the availability of 
                                appropriated funds for carrying 
                                out this section) the 
                                individual into the Service or 
                                place the individual with a 
                                Tribal Health Program or Urban 
                                Indian Organization as provided 
                                in clause (ii)(III); and
                          (ii) subject to subparagraph (C), the 
                        individual agrees--
                                  (I) to accept loan payments 
                                on behalf of the individual;
                                  (II) in the case of an 
                                individual described in 
                                subsection (b)(1)--
                                          (aa) to maintain 
                                        enrollment in a course 
                                        of study or training 
                                        described in subsection 
                                        (b)(1)(A) until the 
                                        individual completes 
                                        the course of study or 
                                        training; and
                                          (bb) while enrolled 
                                        in such course of study 
                                        or training, to 
                                        maintain an acceptable 
                                        level of academic 
                                        standing (as determined 
                                        under regulations of 
                                        the Secretary by the 
                                        educational institution 
                                        offering such course of 
                                        study or training); and
                                  (III) to serve for a time 
                                period (hereinafter in this 
                                section referred to as the 
                                ``period of obligated 
                                service'') equal to 2 years or 
                                such longer period as the 
                                individual may agree to serve 
                                in the full-time clinical 
                                practice of such individual's 
                                profession in an Indian Health 
                                Program or Urban Indian 
                                Organization to which the 
                                individual may be assigned by 
                                the Secretary;
                  (B) a provision permitting the Secretary to 
                extend for such longer additional periods, as 
                the individual may agree to, the period of 
                obligated service agreed to by the individual 
                under subparagraph (A)(ii)(III);
                  (C) a provision that any financial obligation 
                of the United States arising out of a contract 
                entered into under this section and any 
                obligation of the individual which is 
                conditioned thereon is contingent upon funds 
                being appropriated for loan repayments under 
                this section;
                  (D) a statement of the damages to which the 
                United States is entitled under subsection (l) 
                for the individual's breach of the contract; 
                and
                  (E) such other statements of the rights and 
                liabilities of the Secretary and of the 
                individual, not inconsistent with this section.
  (f) Deadline for Decision on Application.--The Secretary 
shall provide written notice to an individual within 21 days 
on--
          (1) the Secretary's approving, under subsection 
        (e)(1), of the individual's participation in the Loan 
        Repayment Program, including extensions resulting in an 
        aggregate period of obligated service in excess of 4 
        years; or
          (2) the Secretary's disapproving an individual's 
        participation in such Program.
  (g) Payments.--
          (1) In general.--A loan repayment provided for an 
        individual under a written contract under the Loan 
        Repayment Program shall consist of payment, in 
        accordance with paragraph (2), on behalf of the 
        individual of the principal, interest, and related 
        expenses on government and commercial loans received by 
        the individual regarding the undergraduate or graduate 
        education of the individual (or both), which loans were 
        made for--
                  (A) tuition expenses;
                  (B) all other reasonable educational 
                expenses, including fees, books, and laboratory 
                expenses, incurred by the individual; and
                  (C) reasonable living expenses as determined 
                by the Secretary.
          (2) Amount.--For each year of obligated service that 
        an individual contracts to serve under subsection (e), 
        the Secretary may pay up to $35,000 or an amount equal 
        to the amount specified in section 338B(g)(2)(A) of the 
        Public Health Service Act, whichever is more, on behalf 
        of the individual for loans described in paragraph (1). 
        In making a determination of the amount to pay for a 
        year of such service by an individual, the Secretary 
        shall consider the extent to which each such 
        determination--
                  (A) affects the ability of the Secretary to 
                maximize the number of contracts that can be 
                provided under the Loan Repayment Program from 
                the amounts appropriated for such contracts;
                  (B) provides an incentive to serve in Indian 
                Health Programs and Urban Indian Organizations 
                with the greatest shortages of health 
                professionals; and
                  (C) provides an incentive with respect to the 
                health professional involved remaining in an 
                Indian Health Program or Urban Indian 
                Organization with such a health professional 
                shortage, and continuing to provide primary 
                health services, after the completion of the 
                period of obligated service under the Loan 
                Repayment Program.
          (3) Timing.--Any arrangement made by the Secretary 
        for the making of loan repayments in accordance with 
        this subsection shall provide that any repayments for a 
        year of obligated service shall be made no later than 
        the end of the fiscal year in which the individual 
        completes such year of service.
          (4) Reimbursements for tax liability.--For the 
        purpose of providing reimbursements for tax liability 
        resulting from a payment under paragraph (2) on behalf 
        of an individual, the Secretary--
                  (A) in addition to such payments, may make 
                payments to the individual in an amount equal 
                to not less than 20 percent and not more than 
                39 percent of the total amount of loan 
                repayments made for the taxable year involved; 
                and
                  (B) may make such additional payments as the 
                Secretary determines to be appropriate with 
                respect to such purpose.
          (5) Payment schedule.--The Secretary may enter into 
        an agreement with the holder of any loan for which 
        payments are made under the Loan Repayment Program to 
        establish a schedule for the making of such payments.
  (h) Employment Ceiling.--Notwithstanding any other provision 
of law, individuals who have entered into written contracts 
with the Secretary under this section shall not be counted 
against any employment ceiling affecting the Department while 
those individuals are undergoing academic training.
  (i) Recruitment.--The Secretary shall conduct recruiting 
programs for the Loan Repayment Program and other manpower 
programs of the Service at educational institutions training 
health professionals or specialists identified in subsection 
(a).
  (j) Applicability of Law.--Section 214 of the Public Health 
Service Act (42 U.S.C. 215) shall not apply to individuals 
during their period of obligated service under the Loan 
Repayment Program.
  (k) Assignment of Individuals.--The Secretary, in assigning 
individuals to serve in Indian Health Programs or Urban Indian 
Organizations pursuant to contracts entered into under this 
section, shall--
          (1) ensure that the staffing needs of Tribal Health 
        Programs and Urban Indian Organizations receive 
        consideration on an equal basis with programs that are 
        administered directly by the Service; and
          (2) give priority to assigning individuals to Indian 
        Health Programs and Urban Indian Organizations that 
        have a need for health professionals to provide health 
        care services as a result of individuals having 
        breached contracts entered into under this section.
  (l) Breach of Contract.--
          (1) Specific breaches.--An individual who has entered 
        into a written contract with the Secretary under this 
        section and has not received a waiver under subsection 
        (m) shall be liable, in lieu of any service obligation 
        arising under such contract, to the United States for 
        the amount which has been paid on such individual's 
        behalf under the contract if that individual--
                  (A) is enrolled in the final year of a course 
                of study and--
                          (i) fails to maintain an acceptable 
                        level of academic standing in the 
                        educational institution in which he or 
                        she is enrolled (such level determined 
                        by the educational institution under 
                        regulations of the Secretary);
                          (ii) voluntarily terminates such 
                        enrollment; or
                          (iii) is dismissed from such 
                        educational institution before 
                        completion of such course of study; or
                  (B) is enrolled in a graduate training 
                program and fails to complete such training 
                program.
          (2) Other breaches; formula for amount owed.--If, for 
        any reason not specified in paragraph (1), an 
        individual breaches his or her written contract under 
        this section by failing either to begin, or complete, 
        such individual's period of obligated service in 
        accordance with subsection (e)(2), the United States 
        shall be entitled to recover from such individual an 
        amount to be determined in accordance with the 
        following formula: A=3Z(t-s/t) in which--
                  (A) ``A'' is the amount the United States is 
                entitled to recover;
                  (B) ``Z'' is the sum of the amounts paid 
                under this section to, or on behalf of, the 
                individual and the interest on such amounts 
                which would be payable if, at the time the 
                amounts were paid, they were loans bearing 
                interest at the maximum legal prevailing rate, 
                as determined by the Secretary of the Treasury;
                  (C) ``t'' is the total number of months in 
                the individual's period of obligated service in 
                accordance with subsection (f); and
                  (D) ``s'' is the number of months of such 
                period served by such individual in accordance 
                with this section.
          (3) Deductions in medicare payments.--Amounts not 
        paid within such period shall be subject to collection 
        through deductions in Medicare payments pursuant to 
        section 1892 of the Social Security Act.
          (4) Time period for repayment.--Any amount of damages 
        which the United States is entitled to recover under 
        this subsection shall be paid to the United States 
        within the 1-year period beginning on the date of the 
        breach or such longer period beginning on such date as 
        shall be specified by the Secretary.
          (5) Recovery of delinquency.--
                  (A) In general.--If damages described in 
                paragraph (4) are delinquent for 3 months, the 
                Secretary shall, for the purpose of recovering 
                such damages--
                          (i) use collection agencies 
                        contracted with by the Administrator of 
                        General Services; or
                          (ii) enter into contracts for the 
                        recovery of such damages with 
                        collection agencies selected by the 
                        Secretary.
                  (B) Report.--Each contract for recovering 
                damages pursuant to this subsection shall 
                provide that the contractor will, not less than 
                once each 6 months, submit to the Secretary a 
                status report on the success of the contractor 
                in collecting such damages. Section 3718 of 
                title 31, United States Code, shall apply to 
                any such contract to the extent not 
                inconsistent with this subsection.
  (m) Waiver or Suspension of Obligation.--
          (1) In general.--The Secretary shall by regulation 
        provide for the partial or total waiver or suspension 
        of any obligation of service or payment by an 
        individual under the Loan Repayment Program whenever 
        compliance by the individual is impossible or would 
        involve extreme hardship to the individual and if 
        enforcement of such obligation with respect to any 
        individual would be unconscionable.
          (2) Canceled upon death.--Any obligation of an 
        individual under the Loan Repayment Program for service 
        or payment of damages shall be canceled upon the death 
        of the individual.
          (3) Hardship waiver.--The Secretary may waive, in 
        whole or in part, the rights of the United States to 
        recover amounts under this section in any case of 
        extreme hardship or other good cause shown, as 
        determined by the Secretary.
          (4) Bankruptcy.--Any obligation of an individual 
        under the Loan Repayment Program for payment of damages 
        may be released by a discharge in bankruptcy under 
        title 11 of the United States Code only if such 
        discharge is granted after the expiration of the 5-year 
        period beginning on the first date that payment of such 
        damages is required, and only if the bankruptcy court 
        finds that nondischarge of the obligation would be 
        unconscionable.
  (n) Report.--The Secretary shall submit to the President, for 
inclusion in the report required to be submitted to Congress 
under section 801, a report concerning the previous fiscal year 
which sets forth by Service Area the following:
          (1) A list of the health professional positions 
        maintained by Indian Health Programs and Urban Indian 
        Organizations for which recruitment or retention is 
        difficult.
          (2) The number of Loan Repayment Program applications 
        filed with respect to each type of health profession.
          (3) The number of contracts described in subsection 
        (e) that are entered into with respect to each health 
        profession.
          (4) The amount of loan payments made under this 
        section, in total and by health profession.
          (5) The number of scholarships that are provided 
        under sections 104 and 106 with respect to each health 
        profession.
          (6) The amount of scholarship grants provided under 
        section 104 and 106, in total and by health profession.
          (7) The number of providers of health care that will 
        be needed by Indian Health Programs and Urban Indian 
        Organizations, by location and profession, during the 3 
        fiscal years beginning after the date the report is 
        filed.
          (8) The measures the Secretary plans to take to fill 
        the health professional positions maintained by Indian 
        Health Programs or Urban Indian Organizations for which 
        recruitment or retention is difficult.

SEC. 111. SCHOLARSHIP AND LOAN REPAYMENT RECOVERY FUND.

  (a) Establishment.--There is established in the Treasury of 
the United States a fund to be known as the Indian Health 
Scholarship and Loan Repayment Recovery Fund (hereafter in this 
section referred to as the ``LRRF''). The LRRF shall consist of 
such amounts as may be collected from individuals under section 
104(d), section 106(e), and section 110(l) for breach of 
contract, such funds as may be appropriated to the LRRF, and 
interest earned on amounts in the LRRF. All amounts collected, 
appropriated, or earned relative to the LRRF shall remain 
available until expended.
  (b) Use of Funds.--
          (1) By secretary.--Amounts in the LRRF may be 
        expended by the Secretary, acting through the Service, 
        to make payments to an Indian Health Program--
                  (A) to which a scholarship recipient under 
                section 104 and 106 or a loan repayment program 
                participant under section 110 has been assigned 
                to meet the obligated service requirements 
                pursuant to such sections; and
                  (B) that has a need for a health professional 
                to provide health care services as a result of 
                such recipient or participant having breached 
                the contract entered into under section 104, 
                106, or section 110.
          (2) By tribal health programs.--A Tribal Health 
        Program receiving payments pursuant to paragraph (1) 
        may expend the payments to provide scholarships or 
        recruit and employ, directly or by contract, health 
        professionals to provide health care services.
  (c) Investment of Funds.--The Secretary of the Treasury shall 
invest such amounts of the LRRF as the Secretary of Health and 
Human Services determines are not required to meet current 
withdrawals from the LRRF. Such investments may be made only in 
interest bearing obligations of the United States. For such 
purpose, such obligations may be acquired on original issue at 
the issue price, or by purchase of outstanding obligations at 
the market price.
  (d) Sale of Obligations.--Any obligation acquired by the LRRF 
may be sold by the Secretary of the Treasury at the market 
price.

SEC. 112. RECRUITMENT ACTIVITIES.

  (a) Reimbursement for Travel.--The Secretary, acting through 
the Service, may reimburse health professionals seeking 
positions with Indian Health Programs or Urban Indian 
Organizations, including individuals considering entering into 
a contract under section 110 and their spouses, for actual and 
reasonable expenses incurred in traveling to and from their 
places of residence to an area in which they may be assigned 
for the purpose of evaluating such area with respect to such 
assignment.
  (b) Recruitment Personnel.--The Secretary, acting through the 
Service, shall assign 1 individual in each Area Office to be 
responsible on a full-time basis for recruitment activities.

SEC. 113. INDIAN RECRUITMENT AND RETENTION PROGRAM.

  (a) In General.--The Secretary, acting through the Service, 
shall fund, on a competitive basis, innovative demonstration 
projects for a period not to exceed 3 years to enable Tribal 
Health Programs and Urban Indian Organizations to recruit, 
place, and retain health professionals to meet their staffing 
needs.
  (b) Eligible Entities; Application.--Any Tribal Health 
Program or Urban Indian Organization may submit an application 
for funding of a project pursuant to this section.

SEC. 114. ADVANCED TRAINING AND RESEARCH.

  (a) Demonstration Program.--The Secretary, acting through the 
Service, shall establish a demonstration project to enable 
health professionals who have worked in an Indian Health 
Program or Urban Indian Organization for a substantial period 
of time to pursue advanced training or research areas of study 
for which the Secretary determines a need exists.
  (b) Service Obligation.--An individual who participates in a 
program under subsection (a), where the educational costs are 
borne by the Service, shall incur an obligation to serve in an 
Indian Health Program or Urban Indian Organization for a period 
of obligated service equal to at least the period of time 
during which the individual participates in such program. In 
the event that the individual fails to complete such obligated 
service, the individual shall be liable to the United States 
for the period of service remaining. In such event, with 
respect to individuals entering the program after the date of 
enactment of the Indian Health Care Improvement Act Amendments 
of 2007, the United States shall be entitled to recover from 
such individual an amount to be determined in accordance with 
the formula specified in subsection (l) of section 110 in the 
manner provided for in such subsection.
  (c) Equal Opportunity for Participation.--Health 
professionals from Tribal Health Programs and Urban Indian 
Organizations shall be given an equal opportunity to 
participate in the program under subsection (a).

SEC. 115. QUENTIN N. BURDICK AMERICAN INDIANS INTO NURSING PROGRAM.

  (a) Grants Authorized.--For the purpose of increasing the 
number of nurses, nurse midwives, and nurse practitioners who 
deliver health care services to Indians, the Secretary, acting 
through the Service, shall provide grants to the following:
          (1) Public or private schools of nursing.
          (2) Tribal colleges or universities.
          (3) Nurse midwife programs and advanced practice 
        nurse programs that are provided by any tribal college 
        or university accredited nursing program, or in the 
        absence of such, any other public or private 
        institutions.
  (b) Use of Grants.--Grants provided under subsection (a) may 
be used for 1 or more of the following:
          (1) To recruit individuals for programs which train 
        individuals to be nurses, nurse midwives, or advanced 
        practice nurses.
          (2) To provide scholarships to Indians enrolled in 
        such programs that may pay the tuition charged for such 
        program and other expenses incurred in connection with 
        such program, including books, fees, room and board, 
        and stipends for living expenses.
          (3) To provide a program that encourages nurses, 
        nurse midwives, and advanced practice nurses to 
        provide, or continue to provide, health care services 
        to Indians.
          (4) To provide a program that increases the skills 
        of, and provides continuing education to, nurses, nurse 
        midwives, and advanced practice nurses.
          (5) To provide any program that is designed to 
        achieve the purpose described in subsection (a).
  (c) Applications.--Each application for a grant under 
subsection (a) shall include such information as the Secretary 
may require to establish the connection between the program of 
the applicant and a health care facility that primarily serves 
Indians.
  (d) Preferences for Grant Recipients.--In providing grants 
under subsection (a), the Secretary shall extend a preference 
to the following:
          (1) Programs that provide a preference to Indians.
          (2) Programs that train nurse midwives or advanced 
        practice nurses.
          (3) Programs that are interdisciplinary.
          (4) Programs that are conducted in cooperation with a 
        program for gifted and talented Indian students.
          (5) Programs conducted by tribal colleges and 
        universities.
  (e) Quentin N. Burdick Program Grant.--The Secretary shall 
provide 1 of the grants authorized under subsection (a) to 
establish and maintain a program at the University of North 
Dakota to be known as the ``Quentin N. Burdick American Indians 
Into Nursing Program''. Such program shall, to the maximum 
extent feasible, coordinate with the Quentin N. Burdick Indian 
Health Programs established under section 117(b) and the 
Quentin N. Burdick American Indians Into Psychology Program 
established under section 105(b).
  (f) Active Duty Service Obligation.--The active duty service 
obligation prescribed under section 338C of the Public Health 
Service Act (42 U.S.C. 254m) shall be met by each individual 
who receives training or assistance described in paragraph (1) 
or (2) of subsection (b) that is funded by a grant provided 
under subsection (a). Such obligation shall be met by service--
          (1) in the Service;
          (2) in a program of an Indian Tribe or Tribal 
        Organization conducted under the Indian Self-
        Determination and Education Assistance Act (25 U.S.C. 
        450 et seq.) (including programs under agreements with 
        the Bureau of Indian Affairs);
          (3) in a program assisted under title V of this Act;
          (4) in the private practice of nursing if, as 
        determined by the Secretary, in accordance with 
        guidelines promulgated by the Secretary, such practice 
        is situated in a physician or other health shortage 
        area and addresses the health care needs of a 
        substantial number of Indians; or
          (5) in a teaching capacity in a tribal college or 
        university nursing program (or a related health 
        profession program) if, as determined by the Secretary, 
        health services provided to Indians would not decrease.

SEC. 116. TRIBAL CULTURAL ORIENTATION.

  (a) Cultural Education of Employees.--The Secretary, acting 
through the Service, shall require that appropriate employees 
of the Service who serve Indian Tribes in each Service Area 
receive educational instruction in the history and culture of 
such Indian Tribes and their relationship to the Service.
  (b) Program.--In carrying out subsection (a), the Secretary 
shall establish a program which shall, to the extent feasible--
          (1) be developed in consultation with the affected 
        Indian Tribes, Tribal Organizations, and Urban Indian 
        Organizations;
          (2) be carried out through tribal colleges or 
        universities;
          (3) include instruction in American Indian studies; 
        and
          (4) describe the use and place of traditional health 
        care practices of the Indian Tribes in the Service 
        Area.

SEC. 117. INMED PROGRAM.

  (a) Grants Authorized.--The Secretary, acting through the 
Service, is authorized to provide grants to colleges and 
universities for the purpose of maintaining and expanding the 
Indian health careers recruitment program known as the 
``Indians Into Medicine Program'' (hereinafter in this section 
referred to as ``INMED'') as a means of encouraging Indians to 
enter the health professions.
  (b) Quentin N. Burdick Grant.--The Secretary shall provide 1 
of the grants authorized under subsection (a) to maintain the 
INMED program at the University of North Dakota, to be known as 
the ``Quentin N. Burdick Indian Health Programs'', unless the 
Secretary makes a determination, based upon program reviews, 
that the program is not meeting the purposes of this section. 
Such program shall, to the maximum extent feasible, coordinate 
with the Quentin N. Burdick American Indians Into Psychology 
Program established under section 105(b) and the Quentin N. 
Burdick American Indians Into Nursing Program established under 
section 115.
  (c) Regulations.--The Secretary, pursuant to this Act, shall 
develop regulations to govern grants pursuant to this section.
  (d) Requirements.--Applicants for grants provided under this 
section shall agree to provide a program which--
          (1) provides outreach and recruitment for health 
        professions to Indian communities including elementary 
        and secondary schools and community colleges located on 
        reservations which will be served by the program;
          (2) incorporates a program advisory board comprised 
        of representatives from the Indian Tribes and Indian 
        communities which will be served by the program;
          (3) provides summer preparatory programs for Indian 
        students who need enrichment in the subjects of math 
        and science in order to pursue training in the health 
        professions;
          (4) provides tutoring, counseling, and support to 
        students who are enrolled in a health career program of 
        study at the respective college or university; and
          (5) to the maximum extent feasible, employs qualified 
        Indians in the program.

SEC. 118. HEALTH TRAINING PROGRAMS OF COMMUNITY COLLEGES.

  (a) Grants to Establish Programs.--
          (1) In general.--The Secretary, acting through the 
        Service, shall award grants to accredited and 
        accessible community colleges for the purpose of 
        assisting such community colleges in the establishment 
        of programs which provide education in a health 
        profession leading to a degree or diploma in a health 
        profession for individuals who desire to practice such 
        profession on or near a reservation or in an Indian 
        Health Program.
          (2) Amount of grants.--The amount of any grant 
        awarded to a community college under paragraph (1) for 
        the first year in which such a grant is provided to the 
        community college shall not exceed $250,000.
  (b) Grants for Maintenance and Recruiting.--
          (1) In general.--The Secretary, acting through the 
        Service, shall award grants to accredited and 
        accessible community colleges that have established a 
        program described in subsection (a)(1) for the purpose 
        of maintaining the program and recruiting students for 
        the program.
          (2) Requirements.--Grants may only be made under this 
        section to a community college which--
                  (A) is accredited;
                  (B) has a relationship with a hospital 
                facility, Service facility, or hospital that 
                could provide training of nurses or health 
                professionals;
                  (C) has entered into an agreement with an 
                accredited college or university medical 
                school, the terms of which--
                          (i) provide a program that enhances 
                        the transition and recruitment of 
                        students into advanced baccalaureate or 
                        graduate programs that train health 
                        professionals; and
                          (ii) stipulate certifications 
                        necessary to approve internship and 
                        field placement opportunities at Indian 
                        Health Programs;
                  (D) has a qualified staff which has the 
                appropriate certifications;
                  (E) is capable of obtaining State or regional 
                accreditation of the program described in 
                subsection (a)(1); and
                  (F) agrees to provide for Indian preference 
                for applicants for programs under this section.
  (c) Technical Assistance.--The Secretary shall encourage 
community colleges described in subsection (b)(2) to establish 
and maintain programs described in subsection (a)(1) by--
          (1) entering into agreements with such colleges for 
        the provision of qualified personnel of the Service to 
        teach courses of study in such programs; and
          (2) providing technical assistance and support to 
        such colleges.
  (d) Advanced Training.--
          (1) Required.--Any program receiving assistance under 
        this section that is conducted with respect to a health 
        profession shall also offer courses of study which 
        provide advanced training for any health professional 
        who--
                  (A) has already received a degree or diploma 
                in such health profession; and
                  (B) provides clinical services on or near a 
                reservation or for an Indian Health Program.
          (2) May be offered at alternate site.--Such courses 
        of study may be offered in conjunction with the college 
        or university with which the community college has 
        entered into the agreement required under subsection 
        (b)(2)(C).
  (e) Priority.--Where the requirements of subsection (b) are 
met, grant award priority shall be provided to tribal colleges 
and universities in Service Areas where they exist.

SEC. 119. RETENTION BONUS.

  (a) Bonus Authorized.--The Secretary may pay a retention 
bonus to any health professional employed by, or assigned to, 
and serving in, an Indian Health Program or Urban Indian 
Organization either as a civilian employee or as a commissioned 
officer in the Regular or Reserve Corps of the Public Health 
Service who--
          (1) is assigned to, and serving in, a position for 
        which recruitment or retention of personnel is 
        difficult;
          (2) the Secretary determines is needed by Indian 
        Health Programs and Urban Indian Organizations;
          (3) has--
                  (A) completed 2 years of employment with an 
                Indian Health Program or Urban Indian 
                Organization; or
                  (B) completed any service obligations 
                incurred as a requirement of--
                          (i) any Federal scholarship program; 
                        or
                          (ii) any Federal education loan 
                        repayment program; and
          (4) enters into an agreement with an Indian Health 
        Program or Urban Indian Organization for continued 
        employment for a period of not less than 1 year.
  (b) Rates.--The Secretary may establish rates for the 
retention bonus which shall provide for a higher annual rate 
for multiyear agreements than for single year agreements 
referred to in subsection (a)(4), but in no event shall the 
annual rate be more than $25,000 per annum.
  (c) Default of Retention Agreement.--Any health professional 
failing to complete the agreed upon term of service, except 
where such failure is through no fault of the individual, shall 
be obligated to refund to the Government the full amount of the 
retention bonus for the period covered by the agreement, plus 
interest as determined by the Secretary in accordance with 
section 110(l)(2)(B).
  (d) Other Retention Bonus.--The Secretary may pay a retention 
bonus to any health professional employed by a Tribal Health 
Program if such health professional is serving in a position 
which the Secretary determines is--
          (1) a position for which recruitment or retention is 
        difficult; and
          (2) necessary for providing health care services to 
        Indians.

SEC. 120. NURSING RESIDENCY PROGRAM.

  (a) Establishment of Program.--The Secretary, acting through 
the Service, shall establish a program to enable Indians who 
are licensed practical nurses, licensed vocational nurses, and 
registered nurses who are working in an Indian Health Program 
or Urban Indian Organization, and have done so for a period of 
not less than 1 year, to pursue advanced training. Such program 
shall include a combination of education and work study in an 
Indian Health Program or Urban Indian Organization leading to 
an associate or bachelor's degree (in the case of a licensed 
practical nurse or licensed vocational nurse), a bachelor's 
degree (in the case of a registered nurse), or advanced degrees 
or certifications in nursing and public health.
  (b) Service Obligation.--An individual who participates in a 
program under subsection (a), where the educational costs are 
paid by the Service, shall incur an obligation to serve in an 
Indian Health Program or Urban Indian Organization for a period 
of obligated service equal to 1 year for every year that 
nonprofessional employee (licensed practical nurses, licensed 
vocational nurses, nursing assistants, and various health care 
technicals), or 2 years for every year that professional nurse 
(associate degree and bachelor-prepared registered nurses), 
participates in such program. In the event that the individual 
fails to complete such obligated service, the United States 
shall be entitled to recover from such individual an amount 
determined in accordance with the formula specified in 
subsection (l) of section 110 in the manner provided for in 
such subsection.

SEC. 121. COMMUNITY HEALTH AIDE PROGRAM.

  (a) General Purposes of Program.--Under the authority of the 
Act of November 2, 1921 (25 U.S.C. 13) (commonly known as the 
``Snyder Act''), the Secretary, acting through the Service, 
shall develop and operate a Community Health Aide Program in 
Alaska under which the Service--
          (1) provides for the training of Alaska Natives as 
        health aides or community health practitioners;
          (2) uses such aides or practitioners in the provision 
        of health care, health promotion, and disease 
        prevention services to Alaska Natives living in 
        villages in rural Alaska; and
          (3) provides for the establishment of 
        teleconferencing capacity in health clinics located in 
        or near such villages for use by community health aides 
        or community health practitioners.
  (b) Specific Program Requirements.--The Secretary, acting 
through the Community Health Aide Program of the Service, 
shall--
          (1) using trainers accredited by the Program, provide 
        a high standard of training to community health aides 
        and community health practitioners to ensure that such 
        aides and practitioners provide quality health care, 
        health promotion, and disease prevention services to 
        the villages served by the Program;
          (2) in order to provide such training, develop a 
        curriculum that--
                  (A) combines education in the theory of 
                health care with supervised practical 
                experience in the provision of health care;
                  (B) provides instruction and practical 
                experience in the provision of acute care, 
                emergency care, health promotion, disease 
                prevention, and the efficient and effective 
                management of clinic pharmacies, supplies, 
                equipment, and facilities; and
                  (C) promotes the achievement of the health 
                status objectives specified in section 3(2);
          (3) establish and maintain a Community Health Aide 
        Certification Board to certify as community health 
        aides or community health practitioners individuals who 
        have successfully completed the training described in 
        paragraph (1) or can demonstrate equivalent experience;
          (4) develop and maintain a system which identifies 
        the needs of community health aides and community 
        health practitioners for continuing education in the 
        provision of health care, including the areas described 
        in paragraph (2)(B), and develop programs that meet the 
        needs for such continuing education;
          (5) develop and maintain a system that provides close 
        supervision of community health aides and community 
        health practitioners;
          (6) develop a system under which the work of 
        community health aides and community health 
        practitioners is reviewed and evaluated to assure the 
        provision of quality health care, health promotion, and 
        disease prevention services; and
          (7) ensure that pulpal therapy (not including 
        pulpotomies on deciduous teeth) or extraction of adult 
        teeth can be performed by a dental health aide 
        therapist only after consultation with a licensed 
        dentist who determines that the procedure is a medical 
        emergency that cannot be resolved with palliative 
        treatment, and further that dental health aide 
        therapists are strictly prohibited from performing all 
        other oral or jaw surgeries, provided that 
        uncomplicated extractions shall not be considered oral 
        surgery under this section.
  (c) Program Review.--
          (1) Neutral panel.--
                  (A) Establishment.--The Secretary, acting 
                through the Service, shall establish a neutral 
                panel to carry out the study under paragraph 
                (2).
                  (B) Membership.--Members of the neutral panel 
                shall be appointed by the Secretary from among 
                clinicians, economists, community 
                practitioners, oral epidemiologists, and Alaska 
                Natives.
          (2) Study.--
                  (A) In general.--The neutral panel 
                established under paragraph (1) shall conduct a 
                study of the dental health aide therapist 
                services provided by the Community Health Aide 
                Program under this section to ensure that the 
                quality of care provided through those services 
                is adequate and appropriate.
                  (B) Parameters of study.--The Secretary, in 
                consultation with interested parties, including 
                professional dental organizations, shall 
                develop the parameters of the study.
                  (C) Inclusions.--The study shall include a 
                determination by the neutral panel with respect 
                to--
                          (i) the ability of the dental health 
                        aide therapist services under this 
                        section to address the dental care 
                        needs of Alaska Natives;
                          (ii) the quality of care provided 
                        through those services, including any 
                        training, improvement, or additional 
                        oversight required to improve the 
                        quality of care; and
                          (iii) whether safer and less costly 
                        alternatives to the dental health aide 
                        therapist services exist.
                  (D) Consultation.--In carrying out the study 
                under this paragraph, the neutral panel shall 
                consult with Alaska Tribal Organizations with 
                respect to the adequacy and accuracy of the 
                study.
          (3) Report.--The neutral panel shall submit to the 
        Secretary, the Committee on Indian Affairs of the 
        Senate, and the Committee on Natural Resources of the 
        House of Representatives a report describing the 
        results of the study under paragraph (2), including a 
        description of--
                  (A) any determination of the neutral panel 
                under paragraph (2)(C); and
                  (B) any comments received from an Alaska 
                Tribal Organization under paragraph (2)(D).
  (d) Nationalization of Program.--
          (1) In general.--Except as provided in paragraph (2), 
        the Secretary, acting through the Service, may 
        establish a national Community Health Aide Program in 
        accordance with the program under this section, as the 
        Secretary determines to be appropriate.
          (2) Exception.--The national Community Health Aide 
        Program under paragraph (1) shall not include dental 
        health aide therapist services.
          (3) Requirement.--In establishing a national program 
        under paragraph (1), the Secretary shall not reduce the 
        amount of funds provided for the Community Health Aide 
        Program described in subsections (a) and (b).

SEC. 122. TRIBAL HEALTH PROGRAM ADMINISTRATION.

  The Secretary, acting through the Service, shall, by contract 
or otherwise, provide training for Indians in the 
administration and planning of Tribal Health Programs.

SEC. 123. HEALTH PROFESSIONAL CHRONIC SHORTAGE DEMONSTRATION PROGRAMS.

  (a) Demonstration Programs Authorized.--The Secretary, acting 
through the Service, may fund demonstration programs for Tribal 
Health Programs to address the chronic shortages of health 
professionals.
  (b) Purposes of Programs.--The purposes of demonstration 
programs funded under subsection (a) shall be--
          (1) to provide direct clinical and practical 
        experience at a Service Unit to health profession 
        students and residents from medical schools;
          (2) to improve the quality of health care for Indians 
        by assuring access to qualified health care 
        professionals; and
          (3) to provide academic and scholarly opportunities 
        for health professionals serving Indians by identifying 
        all academic and scholarly resources of the region.
  (c) Advisory Board.--The demonstration programs established 
pursuant to subsection (a) shall incorporate a program advisory 
board composed of representatives from the Indian Tribes and 
Indian communities in the area which will be served by the 
program.

SEC. 124. NATIONAL HEALTH SERVICE CORPS.

  (a) No Reduction in Services.--The Secretary shall not--
          (1) remove a member of the National Health Service 
        Corps from an Indian Health Program or Urban Indian 
        Organization; or
          (2) withdraw funding used to support such member, 
        unless the Secretary, acting through the Service, has 
        ensured that the Indians receiving services from such 
        member will experience no reduction in services.
  (b) Exemption From Limitations.--National Health Service 
Corps scholars qualifying for the Commissioned Corps in the 
Public Health Service shall be exempt from the full-time 
equivalent limitations of the National Health Service Corps and 
the Service when serving as a commissioned corps officer in a 
Tribal Health Program or an Urban Indian Organization.

SEC. 125. SUBSTANCE ABUSE COUNSELOR EDUCATIONAL CURRICULA DEMONSTRATION 
                    PROGRAMS.

  (a) Contracts and Grants.--The Secretary, acting through the 
Service, may enter into contracts with, or make grants to, 
accredited tribal colleges and universities and eligible 
accredited and accessible community colleges to establish 
demonstration programs to develop educational curricula for 
substance abuse counseling.
  (b) Use of Funds.--Funds provided under this section shall be 
used only for developing and providing educational curriculum 
for substance abuse counseling (including paying salaries for 
instructors). Such curricula may be provided through satellite 
campus programs.
  (c) Time Period of Assistance; Renewal.--A contract entered 
into or a grant provided under this section shall be for a 
period of 3 years. Such contract or grant may be renewed for an 
additional 2-year period upon the approval of the Secretary.
  (d) Criteria for Review and Approval of Applications.--Not 
later than 180 days after the date of enactment of the Indian 
Health Care Improvement Act Amendments of 2007, the Secretary, 
after consultation with Indian Tribes and administrators of 
tribal colleges and universities and eligible accredited and 
accessible community colleges, shall develop and issue criteria 
for the review and approval of applications for funding 
(including applications for renewals of funding) under this 
section. Such criteria shall ensure that demonstration programs 
established under this section promote the development of the 
capacity of such entities to educate substance abuse 
counselors.
  (e) Assistance.--The Secretary shall provide such technical 
and other assistance as may be necessary to enable grant 
recipients to comply with the provisions of this section.
  (f) Report.--Each fiscal year, the Secretary shall submit to 
the President, for inclusion in the report which is required to 
be submitted under section 801 for that fiscal year, a report 
on the findings and conclusions derived from the demonstration 
programs conducted under this section during that fiscal year.
  (g) Definition.--For the purposes of this section, the term 
``educational curriculum'' means 1 or more of the following:
          (1) Classroom education.
          (2) Clinical work experience.
          (3) Continuing education workshops.

SEC. 126. BEHAVIORAL HEALTH TRAINING AND COMMUNITY EDUCATION PROGRAMS.

  (a) Study; List.--The Secretary, acting through the Service, 
and the Secretary of the Interior, in consultation with Indian 
Tribes and Tribal Organizations, shall conduct a study and 
compile a list of the types of staff positions specified in 
subsection (b) whose qualifications include, or should include, 
training in the identification, prevention, education, 
referral, or treatment of mental illness, or dysfunctional and 
self destructive behavior.
  (b) Positions.--The positions referred to in subsection (a) 
are--
          (1) staff positions within the Bureau of Indian 
        Affairs, including existing positions, in the fields 
        of--
                  (A) elementary and secondary education;
                  (B) social services and family and child 
                welfare;
                  (C) law enforcement and judicial services; 
                and
                  (D) alcohol and substance abuse;
          (2) staff positions within the Service; and
          (3) staff positions similar to those identified in 
        paragraphs (1) and (2) established and maintained by 
        Indian Tribes, Tribal Organizations (without regard to 
        the funding source), and Urban Indian Organizations.
  (c) Training Criteria.--
          (1) In general.--The appropriate Secretary shall 
        provide training criteria appropriate to each type of 
        position identified in subsection (b)(1) and (b)(2) and 
        ensure that appropriate training has been, or shall be 
        provided to any individual in any such position. With 
        respect to any such individual in a position identified 
        pursuant to subsection (b)(3), the respective 
        Secretaries shall provide appropriate training to, or 
        provide funds to, an Indian Tribe, Tribal Organization, 
        or Urban Indian Organization for training of 
        appropriate individuals. In the case of positions 
        funded under a contract or compact under the Indian 
        Self-Determination and Education Assistance Act (25 
        U.S.C. 450 et seq.), the appropriate Secretary shall 
        ensure that such training costs are included in the 
        contract or compact, as the Secretary determines 
        necessary.
          (2) Position specific training criteria.--Position 
        specific training criteria shall be culturally relevant 
        to Indians and Indian Tribes and shall ensure that 
        appropriate information regarding traditional health 
        care practices is provided.
  (d) Community Education on Mental Illness.--The Service shall 
develop and implement, on request of an Indian Tribe, Tribal 
Organization, or Urban Indian Organization, or assist the 
Indian Tribe, Tribal Organization, or Urban Indian Organization 
to develop and implement, a program of community education on 
mental illness. In carrying out this subsection, the Service 
shall, upon request of an Indian Tribe, Tribal Organization, or 
Urban Indian Organization, provide technical assistance to the 
Indian Tribe, Tribal Organization, or Urban Indian Organization 
to obtain and develop community educational materials on the 
identification, prevention, referral, and treatment of mental 
illness and dysfunctional and self-destructive behavior.
  (e) Plan.--Not later than 90 days after the date of enactment 
of the Indian Health Care Improvement Act Amendments of 2007, 
the Secretary shall develop a plan under which the Service will 
increase the health care staff providing behavioral health 
services by at least 500 positions within 5 years after the 
date of enactment of this section, with at least 200 of such 
positions devoted to child, adolescent, and family services. 
The plan developed under this subsection shall be implemented 
under the Act of November 2, 1921 (25 U.S.C. 13) (commonly 
known as the ``Snyder Act'').

SEC. 127. AUTHORIZATION OF APPROPRIATIONS.

  There are authorized to be appropriated such sums as may be 
necessary for each fiscal year through fiscal year 2017 to 
carry out this title.

                       TITLE II--HEALTH SERVICES

SEC. 201. INDIAN HEALTH CARE IMPROVEMENT FUND.

  (a) Use of Funds.--The Secretary, acting through the Service, 
is authorized to expend funds, directly or under the authority 
of the Indian Self-Determination and Education Assistance Act 
(25 U.S.C. 450 et seq.), which are appropriated under the 
authority of this section, for the purposes of--
          (1) eliminating the deficiencies in health status and 
        health resources of all Indian Tribes;
          (2) eliminating backlogs in the provision of health 
        care services to Indians;
          (3) meeting the health needs of Indians in an 
        efficient and equitable manner, including the use of 
        telehealth and telemedicine when appropriate;
          (4) eliminating inequities in funding for both direct 
        care and contract health service programs; and
          (5) augmenting the ability of the Service to meet the 
        following health service responsibilities with respect 
        to those Indian Tribes with the highest levels of 
        health status deficiencies and resource deficiencies:
                  (A) Clinical care, including inpatient care, 
                outpatient care (including audiology, clinical 
                eye, and vision care), primary care, secondary 
                and tertiary care, and long-term care.
                  (B) Preventive health, including mammography 
                and other cancer screening in accordance with 
                section 207.
                  (C) Dental care.
                  (D) Mental health, including community mental 
                health services, inpatient mental health 
                services, dormitory mental health services, 
                therapeutic and residential treatment centers, 
                and training of traditional health care 
                practitioners.
                  (E) Emergency medical services.
                  (F) Treatment and control of, and 
                rehabilitative care related to, alcoholism and 
                drug abuse (including fetal alcohol syndrome) 
                among Indians.
                  (G) Injury prevention programs, including 
                data collection and evaluation, demonstration 
                projects, training, and capacity building.
                  (H) Home health care.
                  (I) Community health representatives.
                  (J) Maintenance and improvement.
  (b) No Offset or Limitation.--Any funds appropriated under 
the authority of this section shall not be used to offset or 
limit any other appropriations made to the Service under this 
Act or the Act of November 2, 1921 (25 U.S.C. 13) (commonly 
known as the ``Snyder Act''), or any other provision of law.
  (c) Allocation; Use.--
          (1) In general.--Funds appropriated under the 
        authority of this section shall be allocated to Service 
        Units, Indian Tribes, or Tribal Organizations. The 
        funds allocated to each Indian Tribe, Tribal 
        Organization, or Service Unit under this paragraph 
        shall be used by the Indian Tribe, Tribal Organization, 
        or Service Unit under this paragraph to improve the 
        health status and reduce the resource deficiency of 
        each Indian Tribe served by such Service Unit, Indian 
        Tribe, or Tribal Organization.
          (2) Apportionment of allocated funds.--The 
        apportionment of funds allocated to a Service Unit, 
        Indian Tribe, or Tribal Organization under paragraph 
        (1) among the health service responsibilities described 
        in subsection (a)(5) shall be determined by the Service 
        in consultation with, and with the active participation 
        of, the affected Indian Tribes and Tribal 
        Organizations.
  (d) Provisions Relating to Health Status and Resource 
Deficiencies.--For the purposes of this section, the following 
definitions apply:
          (1) Definition.--The term ``health status and 
        resource deficiency'' means the extent to which--
                  (A) the health status objectives set forth in 
                section 3(2) are not being achieved; and
                  (B) the Indian Tribe or Tribal Organization 
                does not have available to it the health 
                resources it needs, taking into account the 
                actual cost of providing health care services 
                given local geographic, climatic, rural, or 
                other circumstances.
          (2) Available resources.--The health resources 
        available to an Indian Tribe or Tribal Organization 
        include health resources provided by the Service as 
        well as health resources used by the Indian Tribe or 
        Tribal Organization, including services and financing 
        systems provided by any Federal programs, private 
        insurance, and programs of State or local governments.
          (3) Process for review of determinations.--The 
        Secretary shall establish procedures which allow any 
        Indian Tribe or Tribal Organization to petition the 
        Secretary for a review of any determination of the 
        extent of the health status and resource deficiency of 
        such Indian Tribe or Tribal Organization.
  (e) Eligibility for Funds.--Tribal Health Programs shall be 
eligible for funds appropriated under the authority of this 
section on an equal basis with programs that are administered 
directly by the Service.
  (f) Report.--By no later than the date that is 3 years after 
the date of enactment of the Indian Health Care Improvement Act 
Amendments of 2007, the Secretary shall submit to Congress the 
current health status and resource deficiency report of the 
Service for each Service Unit, including newly recognized or 
acknowledged Indian Tribes. Such report shall set out--
          (1) the methodology then in use by the Service for 
        determining Tribal health status and resource 
        deficiencies, as well as the most recent application of 
        that methodology;
          (2) the extent of the health status and resource 
        deficiency of each Indian Tribe served by the Service 
        or a Tribal Health Program;
          (3) the amount of funds necessary to eliminate the 
        health status and resource deficiencies of all Indian 
        Tribes served by the Service or a Tribal Health 
        Program; and
          (4) an estimate of--
                  (A) the amount of health service funds 
                appropriated under the authority of this Act, 
                or any other Act, including the amount of any 
                funds transferred to the Service for the 
                preceding fiscal year which is allocated to 
                each Service Unit, Indian Tribe, or Tribal 
                Organization;
                  (B) the number of Indians eligible for health 
                services in each Service Unit or Indian Tribe 
                or Tribal Organization; and
                  (C) the number of Indians using the Service 
                resources made available to each Service Unit, 
                Indian Tribe or Tribal Organization, and, to 
                the extent available, information on the 
                waiting lists and number of Indians turned away 
                for services due to lack of resources.
  (g) Inclusion in Base Budget.--Funds appropriated under this 
section for any fiscal year shall be included in the base 
budget of the Service for the purpose of determining 
appropriations under this section in subsequent fiscal years.
  (h) Clarification.--Nothing in this section is intended to 
diminish the primary responsibility of the Service to eliminate 
existing backlogs in unmet health care needs, nor are the 
provisions of this section intended to discourage the Service 
from undertaking additional efforts to achieve equity among 
Indian Tribes and Tribal Organizations.
  (i) Funding Designation.--Any funds appropriated under the 
authority of this section shall be designated as the ``Indian 
Health Care Improvement Fund''.

SEC. 202. CATASTROPHIC HEALTH EMERGENCY FUND.

  (a) Establishment.--There is established an Indian 
Catastrophic Health Emergency Fund (hereafter in this section 
referred to as the ``CHEF'') consisting of--
          (1) the amounts deposited under subsection (f); and
          (2) the amounts appropriated to CHEF under this 
        section.
  (b) Administration.--CHEF shall be administered by the 
Secretary, acting through the headquarters 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.
  (c) Conditions on Use of Fund.--No part of CHEF or its 
administration shall be subject to contract or grant under any 
law, including the Indian Self-Determination and Education 
Assistance Act (25 U.S.C. 450 et seq.), nor shall CHEF funds be 
allocated, apportioned, or delegated on an Area Office, Service 
Unit, or other similar basis.
  (d) Regulations.--The Secretary shall promulgate regulations 
consistent with the provisions of this section to--
          (1) establish a definition of disasters and 
        catastrophic illnesses for which the cost of the 
        treatment provided under contract would qualify for 
        payment from CHEF;
          (2) provide that a Service Unit shall not be eligible 
        for reimbursement for the cost of treatment from CHEF 
        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) the 2000 level of $19,000; and
                  (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 that exceeds such threshold 
        cost incurred by--
                  (A) Service Units; or
                  (B) whenever otherwise authorized by the 
                Service, non-Service facilities or providers;
          (4) establish a procedure for payment from CHEF 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 CHEF 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.
  (e) No Offset or Limitation.--Amounts appropriated to CHEF 
under this section shall not be used to offset or limit 
appropriations made to the Service under the authority of the 
Act of November 2, 1921 (25 U.S.C. 13) (commonly known as the 
``Snyder Act''), or any other law.
  (f) Deposit of Reimbursement Funds.--There shall be deposited 
into CHEF 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 CHEF.

SEC. 203. HEALTH PROMOTION AND DISEASE PREVENTION SERVICES.

  (a) Findings.--Congress finds that health promotion and 
disease prevention activities--
          (1) improve the health and well-being of Indians; and
          (2) reduce the expenses for health care of Indians.
  (b) Provision of Services.--The Secretary, acting through the 
Service and Tribal Health Programs, shall provide health 
promotion and disease prevention services to Indians to achieve 
the health status objectives set forth in section 3(2).
  (c) Evaluation.--The Secretary, after obtaining input from 
the affected Tribal Health Programs, shall submit to the 
President for inclusion in the report which is required to be 
submitted to Congress under section 801 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 and Tribal 
        Health Programs to meet such needs; and
          (4) the resources which would be required to enable 
        the Service and Tribal Health Programs to undertake the 
        health promotion and disease prevention activities 
        necessary to meet such needs.

SEC. 204. DIABETES PREVENTION, TREATMENT, AND CONTROL.

  (a) Determinations Regarding Diabetes.--The Secretary, acting 
through the Service, and in consultation with Indian Tribes and 
Tribal Organizations, shall determine--
          (1) by Indian Tribe and by Service Unit, the 
        incidence of, and the types of complications resulting 
        from, diabetes among Indians; and
          (2) based on the determinations made pursuant to 
        paragraph (1), the measures (including patient 
        education and effective ongoing monitoring of disease 
        indicators) each Service Unit should take to reduce the 
        incidence of, and prevent, treat, and control the 
        complications resulting from, diabetes among Indian 
        Tribes within that Service Unit.
  (b) Diabetes Screening.--To the extent medically indicated 
and with informed consent, 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 and establish a cost-effective approach to 
ensure ongoing monitoring of disease indicators. Such screening 
and monitoring may be conducted by a Tribal Health Program and 
may be conducted through appropriate Internet-based health care 
management programs.
  (c) Diabetes Projects.--The Secretary shall continue to 
maintain each model diabetes project in existence on the date 
of enactment of the Indian Health Care Improvement Act 
Amendments of 2007, any such other diabetes programs operated 
by the Service or Tribal Health Programs, and any additional 
diabetes projects, such as the Medical Vanguard program 
provided for in title IV of Public Law 108-87, as implemented 
to serve Indian Tribes. Tribal Health Programs shall receive 
recurring funding for the diabetes projects that they operate 
pursuant to this section, both at the date of enactment of the 
Indian Health Care Improvement Act Amendments of 2007 and for 
projects which are added and funded thereafter.
  (d) Dialysis Programs.--The Secretary is authorized to 
provide, through the Service, Indian Tribes, and Tribal 
Organizations, dialysis programs, including the purchase of 
dialysis equipment and the provision of necessary staffing.
  (e) Other Duties of the Secretary.--
          (1) In general.--The Secretary shall, to the extent 
        funding is available--
                  (A) in each Area Office, consult with Indian 
                Tribes and Tribal Organizations regarding 
                programs for the prevention, treatment, and 
                control of diabetes;
                  (B) establish in each Area Office a registry 
                of patients with diabetes to track the 
                incidence of diabetes and the complications 
                from diabetes in that area; and
                  (C) ensure that data collected in each Area 
                Office regarding diabetes and related 
                complications among Indians are disseminated to 
                all other Area Offices, subject to applicable 
                patient privacy laws.
          (2) Diabetes control officers.--
                  (A) In general.--The Secretary may establish 
                and maintain in each Area Office a position of 
                diabetes control officer to coordinate and 
                manage any activity of that Area Office 
                relating to the prevention, treatment, or 
                control of diabetes to assist the Secretary in 
                carrying out a program under this section or 
                section 330C of the Public Health Service Act 
                (42 U.S.C. 254c-3).
                  (B) Certain activities.--Any activity carried 
                out by a diabetes control officer under 
                subparagraph (A) that is the subject of a 
                contract or compact under the Indian Self-
                Determination and Education Assistance Act (25 
                U.S.C. 450 et seq.), and any funds made 
                available to carry out such an activity, shall 
                not be divisible for purposes of that Act.

SEC. 205. SHARED SERVICES FOR LONG-TERM CARE.

  (a) Long-Term Care.--Notwithstanding any other provision of 
law, the Secretary, acting through the Service, is authorized 
to provide directly, or enter into contracts or compacts under 
the Indian Self-Determination and Education Assistance Act (25 
U.S.C. 450 et seq.) with Indian Tribes or Tribal Organizations 
for, the delivery of long-term care (including health care 
services associated with long-term care) provided in a facility 
to Indians. Such agreements shall provide for the sharing of 
staff or other services between the Service or a Tribal Health 
Program and a long-term care or related facility owned and 
operated (directly or through a contract or compact under the 
Indian Self-Determination and Education Assistance Act (25 
U.S.C. 450 et seq.)) by such Indian Tribe or Tribal 
Organization.
  (b) Contents of Agreements.--An agreement entered into 
pursuant to subsection (a)--
          (1) may, at the request of the Indian Tribe or Tribal 
        Organization, delegate to such Indian Tribe or Tribal 
        Organization such powers of supervision and control 
        over Service employees as the Secretary deems necessary 
        to carry out the purposes of this section;
          (2) shall provide that expenses (including salaries) 
        relating to services that are shared between the 
        Service and the Tribal Health Program be allocated 
        proportionately between the Service and the Indian 
        Tribe or Tribal Organization; and
          (3) may authorize such Indian Tribe or Tribal 
        Organization to construct, renovate, or expand a long-
        term care or other similar facility (including the 
        construction of a facility attached to a Service 
        facility).
  (c) Minimum Requirement.--Any nursing facility provided for 
under this section shall meet the requirements for nursing 
facilities under section 1919 of the Social Security Act.
  (d) Other Assistance.--The Secretary shall provide such 
technical and other assistance as may be necessary to enable 
applicants to comply with the provisions of this section.
  (e) Use of Existing or Underused Facilities.--The Secretary 
shall encourage the use of existing facilities that are 
underused or allow the use of swing beds for long-term or 
similar care.

SEC. 206. HEALTH SERVICES RESEARCH.

  (a) In General.--The Secretary, acting through the Service, 
shall make funding available for research to further the 
performance of the health service responsibilities of Indian 
Health Programs.
  (b) Coordination of Resources and Activities.--The Secretary 
shall also, to the maximum extent practicable, coordinate 
departmental research resources and activities to address 
relevant Indian Health Program research needs.
  (c) Availability.--Tribal Health Programs shall be given an 
equal opportunity to compete for, and receive, research funds 
under this section.
  (d) Use of Funds.--This funding may be used for both clinical 
and nonclinical research.
  (e) Evaluation and Dissemination.--The Secretary shall 
periodically--
          (1) evaluate the impact of research conducted under 
        this section; and
          (2) disseminate to Tribal Health Programs information 
        regarding that research as the Secretary determines to 
        be appropriate.

SEC. 207. MAMMOGRAPHY AND OTHER CANCER SCREENING.

  The Secretary, acting through the Service or Tribal Health 
Programs, shall provide for screening as follows:
          (1) Screening mammography (as defined in section 
        1861(jj) of the Social Security Act) for Indian women 
        at a frequency appropriate to such women under accepted 
        and appropriate national standards, and under such 
        terms and conditions as are consistent with standards 
        established by the Secretary to ensure the safety and 
        accuracy of screening mammography under part B of title 
        XVIII of such Act.
          (2) Other cancer screening that receives an A or B 
        rating as recommended by the United States Preventive 
        Services Task Force established under section 915(a)(1) 
        of the Public Health Service Act (42 U.S.C. 299b-
        4(a)(1)). The Secretary shall ensure that screening 
        provided for under this paragraph complies with the 
        recommendations of the Task Force with respect to--
                  (A) frequency;
                  (B) the population to be served;
                  (C) the procedure or technology to be used;
                  (D) evidence of effectiveness; and
                  (E) other matters that the Secretary 
                determines appropriate.

SEC. 208. PATIENT TRAVEL COSTS.

  (a) Definition of Qualified Escort.--In this section, the 
term ``qualified escort'' means--
          (1) an adult escort (including a parent, guardian, or 
        other family member) who is required because of the 
        physical or mental condition, or age, of the applicable 
        patient;
          (2) a health professional for the purpose of 
        providing necessary medical care during travel by the 
        applicable patient; or
          (3) other escorts, as the Secretary or applicable 
        Indian Health Program determines to be appropriate.
  (b) Provision of Funds.--The Secretary, acting through the 
Service and Tribal Health Programs, is authorized to provide 
funds for the following patient travel costs, including 
qualified escorts, associated with receiving health care 
services provided (either through direct or contract care or 
through a contract or compact under the Indian Self-
Determination and Education Assistance Act (25 U.S.C. 450 et 
seq.)) under this Act--
          (1) emergency air transportation and non-emergency 
        air transportation where ground transportation is 
        infeasible;
          (2) transportation by private vehicle (where no other 
        means of transportation is available), specially 
        equipped vehicle, and ambulance; and
          (3) transportation by such other means as may be 
        available and required when air or motor vehicle 
        transportation is not available.

SEC. 209. EPIDEMIOLOGY CENTERS.

  (a) Establishment of Centers.--The Secretary shall establish 
an epidemiology center in each Service Area to carry out the 
functions described in subsection (b). Any new center 
established after the date of the enactment of the Indian 
Health Care Improvement Act Amendments of 2007 may be operated 
under a grant authorized by subsection (d), but funding under 
such a grant shall not be divisible.
  (b) Functions of Centers.--In consultation with and upon the 
request of Indian Tribes, Tribal Organizations, and Urban 
Indian Organizations, each Service Area epidemiology center 
established under this subsection shall, with respect to such 
Service Area--
          (1) collect data relating to, and monitor progress 
        made toward meeting, each of the health status 
        objectives of the Service, the Indian Tribes, Tribal 
        Organizations, and Urban Indian Organizations in the 
        Service Area;
          (2) evaluate existing delivery systems, data systems, 
        and other systems that impact the improvement of Indian 
        health;
          (3) assist Indian Tribes, Tribal Organizations, and 
        Urban Indian Organizations in identifying their highest 
        priority health status objectives and the services 
        needed to achieve such objectives, based on 
        epidemiological data;
          (4) make recommendations for the targeting of 
        services needed by the populations served;
          (5) make recommendations to improve health care 
        delivery systems for Indians and Urban Indians;
          (6) provide requested technical assistance to Indian 
        Tribes, Tribal Organizations, and Urban Indian 
        Organizations in the development of local health 
        service priorities and incidence and prevalence rates 
        of disease and other illness in the community; and
          (7) provide disease surveillance and assist Indian 
        Tribes, Tribal Organizations, and Urban Indian 
        Organizations to promote public health.
  (c) Technical Assistance.--The Director of the Centers for 
Disease Control and Prevention shall provide technical 
assistance to the centers in carrying out the requirements of 
this subsection.
  (d) Grants for Studies.--
          (1) In general.--The Secretary may make grants to 
        Indian Tribes, Tribal Organizations, Urban Indian 
        Organizations, and eligible intertribal consortia to 
        conduct epidemiological studies of Indian communities.
          (2) Eligible intertribal consortia.--An intertribal 
        consortium is eligible to receive a grant under this 
        subsection if--
                  (A) the intertribal consortium is 
                incorporated for the primary purpose of 
                improving Indian health; and
                  (B) the intertribal consortium is 
                representative of the Indian Tribes or urban 
                Indian communities in which the intertribal 
                consortium is located.
          (3) Applications.--An application for a grant under 
        this subsection shall be submitted in such manner and 
        at such time as the Secretary shall prescribe.
          (4) Requirements.--An applicant for a grant under 
        this subsection shall--
                  (A) demonstrate the technical, 
                administrative, and financial expertise 
                necessary to carry out the functions described 
                in paragraph (5);
                  (B) consult and cooperate with providers of 
                related health and social services in order to 
                avoid duplication of existing services; and
                  (C) demonstrate cooperation from Indian 
                tribes or Urban Indian Organizations in the 
                area to be served.
          (5) Use of funds.--A grant awarded under paragraph 
        (1) may be used--
                  (A) to carry out the functions described in 
                subsection (b);
                  (B) to provide information to and consult 
                with tribal leaders, urban Indian community 
                leaders, and related health staff on health 
                care and health service management issues; and
                  (C) in collaboration with Indian Tribes, 
                Tribal Organizations, and urban Indian 
                communities, to provide the Service with 
                information regarding ways to improve the 
                health status of Indians.
  (e) Access to Information.--An epidemiology center operated 
by a grantee pursuant to a grant awarded under subsection (d) 
shall be treated as a public health authority for purposes of 
the Health Insurance Portability and Accountability Act of 1996 
(Public Law 104-191; 110 Stat. 2033), as such entities are 
defined in part 164.501 of title 45, Code of Federal 
Regulations (or a successor regulation). The Secretary shall 
grant such grantees access to and use of data, data sets, 
monitoring systems, delivery systems, and other protected 
health information in the possession of the Secretary.

SEC. 210. COMPREHENSIVE SCHOOL HEALTH EDUCATION PROGRAMS.

  (a) Funding for Development of Programs.--In addition to 
carrying out any other program for health promotion or disease 
prevention, the Secretary, acting through the Service, is 
authorized to award grants to Indian Tribes, Tribal 
Organizations, and Urban Indian Organizations to develop 
comprehensive school health education programs for children 
from pre-school through grade 12 in schools for the benefit of 
Indian and Urban Indian children.
  (b) Use of Grant Funds.--A grant awarded under this section 
may be used for purposes which may include, but are not limited 
to, the following:
          (1) Developing health education materials both for 
        regular school programs and afterschool programs.
          (2) Training teachers in comprehensive school health 
        education materials.
          (3) Integrating school-based, community-based, and 
        other public and private health promotion efforts.
          (4) Encouraging healthy, tobacco-free school 
        environments.
          (5) Coordinating school-based health programs with 
        existing services and programs available in the 
        community.
          (6) Developing school programs on nutrition 
        education, personal health, oral health, and fitness.
          (7) Developing behavioral health wellness programs.
          (8) Developing chronic disease prevention programs.
          (9) Developing substance abuse prevention programs.
          (10) Developing injury prevention and safety 
        education programs.
          (11) Developing activities for the prevention and 
        control of communicable diseases.
          (12) Developing community and environmental health 
        education programs that include traditional health care 
        practitioners.
          (13) Violence prevention.
          (14) Such other health issues as are appropriate.
  (c) Technical Assistance.--Upon request, the Secretary, 
acting through the Service, shall provide technical assistance 
to Indian Tribes, Tribal Organizations, and Urban Indian 
Organizations in the development of comprehensive health 
education plans and the dissemination of comprehensive health 
education materials and information on existing health programs 
and resources.
  (d) Criteria for Review and Approval of Applications.--The 
Secretary, acting through the Service, and in consultation with 
Indian Tribes, Tribal Organizations, and Urban Indian 
Organizations, shall establish criteria for the review and 
approval of applications for grants awarded under this section.
  (e) Development of Program for BIA-Funded Schools.--
          (1) In general.--The Secretary of the Interior, 
        acting through the Bureau of Indian Affairs and in 
        cooperation with the Secretary, acting through the 
        Service, and affected Indian Tribes and Tribal 
        Organizations, shall develop a comprehensive school 
        health education program for children from preschool 
        through grade 12 in schools for which support is 
        provided by the Bureau of Indian Affairs.
          (2) Requirements for programs.--Such programs shall 
        include--
                  (A) school programs on nutrition education, 
                personal health, oral health, and fitness;
                  (B) behavioral health wellness programs;
                  (C) chronic disease prevention programs;
                  (D) substance abuse prevention programs;
                  (E) injury prevention and safety education 
                programs; and
                  (F) activities for the prevention and control 
                of communicable diseases.
          (3) Duties of the secretary.--The Secretary of the 
        Interior shall--
                  (A) provide training to teachers in 
                comprehensive school health education 
                materials;
                  (B) ensure the integration and coordination 
                of school-based programs with existing services 
                and health programs available in the community; 
                and
                  (C) encourage healthy, tobacco-free school 
                environments.

SEC. 211. INDIAN YOUTH PROGRAM.

  (a) Program Authorized.--The Secretary, acting through the 
Service, is authorized to establish and administer a program to 
provide grants to Indian Tribes, Tribal Organizations, and 
Urban Indian Organizations for innovative mental and physical 
disease prevention and health promotion and treatment programs 
for Indian and Urban Indian preadolescent and adolescent 
youths.
  (b) Use of Funds.--
          (1) Allowable uses.--Funds made available under this 
        section may be used to--
                  (A) develop prevention and treatment programs 
                for Indian youth which promote mental and 
                physical health and incorporate cultural 
                values, community and family involvement, and 
                traditional health care practitioners; and
                  (B) develop and provide community training 
                and education.
          (2) Prohibited use.--Funds made available under this 
        section may not be used to provide services described 
        in section 707(c).
  (c) Duties of the Secretary.--The Secretary shall--
          (1) disseminate to Indian Tribes, Tribal 
        Organizations, and Urban Indian Organizations 
        information regarding models for the delivery of 
        comprehensive health care services to Indian and Urban 
        Indian adolescents;
          (2) encourage the implementation of such models; and
          (3) at the request of an Indian Tribe, Tribal 
        Organization, or Urban Indian Organization, provide 
        technical assistance in the implementation of such 
        models.
  (d) Criteria for Review and Approval of Applications.--The 
Secretary, in consultation with Indian Tribes, Tribal 
Organizations, and Urban Indian Organizations, shall establish 
criteria for the review and approval of applications or 
proposals under this section.

SEC. 212. PREVENTION, CONTROL, AND ELIMINATION OF COMMUNICABLE AND 
                    INFECTIOUS DISEASES.

  (a) Grants Authorized.--The Secretary, acting through the 
Service, and after consultation with the Centers for Disease 
Control and Prevention, may make grants available to Indian 
Tribes, Tribal Organizations, and Urban Indian Organizations 
for the following:
          (1) Projects for the prevention, control, and 
        elimination of communicable and infectious diseases, 
        including tuberculosis, hepatitis, HIV, respiratory 
        syncytial virus, hanta virus, sexually transmitted 
        diseases, and H. Pylori.
          (2) Public information and education programs for the 
        prevention, control, and elimination of communicable 
        and infectious diseases.
          (3) Education, training, and clinical skills 
        improvement activities in the prevention, control, and 
        elimination of communicable and infectious diseases for 
        health professionals, including allied health 
        professionals.
          (4) Demonstration projects for the screening, 
        treatment, and prevention of hepatitis C virus (HCV).
  (b) Application Required.--The Secretary may provide funding 
under subsection (a) only if an application or proposal for 
funding is submitted to the Secretary.
  (c) Coordination With Health Agencies.--Indian Tribes, Tribal 
Organizations, and Urban Indian Organizations receiving funding 
under this section are encouraged to coordinate their 
activities with the Centers for Disease Control and Prevention 
and State and local health agencies.
  (d) Technical Assistance; Report.--In carrying out this 
section, the Secretary--
          (1) may, at the request of an Indian Tribe, Tribal 
        Organization, or Urban Indian Organization, provide 
        technical assistance; and
          (2) shall prepare and submit a report to Congress 
        biennially on the use of funds under this section and 
        on the progress made toward the prevention, control, 
        and elimination of communicable and infectious diseases 
        among Indians and Urban Indians.

SEC. 213. AUTHORITY FOR PROVISION OF OTHER SERVICES.

  (a) Funding Authorized.--The Secretary, acting through the 
Service, Indian Tribes, and Tribal Organizations, may provide 
funding under this Act to meet the objectives set forth in 
section 3 through health care-related services and programs not 
otherwise described in this Act, including--
          (1) hospice care;
          (2) assisted living;
          (3) long-term care; and
          (4) home- and community-based services.
  (b) Terms and Conditions.--
          (1) In general.--Any service provided under this 
        section shall be in accordance with such terms and 
        conditions as are consistent with accepted and 
        appropriate standards relating to the service, 
        including any licensing term or condition under this 
        Act.
          (2) Standards.--
                  (A) In general.--The Secretary may establish, 
                by regulation, the standards for a service 
                provided under this section, provided that such 
                standards shall not be more stringent than the 
                standards required by the State in which the 
                service is provided.
                  (B) Use of state standards.--If the Secretary 
                does not, by regulation, establish standards 
                for a service provided under this section, the 
                standards required by the State in which the 
                service is or will be provided shall apply to 
                such service.
                  (C) Indian tribes.--If a service under this 
                section is provided by an Indian Tribe or 
                Tribal Organization pursuant to the Indian 
                Self-Determination and Education Assistance Act 
                (25 U.S.C. 450 et seq.), the verification by 
                the Secretary that the service meets any 
                standards required by the State in which the 
                service is or will be provided shall be 
                considered to meet the terms and conditions 
                required under this subsection.
          (3) Eligibility.--The following individuals shall be 
        eligible to receive long-term care under this section:
                  (A) Individuals who are unable to perform a 
                certain number of activities of daily living 
                without assistance.
                  (B) Individuals with a mental impairment, 
                such as dementia, Alzheimer's disease, or 
                another disabling mental illness, who may be 
                able to perform activities of daily living 
                under supervision.
                  (C) Such other individuals as an applicable 
                Indian Health Program determines to be 
                appropriate.
  (c) Definitions.--For the purposes of this section, the 
following definitions shall apply:
          (1) The term ``home- and community-based services'' 
        means 1 or more of the services specified in paragraphs 
        (1) through (9) of section 1929(a) of the Social 
        Security Act (42 U.S.C. 1396t(a)) (whether provided by 
        the Service or by an Indian Tribe or Tribal 
        Organization pursuant to the Indian Self-Determination 
        and Education Assistance Act (25 U.S.C. 450 et seq.)) 
        that are or will be provided in accordance with the 
        standards described in subsection (b).
          (2) The term ``hospice care'' means the items and 
        services specified in subparagraphs (A) through (H) of 
        section 1861(dd)(1) of the Social Security Act (42 
        U.S.C. 1395x(dd)(1)), and such other services which an 
        Indian Tribe or Tribal Organization determines are 
        necessary and appropriate to provide in furtherance of 
        this care.

SEC. 214. INDIAN WOMEN'S HEALTH CARE.

  The Secretary, acting through the Service and Indian Tribes, 
Tribal Organizations, and Urban Indian Organizations, shall 
monitor and improve the quality of health care for Indian women 
of all ages through the planning and delivery of programs 
administered by the Service, in order to improve and enhance 
the treatment models of care for Indian women.

SEC. 215. ENVIRONMENTAL AND NUCLEAR HEALTH HAZARDS.

  (a) Studies and Monitoring.--The Secretary and the Service 
shall conduct, in conjunction with other appropriate Federal 
agencies and in consultation with concerned Indian Tribes and 
Tribal Organizations, studies and ongoing monitoring programs 
to determine trends in the health hazards to Indian miners and 
to Indians on or near reservations and Indian communities as a 
result of environmental hazards which may result in chronic or 
life threatening health problems, such as nuclear resource 
development, petroleum contamination, and contamination of 
water source and of the food chain. Such studies shall 
include--
          (1) an evaluation of the nature and extent of health 
        problems caused by environmental hazards currently 
        exhibited among Indians and the causes of such health 
        problems;
          (2) an analysis of the potential effect of ongoing 
        and future environmental resource development on or 
        near reservations and Indian communities, including the 
        cumulative effect over time on health;
          (3) an evaluation of the types and nature of 
        activities, practices, and conditions causing or 
        affecting such health problems, including uranium 
        mining and milling, uranium mine tailing deposits, 
        nuclear power plant operation and construction, and 
        nuclear waste disposal; oil and gas production or 
        transportation on or near reservations or Indian 
        communities; and other development that could affect 
        the health of Indians and their water supply and food 
        chain;
          (4) a summary of any findings and recommendations 
        provided in Federal and State studies, reports, 
        investigations, and inspections during the 5 years 
        prior to the date of enactment of the Indian Health 
        Care Improvement Act Amendments of 2007 that directly 
        or indirectly relate to the activities, practices, and 
        conditions affecting the health or safety of such 
        Indians; and
          (5) the efforts that have been made by Federal and 
        State agencies and resource and economic development 
        companies to effectively carry out an education program 
        for such Indians regarding the health and safety 
        hazards of such development.
  (b) Health Care Plans.--Upon completion of such studies, the 
Secretary and the Service shall take into account the results 
of such studies and develop health care plans to address the 
health problems studied under subsection (a). The plans shall 
include--
          (1) methods for diagnosing and treating Indians 
        currently exhibiting such health problems;
          (2) preventive care and testing for Indians who may 
        be exposed to such health hazards, including the 
        monitoring of the health of individuals who have or may 
        have been exposed to excessive amounts of radiation or 
        affected by other activities that have had or could 
        have a serious impact upon the health of such 
        individuals; and
          (3) a program of education for Indians who, by reason 
        of their work or geographic proximity to such nuclear 
        or other development activities, may experience health 
        problems.
  (c) Submission of Report and Plan to Congress.--The Secretary 
and the Service shall submit to Congress the study prepared 
under subsection (a) no later than 18 months after the date of 
enactment of the Indian Health Care Improvement Act Amendments 
of 2007. The health care plan prepared under subsection (b) 
shall be submitted in a report no later than 1 year after the 
study prepared under subsection (a) is submitted to Congress. 
Such report shall include recommended activities for the 
implementation of the plan, as well as an evaluation of any 
activities previously undertaken by the Service to address such 
health problems.
  (d) Intergovernmental Task Force.--
          (1) Establishment; members.--There is established an 
        Intergovernmental Task Force to be composed of the 
        following individuals (or their designees):
                  (A) The Secretary of Energy.
                  (B) The Secretary of the Environmental 
                Protection Agency.
                  (C) The Director of the Bureau of Mines.
                  (D) The Assistant Secretary for Occupational 
                Safety and Health.
                  (E) The Secretary of the Interior.
                  (F) The Secretary of Health and Human 
                Services.
                  (G) The Director of the Indian Health 
                Service.
          (2) Duties.--The Task Force shall--
                  (A) identify existing and potential 
                operations related to nuclear resource 
                development or other environmental hazards that 
                affect or may affect the health of Indians on 
                or near a reservation or in an Indian 
                community; and
                  (B) enter into activities to correct existing 
                health hazards and ensure that current and 
                future health problems resulting from nuclear 
                resource or other development activities are 
                minimized or reduced.
          (3) Chairman; meetings.--The Secretary of Health and 
        Human Services shall be the Chairman of the Task Force. 
        The Task Force shall meet at least twice each year.
  (e) Health Services to Certain Employees.--In the case of any 
Indian who--
          (1) as a result of employment in or near a uranium 
        mine or mill or near any other environmental hazard, 
        suffers from a work-related illness or condition;
          (2) is eligible to receive diagnosis and treatment 
        services from an Indian Health Program; and
          (3) by reason of such Indian's employment, is 
        entitled to medical care at the expense of such mine or 
        mill operator or entity responsible for the 
        environmental hazard, the Indian Health Program shall, 
        at the request of such Indian, render appropriate 
        medical care to such Indian for such illness or 
        condition and may be reimbursed for any medical care so 
        rendered to which such Indian is entitled at the 
        expense of such operator or entity from such operator 
        or entity. Nothing in this subsection shall affect the 
        rights of such Indian to recover damages other than 
        such amounts paid to the Indian Health Program from the 
        employer for providing medical care for such illness or 
        condition.

SEC. 216. ARIZONA AS A CONTRACT HEALTH SERVICE DELIVERY AREA.

  (a) In General.--For fiscal years beginning with the fiscal 
year ending September 30, 1983, and ending with the fiscal year 
ending September 30, 2016, the State of Arizona shall be 
designated as a contract health service delivery area by the 
Service for the purpose of providing contract health care 
services to members of federally recognized Indian Tribes of 
Arizona.
  (b) Maintenance of Services.--The Service shall not curtail 
any health care services provided to Indians residing on 
reservations in the State of Arizona if such curtailment is due 
to the provision of contract services in such State pursuant to 
the designation of such State as a contract health service 
delivery area pursuant to subsection (a).

SEC. 217. NORTH DAKOTA AND SOUTH DAKOTA AS CONTRACT HEALTH SERVICE 
                    DELIVERY AREA.

  (a) In General.--Beginning in fiscal year 2003, the States of 
North Dakota and South Dakota shall be designated as a contract 
health service delivery area by the Service for the purpose of 
providing contract health care services to members of federally 
recognized Indian Tribes of North Dakota and South Dakota.
  (b) Limitation.--The Service shall not curtail any health 
care services provided to Indians residing on any reservation, 
or in any county that has a common boundary with any 
reservation, in the State of North Dakota or South Dakota if 
such curtailment is due to the provision of contract services 
in such States pursuant to the designation of such States as a 
contract health service delivery area pursuant to subsection 
(a).

SEC. 218. CALIFORNIA CONTRACT HEALTH SERVICES PROGRAM.

  (a) Funding Authorized.--The Secretary is authorized to fund 
a program using the California Rural Indian Health Board 
(hereafter in this section referred to as the ``CRIHB'') as a 
contract care intermediary to improve the accessibility of 
health services to California Indians.
  (b) Reimbursement Contract.--The Secretary shall enter into 
an agreement with the CRIHB to reimburse the CRIHB for costs 
(including reasonable administrative costs) incurred pursuant 
to this section, in providing medical treatment under contract 
to California Indians described in section 806(a) throughout 
the California contract health services delivery area described 
in section 218 with respect to high cost contract care cases.
  (c) Administrative Expenses.--Not more than 5 percent of the 
amounts provided to the CRIHB under this section for any fiscal 
year may be for reimbursement for administrative expenses 
incurred by the CRIHB during such fiscal year.
  (d) Limitation on Payment.--No payment may be made for 
treatment provided hereunder to the extent payment may be made 
for such treatment under the Indian Catastrophic Health 
Emergency Fund described in section 202 or from amounts 
appropriated or otherwise made available to the California 
contract health service delivery area for a fiscal year.
  (e) Advisory Board.--There is established an advisory board 
which shall advise the CRIHB in carrying out this section. The 
advisory board shall be composed of representatives, selected 
by the CRIHB, from not less than 8 Tribal Health Programs 
serving California Indians covered under this section at least 
\1/2\ of whom of whom are not affiliated with the CRIHB.

SEC. 219. CALIFORNIA AS A CONTRACT HEALTH SERVICE DELIVERY AREA.

  The State of California, excluding the counties of Alameda, 
Contra Costa, Los Angeles, Marin, Orange, Sacramento, San 
Francisco, San Mateo, Santa Clara, Kern, Merced, Monterey, 
Napa, San Benito, San Joaquin, San Luis Obispo, Santa Cruz, 
Solano, Stanislaus, and Ventura, shall be designated as a 
contract health service delivery area by the Service for the 
purpose of providing contract health services to California 
Indians. However, any of the counties listed herein may only be 
included in the contract health services delivery area if 
funding is specifically provided by the Service for such 
services in those counties.

SEC. 220. CONTRACT HEALTH SERVICES FOR THE TRENTON SERVICE AREA.

  (a) Authorization for Services.--The Secretary, acting 
through the Service, is directed to provide contract health 
services to members of the Turtle Mountain Band of Chippewa 
Indians that reside in the Trenton Service Area of Divide, 
McKenzie, and Williams counties in the State of North Dakota 
and the adjoining counties of Richland, Roosevelt, and Sheridan 
in the State of Montana.
  (b) No Expansion of Eligibility.--Nothing in this section may 
be construed as expanding the eligibility of members of the 
Turtle Mountain Band of Chippewa Indians for health services 
provided by the Service beyond the scope of eligibility for 
such health services that applied on May 1, 1986.

SEC. 221. PROGRAMS OPERATED BY INDIAN TRIBES AND TRIBAL ORGANIZATIONS.

  The Service shall provide funds for health care programs and 
facilities operated by Tribal Health Programs on the same basis 
as such funds are provided to programs and facilities operated 
directly by the Service.

SEC. 222. LICENSING.

  Health care professionals employed by a Tribal Health Program 
shall, if licensed in any State, be exempt from the licensing 
requirements of the State in which the Tribal Health Program 
performs the services described in its contract or compact 
under the Indian Self-Determination and Education Assistance 
Act (25 U.S.C. 450 et seq.).

SEC. 223. NOTIFICATION OF PROVISION OF EMERGENCY CONTRACT HEALTH 
                    SERVICES.

  With respect to an elderly Indian or an Indian with a 
disability receiving emergency medical care or services from a 
non-Service provider or in a non-Service facility under the 
authority of this Act, the time limitation (as a condition of 
payment) for notifying the Service of such treatment or 
admission shall be 30 days.

SEC. 224. PROMPT ACTION ON PAYMENT OF CLAIMS.

  (a) Deadline for Response.--The Service shall respond to a 
notification of a claim by a provider of a contract care 
service with either an individual purchase order or a denial of 
the claim within 5 working days after the receipt of such 
notification.
  (b) Effect of Untimely Response.--If the Service fails to 
respond to a notification of a claim in accordance with 
subsection (a), the Service shall accept as valid the claim 
submitted by the provider of a contract care service.
  (c) Deadline for Payment of Valid Claim.--The Service shall 
pay a valid contract care service claim within 30 days after 
the completion of the claim.

SEC. 225. LIABILITY FOR PAYMENT.

  (a) No Patient Liability.--A patient who receives contract 
health care services that are authorized by the Service shall 
not be liable for the payment of any charges or costs 
associated with the provision of such services.
  (b) Notification.--The Secretary shall notify a contract care 
provider and any patient who receives contract health care 
services authorized by the Service that such patient is not 
liable for the payment of any charges or costs associated with 
the provision of such services not later than 5 business days 
after receipt of a notification of a claim by a provider of 
contract care services.
  (c) No Recourse.--Following receipt of the notice provided 
under subsection (b), or, if a claim has been deemed accepted 
under section 223(b), the provider shall have no further 
recourse against the patient who received the services.

SEC. 226. OFFICE OF INDIAN MEN'S HEALTH.

  (a) Establishment.--The Secretary may establish within the 
Service an office to be known as the ``Office of Indian Men's 
Health'' (referred to in this section as the ``Office'').
  (b) Director.--
          (1) In general.--The Office shall be headed by a 
        director, to be appointed by the Secretary.
          (2) Duties.--The director shall coordinate and 
        promote the status of the health of Indian men in the 
        United States.
  (c) Report.--Not later than 2 years after the date of 
enactment of the Indian Health Care Improvement Act Amendments 
of 2007, the Secretary, acting through the director of the 
Office, shall submit to Congress a report describing--
          (1) any activity carried out by the director as of 
        the date on which the report is prepared; and
          (2) any finding of the director with respect to the 
        health of Indian men.

SEC. 227. AUTHORIZATION OF APPROPRIATIONS.

  There are authorized to be appropriated such sums as may be 
necessary for each fiscal year through fiscal year 2017 to 
carry out this title.

                         TITLE III--FACILITIES

SEC. 301. CONSULTATION; CONSTRUCTION AND RENOVATION OF FACILITIES; 
                    REPORTS.

  (a) Prerequisites for Expenditure of Funds.--Prior to the 
expenditure of, or the making of any binding commitment to 
expend, any funds appropriated for the planning, design, 
construction, or renovation of facilities pursuant to the Act 
of November 2, 1921 (25 U.S.C. 13) (commonly known as the 
``Snyder Act''), the Secretary, acting through the Service, 
shall--
          (1) consult with any Indian Tribe that would be 
        significantly affected by such expenditure for the 
        purpose of determining and, whenever practicable, 
        honoring tribal preferences concerning size, location, 
        type, and other characteristics of any facility on 
        which such expenditure is to be made; and
          (2) ensure, whenever practicable and applicable, that 
        such facility meets the construction standards of any 
        accrediting body recognized by the Secretary for the 
        purposes of the Medicare, Medicaid, and SCHIP programs 
        under titles XVIII, XIX, and XXI of the Social Security 
        Act by not later than 1 year after the date on which 
        the construction or renovation of such facility is 
        completed.
  (b) Closures.--
          (1) Evaluation required.--Notwithstanding any other 
        provision of law, no facility operated by the Service, 
        or any portion of such facility, may be closed if the 
        Secretary has not submitted to Congress, not less than 
        1 year and not more than 2 years before the date of the 
        proposed closure, an evaluation, completed not more 
        than 2 years before such submission, of the impact of 
        the proposed closure that specifies, in addition to 
        other considerations--
                  (A) the accessibility of alternative health 
                care resources for the population served by 
                such facility;
                  (B) the cost-effectiveness of such closure;
                  (C) the quality of health care to be provided 
                to the population served by such facility after 
                such closure;
                  (D) the availability of contract health care 
                funds to maintain existing levels of service;
                  (E) the views of the Indian Tribes served by 
                such facility concerning such closure;
                  (F) the level of use of such facility by all 
                eligible Indians; and
                  (G) the distance between such facility and 
                the nearest operating Service hospital.
          (2) Exception for certain temporary closures.--
        Paragraph (1) shall not apply to any temporary closure 
        of a facility or any portion of a facility if such 
        closure is necessary for medical, environmental, or 
        construction safety reasons.
  (c) Health Care Facility Priority System.--
          (1) In general.--
                  (A) Priority system.--The Secretary, acting 
                through the Service, shall maintain a health 
                care facility priority system, which--
                          (i) shall be developed in 
                        consultation with Indian Tribes and 
                        Tribal Organizations;
                          (ii) shall give Indian Tribes' needs 
                        the highest priority;
                          (iii)(I) may include the lists 
                        required in paragraph (2)(B)(ii); and
                          (II) shall include the methodology 
                        required in paragraph (2)(B)(v); and
                          (III) may include such other 
                        facilities, and such renovation or 
                        expansion needs of any health care 
                        facility, as the Service, Indian 
                        Tribes, and Tribal Organizations may 
                        identify; and
                          (iv) shall provide an opportunity for 
                        the nomination of planning, design, and 
                        construction projects by the Service, 
                        Indian Tribes, and Tribal Organizations 
                        for consideration under the priority 
                        system at least once every 3 years, or 
                        more frequently as the Secretary 
                        determines to be appropriate.
                  (B) Needs of facilities under isdeaa 
                agreements.--The Secretary shall ensure that 
                the planning, design, construction, renovation, 
                and expansion needs of Service and non-Service 
                facilities operated under contracts or compacts 
                in accordance with the Indian Self-
                Determination and Education Assistance Act (25 
                U.S.C. 450 et seq.) are fully and equitably 
                integrated into the health care facility 
                priority system.
                  (C) Criteria for evaluating needs.--For 
                purposes of this subsection, the Secretary, in 
                evaluating the needs of facilities operated 
                under a contract or compact under the Indian 
                Self-Determination and Education Assistance Act 
                (25 U.S.C. 450 et seq.), shall use the criteria 
                used by the Secretary in evaluating the needs 
                of facilities operated directly by the Service.
                  (D) Priority of certain projects protected.--
                The priority of any project established under 
                the construction priority system in effect on 
                the date of enactment of the Indian Health Care 
                Improvement Act Amendments of 2007 shall not be 
                affected by any change in the construction 
                priority system taking place after that date if 
                the project--
                          (i) was identified in the fiscal year 
                        2008 Service budget justification as--
                                  (I) 1 of the 10 top-priority 
                                inpatient projects;
                                  (II) 1 of the 10 top-priority 
                                outpatient projects;
                                  (III) 1 of the 10 top-
                                priority staff quarters 
                                developments; or
                                  (IV) 1 of the 10 top-priority 
                                Youth Regional Treatment 
                                Centers;
                          (ii) had completed both Phase I and 
                        Phase II of the construction priority 
                        system in effect on the date of 
                        enactment of such Act; or
                          (iii) is not included in clause (i) 
                        or (ii) and is selected, as determined 
                        by the Secretary--
                                  (I) on the initiative of the 
                                Secretary; or
                                  (II) pursuant to a request of 
                                an Indian Tribe or Tribal 
                                Organization.
          (2) Report; contents.--
                  (A) Initial comprehensive report.--
                          (i) Definitions.--In this 
                        subparagraph:
                                  (I) Facilities appropriation 
                                advisory board.--The term 
                                ``Facilities Appropriation 
                                Advisory Board'' means the 
                                advisory board, comprised of 12 
                                members representing Indian 
                                tribes and 2 members 
                                representing the Service, 
                                established at the discretion 
                                of the Assistant Secretary--
                                          (aa) to provide 
                                        advice and 
                                        recommendations for 
                                        policies and procedures 
                                        of the programs funded 
                                        pursuant to facilities 
                                        appropriations; and
                                          (bb) to address other 
                                        facilities issues.
                                  (II) Facilities needs 
                                assessment workgroup.--The term 
                                ``Facilities Needs Assessment 
                                Workgroup'' means the workgroup 
                                established at the discretion 
                                of the Assistant Secretary--
                                          (aa) to review the 
                                        health care facilities 
                                        construction priority 
                                        system; and
                                          (bb) to make 
                                        recommendations to the 
                                        Facilities 
                                        Appropriation Advisory 
                                        Board for revising the 
                                        priority system.
                          (ii) Initial report.--
                                  (I) In general.--Not later 
                                than 1 year after the date of 
                                enactment of the Indian Health 
                                Care Improvement Act Amendments 
                                of 2007, the Secretary shall 
                                submit to the Committee on 
                                Indian Affairs of the Senate 
                                and the Committee on Natural 
                                Resources of the House of 
                                Representatives a report that 
                                describes the comprehensive, 
                                national, ranked list of all 
                                health care facilities needs 
                                for the Service, Indian Tribes, 
                                and Tribal Organizations 
                                (including inpatient health 
                                care facilities, outpatient 
                                health care facilities, 
                                specialized health care 
                                facilities (such as for long-
                                term care and alcohol and drug 
                                abuse treatment), wellness 
                                centers, staff quarters and 
                                hostels associated with health 
                                care facilities, and the 
                                renovation and expansion needs, 
                                if any, of such facilities) 
                                developed by the Service, 
                                Indian Tribes, and Tribal 
                                Organizations for the 
                                Facilities Needs Assessment 
                                Workgroup and the Facilities 
                                Appropriation Advisory Board.
                                  (II) Inclusions.--The initial 
                                report shall include--
                                          (aa) the methodology 
                                        and criteria used by 
                                        the Service in 
                                        determining the needs 
                                        and establishing the 
                                        ranking of the 
                                        facilities needs; and
                                          (bb) such other 
                                        information as the 
                                        Secretary determines to 
                                        be appropriate.
                          (iii) Updates of report.--Beginning 
                        in calendar year 2011, the Secretary 
                        shall--
                                  (I) update the report under 
                                clause (ii) not less frequently 
                                that once every 5 years; and
                                  (II) include the updated 
                                report in the appropriate 
                                annual report under 
                                subparagraph (B) for submission 
                                to Congress under section 801.
                  (B) Annual reports.--The Secretary shall 
                submit to the President, for inclusion in the 
                report required to be transmitted to Congress 
                under section 801, a report which sets forth 
                the following:
                          (i) A description of the health care 
                        facility priority system of the Service 
                        established under paragraph (1).
                          (ii) Health care facilities lists, 
                        which may include--
                                  (I) the 10 top-priority 
                                inpatient health care 
                                facilities;
                                  (II) the 10 top-priority 
                                outpatient health care 
                                facilities;
                                  (III) the 10 top-priority 
                                specialized health care 
                                facilities (such as long-term 
                                care and alcohol and drug abuse 
                                treatment);
                                  (IV) the 10 top-priority 
                                staff quarters developments 
                                associated with health care 
                                facilities; and
                                  (V) the 10 top-priority 
                                hostels associated with health 
                                care facilities.
                          (iii) The justification for such 
                        order of priority.
                          (iv) The projected cost of such 
                        projects.
                          (v) The methodology adopted by the 
                        Service in establishing priorities 
                        under its health care facility priority 
                        system.
          (3) Requirements for preparation of reports.--In 
        preparing the report required under paragraph (2), the 
        Secretary shall--
                  (A) consult with and obtain information on 
                all health care facilities needs from Indian 
                Tribes, Tribal Organizations, and Urban Indian 
                Organizations; and
                  (B) review the total unmet needs of all 
                Indian Tribes, Tribal Organizations, and Urban 
                Indian Organizations for health care facilities 
                (including hostels and staff quarters), 
                including needs for renovation and expansion of 
                existing facilities.
  (d) Review of Methodology Used for Health Facilities 
Construction Priority System.--
          (1) In general.--Not later than 1 year after the 
        establishment of the priority system under subsection 
        (c)(1)(A), the Comptroller General of the United States 
        shall prepare and finalize a report reviewing the 
        methodologies applied, and the processes followed, by 
        the Service in making each assessment of needs for the 
        list under subsection (c)(2)(A)(ii) and developing the 
        priority system under subsection (c)(1), including a 
        review of--
                  (A) the recommendations of the Facilities 
                Appropriation Advisory Board and the Facilities 
                Needs Assessment Workgroup (as those terms are 
                defined in subsection (c)(2)(A)(i)); and
                  (B) the relevant criteria used in ranking or 
                prioritizing facilities other than hospitals or 
                clinics.
          (2) Submission to congress.--The Comptroller General 
        of the United States shall submit the report under 
        paragraph (1) to--
                  (A) the Committees on Indian Affairs and 
                Appropriations of the Senate;
                  (B) the Committees on Natural Resources and 
                Appropriations of the House of Representatives; 
                and
                  (C) the Secretary.
  (e) Funding Condition.--All funds appropriated under the Act 
of November 2, 1921 (25 U.S.C. 13) (commonly known as the 
``Snyder Act''), for the planning, design, construction, or 
renovation of health facilities for the benefit of 1 or more 
Indian Tribes shall be subject to the provisions of the Indian 
Self-Determination and Education Assistance Act (25 U.S.C. 450 
et seq.).
  (f) Development of Innovative Approaches.--The Secretary 
shall consult and cooperate with Indian Tribes, Tribal 
Organizations, and Urban Indian Organizations in developing 
innovative approaches to address all or part of the total unmet 
need for construction of health facilities, including those 
provided for in other sections of this title and other 
approaches.

SEC. 302. SANITATION FACILITIES.

  (a) Findings.--Congress finds the following:
          (1) The provision of sanitation facilities is 
        primarily a health consideration and function.
          (2) Indian people suffer an inordinately high 
        incidence of disease, injury, and illness directly 
        attributable to the absence or inadequacy of sanitation 
        facilities.
          (3) The long-term cost to the United States of 
        treating and curing such disease, injury, and illness 
        is substantially greater than the short-term cost of 
        providing sanitation facilities and other preventive 
        health measures.
          (4) Many Indian homes and Indian communities still 
        lack sanitation facilities.
          (5) It is in the interest of the United States, and 
        it is the policy of the United States, that all Indian 
        communities and Indian homes, new and existing, be 
        provided with sanitation facilities.
  (b) Facilities and Services.--In furtherance of the findings 
made in subsection (a), Congress reaffirms the primary 
responsibility and authority of the Service to provide the 
necessary sanitation facilities and services as provided in 
section 7 of the Act of August 5, 1954 (42 U.S.C. 2004a). Under 
such authority, the Secretary, acting through the Service, is 
authorized to provide the following:
          (1) Financial and technical assistance to Indian 
        Tribes, Tribal Organizations, and Indian communities in 
        the establishment, training, and equipping of utility 
        organizations to operate and maintain sanitation 
        facilities, including the provision of existing plans, 
        standard details, and specifications available in the 
        Department, to be used at the option of the Indian 
        Tribe, Tribal Organization, or Indian community.
          (2) Ongoing technical assistance and training to 
        Indian Tribes, Tribal Organizations, and Indian 
        communities in the management of utility organizations 
        which operate and maintain sanitation facilities.
          (3) Priority funding for operation and maintenance 
        assistance for, and emergency repairs to, sanitation 
        facilities operated by an Indian Tribe, Tribal 
        Organization or Indian community when necessary to 
        avoid an imminent health threat or to protect the 
        investment in sanitation facilities and the investment 
        in the health benefits gained through the provision of 
        sanitation facilities.
  (c) Funding.--Notwithstanding any other provision of law--
          (1) the Secretary of Housing and Urban Development is 
        authorized to transfer funds appropriated under the 
        Native American Housing Assistance and Self-
        Determination Act of 1996 (25 U.S.C. 4101 et seq.) to 
        the Secretary of Health and Human Services;
          (2) the Secretary of Health and Human Services is 
        authorized to accept and use such funds for the purpose 
        of providing sanitation facilities and services for 
        Indians under section 7 of the Act of August 5, 1954 
        (42 U.S.C. 2004a);
          (3) unless specifically authorized when funds are 
        appropriated, the Secretary shall not use funds 
        appropriated under section 7 of the Act of August 5, 
        1954 (42 U.S.C. 2004a), to provide sanitation 
        facilities to new homes constructed using funds 
        provided by the Department of Housing and Urban 
        Development;
          (4) the Secretary of Health and Human Services is 
        authorized to accept from any source, including Federal 
        and State agencies, funds for the purpose of providing 
        sanitation facilities and services and place these 
        funds into contracts or compacts under the Indian Self-
        Determination and Education Assistance Act (25 U.S.C. 
        450 et seq.);
          (5) except as otherwise prohibited by this section, 
        the Secretary may use funds appropriated under the 
        authority of section 7 of the Act of August 5, 1954 (42 
        U.S.C. 2004a), to fund up to 100 percent of the amount 
        of an Indian Tribe's loan obtained under any Federal 
        program for new projects to construct eligible 
        sanitation facilities to serve Indian homes;
          (6) except as otherwise prohibited by this section, 
        the Secretary may use funds appropriated under the 
        authority of section 7 of the Act of August 5, 1954 (42 
        U.S.C. 2004a) to meet matching or cost participation 
        requirements under other Federal and non-Federal 
        programs for new projects to construct eligible 
        sanitation facilities;
          (7) all Federal agencies are authorized to transfer 
        to the Secretary funds identified, granted, loaned, or 
        appropriated whereby the Department's applicable 
        policies, rules, and regulations shall apply in the 
        implementation of such projects;
          (8) the Secretary of Health and Human Services shall 
        enter into interagency agreements with Federal and 
        State agencies for the purpose of providing financial 
        assistance for sanitation facilities and services under 
        this Act;
          (9) the Secretary of Health and Human Services shall, 
        by regulation, establish standards applicable to the 
        planning, design, and construction of sanitation 
        facilities funded under this Act; and
          (10) the Secretary of Health and Human Services is 
        authorized to accept payments for goods and services 
        furnished by the Service from appropriate public 
        authorities, nonprofit organizations or agencies, or 
        Indian Tribes, as contributions by that authority, 
        organization, agency, or tribe to agreements made under 
        section 7 of the Act of August 5, 1954 (42 U.S.C. 
        2004a), and such payments shall be credited to the same 
        or subsequent appropriation account as funds 
        appropriated under the authority of section 7 of the 
        Act of August 5, 1954 (42 U.S.C. 2004a).
  (d) Certain Capabilities Not Prerequisite.--The financial and 
technical capability of an Indian Tribe, Tribal Organization, 
or Indian community to safely operate, manage, and maintain a 
sanitation facility shall not be a prerequisite to the 
provision or construction of sanitation facilities by the 
Secretary.
  (e) Financial Assistance.--The Secretary is authorized to 
provide financial assistance to Indian Tribes, Tribal 
Organizations, and Indian communities for operation, 
management, and maintenance of their sanitation facilities.
  (f) Operation, Management, and Maintenance of Facilities.--
The Indian Tribe has the primary responsibility to establish, 
collect, and use reasonable user fees, or otherwise set aside 
funding, for the purpose of operating, managing, and 
maintaining sanitation facilities. If a sanitation facility 
serving a community that is operated by an Indian Tribe or 
Tribal Organization is threatened with imminent failure and 
such operator lacks capacity to maintain the integrity or the 
health benefits of the sanitation facility, then the Secretary 
is authorized to assist the Indian Tribe, Tribal Organization, 
or Indian community in the resolution of the problem on a 
short-term basis through cooperation with the emergency 
coordinator or by providing operation, management, and 
maintenance service.
  (g) ISDEAA Program Funded on Equal Basis.--Tribal Health 
Programs shall be eligible (on an equal basis with programs 
that are administered directly by the Service) for--
          (1) any funds appropriated pursuant to this section; 
        and
          (2) any funds appropriated for the purpose of 
        providing sanitation facilities.
  (h) Report.--
          (1) Required; contents.--The Secretary, in 
        consultation with the Secretary of Housing and Urban 
        Development, Indian Tribes, Tribal Organizations, and 
        tribally designated housing entities (as defined in 
        section 4 of the Native American Housing Assistance and 
        Self-Determination Act of 1996 (25 U.S.C. 4103)) shall 
        submit to the President, for inclusion in the report 
        required to be transmitted to Congress under section 
        801, a report which sets forth--
                  (A) the current Indian sanitation facility 
                priority system of the Service;
                  (B) the methodology for determining 
                sanitation deficiencies and needs;
                  (C) the criteria on which the deficiencies 
                and needs will be evaluated;
                  (D) the level of initial and final sanitation 
                deficiency for each type of sanitation facility 
                for each project of each Indian Tribe or Indian 
                community;
                  (E) the amount and most effective use of 
                funds, derived from whatever source, necessary 
                to accommodate the sanitation facilities needs 
                of new homes assisted with funds under the 
                Native American Housing Assistance and Self-
                Determination Act (25 U.S.C. 4101 et seq.), and 
                to reduce the identified sanitation deficiency 
                levels of all Indian Tribes and Indian 
                communities to level I sanitation deficiency as 
                defined in paragraph (3)(A); and
                  (F) a 10-year plan to provide sanitation 
                facilities to serve existing Indian homes and 
                Indian communities and new and renovated Indian 
                homes.
          (2) Uniform methodology.--The methodology used by the 
        Secretary in determining, preparing cost estimates for, 
        and reporting sanitation deficiencies for purposes of 
        paragraph (1) shall be applied uniformly to all Indian 
        Tribes and Indian communities.
          (3) Sanitation deficiency levels.--For purposes of 
        this subsection, the sanitation deficiency levels for 
        an individual, Indian Tribe, or Indian community 
        sanitation facility to serve Indian homes are 
        determined as follows:
                  (A) A level I deficiency exists if a 
                sanitation facility serving an individual, 
                Indian Tribe, or Indian community--
                          (i) complies with all applicable 
                        water supply, pollution control, and 
                        solid waste disposal laws; and
                          (ii) deficiencies relate to routine 
                        replacement, repair, or maintenance 
                        needs.
                  (B) A level II deficiency exists if a 
                sanitation facility serving an individual, 
                Indian Tribe, or Indian community substantially 
                or recently complied with all applicable water 
                supply, pollution control, and solid waste laws 
                and any deficiencies relate to--
                          (i) small or minor capital 
                        improvements needed to bring the 
                        facility back into compliance;
                          (ii) capital improvements that are 
                        necessary to enlarge or improve the 
                        facilities in order to meet the current 
                        needs for domestic sanitation 
                        facilities; or
                          (iii) the lack of equipment or 
                        training by an Indian Tribe, Tribal 
                        Organization, or an Indian community to 
                        properly operate and maintain the 
                        sanitation facilities.
                  (C) A level III deficiency exists if a 
                sanitation facility serving an individual, 
                Indian Tribe or Indian community meets 1 or 
                more of the following conditions--
                          (i) water or sewer service in the 
                        home is provided by a haul system with 
                        holding tanks and interior plumbing;
                          (ii) major significant interruptions 
                        to water supply or sewage disposal 
                        occur frequently, requiring major 
                        capital improvements to correct the 
                        deficiencies; or
                          (iii) there is no access to or no 
                        approved or permitted solid waste 
                        facility available.
                  (D) A level IV deficiency exists--
                          (i) if a sanitation facility for an 
                        individual home, an Indian Tribe, or an 
                        Indian community exists but--
                                  (I) lacks--
                                          (aa) a safe water 
                                        supply system; or
                                          (bb) a waste disposal 
                                        system;
                                  (II) contains no piped water 
                                or sewer facilities; or
                                  (III) has become inoperable 
                                due to a major component 
                                failure; or
                          (ii) if only a washeteria or central 
                        facility exists in the community.
                  (E) A level V deficiency exists in the 
                absence of a sanitation facility, where 
                individual homes do not have access to safe 
                drinking water or adequate wastewater 
                (including sewage) disposal.
  (i) Definitions.--For purposes of this section, the following 
terms apply:
          (1) Indian community.--The term ``Indian community'' 
        means a geographic area, a significant proportion of 
        whose inhabitants are Indians and which is served by or 
        capable of being served by a facility described in this 
        section.
          (2) Sanitation facilities.--The terms ``sanitation 
        facility'' and ``sanitation facilities'' mean safe and 
        adequate water supply systems, sanitary sewage disposal 
        systems, and sanitary solid waste systems (and all 
        related equipment and support infrastructure).

SEC. 303. PREFERENCE TO INDIANS AND INDIAN FIRMS.

  (a) Buy Indian Act.--The Secretary, acting through the 
Service, may use the negotiating authority of section 23 of the 
Act of June 25, 1910 (25 U.S.C. 47, commonly known as the ``Buy 
Indian Act''), to give preference to any Indian or any 
enterprise, partnership, corporation, or other type of business 
organization owned and controlled by an Indian or Indians 
including former or currently federally recognized Indian 
Tribes in the State of New York (hereinafter referred to as an 
``Indian firm'') in the construction and renovation of Service 
facilities pursuant to section 301 and in the construction of 
sanitation facilities pursuant to section 302. Such preference 
may be accorded by the Secretary unless the Secretary finds, 
pursuant to regulations, that the project or function to be 
contracted for will not be satisfactory or such project or 
function cannot be properly completed or maintained under the 
proposed contract. The Secretary, in arriving at such a 
finding, shall consider whether the Indian or Indian firm will 
be deficient with respect to--
          (1) ownership and control by Indians;
          (2) equipment;
          (3) bookkeeping and accounting procedures;
          (4) substantive knowledge of the project or function 
        to be contracted for;
          (5) adequately trained personnel; or
          (6) other necessary components of contract 
        performance.
  (b) Labor Standards.--For the purposes of implementing the 
provisions of this title, contracts for the construction or 
renovation of health care facilities, staff quarters, and 
sanitation facilities, and related support infrastructure, 
funded in whole or in part with funds made available pursuant 
to this title, shall contain a provision requiring compliance 
with subchapter IV of chapter 31 of title 40, United States 
Code (commonly known as the ``Davis-Bacon Act'').

SEC. 304. EXPENDITURE OF NON-SERVICE FUNDS FOR RENOVATION.

  (a) In General.--Notwithstanding any other provision of law, 
if the requirements of subsection (c) are met, the Secretary, 
acting through the Service, is authorized to accept any major 
expansion, renovation, or modernization by any Indian Tribe or 
Tribal Organization of any Service facility or of any other 
Indian health facility operated pursuant to a contract or 
compact under the Indian Self-Determination and Education 
Assistance Act (25 U.S.C. 450 et seq.), including--
          (1) any plans or designs for such expansion, 
        renovation, or modernization; and
          (2) any expansion, renovation, or modernization for 
        which funds appropriated under any Federal law were 
        lawfully expended.
  (b) Priority List.--
          (1) In general.--The Secretary shall maintain a 
        separate priority list to address the needs for 
        increased operating expenses, personnel, or equipment 
        for such facilities. The methodology for establishing 
        priorities shall be developed through regulations. The 
        list of priority facilities will be revised annually in 
        consultation with Indian Tribes and Tribal 
        Organizations.
          (2) Report.--The Secretary shall submit to the 
        President, for inclusion in the report required to be 
        transmitted to Congress under section 801, the priority 
        list maintained pursuant to paragraph (1).
  (c) Requirements.--The requirements of this subsection are 
met with respect to any expansion, renovation, or modernization 
if--
          (1) the Indian Tribe or Tribal Organization--
                  (A) provides notice to the Secretary of its 
                intent to expand, renovate, or modernize; and
                  (B) applies to the Secretary to be placed on 
                a separate priority list to address the needs 
                of such new facilities for increased operating 
                expenses, personnel, or equipment; and
          (2) the expansion, renovation, or modernization--
                  (A) is approved by the appropriate area 
                director of the Service for Federal facilities; 
                and
                  (B) is administered by the Indian Tribe or 
                Tribal Organization in accordance with any 
                applicable regulations prescribed by the 
                Secretary with respect to construction or 
                renovation of Service facilities.
  (d) Additional Requirement for Expansion.--In addition to the 
requirements under subsection (c), for any expansion, the 
Indian Tribe or Tribal Organization shall provide to the 
Secretary additional information pursuant to regulations, 
including additional staffing, equipment, and other costs 
associated with the expansion.
  (e) Closure or Conversion of Facilities.--If any Service 
facility which has been expanded, renovated, or modernized by 
an Indian Tribe or Tribal Organization under this section 
ceases to be used as a Service facility during the 20-year 
period beginning on the date such expansion, renovation, or 
modernization is completed, such Indian Tribe or Tribal 
Organization shall be entitled to recover from the United 
States an amount which bears the same ratio to the value of 
such facility at the time of such cessation as the value of 
such expansion, renovation, or modernization (less the total 
amount of any funds provided specifically for such facility 
under any Federal program that were expended for such 
expansion, renovation, or modernization) bore to the value of 
such facility at the time of the completion of such expansion, 
renovation, or modernization.

SEC. 305. FUNDING FOR THE CONSTRUCTION, EXPANSION, AND MODERNIZATION OF 
                    SMALL AMBULATORY CARE FACILITIES.

  (a) Grants.--
          (1) In general.--The Secretary, acting through the 
        Service, shall make grants to Indian Tribes and Tribal 
        Organizations for the construction, expansion, or 
        modernization of facilities for the provision of 
        ambulatory care services to eligible Indians (and 
        noneligible persons pursuant to subsections (b)(2) and 
        (c)(1)(C)). A grant made under this section may cover 
        up to 100 percent of the costs of such construction, 
        expansion, or modernization. For the purposes of this 
        section, the term ``construction'' includes the 
        replacement of an existing facility.
          (2) Grant agreement required.--A grant under 
        paragraph (1) may only be made available to a Tribal 
        Health Program operating an Indian health facility 
        (other than a facility owned or constructed by the 
        Service, including a facility originally owned or 
        constructed by the Service and transferred to an Indian 
        Tribe or Tribal Organization).
  (b) Use of Grant Funds.--
          (1) Allowable uses.--A grant awarded under this 
        section may be used for the construction, expansion, or 
        modernization (including the planning and design of 
        such construction, expansion, or modernization) of an 
        ambulatory care facility--
                  (A) located apart from a hospital;
                  (B) not funded under section 301 or section 
                306; and
                  (C) which, upon completion of such 
                construction or modernization will--
                          (i) have a total capacity appropriate 
                        to its projected service population;
                          (ii) provide annually no fewer than 
                        150 patient visits by eligible Indians 
                        and other users who are eligible for 
                        services in such facility in accordance 
                        with section 807(c)(2); and
                          (iii) provide ambulatory care in a 
                        Service Area (specified in the contract 
                        or compact under the Indian Self-
                        Determination and Education Assistance 
                        Act (25 U.S.C. 450 et seq.)) with a 
                        population of no fewer than 1,500 
                        eligible Indians and other users who 
                        are eligible for services in such 
                        facility in accordance with section 
                        807(c)(2).
          (2) Additional allowable use.--The Secretary may also 
        reserve a portion of the funding provided under this 
        section and use those reserved funds to reduce an 
        outstanding debt incurred by Indian Tribes or Tribal 
        Organizations for the construction, expansion, or 
        modernization of an ambulatory care facility that meets 
        the requirements under paragraph (1). The provisions of 
        this section shall apply, except that such applications 
        for funding under this paragraph shall be considered 
        separately from applications for funding under 
        paragraph (1).
          (3) Use only for certain portion of costs.--A grant 
        provided under this section may be used only for the 
        cost of that portion of a construction, expansion, or 
        modernization project that benefits the Service 
        population identified above in subsection (b)(1)(C) 
        (ii) and (iii). The requirements of clauses (ii) and 
        (iii) of paragraph (1)(C) shall not apply to an Indian 
        Tribe or Tribal Organization applying for a grant under 
        this section for a health care facility located or to 
        be constructed on an island or when such facility is 
        not located on a road system providing direct access to 
        an inpatient hospital where care is available to the 
        Service population.
  (c) Grants.--
          (1) Application.--No grant may be made under this 
        section unless an application or proposal for the grant 
        has been approved by the Secretary in accordance with 
        applicable regulations and has set forth reasonable 
        assurance by the applicant that, at all times after the 
        construction, expansion, or modernization of a facility 
        carried out using a grant received under this section--
                  (A) adequate financial support will be 
                available for the provision of services at such 
                facility;
                  (B) such facility will be available to 
                eligible Indians without regard to ability to 
                pay or source of payment; and
                  (C) such facility will, as feasible without 
                diminishing the quality or quantity of services 
                provided to eligible Indians, serve noneligible 
                persons on a cost basis.
          (2) Priority.--In awarding grants under this section, 
        the Secretary shall give priority to Indian Tribes and 
        Tribal Organizations that demonstrate--
                  (A) a need for increased ambulatory care 
                services; and
                  (B) insufficient capacity to deliver such 
                services.
          (3) Peer review panels.--The Secretary may provide 
        for the establishment of peer review panels, as 
        necessary, to review and evaluate applications and 
        proposals and to advise the Secretary regarding such 
        applications using the criteria developed pursuant to 
        subsection (a)(1).
  (d) Reversion of Facilities.--If any facility (or portion 
thereof) with respect to which funds have been paid under this 
section, ceases, at any time after completion of the 
construction, expansion, or modernization carried out with such 
funds, to be used for the purposes of providing health care 
services to eligible Indians, all of the right, title, and 
interest in and to such facility (or portion thereof) shall 
transfer to the United States unless otherwise negotiated by 
the Service and the Indian Tribe or Tribal Organization.
  (e) Funding Nonrecurring.--Funding provided under this 
section shall be nonrecurring and shall not be available for 
inclusion in any individual Indian Tribe's tribal share for an 
award under the Indian Self-Determination and Education 
Assistance Act (25 U.S.C. 450 et seq.) or for reallocation or 
redesign thereunder.

SEC. 306. INDIAN HEALTH CARE DELIVERY DEMONSTRATION PROJECT.

  (a) Health Care Demonstration Projects.--The Secretary, 
acting through the Service, is authorized to enter into 
contracts under the Indian Self-Determination and Education 
Assistance Act (25 U.S.C. 450 et seq.) with Indian Tribes or 
Tribal Organizations for the purpose of carrying out a health 
care delivery demonstration project to test alternative means 
of delivering health care and services to Indians through 
facilities.
  (b) Use of Funds.--The Secretary, in approving projects 
pursuant to this section, may authorize such contracts for the 
construction and renovation of hospitals, health centers, 
health stations, and other facilities to deliver health care 
services and is authorized to--
          (1) waive any leasing prohibition;
          (2) permit carryover of funds appropriated for the 
        provision of health care services;
          (3) permit the use of other available funds;
          (4) permit the use of funds or property donated from 
        any source for project purposes;
          (5) provide for the reversion of donated real or 
        personal property to the donor; and
          (6) permit the use of Service funds to match other 
        funds, including Federal funds.
  (c) Regulations.--The Secretary shall develop and promulgate 
regulations, not later than 1 year after the date of enactment 
of the Indian Health Care Improvement Act Amendments of 2007, 
for the review and approval of applications submitted under 
this section.
  (d) Criteria.--The Secretary may approve projects that meet 
the following criteria:
          (1) There is a need for a new facility or program or 
        the reorientation of an existing facility or program.
          (2) A significant number of Indians, including those 
        with low health status, will be served by the project.
          (3) The project has the potential to deliver services 
        in an efficient and effective manner.
          (4) The project is economically viable.
          (5) The Indian Tribe or Tribal Organization has the 
        administrative and financial capability to administer 
        the project.
          (6) The project is integrated with providers of 
        related health and social services and is coordinated 
        with, and avoids duplication of, existing services.
  (e) Peer Review Panels.--The Secretary may provide for the 
establishment of peer review panels, as necessary, to review 
and evaluate applications using the criteria developed pursuant 
to subsection (d).
  (f) Priority.--The Secretary shall give priority to 
applications for demonstration projects in each of the 
following Service Units to the extent that such applications 
are timely filed and meet the criteria specified in subsection 
(d):
          (1) Cass Lake, Minnesota.
          (2) Mescalero, New Mexico.
          (3) Owyhee, Nevada.
          (4) Schurz, Nevada.
          (5) Ft. Yuma, California.
  (g) Technical Assistance.--The Secretary shall provide such 
technical and other assistance as may be necessary to enable 
applicants to comply with the provisions of this section.
  (h) Service to Ineligible Persons.--Subject to section 807, 
the authority to provide services to persons otherwise 
ineligible for the health care benefits of the Service and the 
authority to extend hospital privileges in Service facilities 
to non-Service health practitioners as provided in section 807 
may be included, subject to the terms of such section, in any 
demonstration project approved pursuant to this section.
  (i) Equitable Treatment.--For purposes of subsection (d)(1), 
the Secretary shall, in evaluating facilities operated under 
any contract or compact under the Indian Self-Determination and 
Education Assistance Act (25 U.S.C. 450 et seq.), use the same 
criteria that the Secretary uses in evaluating facilities 
operated directly by the Service.
  (j) Equitable Integration of Facilities.--The Secretary shall 
ensure that the planning, design, construction, renovation, and 
expansion needs of Service and non-Service facilities which are 
the subject of a contract or compact under the Indian Self-
Determination and Education Assistance Act (25 U.S.C. 450 et 
seq.) for health services are fully and equitably integrated 
into the implementation of the health care delivery 
demonstration projects under this section.

SEC. 307. LAND TRANSFER.

  Notwithstanding any other provision of law, the Bureau of 
Indian Affairs and all other agencies and departments of the 
United States are authorized to transfer, at no cost, land and 
improvements to the Service for the provision of health care 
services. The Secretary is authorized to accept such land and 
improvements for such purposes.

SEC. 308. LEASES, CONTRACTS, AND OTHER AGREEMENTS.

  The Secretary, acting through the Service, may enter into 
leases, contracts, and other agreements with Indian Tribes and 
Tribal Organizations which hold (1) title to, (2) a leasehold 
interest in, or (3) a beneficial interest in (when title is 
held by the United States in trust for the benefit of an Indian 
Tribe) facilities used or to be used for the administration and 
delivery of health services by an Indian Health Program. Such 
leases, contracts, or agreements may include provisions for 
construction or renovation and provide for compensation to the 
Indian Tribe or Tribal Organization of rental and other costs 
consistent with section 105(l) of the Indian Self-Determination 
and Education Assistance Act (25 U.S.C. 450j(l)) and 
regulations thereunder.

SEC. 309. STUDY ON LOANS, LOAN GUARANTEES, AND LOAN REPAYMENT.

  (a) In General.--The Secretary, in consultation with the 
Secretary of the Treasury, Indian Tribes, and Tribal 
Organizations, shall carry out a study to determine the 
feasibility of establishing a loan fund to provide to Indian 
Tribes and Tribal Organizations direct loans or guarantees for 
loans for the construction of health care facilities, 
including--
          (1) inpatient facilities;
          (2) outpatient facilities;
          (3) staff quarters;
          (4) hostels; and
          (5) specialized care facilities, such as behavioral 
        health and elder care facilities.
  (b) Determinations.--In carrying out the study under 
subsection (a), the Secretary shall determine--
          (1) the maximum principal amount of a loan or loan 
        guarantee that should be offered to a recipient from 
        the loan fund;
          (2) the percentage of eligible costs, not to exceed 
        100 percent, that may be covered by a loan or loan 
        guarantee from the loan fund (including costs relating 
        to planning, design, financing, site land development, 
        construction, rehabilitation, renovation, conversion, 
        improvements, medical equipment and furnishings, and 
        other facility-related costs and capital purchase (but 
        excluding staffing));
          (3) the cumulative total of the principal of direct 
        loans and loan guarantees, respectively, that may be 
        outstanding at any 1 time;
          (4) the maximum term of a loan or loan guarantee that 
        may be made for a facility from the loan fund;
          (5) the maximum percentage of funds from the loan 
        fund that should be allocated for payment of costs 
        associated with planning and applying for a loan or 
        loan guarantee;
          (6) whether acceptance by the Secretary of an 
        assignment of the revenue of an Indian Tribe or Tribal 
        Organization as security for any direct loan or loan 
        guarantee from the loan fund would be appropriate;
          (7) whether, in the planning and design of health 
        facilities under this section, users eligible under 
        section 807(c) may be included in any projection of 
        patient population;
          (8) whether funds of the Service provided through 
        loans or loan guarantees from the loan fund should be 
        eligible for use in matching other Federal funds under 
        other programs;
          (9) the appropriateness of, and best methods for, 
        coordinating the loan fund with the health care 
        priority system of the Service under section 301; and
          (10) any legislative or regulatory changes required 
        to implement recommendations of the Secretary based on 
        results of the study.
  (c) Report.--Not later than September 30, 2009, the Secretary 
shall submit to the Committee on Indian Affairs of the Senate 
and the Committee on Natural Resources and the Committee on 
Energy and Commerce of the House of Representatives a report 
that describes--
          (1) the manner of consultation made as required by 
        subsection (a); and
          (2) the results of the study, including any 
        recommendations of the Secretary based on results of 
        the study.

SEC. 310. TRIBAL LEASING.

  A Tribal Health Program may lease permanent structures for 
the purpose of providing health care services without obtaining 
advance approval in appropriation Acts.

SEC. 311. INDIAN HEALTH SERVICE/TRIBAL FACILITIES JOINT VENTURE 
                    PROGRAM.

  (a) In General.--The Secretary, acting through the Service, 
shall make arrangements with Indian Tribes and Tribal 
Organizations to establish joint venture demonstration projects 
under which an Indian Tribe or Tribal Organization shall expend 
tribal, private, or other available funds, for the acquisition 
or construction of a health facility for a minimum of 10 years, 
under a no-cost lease, in exchange for agreement by the Service 
to provide the equipment, supplies, and staffing for the 
operation and maintenance of such a health facility. An Indian 
Tribe or Tribal Organization may use tribal funds, private 
sector, or other available resources, including loan 
guarantees, to fulfill its commitment under a joint venture 
entered into under this subsection. An Indian Tribe or Tribal 
Organization shall be eligible to establish a joint venture 
project if, when it submits a letter of intent, it--
          (1) has begun but not completed the process of 
        acquisition or construction of a health facility to be 
        used in the joint venture project; or
          (2) has not begun the process of acquisition or 
        construction of a health facility for use in the joint 
        venture project.
  (b) Requirements.--The Secretary shall make such an 
arrangement with an Indian Tribe or Tribal Organization only 
if--
          (1) the Secretary first determines that the Indian 
        Tribe or Tribal Organization has the administrative and 
        financial capabilities necessary to complete the timely 
        acquisition or construction of the relevant health 
        facility; and
          (2) the Indian Tribe or Tribal Organization meets the 
        need criteria determined using the criteria developed 
        under the health care facility priority system under 
        section 301, unless the Secretary determines, pursuant 
        to regulations, that other criteria will result in a 
        more cost-effective and efficient method of 
        facilitating and completing construction of health care 
        facilities.
  (c) Continued Operation.--The Secretary shall negotiate an 
agreement with the Indian Tribe or Tribal Organization 
regarding the continued operation of the facility at the end of 
the initial 10 year no-cost lease period.
  (d) Breach of Agreement.--An Indian Tribe or Tribal 
Organization that has entered into a written agreement with the 
Secretary under this section, and that breaches or terminates 
without cause such agreement, shall be liable to the United 
States for the amount that has been paid to the Indian Tribe or 
Tribal Organization, or paid to a third party on the Indian 
Tribe's or Tribal Organization's behalf, under the agreement. 
The Secretary has the right to recover tangible property 
(including supplies) and equipment, less depreciation, and any 
funds expended for operations and maintenance under this 
section. The preceding sentence does not apply to any funds 
expended for the delivery of health care services, personnel, 
or staffing.
  (e) Recovery for Nonuse.--An Indian Tribe or Tribal 
Organization that has entered into a written agreement with the 
Secretary under this subsection shall be entitled to recover 
from the United States an amount that is proportional to the 
value of such facility if, at any time within the 10-year term 
of the agreement, the Service ceases to use the facility or 
otherwise breaches the agreement.
  (f) Definition.--For the purposes of this section, the term 
``health facility'' or ``health facilities'' includes quarters 
needed to provide housing for staff of the relevant Tribal 
Health Program.

SEC. 312. LOCATION OF FACILITIES.

  (a) In General.--In all matters involving the reorganization 
or development of Service facilities or in the establishment of 
related employment projects to address unemployment conditions 
in economically depressed areas, the Bureau of Indian Affairs 
and the Service shall give priority to locating such facilities 
and projects on Indian lands, or lands in Alaska owned by any 
Alaska Native village, or village or regional corporation under 
the Alaska Native Claims Settlement Act (43 U.S.C. 1601 et 
seq.), or any land allotted to any Alaska Native, if requested 
by the Indian owner and the Indian Tribe with jurisdiction over 
such lands or other lands owned or leased by the Indian Tribe 
or Tribal Organization. Top priority shall be given to Indian 
land owned by 1 or more Indian Tribes.
  (b) Definition.--For purposes of this section, the term 
``Indian lands'' means--
          (1) all lands within the exterior boundaries of any 
        reservation; and
          (2) any lands title to which is held in trust by the 
        United States for the benefit of any Indian Tribe or 
        individual Indian or held by any Indian Tribe or 
        individual Indian subject to restriction by the United 
        States against alienation.

SEC. 313. MAINTENANCE AND IMPROVEMENT OF HEALTH CARE FACILITIES.

  (a) Report.--The Secretary shall submit to the President, for 
inclusion in the report required to be transmitted to Congress 
under section 801, a report which identifies the backlog of 
maintenance and repair work required at both Service and tribal 
health care facilities, including new health care facilities 
expected to be in operation in the next fiscal year. The report 
shall also identify the need for renovation and expansion of 
existing facilities to support the growth of health care 
programs.
  (b) Maintenance of Newly Constructed Space.--The Secretary, 
acting through the Service, is authorized to expend maintenance 
and improvement funds to support maintenance of newly 
constructed space only if such space falls within the approved 
supportable space allocation for the Indian Tribe or Tribal 
Organization. Supportable space allocation shall be defined 
through the health care facility priority system under section 
301(c).
  (c) Replacement Facilities.--In addition to using maintenance 
and improvement funds for renovation, modernization, and 
expansion of facilities, an Indian Tribe or Tribal Organization 
may use maintenance and improvement funds for construction of a 
replacement facility if the costs of renovation of such 
facility would exceed a maximum renovation cost threshold. The 
maximum renovation cost threshold shall be determined through 
the negotiated rulemaking process provided for under section 
802.

SEC. 314. TRIBAL MANAGEMENT OF FEDERALLY-OWNED QUARTERS.

  (a) Rental Rates.--
          (1) Establishment.--Notwithstanding any other 
        provision of law, a Tribal Health Program which 
        operates a hospital or other health facility and the 
        federally-owned quarters associated therewith pursuant 
        to a contract or compact under the Indian Self-
        Determination and Education Assistance Act (25 U.S.C. 
        450 et seq.) shall have the authority to establish the 
        rental rates charged to the occupants of such quarters 
        by providing notice to the Secretary of its election to 
        exercise such authority.
          (2) Objectives.--In establishing rental rates 
        pursuant to authority of this subsection, a Tribal 
        Health Program shall endeavor to achieve the following 
        objectives:
                  (A) To base such rental rates on the 
                reasonable value of the quarters to the 
                occupants thereof.
                  (B) To generate sufficient funds to prudently 
                provide for the operation and maintenance of 
                the quarters, and subject to the discretion of 
                the Tribal Health Program, to supply reserve 
                funds for capital repairs and replacement of 
                the quarters.
          (3) Equitable funding.--Any quarters whose rental 
        rates are established by a Tribal Health Program 
        pursuant to this subsection shall remain eligible for 
        quarters improvement and repair funds to the same 
        extent as all federally-owned quarters used to house 
        personnel in Services-supported programs.
          (4) Notice of rate change.--A Tribal Health Program 
        which exercises the authority provided under this 
        subsection shall provide occupants with no less than 60 
        days notice of any change in rental rates.
  (b) Direct Collection of Rent.--
          (1) In general.--Notwithstanding any other provision 
        of law, and subject to paragraph (2), a Tribal Health 
        Program shall have the authority to collect rents 
        directly from Federal employees who occupy such 
        quarters in accordance with the following:
                  (A) The Tribal Health Program shall notify 
                the Secretary and the subject Federal employees 
                of its election to exercise its authority to 
                collect rents directly from such Federal 
                employees.
                  (B) Upon receipt of a notice described in 
                subparagraph (A), the Federal employees shall 
                pay rents for occupancy of such quarters 
                directly to the Tribal Health Program and the 
                Secretary shall have no further authority to 
                collect rents from such employees through 
                payroll deduction or otherwise.
                  (C) Such rent payments shall be retained by 
                the Tribal Health Program and shall not be made 
                payable to or otherwise be deposited with the 
                United States.
                  (D) Such rent payments shall be deposited 
                into a separate account which shall be used by 
                the Tribal Health Program for the maintenance 
                (including capital repairs and replacement) and 
                operation of the quarters and facilities as the 
                Tribal Health Program shall determine.
          (2) Retrocession of authority.--If a Tribal Health 
        Program which has made an election under paragraph (1) 
        requests retrocession of its authority to directly 
        collect rents from Federal employees occupying 
        federally-owned quarters, such retrocession shall 
        become effective on the earlier of--
                  (A) the first day of the month that begins no 
                less than 180 days after the Tribal Health 
                Program notifies the Secretary of its desire to 
                retrocede; or
                  (B) such other date as may be mutually agreed 
                by the Secretary and the Tribal Health Program.
  (c) Rates in Alaska.--To the extent that a Tribal Health 
Program, pursuant to authority granted in subsection (a), 
establishes rental rates for federally-owned quarters provided 
to a Federal employee in Alaska, such rents may be based on the 
cost of comparable private rental housing in the nearest 
established community with a year-round population of 1,500 or 
more individuals.

SEC. 315. APPLICABILITY OF BUY AMERICAN ACT REQUIREMENT.

  (a) Applicability.--The Secretary shall ensure that the 
requirements of the Buy American Act apply to all procurements 
made with funds provided pursuant to section 317. Indian Tribes 
and Tribal Organizations shall be exempt from these 
requirements.
  (b) Effect of Violation.--If it has been finally determined 
by a court or Federal agency that any person intentionally 
affixed a label bearing a ``Made in America'' inscription or 
any inscription with the same meaning, to any product sold in 
or shipped to the United States that is not made in the United 
States, such person shall be ineligible to receive any contract 
or subcontract made with funds provided pursuant to section 
317, pursuant to the debarment, suspension, and ineligibility 
procedures described in sections 9.400 through 9.409 of title 
48, Code of Federal Regulations.
  (c) Definitions.--For purposes of this section, the term 
``Buy American Act'' means title III of the Act entitled ``An 
Act making appropriations for the Treasury and Post Office 
Departments for the fiscal year ending June 30, 1934, and for 
other purposes'', approved March 3, 1933 (41 U.S.C. 10a et 
seq.).

SEC. 316. OTHER FUNDING FOR FACILITIES.

  (a) Authority To Accept Funds.--The Secretary is authorized 
to accept from any source, including Federal and State 
agencies, funds that are available for the construction of 
health care facilities and use such funds to plan, design, and 
construct health care facilities for Indians and to place such 
funds into a contract or compact under the Indian Self-
Determination and Education Assistance Act (25 U.S.C. 450 et 
seq.). Receipt of such funds shall have no effect on the 
priorities established pursuant to section 301.
  (b) Interagency Agreements.--The Secretary is authorized to 
enter into interagency agreements with other Federal agencies 
or State agencies and other entities and to accept funds from 
such Federal or State agencies or other sources to provide for 
the planning, design, and construction of health care 
facilities to be administered by Indian Health Programs in 
order to carry out the purposes of this Act and the purposes 
for which the funds were appropriated or for which the funds 
were otherwise provided.
  (c) Establishment of Standards.--The Secretary, through the 
Service, shall establish standards by regulation for the 
planning, design, and construction of health care facilities 
serving Indians under this Act.

SEC. 317. AUTHORIZATION OF APPROPRIATIONS.

  There are authorized to be appropriated such sums as may be 
necessary for each fiscal year through fiscal year 2017 to 
carry out this title.

                  TITLE IV--ACCESS TO HEALTH SERVICES

SEC. 401. TREATMENT OF PAYMENTS UNDER SOCIAL SECURITY ACT HEALTH 
                    BENEFITS PROGRAMS.

  (a) Disregard of Medicare, Medicaid, and SCHIP Payments in 
Determining Appropriations.--Any payments received by an Indian 
Health Program or by an Urban Indian Organization under title 
XVIII, XIX, or XXI of the Social Security Act for services 
provided to Indians eligible for benefits under such respective 
titles shall not be considered in determining appropriations 
for the provision of health care and services to Indians.
  (b) Nonpreferential Treatment.--Nothing in this Act 
authorizes the Secretary to provide services to an Indian with 
coverage under title XVIII, XIX, or XXI of the Social Security 
Act in preference to an Indian without such coverage.
  (c) Use of Funds.--
          (1) Special fund.--
                  (A) 100 percent pass-through of payments due 
                to facilities.--Notwithstanding any other 
                provision of law, but subject to paragraph (2), 
                payments to which a facility of the Service is 
                entitled by reason of a provision of the Social 
                Security Act shall be placed in a special fund 
                to be held by the Secretary. In making payments 
                from such fund, the Secretary shall ensure that 
                each Service Unit of the Service receives 100 
                percent of the amount to which the facilities 
                of the Service, for which such Service Unit 
                makes collections, are entitled by reason of a 
                provision of the Social Security Act.
                  (B) Use of funds.--Amounts received by a 
                facility of the Service under subparagraph (A) 
                shall first be used (to such extent or in such 
                amounts as are provided in appropriation Acts) 
                for the purpose of making any improvements in 
                the programs of the Service operated by or 
                through such facility which may be necessary to 
                achieve or maintain compliance with the 
                applicable conditions and requirements of 
                titles XVIII and XIX of the Social Security 
                Act. Any amounts so received that are in excess 
                of the amount necessary to achieve or maintain 
                such conditions and requirements shall, subject 
                to consultation with the Indian Tribes being 
                served by the Service Unit, be used for 
                reducing the health resource deficiencies (as 
                determined under section 201(d)) of such Indian 
                Tribes.
          (2) Direct payment option.--Paragraph (1) shall not 
        apply to a Tribal Health Program upon the election of 
        such Program under subsection (d) to receive payments 
        directly. No payment may be made out of the special 
        fund described in such paragraph with respect to 
        reimbursement made for services provided by such 
        Program during the period of such election.
  (d) Direct Billing.--
          (1) In general.--Subject to complying with the 
        requirements of paragraph (2), a Tribal Health Program 
        may elect to directly bill for, and receive payment 
        for, health care items and services provided by such 
        Program for which payment is made under title XVIII or 
        XIX of the Social Security Act or from any other third 
        party payor.
          (2) Direct reimbursement.--
                  (A) Use of funds.--Each Tribal Health Program 
                making the election described in paragraph (1) 
                with respect to a program under a title of the 
                Social Security Act shall be reimbursed 
                directly by that program for items and services 
                furnished without regard to subsection (c)(1), 
                but all amounts so reimbursed shall be used by 
                the Tribal Health Program for the purpose of 
                making any improvements in facilities of the 
                Tribal Health Program that may be necessary to 
                achieve or maintain compliance with the 
                conditions and requirements applicable 
                generally to such items and services under the 
                program under such title and to provide 
                additional health care services, improvements 
                in health care facilities and Tribal Health 
                Programs, any health care related purpose, or 
                otherwise to achieve the objectives provided in 
                section 3 of this Act.
                  (B) Audits.--The amounts paid to a Tribal 
                Health Program making the election described in 
                paragraph (1) with respect to a program under a 
                title of the Social Security Act shall be 
                subject to all auditing requirements applicable 
                to the program under such title, as well as all 
                auditing requirements applicable to programs 
                administered by an Indian Health Program. 
                Nothing in the preceding sentence shall be 
                construed as limiting the application of 
                auditing requirements applicable to amounts 
                paid under title XVIII, XIX, or XXI of the 
                Social Security Act.
                  (C) Identification of source of payments.--
                Any Tribal Health Program that receives 
                reimbursements or payments under title XVIII, 
                XIX, or XXI of the Social Security Act, shall 
                provide to the Service a list of each provider 
                enrollment number (or other identifier) under 
                which such Program receives such reimbursements 
                or payments.
          (3) Examination and implementation of changes.--
                  (A) In general.--The Secretary, acting 
                through the Service and with the assistance of 
                the Administrator of the Centers for Medicare & 
                Medicaid Services, shall examine on an ongoing 
                basis and implement any administrative changes 
                that may be necessary to facilitate direct 
                billing and reimbursement under the program 
                established under this subsection, including 
                any agreements with States that may be 
                necessary to provide for direct billing under a 
                program under a title of the Social Security 
                Act.
                  (B) Coordination of information.--The Service 
                shall provide the Administrator of the Centers 
                for Medicare & Medicaid Services with copies of 
                the lists submitted to the Service under 
                paragraph (2)(C), enrollment data regarding 
                patients served by the Service (and by Tribal 
                Health Programs, to the extent such data is 
                available to the Service), and such other 
                information as the Administrator may require 
                for purposes of administering title XVIII, XIX, 
                or XXI of the Social Security Act.
          (4) Withdrawal from program.--A Tribal Health Program 
        that bills directly under the program established under 
        this subsection may withdraw from participation in the 
        same manner and under the same conditions that an 
        Indian Tribe or Tribal Organization may retrocede a 
        contracted program to the Secretary under the authority 
        of the Indian Self-Determination and Education 
        Assistance Act (25 U.S.C. 450 et seq.). All cost 
        accounting and billing authority under the program 
        established under this subsection shall be returned to 
        the Secretary upon the Secretary's acceptance of the 
        withdrawal of participation in this program.
          (5) Termination for failure to comply with 
        requirements.--The Secretary may terminate the 
        participation of a Tribal Health Program or in the 
        direct billing program established under this 
        subsection if the Secretary determines that the Program 
        has failed to comply with the requirements of paragraph 
        (2). The Secretary shall provide a Tribal Health 
        Program with notice of a determination that the Program 
        has failed to comply with any such requirement and a 
        reasonable opportunity to correct such noncompliance 
        prior to terminating the Program's participation in the 
        direct billing program established under this 
        subsection.
  (e) Related Provisions Under the Social Security Act.--For 
provisions related to subsections (c) and (d), see sections 
1880, 1911, and 2107(e)(1)(D) of the Social Security Act.

SEC. 402. GRANTS TO AND CONTRACTS WITH THE SERVICE, INDIAN TRIBES, 
                    TRIBAL ORGANIZATIONS, AND URBAN INDIAN 
                    ORGANIZATIONS TO FACILITATE OUTREACH, ENROLLMENT, 
                    AND COVERAGE OF INDIANS UNDER SOCIAL SECURITY ACT 
                    HEALTH BENEFIT PROGRAMS AND OTHER HEALTH BENEFITS 
                    PROGRAMS.

  (a) Indian Tribes and Tribal Organizations.--From funds 
appropriated to carry out this title in accordance with section 
416, the Secretary, acting through the Service, shall make 
grants to or enter into contracts with Indian Tribes and Tribal 
Organizations to assist such Tribes and Tribal Organizations in 
establishing and administering programs on or near reservations 
and trust lands to assist individual Indians--
          (1) to enroll for benefits under a program 
        established under title XVIII, XIX, or XXI of the 
        Social Security Act and other health benefits programs; 
        and
          (2) with respect to such programs for which the 
        charging of premiums and cost sharing is not prohibited 
        under such programs, to pay premiums or cost sharing 
        for coverage for such benefits, which may be based on 
        financial need (as determined by the Indian Tribe or 
        Tribes or Tribal Organizations being served based on a 
        schedule of income levels developed or implemented by 
        such Tribe, Tribes, or Tribal Organizations).
  (b) Conditions.--The Secretary, acting through the Service, 
shall place conditions as deemed necessary to effect the 
purpose of this section in any grant or contract which the 
Secretary makes with any Indian Tribe or Tribal Organization 
pursuant to this section. Such conditions shall include 
requirements that the Indian Tribe or Tribal Organization 
successfully undertake--
          (1) to determine the population of Indians eligible 
        for the benefits described in subsection (a);
          (2) to educate Indians with respect to the benefits 
        available under the respective programs;
          (3) to provide transportation for such individual 
        Indians to the appropriate offices for enrollment or 
        applications for such benefits; and
          (4) to develop and implement methods of improving the 
        participation of Indians in receiving benefits under 
        such programs.
  (c) Application to Urban Indian Organizations.--
          (1) In general.--The provisions of subsection (a) 
        shall apply with respect to grants and other funding to 
        Urban Indian Organizations with respect to populations 
        served by such organizations in the same manner they 
        apply to grants and contracts with Indian Tribes and 
        Tribal Organizations with respect to programs on or 
        near reservations.
          (2) Requirements.--The Secretary shall include in the 
        grants or contracts made or provided under paragraph 
        (1) requirements that are--
                  (A) consistent with the requirements imposed 
                by the Secretary under subsection (b);
                  (B) appropriate to Urban Indian Organizations 
                and Urban Indians; and
                  (C) necessary to effect the purposes of this 
                section.
  (d) Facilitating Cooperation.--The Secretary, acting through 
the Centers for Medicare & Medicaid Services, shall take such 
steps as are necessary to facilitate cooperation with, and 
agreements between, States and the Service, Indian Tribes, 
Tribal Organizations, or Urban Indian Organizations with 
respect to the provision of health care items and services to 
Indians under the programs established under title XVIII, XIX, 
or XXI of the Social Security Act.
  (e) Agreements Relating To Improving Enrollment of Indians 
Under Social Security Act Health Benefits Programs.--For 
provisions relating to agreements between the Secretary, acting 
through the Service, and Indian Tribes, Tribal Organizations, 
and Urban Indian Organizations for the collection, preparation, 
and submission of applications by Indians for assistance under 
the Medicaid and State children's health insurance programs 
established under titles XIX and XXI of the Social Security 
Act, and benefits under the Medicare program established under 
title XVIII of such Act, see subsections (a) and (b) of section 
1139 of the Social Security Act.
  (f) Definition of Premiums and Cost Sharing.--In this 
section:
          (1) Premium.--The term ``premium'' includes any 
        enrollment fee or similar charge.
          (2) Cost sharing.--The term ``cost sharing'' includes 
        any deduction, deductible, copayment, coinsurance, or 
        similar charge.

SEC. 403. REIMBURSEMENT FROM CERTAIN THIRD PARTIES OF COSTS OF HEALTH 
                    SERVICES.

  (a) Right of Recovery.--Except as provided in subsection (f), 
the United States, an Indian Tribe, or Tribal Organization 
shall have the right to recover from an insurance company, 
health maintenance organization, employee benefit plan, third-
party tortfeasor, or any other responsible or liable third 
party (including a political subdivision or local governmental 
entity of a State) the reasonable charges billed by the 
Secretary, an Indian Tribe, or Tribal Organization in providing 
health services through the Service, an Indian Tribe, or Tribal 
Organization to any individual to the same extent that such 
individual, or any nongovernmental provider of such services, 
would be eligible to receive damages, reimbursement, or 
indemnification for such charges or expenses if--
          (1) such services had been provided by a 
        nongovernmental provider; and
          (2) such individual had been required to pay such 
        charges or expenses and did pay such charges or 
        expenses.
  (b) Limitations on Recoveries From States.--Subsection (a) 
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) Nonapplication of Other Laws.--No law of any State, or of 
any political subdivision of a State and no provision of any 
contract, insurance or health maintenance organization policy, 
employee benefit plan, self-insurance plan, managed care plan, 
or other health care plan or program entered into or renewed 
after the date of the enactment of the Indian Health Care 
Amendments of 1988, shall prevent or hinder the right of 
recovery of the United States, an Indian Tribe, or Tribal 
Organization under subsection (a).
  (d) No Effect on Private Rights of Action.--No action taken 
by the United States, an Indian Tribe, or Tribal Organization 
to enforce the right of recovery provided under this section 
shall operate to deny to the injured person the recovery for 
that portion of the person's damage not covered hereunder.
  (e) Enforcement.--
          (1) In general.--The United States, an Indian Tribe, 
        or Tribal Organization may enforce the right of 
        recovery provided under subsection (a) by--
                  (A) intervening or joining in any civil 
                action or proceeding brought--
                          (i) by the individual for whom health 
                        services were provided by the 
                        Secretary, an Indian Tribe, or Tribal 
                        Organization; or
                          (ii) by any representative or heirs 
                        of such individual, or
                  (B) instituting a civil action, including a 
                civil action for injunctive relief and other 
                relief and including, with respect to a 
                political subdivision or local governmental 
                entity of a State, such an action against an 
                official thereof.
          (2) Notice.--All reasonable efforts shall be made to 
        provide notice of action instituted under paragraph 
        (1)(B) to the individual to whom health services were 
        provided, either before or during the pendency of such 
        action.
          (3) Recovery from tortfeasors.--
                  (A) In general.--In any case in which an 
                Indian Tribe or Tribal Organization that is 
                authorized or required under a compact or 
                contract issued pursuant to the Indian Self-
                Determination and Education Assistance Act (25 
                U.S.C. 450 et seq.) to furnish or pay for 
                health services to a person who is injured or 
                suffers a disease on or after the date of 
                enactment of the Indian Health Care Improvement 
                Act Amendments of 2007 under circumstances that 
                establish grounds for a claim of liability 
                against the tortfeasor with respect to the 
                injury or disease, the Indian Tribe or Tribal 
                Organization shall have a right to recover from 
                the tortfeasor (or an insurer of the 
                tortfeasor) the reasonable value of the health 
                services so furnished, paid for, or to be paid 
                for, in accordance with the Federal Medical 
                Care Recovery Act (42 U.S.C. 2651 et seq.), to 
                the same extent and under the same 
                circumstances as the United States may recover 
                under that Act.
                  (B) Treatment.--The right of an Indian Tribe 
                or Tribal Organization to recover under 
                subparagraph (A) shall be independent of the 
                rights of the injured or diseased person served 
                by the Indian Tribe or Tribal Organization.
  (f) Limitation.--Absent specific written authorization by the 
governing body of an Indian Tribe for the period of such 
authorization (which may not be for a period of more than 1 
year and which may be revoked at any time upon written notice 
by the governing body to the Service), 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, Tribal Organization, or Urban Indian Organization. Where 
such authorization is provided, the Service may receive and 
expend such amounts for the provision of additional health 
services consistent with such authorization.
  (g) Costs and Attorneys' Fees.--In any action brought to 
enforce the provisions of this section, a prevailing plaintiff 
shall be awarded its reasonable attorneys' fees and costs of 
litigation.
  (h) Nonapplication of Claims Filing Requirements.--An 
insurance company, health maintenance organization, self-
insurance plan, managed care plan, or other health care plan or 
program (under the Social Security Act or otherwise) may not 
deny a claim for benefits submitted by the Service or by an 
Indian Tribe or Tribal Organization based on the format in 
which the claim is submitted if such format complies with the 
format required for submission of claims under title XVIII of 
the Social Security Act or recognized under section 1175 of 
such Act.
  (i) Application to Urban Indian Organizations.--The previous 
provisions of this section shall apply to Urban Indian 
Organizations with respect to populations served by such 
Organizations in the same manner they apply to Indian Tribes 
and Tribal Organizations with respect to populations served by 
such Indian Tribes and Tribal Organizations.
  (j) Statute of Limitations.--The provisions of section 2415 
of title 28, United States Code, shall apply to all actions 
commenced under this section, and the references therein to the 
United States are deemed to include Indian Tribes, Tribal 
Organizations, and Urban Indian Organizations.
  (k) Savings.--Nothing in this section shall be construed to 
limit any right of recovery available to the United States, an 
Indian Tribe, or Tribal Organization under the provisions of 
any applicable, Federal, State, or Tribal law, including 
medical lien laws.

SEC. 404. CREDITING OF REIMBURSEMENTS.

  (a) Use of Amounts.--
          (1) Retention by program.--Except as provided in 
        section 202(f) (relating to the Catastrophic Health 
        Emergency Fund) and section 807 (relating to health 
        services for ineligible persons), all reimbursements 
        received or recovered under any of the programs 
        described in paragraph (2), including under section 
        807, by reason of the provision of health services by 
        the Service, by an Indian Tribe or Tribal Organization, 
        or by an Urban Indian Organization, shall be credited 
        to the Service, such Indian Tribe or Tribal 
        Organization, or such Urban Indian Organization, 
        respectively, and may be used as provided in section 
        401. In the case of such a service provided by or 
        through a Service Unit, such amounts shall be credited 
        to such unit and used for such purposes.
          (2) Programs covered.--The programs referred to in 
        paragraph (1) are the following:
                  (A) Titles XVIII, XIX, and XXI of the Social 
                Security Act.
                  (B) This Act, including section 807.
                  (C) Public Law 87-693.
                  (D) Any other provision of law.
  (b) No Offset of Amounts.--The Service may not offset or 
limit any amount obligated to any Service Unit or entity 
receiving funding from the Service because of the receipt of 
reimbursements under subsection (a).

SEC. 405. PURCHASING HEALTH CARE COVERAGE.

  (a) In General.--Insofar as amounts are made available under 
law (including a provision of the Social Security Act, the 
Indian Self-Determination and Education Assistance Act (25 
U.S.C. 450 et seq.), or other law, other than under section 
402) to Indian Tribes, Tribal Organizations, and Urban Indian 
Organizations for health benefits for Service beneficiaries, 
Indian Tribes, Tribal Organizations, and Urban Indian 
Organizations may use such amounts to purchase health benefits 
coverage for such beneficiaries in any manner, including 
through--
          (1) a tribally owned and operated health care plan;
          (2) a State or locally authorized or licensed health 
        care plan;
          (3) a health insurance provider or managed care 
        organization; or
          (4) a self-insured plan.
The purchase of such coverage by an Indian Tribe, Tribal 
Organization, or Urban Indian Organization may be based on the 
financial needs of such beneficiaries (as determined by the 
Indian Tribe or Tribes being served based on a schedule of 
income levels developed or implemented by such Indian Tribe or 
Tribes).
  (b) Expenses for Self-Insured Plan.--In the case of a self-
insured plan under subsection (a)(4), the amounts may be used 
for expenses of operating the plan, including administration 
and insurance to limit the financial risks to the entity 
offering the plan.
  (c) Construction.--Nothing in this section shall be construed 
as affecting the use of any amounts not referred to in 
subsection (a).

SEC. 406. SHARING ARRANGEMENTS WITH FEDERAL AGENCIES.

  (a) Authority.--
          (1) In general.--The Secretary may enter into (or 
        expand) arrangements for the sharing of medical 
        facilities and services between the Service, Indian 
        Tribes, and Tribal Organizations and the Department of 
        Veterans Affairs and the Department of Defense.
          (2) Consultation by secretary required.--The 
        Secretary may not finalize any arrangement between the 
        Service and a Department described in paragraph (1) 
        without first consulting with the Indian Tribes which 
        will be significantly affected by the arrangement.
  (b) Limitations.--The Secretary shall not take any action 
under this section or under subchapter IV of chapter 81 of 
title 38, United States Code, which would impair--
          (1) the priority access of any Indian to health care 
        services provided through the Service and the 
        eligibility of any Indian to receive health services 
        through the Service;
          (2) the quality of health care services provided to 
        any Indian through the Service;
          (3) the priority access of any veteran to health care 
        services provided by the Department of Veterans 
        Affairs;
          (4) the quality of health care services provided by 
        the Department of Veterans Affairs or the Department of 
        Defense; or
          (5) the eligibility of any Indian who is a veteran to 
        receive health services through the Department of 
        Veterans Affairs.
  (c) Reimbursement.--The Service, Indian Tribe, or Tribal 
Organization shall be reimbursed by the Department of Veterans 
Affairs or the Department of Defense (as the case may be) where 
services are provided through the Service, an Indian Tribe, or 
a Tribal Organization to beneficiaries eligible for services 
from either such Department, notwithstanding any other 
provision of law.
  (d) Construction.--Nothing in this section may be construed 
as creating any right of a non-Indian veteran to obtain health 
services from the Service.

SEC. 407. PAYOR OF LAST RESORT.

  Indian Health Programs and health care programs operated by 
Urban Indian Organizations shall be the payor of last resort 
for services provided to persons eligible for services from 
Indian Health Programs and Urban Indian Organizations, 
notwithstanding any Federal, State, or local law to the 
contrary.

SEC. 408. NONDISCRIMINATION UNDER FEDERAL HEALTH CARE PROGRAMS IN 
                    QUALIFICATIONS FOR REIMBURSEMENT FOR SERVICES.

  (a) Requirement To Satisfy Generally Applicable Participation 
Requirements.--
          (1) In general.--A Federal health care program must 
        accept an entity that is operated by the Service, an 
        Indian Tribe, Tribal Organization, or Urban Indian 
        Organization as a provider eligible to receive payment 
        under the program for health care services furnished to 
        an Indian on the same basis as any other provider 
        qualified to participate as a provider of health care 
        services under the program if the entity meets 
        generally applicable State or other requirements for 
        participation as a provider of health care services 
        under the program.
          (2) Satisfaction of state or local licensure or 
        recognition requirements.--Any requirement for 
        participation as a provider of health care services 
        under a Federal health care program that an entity be 
        licensed or recognized under the State or local law 
        where the entity is located to furnish health care 
        services shall be deemed to have been met in the case 
        of an entity operated by the Service, an Indian Tribe, 
        Tribal Organization, or Urban Indian Organization if 
        the entity meets all the applicable standards for such 
        licensure or recognition, regardless of whether the 
        entity obtains a license or other documentation under 
        such State or local law. In accordance with section 
        221, the absence of the licensure of a health care 
        professional employed by such an entity under the State 
        or local law where the entity is located shall not be 
        taken into account for purposes of determining whether 
        the entity meets such standards, if the professional is 
        licensed in another State.
  (b) Application of Exclusion From Participation in Federal 
Health Care Programs.--
          (1) Excluded entities.--No entity operated by the 
        Service, an Indian Tribe, Tribal Organization, or Urban 
        Indian Organization that has been excluded from 
        participation in any Federal health care program or for 
        which a license is under suspension or has been revoked 
        by the State where the entity is located shall be 
        eligible to receive payment or reimbursement under any 
        such program for health care services furnished to an 
        Indian.
          (2) Excluded individuals.--No individual who has been 
        excluded from participation in any Federal health care 
        program or whose State license is under suspension 
        shall be eligible to receive payment or reimbursement 
        under any such program for health care services 
        furnished by that individual, directly or through an 
        entity that is otherwise eligible to receive payment 
        for health care services, to an Indian.
          (3) Federal health care program defined.--In this 
        subsection, the term, ``Federal health care program'' 
        has the meaning given that term in section 1128B(f) of 
        the Social Security Act (42 U.S.C. 1320a-7b(f)), except 
        that, for purposes of this subsection, such term shall 
        include the health insurance program under chapter 89 
        of title 5, United States Code.
  (c) Related Provisions.--For provisions related to 
nondiscrimination against providers operated by the Service, an 
Indian Tribe, Tribal Organization, or Urban Indian 
Organization, see section 1139(c) of the Social Security Act 
(42 U.S.C. 1320b-9(c)).

SEC. 409. CONSULTATION.

  For provisions related to consultation with representatives 
of Indian Health Programs and Urban Indian Organizations with 
respect to the health care programs established under titles 
XVIII, XIX, and XXI of the Social Security Act, see section 
1139(d) of the Social Security Act (42 U.S.C. 1320b-9(d)).

SEC. 410. STATE CHILDREN'S HEALTH INSURANCE PROGRAM (SCHIP).

  For provisions relating to--
          (1) outreach to families of Indian children likely to 
        be eligible for child health assistance under the State 
        children's health insurance program established under 
        title XXI of the Social Security Act, see sections 
        2105(c)(2)(C) and 1139(a) of such Act (42 U.S.C. 
        1397ee(c)(2), 1320b-9); and
          (2) ensuring that child health assistance is provided 
        under such program to targeted low-income children who 
        are Indians and that payments are made under such 
        program to Indian Health Programs and Urban Indian 
        Organizations operating in the State that provide such 
        assistance, see sections 2102(b)(3)(D) and 
        2105(c)(6)(B) of such Act (42 U.S.C. 1397bb(b)(3)(D), 
        1397ee(c)(6)(B)).

SEC. 411. EXCLUSION WAIVER AUTHORITY FOR AFFECTED INDIAN HEALTH 
                    PROGRAMS AND SAFE HARBOR TRANSACTIONS UNDER THE 
                    SOCIAL SECURITY ACT.

  For provisions relating to--
          (1) exclusion waiver authority for affected Indian 
        Health Programs under the Social Security Act, see 
        section 1128(k) of the Social Security Act (42 U.S.C. 
        1320a-7(k)); and
          (2) certain transactions involving Indian Health 
        Programs deemed to be in safe harbors under that Act, 
        see section 1128B(b)(4) of the Social Security Act (42 
        U.S.C. 1320a-7b(b)(4)).

SEC. 412. PREMIUM AND COST SHARING PROTECTIONS AND ELIGIBILITY 
                    DETERMINATIONS UNDER MEDICAID AND SCHIP AND 
                    PROTECTION OF CERTAIN INDIAN PROPERTY FROM MEDICAID 
                    ESTATE RECOVERY.

  For provisions relating to--
          (1) premiums or cost sharing protections for Indians 
        furnished items or services directly by Indian Health 
        Programs or through referral under the contract health 
        service under the Medicaid program established under 
        title XIX of the Social Security Act, see sections 
        1916(j) and 1916A(a)(1) of the Social Security Act (42 
        U.S.C. 1396o(j), 1396o-1(a)(1));
          (2) rules regarding the treatment of certain property 
        for purposes of determining eligibility under such 
        programs, see sections 1902(e)(13) and 2107(e)(1)(B) of 
        such Act (42 U.S.C. 1396a(e)(13), 1397gg(e)(1)(B)); and
          (3) the protection of certain property from estate 
        recovery provisions under the Medicaid program, see 
        section 1917(b)(3)(B) of such Act (42 U.S.C. 
        1396p(b)(3)(B)).

SEC. 413. TREATMENT UNDER MEDICAID AND SCHIP MANAGED CARE.

  For provisions relating to the treatment of Indians enrolled 
in a managed care entity under the Medicaid program under title 
XIX of the Social Security Act and Indian Health Programs and 
Urban Indian Organizations that are providers of items or 
services to such Indian enrollees, see sections 1932(h) and 
2107(e)(1)(H) of the Social Security Act (42 U.S.C. 1396u-2(h), 
1397gg(e)(1)(H)).

SEC. 414. NAVAJO NATION MEDICAID AGENCY FEASIBILITY STUDY.

  (a) Study.--The Secretary shall conduct a study to determine 
the feasibility of treating the Navajo Nation as a State for 
the purposes of title XIX of the Social Security Act, to 
provide services to Indians living within the boundaries of the 
Navajo Nation through an entity established having the same 
authority and performing the same functions as single-State 
medicaid agencies responsible for the administration of the 
State plan under title XIX of the Social Security Act.
  (b) Considerations.--In conducting the study, the Secretary 
shall consider the feasibility of--
          (1) assigning and paying all expenditures for the 
        provision of services and related administration funds, 
        under title XIX of the Social Security Act, to Indians 
        living within the boundaries of the Navajo Nation that 
        are currently paid to or would otherwise be paid to the 
        State of Arizona, New Mexico, or Utah;
          (2) providing assistance to the Navajo Nation in the 
        development and implementation of such entity for the 
        administration, eligibility, payment, and delivery of 
        medical assistance under title XIX of the Social 
        Security Act;
          (3) providing an appropriate level of matching funds 
        for Federal medical assistance with respect to amounts 
        such entity expends for medical assistance for services 
        and related administrative costs; and
          (4) authorizing the Secretary, at the option of the 
        Navajo Nation, to treat the Navajo Nation as a State 
        for the purposes of title XIX of the Social Security 
        Act (relating to the State children's health insurance 
        program) under terms equivalent to those described in 
        paragraphs (2) through (4).
  (c) Report.--Not later then 3 years after the date of 
enactment of the Indian Health Care Improvement Act Amendments 
of 2007, the Secretary shall submit to the Committee on Indian 
Affairs and Committee on Finance of the Senate and the 
Committee on Natural Resources and Committee on Energy and 
Commerce of the House of Representatives a report that 
includes--
          (1) the results of the study under this section;
          (2) a summary of any consultation that occurred 
        between the Secretary and the Navajo Nation, other 
        Indian Tribes, the States of Arizona, New Mexico, and 
        Utah, counties which include Navajo Lands, and other 
        interested parties, in conducting this study;
          (3) projected costs or savings associated with 
        establishment of such entity, and any estimated impact 
        on services provided as described in this section in 
        relation to probable costs or savings; and
          (4) legislative actions that would be required to 
        authorize the establishment of such entity if such 
        entity is determined by the Secretary to be feasible.

SEC. 415. GENERAL EXCEPTIONS.

  The requirements of this title shall not apply to any 
excepted benefits described in paragraph (1)(A) or (3) of 
section 2791(c) of the Public Health Service Act (42 U.S.C. 
300gg-91).

SEC. 416. AUTHORIZATION OF APPROPRIATIONS.

  There are authorized to be appropriated such sums as may be 
necessary for each fiscal year through fiscal year 2017 to 
carry out this title.

               TITLE V--HEALTH SERVICES FOR URBAN INDIANS

SEC. 501. PURPOSE.

  The purpose of this title is to establish and maintain 
programs in Urban Centers to make health services more 
accessible and available to Urban Indians.

SEC. 502. CONTRACTS WITH, AND GRANTS TO, URBAN INDIAN ORGANIZATIONS.

  Under authority of the Act of November 2, 1921 (25 U.S.C. 13) 
(commonly known as the ``Snyder Act''), the Secretary, acting 
through the Service, shall enter into contracts with, or make 
grants to, Urban Indian Organizations to assist such 
organizations in the establishment and administration, within 
Urban Centers, of programs which meet the requirements set 
forth in this title. Subject to section 506, the Secretary, 
acting through the Service, shall include such conditions as 
the Secretary considers necessary to effect the purpose of this 
title in any contract into which the Secretary enters with, or 
in any grant the Secretary makes to, any Urban Indian 
Organization pursuant to this title.

SEC. 503. CONTRACTS AND GRANTS FOR THE PROVISION OF HEALTH CARE AND 
                    REFERRAL SERVICES.

  (a) Requirements for Grants and Contracts.--Under authority 
of the Act of November 2, 1921 (25 U.S.C. 13) (commonly known 
as the ``Snyder Act''), the Secretary, acting through the 
Service, shall enter into contracts with, and make grants to, 
Urban Indian Organizations for the provision of health care and 
referral services for Urban Indians. Any such contract or grant 
shall include requirements that the Urban Indian Organization 
successfully undertake to--
          (1) estimate the population of Urban Indians residing 
        in the Urban Center or centers that the organization 
        proposes to serve who are or could be recipients of 
        health care or referral services;
          (2) estimate the current health status of Urban 
        Indians residing in such Urban Center or centers;
          (3) estimate the current health care needs of Urban 
        Indians residing in such Urban Center or centers;
          (4) provide basic health education, including health 
        promotion and disease prevention education, to Urban 
        Indians;
          (5) make recommendations to the Secretary and 
        Federal, State, local, and other resource agencies on 
        methods of improving health service programs to meet 
        the needs of Urban Indians; and
          (6) where necessary, provide, or enter into contracts 
        for the provision of, health care services for Urban 
        Indians.
  (b) Criteria.--The Secretary, acting through the Service, 
shall, by regulation, prescribe the criteria for selecting 
Urban Indian Organizations to enter into contracts or receive 
grants under this section. Such criteria shall, among other 
factors, include--
          (1) the extent of unmet health care needs of Urban 
        Indians in the Urban Center or centers involved;
          (2) the size of the Urban Indian population in the 
        Urban Center or centers involved;
          (3) the extent, if any, to which the activities set 
        forth in subsection (a) would duplicate any project 
        funded under this title, or under any current public 
        health service project funded in a manner other than 
        pursuant to this title;
          (4) the capability of an Urban Indian Organization to 
        perform the activities set forth in subsection (a) and 
        to enter into a contract with the Secretary or to meet 
        the requirements for receiving a grant under this 
        section;
          (5) the satisfactory performance and successful 
        completion by an Urban Indian Organization of other 
        contracts with the Secretary under this title;
          (6) the appropriateness and likely effectiveness of 
        conducting the activities set forth in subsection (a) 
        in an Urban Center or centers; and
          (7) the extent of existing or likely future 
        participation in the activities set forth in subsection 
        (a) by appropriate health and health-related Federal, 
        State, local, and other agencies.
  (c) Access to Health Promotion and Disease Prevention 
Programs.--The Secretary, acting through the Service, shall 
facilitate access to or provide health promotion and disease 
prevention services for Urban Indians through grants made to 
Urban Indian Organizations administering contracts entered into 
or receiving grants under subsection (a).
  (d) Immunization Services.--
          (1) Access or services provided.--The Secretary, 
        acting through the Service, shall facilitate access to, 
        or provide, immunization services for Urban Indians 
        through grants made to Urban Indian Organizations 
        administering contracts entered into or receiving 
        grants under this section.
          (2) Definition.--For purposes of this subsection, the 
        term ``immunization services'' means services to 
        provide without charge immunizations against vaccine-
        preventable diseases.
  (e) Behavioral Health Services.--
          (1) Access or services provided.--The Secretary, 
        acting through the Service, shall facilitate access to, 
        or provide, behavioral health services for Urban 
        Indians through grants made to Urban Indian 
        Organizations administering contracts entered into or 
        receiving grants under subsection (a).
          (2) Assessment required.--Except as provided by 
        paragraph (3)(A), a grant may not be made under this 
        subsection to an Urban Indian Organization until that 
        organization has prepared, and the Service has 
        approved, an assessment of the following:
                  (A) The behavioral health needs of the Urban 
                Indian population concerned.
                  (B) The behavioral health services and other 
                related resources available to that population.
                  (C) The barriers to obtaining those services 
                and resources.
                  (D) The needs that are unmet by such services 
                and resources.
          (3) Purposes of grants.--Grants may be made under 
        this subsection for the following:
                  (A) To prepare assessments required under 
                paragraph (2).
                  (B) To provide outreach, educational, and 
                referral services to Urban Indians regarding 
                the availability of direct behavioral health 
                services, to educate Urban Indians about 
                behavioral health issues and services, and 
                effect coordination with existing behavioral 
                health providers in order to improve services 
                to Urban Indians.
                  (C) To provide outpatient behavioral health 
                services to Urban Indians, including the 
                identification and assessment of illness, 
                therapeutic treatments, case management, 
                support groups, family treatment, and other 
                treatment.
                  (D) To develop innovative behavioral health 
                service delivery models which incorporate 
                Indian cultural support systems and resources.
  (f) Prevention of Child Abuse.--
          (1) Access or services provided.--The Secretary, 
        acting through the Service, shall facilitate access to 
        or provide services for Urban Indians through grants to 
        Urban Indian Organizations administering contracts 
        entered into or receiving grants under subsection (a) 
        to prevent and treat child abuse (including sexual 
        abuse) among Urban Indians.
          (2) Evaluation required.--Except as provided by 
        paragraph (3)(A), a grant may not be made under this 
        subsection to an Urban Indian Organization until that 
        organization has prepared, and the Service has 
        approved, an assessment that documents the prevalence 
        of child abuse in the Urban Indian population concerned 
        and specifies the services and programs (which may not 
        duplicate existing services and programs) for which the 
        grant is requested.
          (3) Purposes of grants.--Grants may be made under 
        this subsection for the following:
                  (A) To prepare assessments required under 
                paragraph (2).
                  (B) For the development of prevention, 
                training, and education programs for Urban 
                Indians, including child education, parent 
                education, provider training on identification 
                and intervention, education on reporting 
                requirements, prevention campaigns, and 
                establishing service networks of all those 
                involved in Indian child protection.
                  (C) To provide direct outpatient treatment 
                services (including individual treatment, 
                family treatment, group therapy, and support 
                groups) to Urban Indians who are child victims 
                of abuse (including sexual abuse) or adult 
                survivors of child sexual abuse, to the 
                families of such child victims, and to Urban 
                Indian perpetrators of child abuse (including 
                sexual abuse).
          (4) Considerations when making grants.--In making 
        grants to carry out this subsection, the Secretary 
        shall take into consideration--
                  (A) the support for the Urban Indian 
                Organization demonstrated by the child 
                protection authorities in the area, including 
                committees or other services funded under the 
                Indian Child Welfare Act of 1978 (25 U.S.C. 
                1901 et seq.), if any;
                  (B) the capability and expertise demonstrated 
                by the Urban Indian Organization to address the 
                complex problem of child sexual abuse in the 
                community; and
                  (C) the assessment required under paragraph 
                (2).
  (g) Other Grants.--The Secretary, acting through the Service, 
may enter into a contract with or make grants to an Urban 
Indian Organization that provides or arranges for the provision 
of health care services (through satellite facilities, provider 
networks, or otherwise) to Urban Indians in more than 1 Urban 
Center.

SEC. 504. CONTRACTS AND GRANTS FOR THE DETERMINATION OF UNMET HEALTH 
                    CARE NEEDS.

  (a) Grants and Contracts Authorized.--Under authority of the 
Act of November 2, 1921 (25 U.S.C. 13) (commonly known as the 
``Snyder Act''), the Secretary, acting through the Service, may 
enter into contracts with or make grants to Urban Indian 
Organizations situated in Urban Centers for which contracts 
have not been entered into or grants have not been made under 
section 503.
  (b) Purpose.--The purpose of a contract or grant made under 
this section shall be the determination of the matters 
described in subsection (c)(1) in order to assist the Secretary 
in assessing the health status and health care needs of Urban 
Indians in the Urban Center involved and determining whether 
the Secretary should enter into a contract or make a grant 
under section 503 with respect to the Urban Indian Organization 
which the Secretary has entered into a contract with, or made a 
grant to, under this section.
  (c) Grant and Contract Requirements.--Any contract entered 
into, or grant made, by the Secretary under this section shall 
include requirements that--
          (1) the Urban Indian Organization successfully 
        undertakes to--
                  (A) document the health care status and unmet 
                health care needs of Urban Indians in the Urban 
                Center involved; and
                  (B) with respect to Urban Indians in the 
                Urban Center involved, determine the matters 
                described in paragraphs (2), (3), (4), and (7) 
                of section 503(b); and
          (2) the Urban Indian Organization complete 
        performance of the contract, or carry out the 
        requirements of the grant, within 1 year after the date 
        on which the Secretary and such organization enter into 
        such contract, or within 1 year after such organization 
        receives such grant, whichever is applicable.
  (d) No Renewals.--The Secretary may not renew any contract 
entered into or grant made under this section.

SEC. 505. EVALUATIONS; RENEWALS.

  (a) Procedures for Evaluations.--The Secretary, acting 
through the Service, shall develop procedures to evaluate 
compliance with grant requirements and compliance with and 
performance of contracts entered into by Urban Indian 
Organizations under this title. Such procedures shall include 
provisions for carrying out the requirements of this section.
  (b) Evaluations.--The Secretary, acting through the Service, 
shall evaluate the compliance of each Urban Indian Organization 
which has entered into a contract or received a grant under 
section 503 with the terms of such contract or grant. For 
purposes of this evaluation, the Secretary shall--
          (1) acting through the Service, conduct an annual 
        onsite evaluation of the organization; or
          (2) accept in lieu of such onsite evaluation evidence 
        of the organization's provisional or full accreditation 
        by a private independent entity recognized by the 
        Secretary for purposes of conducting quality reviews of 
        providers participating in the Medicare program under 
        title XVIII of the Social Security Act.
  (c) Noncompliance; Unsatisfactory Performance.--If, as a 
result of the evaluations conducted under this section, the 
Secretary determines that an Urban Indian Organization has not 
complied with the requirements of a grant or complied with or 
satisfactorily performed a contract under section 503, the 
Secretary shall, prior to renewing such contract or grant, 
attempt to resolve with the organization the areas of 
noncompliance or unsatisfactory performance and modify the 
contract or grant to prevent future occurrences of 
noncompliance or unsatisfactory performance. If the Secretary 
determines that the noncompliance or unsatisfactory performance 
cannot be resolved and prevented in the future, the Secretary 
shall not renew the contract or grant with the organization and 
is authorized to enter into a contract or make a grant under 
section 503 with another Urban Indian Organization which is 
situated in the same Urban Center as the Urban Indian 
Organization whose contract or grant is not renewed under this 
section.
  (d) Considerations for Renewals.--In determining whether to 
renew a contract or grant with an Urban Indian Organization 
under section 503 which has completed performance of a contract 
or grant under section 504, the Secretary shall review the 
records of the Urban Indian Organization, the reports submitted 
under section 507, and shall consider the results of the onsite 
evaluations or accreditations under subsection (b).

SEC. 506. OTHER CONTRACT AND GRANT REQUIREMENTS.

  (a) Procurement.--Contracts with Urban Indian Organizations 
entered into pursuant to this title shall be in accordance with 
all Federal contracting laws and regulations relating to 
procurement except that in the discretion of the Secretary, 
such contracts may be negotiated without advertising and need 
not conform to the provisions of sections 1304 and 3131 through 
3133 of title 40, United States Code.
  (b) Payments Under Contracts or Grants.--
          (1) In general.--Payments under any contracts or 
        grants pursuant to this title, notwithstanding any term 
        or condition of such contract or grant--
                  (A) may be made in a single advance payment 
                by the Secretary to the Urban Indian 
                Organization by no later than the end of the 
                first 30 days of the funding period with 
                respect to which the payments apply, unless the 
                Secretary determines through an evaluation 
                under section 505 that the organization is not 
                capable of administering such a single advance 
                payment; and
                  (B) if any portion thereof is unexpended by 
                the Urban Indian Organization during the 
                funding period with respect to which the 
                payments initially apply, shall be carried 
                forward for expenditure with respect to 
                allowable or reimbursable costs incurred by the 
                organization during 1 or more subsequent 
                funding periods without additional 
                justification or documentation by the 
                organization as a condition of carrying forward 
                the availability for expenditure of such funds.
          (2) Semiannual and quarterly payments and 
        reimbursements.--If the Secretary determines under 
        paragraph (1)(A) that an Urban Indian Organization is 
        not capable of administering an entire single advance 
        payment, on request of the Urban Indian Organization, 
        the payments may be made--
                  (A) in semiannual or quarterly payments by 
                not later than 30 days after the date on which 
                the funding period with respect to which the 
                payments apply begins; or
                  (B) by way of reimbursement.
  (c) Revision or Amendment of Contracts.--Notwithstanding any 
provision of law to the contrary, the Secretary may, at the 
request and consent of an Urban Indian Organization, revise or 
amend any contract entered into by the Secretary with such 
organization under this title as necessary to carry out the 
purposes of this title.
  (d) Fair and Uniform Services and Assistance.--Contracts with 
or grants to Urban Indian Organizations and regulations adopted 
pursuant to this title shall include provisions to assure the 
fair and uniform provision to Urban Indians of services and 
assistance under such contracts or grants by such 
organizations.

SEC. 507. REPORTS AND RECORDS.

  (a) Reports.--
          (1) In general.--For each fiscal year during which an 
        Urban Indian Organization receives or expends funds 
        pursuant to a contract entered into or a grant received 
        pursuant to this title, such Urban Indian Organization 
        shall submit to the Secretary not more frequently than 
        every 6 months, a report that includes the following:
                  (A) In the case of a contract or grant under 
                section 503, recommendations pursuant to 
                section 503(a)(5).
                  (B) Information on activities conducted by 
                the organization pursuant to the contract or 
                grant.
                  (C) An accounting of the amounts and purpose 
                for which Federal funds were expended.
                  (D) A minimum set of data, using uniformly 
                defined elements, as specified by the Secretary 
                after consultation with Urban Indian 
                Organizations.
          (2) Health status and services.--
                  (A) In general.--Not later than 18 months 
                after the date of enactment of the Indian 
                Health Care Improvement Act Amendments of 2007, 
                the Secretary, acting through the Service, 
                shall submit to Congress a report evaluating--
                          (i) the health status of Urban 
                        Indians;
                          (ii) the services provided to Indians 
                        pursuant to this title; and
                          (iii) areas of unmet needs in the 
                        delivery of health services to Urban 
                        Indians.
                  (B) Consultation and contracts.--In preparing 
                the report under paragraph (1), the Secretary--
                          (i) shall consult with Urban Indian 
                        Organizations; and
                          (ii) may enter into a contract with a 
                        national organization representing 
                        Urban Indian Organizations to conduct 
                        any aspect of the report.
  (b) Audit.--The reports and records of the Urban Indian 
Organization with respect to a contract or grant under this 
title shall be subject to audit by the Secretary and the 
Comptroller General of the United States.
  (c) Costs of Audits.--The Secretary shall allow as a cost of 
any contract or grant entered into or awarded under section 502 
or 503 the cost of an annual independent financial audit 
conducted by--
          (1) a certified public accountant; or
          (2) a certified public accounting firm qualified to 
        conduct Federal compliance audits.

SEC. 508. LIMITATION ON CONTRACT AUTHORITY.

  The authority of the Secretary to enter into contracts or to 
award grants under this title shall be to the extent, and in an 
amount, provided for in appropriation Acts.

SEC. 509. FACILITIES.

  (a) Grants.--The Secretary, acting through the Service, may 
make grants to contractors or grant recipients under this title 
for the lease, purchase, renovation, construction, or expansion 
of facilities, including leased facilities, in order to assist 
such contractors or grant recipients in complying with 
applicable licensure or certification requirements.
  (b) Loan Fund Study.--The Secretary, acting through the 
Service, may carry out a study to determine the feasibility of 
establishing a loan fund to provide to Urban Indian 
Organizations direct loans or guarantees for loans for the 
construction of health care facilities in a manner consistent 
with section 309, including by submitting a report in 
accordance with subsection (c) of that section.

SEC. 510. DIVISION OF URBAN INDIAN HEALTH.

  There is established within the Service a Division of Urban 
Indian Health, which shall be responsible for--
          (1) carrying out the provisions of this title;
          (2) providing central oversight of the programs and 
        services authorized under this title; and
          (3) providing technical assistance to Urban Indian 
        Organizations.

SEC. 511. GRANTS FOR ALCOHOL AND SUBSTANCE ABUSE-RELATED SERVICES.

  (a) Grants Authorized.--The Secretary, acting through the 
Service, may make grants for the provision of health-related 
services in prevention of, treatment of, rehabilitation of, or 
school- and community-based education regarding, alcohol and 
substance abuse in Urban Centers to those Urban Indian 
Organizations with which the Secretary has entered into a 
contract under this title or under section 201.
  (b) Goals.--Each grant made pursuant to subsection (a) shall 
set forth the goals to be accomplished pursuant to the grant. 
The goals shall be specific to each grant as agreed to between 
the Secretary and the grantee.
  (c) Criteria.--The Secretary shall establish criteria for the 
grants made under subsection (a), including criteria relating 
to the following:
          (1) The size of the Urban Indian population.
          (2) Capability of the organization to adequately 
        perform the activities required under the grant.
          (3) Satisfactory performance standards for the 
        organization in meeting the goals set forth in such 
        grant. The standards shall be negotiated and agreed to 
        between the Secretary and the grantee on a grant-by-
        grant basis.
          (4) Identification of the need for services.
  (d) Allocation of Grants.--The Secretary shall develop a 
methodology for allocating grants made pursuant to this section 
based on the criteria established pursuant to subsection (c).
  (e) Grants Subject to Criteria.--Any grant received by an 
Urban Indian Organization under this Act for substance abuse 
prevention, treatment, and rehabilitation shall be subject to 
the criteria set forth in subsection (c).

SEC. 512. TREATMENT OF CERTAIN DEMONSTRATION PROJECTS.

  Notwithstanding any other provision of law, the Tulsa Clinic 
and Oklahoma City Clinic demonstration projects shall--
          (1) be permanent programs within the Service's direct 
        care program;
          (2) continue to be treated as Service Units and 
        Operating Units in the allocation of resources and 
        coordination of care; and
          (3) continue to meet the requirements and definitions 
        of an Urban Indian Organization in this Act, and shall 
        not be subject to the provisions of the Indian Self-
        Determination and Education Assistance Act (25 U.S.C. 
        450 et seq.).

SEC. 513. URBAN NIAAA TRANSFERRED PROGRAMS.

  (a) Grants and Contracts.--The Secretary, through the 
Division of Urban Indian Health, shall make grants or enter 
into contracts with Urban Indian Organizations, to take effect 
not later than September 30, 2010, for the administration of 
Urban Indian alcohol programs that were originally established 
under the National Institute on Alcoholism and Alcohol Abuse 
(hereafter in this section referred to as ``NIAAA'') and 
transferred to the Service.
  (b) Use of Funds.--Grants provided or contracts entered into 
under this section shall be used to provide support for the 
continuation of alcohol prevention and treatment services for 
Urban Indian populations and such other objectives as are 
agreed upon between the Service and a recipient of a grant or 
contract under this section.
  (c) Eligibility.--Urban Indian Organizations that operate 
Indian alcohol programs originally funded under the NIAAA and 
subsequently transferred to the Service are eligible for grants 
or contracts under this section.
  (d) Report.--The Secretary shall evaluate and report to 
Congress on the activities of programs funded under this 
section not less than every 5 years.

SEC. 514. CONSULTATION WITH URBAN INDIAN ORGANIZATIONS.

  (a) In General.--The Secretary shall ensure that the Service 
consults, to the greatest extent practicable, with Urban Indian 
Organizations.
  (b) Definition of Consultation.--For purposes of subsection 
(a), consultation is the open and free exchange of information 
and opinions which leads to mutual understanding and 
comprehension and which emphasizes trust, respect, and shared 
responsibility.

SEC. 515. URBAN YOUTH TREATMENT CENTER DEMONSTRATION.

  (a) Construction and Operation.--The Secretary, acting 
through the Service, through grant or contract, is authorized 
to fund the construction and operation of at least 2 
residential treatment centers in each State described in 
subsection (b) to demonstrate the provision of alcohol and 
substance abuse treatment services to Urban Indian youth in a 
culturally competent residential setting.
  (b) Definition of State.--A State described in this 
subsection is a State in which--
          (1) there resides Urban Indian youth with need for 
        alcohol and substance abuse treatment services in a 
        residential setting; and
          (2) there is a significant shortage of culturally 
        competent residential treatment services for Urban 
        Indian youth.

SEC. 516. GRANTS FOR DIABETES PREVENTION, TREATMENT, AND CONTROL.

  (a) Grants Authorized.--The Secretary may make grants to 
those Urban Indian Organizations that have entered into a 
contract or have received a grant under this title for the 
provision of services for the prevention and treatment of, and 
control of the complications resulting from, diabetes among 
Urban Indians.
  (b) Goals.--Each grant made pursuant to subsection (a) shall 
set forth the goals to be accomplished under the grant. The 
goals shall be specific to each grant as agreed to between the 
Secretary and the grantee.
  (c) Establishment of Criteria.--The Secretary shall establish 
criteria for the grants made under subsection (a) relating to--
          (1) the size and location of the Urban Indian 
        population to be served;
          (2) the need for prevention of and treatment of, and 
        control of the complications resulting from, diabetes 
        among the Urban Indian population to be served;
          (3) performance standards for the organization in 
        meeting the goals set forth in such grant that are 
        negotiated and agreed to by the Secretary and the 
        grantee;
          (4) the capability of the organization to adequately 
        perform the activities required under the grant; and
          (5) the willingness of the organization to 
        collaborate with the registry, if any, established by 
        the Secretary under section 204(e) in the Area Office 
        of the Service in which the organization is located.
  (d) Funds Subject to Criteria.--Any funds received by an 
Urban Indian Organization under this Act for the prevention, 
treatment, and control of diabetes among Urban Indians shall be 
subject to the criteria developed by the Secretary under 
subsection (c).

SEC. 517. COMMUNITY HEALTH REPRESENTATIVES.

  The Secretary, acting through the Service, may enter into 
contracts with, and make grants to, Urban Indian Organizations 
for the employment of Indians trained as health service 
providers through the Community Health Representatives Program 
under section 109 in the provision of health care, health 
promotion, and disease prevention services to Urban Indians.

SEC. 518. EFFECTIVE DATE.

  The amendments made by the Indian Health Care Improvement Act 
Amendments of 2007 to this title shall take effect beginning on 
the date of enactment of that Act, regardless of whether the 
Secretary has promulgated regulations implementing such 
amendments.

SEC. 519. ELIGIBILITY FOR SERVICES.

  Urban Indians shall be eligible for, and the ultimate 
beneficiaries of, health care or referral services provided 
pursuant to this title.

SEC. 520. AUTHORIZATION OF APPROPRIATIONS.

  There are authorized to be appropriated such sums as may be 
necessary for each fiscal year through fiscal year 2017 to 
carry out this title.

                 TITLE VI--ORGANIZATIONAL IMPROVEMENTS

SEC. 601. ESTABLISHMENT OF THE INDIAN HEALTH SERVICE AS AN AGENCY OF 
                    THE PUBLIC HEALTH SERVICE.

  (a) Establishment.--
          (1) In general.--In order to more effectively and 
        efficiently carry out the responsibilities, 
        authorities, and functions of the United States to 
        provide health care services to Indians and Indian 
        Tribes, as are or may be hereafter provided by Federal 
        statute or treaties, there is established within the 
        Public Health Service of the Department the Indian 
        Health Service.
          (2) Assistant secretary of indian health.--The 
        Service shall be administered by an Assistant Secretary 
        of Indian Health, who shall be appointed by the 
        President, by and with the advice and consent of the 
        Senate. The Assistant Secretary shall report to the 
        Secretary. Effective with respect to an individual 
        appointed by the President, by and with the advice and 
        consent of the Senate, after January 1, 2007, the term 
        of service of the Assistant Secretary shall be 4 years. 
        An Assistant Secretary may serve more than 1 term.
          (3) Incumbent.--The individual serving in the 
        position of Director of the Service on the day before 
        the date of enactment of the Indian Health Care 
        Improvement Act Amendments of 2007 shall serve as 
        Assistant Secretary.
          (4) Advocacy and consultation.--The position of 
        Assistant Secretary is established to, in a manner 
        consistent with the government-to-government 
        relationship between the United States and Indian 
        Tribes--
                  (A) facilitate advocacy for the development 
                of appropriate Indian health policy; and
                  (B) promote consultation on matters relating 
                to Indian health.
  (b) Agency.--The Service shall be an agency within the Public 
Health Service of the Department, and shall not be an office, 
component, or unit of any other agency of the Department.
  (c) Duties.--The Assistant Secretary shall--
          (1) perform all functions that were, on the day 
        before the date of enactment of the Indian Health Care 
        Improvement Act Amendments of 2007, carried out by or 
        under the direction of the individual serving as 
        Director of the Service on that day;
          (2) perform all functions of the Secretary relating 
        to the maintenance and operation of hospital and health 
        facilities for Indians and the planning for, and 
        provision and utilization of, health services for 
        Indians;
          (3) administer all health programs under which health 
        care is provided to Indians based upon their status as 
        Indians which are administered by the Secretary, 
        including programs under--
                  (A) this Act;
                  (B) the Act of November 2, 1921 (25 U.S.C. 
                13);
                  (C) the Act of August 5, 1954 (42 U.S.C. 2001 
                et seq.);
                  (D) the Act of August 16, 1957 (42 U.S.C. 
                2005 et seq.); and
                  (E) the Indian Self-Determination and 
                Education Assistance Act (25 U.S.C. 450 et 
                seq.);
          (4) administer all scholarship and loan functions 
        carried out under title I;
          (5) report directly to the Secretary concerning all 
        policy- and budget-related matters affecting Indian 
        health;
          (6) collaborate with the Assistant Secretary for 
        Health concerning appropriate matters of Indian health 
        that affect the agencies of the Public Health Service;
          (7) advise each Assistant Secretary of the Department 
        concerning matters of Indian health with respect to 
        which that Assistant Secretary has authority and 
        responsibility;
          (8) advise the heads of other agencies and programs 
        of the Department concerning matters of Indian health 
        with respect to which those heads have authority and 
        responsibility;
          (9) coordinate the activities of the Department 
        concerning matters of Indian health; and
          (10) perform such other functions as the Secretary 
        may designate.
  (d) Authority.--
          (1) In general.--The Secretary, acting through the 
        Assistant Secretary, shall have the authority--
                  (A) except to the extent provided for in 
                paragraph (2), to appoint and compensate 
                employees for the Service in accordance with 
                title 5, United States Code;
                  (B) to enter into contracts for the 
                procurement of goods and services to carry out 
                the functions of the Service; and
                  (C) to manage, expend, and obligate all funds 
                appropriated for the Service.
          (2) Personnel actions.--Notwithstanding any other 
        provision of law, the provisions of section 12 of the 
        Act of June 18, 1934 (48 Stat. 986; 25 U.S.C. 472), 
        shall apply to all personnel actions taken with respect 
        to new positions created within the Service as a result 
        of its establishment under subsection (a).
  (e) References.--Any reference to the Director of the Indian 
Health Service in any other Federal law, Executive order, rule, 
regulation, or delegation of authority, or in any document of 
or relating to the Director of the Indian Health Service, shall 
be deemed to refer to the Assistant Secretary.

SEC. 602. AUTOMATED MANAGEMENT INFORMATION SYSTEM.

  (a) Establishment.--
          (1) In general.--The Secretary shall establish an 
        automated management information system for the 
        Service.
          (2) Requirements of system.--The information system 
        established under paragraph (1) shall include--
                  (A) a financial management system;
                  (B) a patient care information system for 
                each area served by the Service;
                  (C) a privacy component that protects the 
                privacy of patient information held by, or on 
                behalf of, the Service;
                  (D) a services-based cost accounting 
                component that provides estimates of the costs 
                associated with the provision of specific 
                medical treatments or services in each Area 
                office of the Service;
                  (E) an interface mechanism for patient 
                billing and accounts receivable system; and
                  (F) a training component.
  (b) Provision of Systems to Tribes and Organizations.--The 
Secretary shall provide each Tribal Health Program automated 
management information systems which--
          (1) meet the management information needs of such 
        Tribal Health Program with respect to the treatment by 
        the Tribal Health Program of patients of the Service; 
        and
          (2) meet the management information needs of the 
        Service.
  (c) Access to Records.--Notwithstanding any other provision 
of law, each patient shall have reasonable access to the 
medical or health records of such patient which are held by, or 
on behalf of, the Service.
  (d) Authority To Enhance Information Technology.--The 
Secretary, acting through the Assistant Secretary, shall have 
the authority to enter into contracts, agreements, or joint 
ventures with other Federal agencies, States, private and 
nonprofit organizations, for the purpose of enhancing 
information technology in Indian Health Programs and 
facilities.

SEC. 603. AUTHORIZATION OF APPROPRIATIONS.

  There is authorized to be appropriated such sums as may be 
necessary for each fiscal year through fiscal year 2017 to 
carry out this title.

                 TITLE VII--BEHAVIORAL HEALTH PROGRAMS

SEC. 701. BEHAVIORAL HEALTH PREVENTION AND TREATMENT SERVICES.

  (a) Purposes.--The purposes of this section are as follows:
          (1) To authorize and direct the Secretary, acting 
        through the Service, Indian Tribes, Tribal 
        Organizations, and Urban Indian Organizations, to 
        develop a comprehensive behavioral health prevention 
        and treatment program which emphasizes collaboration 
        among alcohol and substance abuse, social services, and 
        mental health programs.
          (2) To provide information, direction, and guidance 
        relating to mental illness and dysfunction and self-
        destructive behavior, including child abuse and family 
        violence, to those Federal, tribal, State, and local 
        agencies responsible for programs in Indian communities 
        in areas of health care, education, social services, 
        child and family welfare, alcohol and substance abuse, 
        law enforcement, and judicial services.
          (3) To assist Indian Tribes to identify services and 
        resources available to address mental illness and 
        dysfunctional and self-destructive behavior.
          (4) To provide authority and opportunities for Indian 
        Tribes and Tribal Organizations to develop, implement, 
        and coordinate with community-based programs which 
        include identification, prevention, education, 
        referral, and treatment services, including through 
        multidisciplinary resource teams.
          (5) To ensure that Indians, as citizens of the United 
        States and of the States in which they reside, have the 
        same access to behavioral health services to which all 
        citizens have access.
          (6) To modify or supplement existing programs and 
        authorities in the areas identified in paragraph (2).
  (b) Plans.--
          (1) Development.--The Secretary, acting through the 
        Service, Indian Tribes, Tribal Organizations, and Urban 
        Indian Organizations, shall encourage Indian Tribes and 
        Tribal Organizations to develop tribal plans, and Urban 
        Indian Organizations to develop local plans, and for 
        all such groups to participate in developing areawide 
        plans for Indian Behavioral Health Services. The plans 
        shall include, to the extent feasible, the following 
        components:
                  (A) An assessment of the scope of alcohol or 
                other substance abuse, mental illness, and 
                dysfunctional and self-destructive behavior, 
                including suicide, child abuse, and family 
                violence, among Indians, including--
                          (i) the number of Indians served who 
                        are directly or indirectly affected by 
                        such illness or behavior; or
                          (ii) an estimate of the financial and 
                        human cost attributable to such illness 
                        or behavior.
                  (B) An assessment of the existing and 
                additional resources necessary for the 
                prevention and treatment of such illness and 
                behavior, including an assessment of the 
                progress toward achieving the availability of 
                the full continuum of care described in 
                subsection (c).
                  (C) An estimate of the additional funding 
                needed by the Service, Indian Tribes, Tribal 
                Organizations, and Urban Indian Organizations 
                to meet their responsibilities under the plans.
          (2) National clearinghouse.--The Secretary, acting 
        through the Service, shall coordinate with existing 
        national clearinghouses and information centers to 
        include at the clearinghouses and centers plans and 
        reports on the outcomes of such plans developed by 
        Indian Tribes, Tribal Organizations, Urban Indian 
        Organizations, and Service Areas relating to behavioral 
        health. The Secretary shall ensure access to these 
        plans and outcomes by any Indian Tribe, Tribal 
        Organization, Urban Indian Organization, or the 
        Service.
          (3) Technical assistance.--The Secretary shall 
        provide technical assistance to Indian Tribes, Tribal 
        Organizations, and Urban Indian Organizations in 
        preparation of plans under this section and in 
        developing standards of care that may be used and 
        adopted locally.
  (c) Programs.--The Secretary, acting through the Service, 
Indian Tribes, and Tribal Organizations, shall provide, to the 
extent feasible and if funding is available, programs including 
the following:
          (1) Comprehensive care.--A comprehensive continuum of 
        behavioral health care which provides--
                  (A) community-based prevention, intervention, 
                outpatient, and behavioral health aftercare;
                  (B) detoxification (social and medical);
                  (C) acute hospitalization;
                  (D) intensive outpatient/day treatment;
                  (E) residential treatment;
                  (F) transitional living for those needing a 
                temporary, stable living environment that is 
                supportive of treatment and recovery goals;
                  (G) emergency shelter;
                  (H) intensive case management; and
                  (I) diagnostic services.
          (2) Child care.--Behavioral health services for 
        Indians from birth through age 17, including--
                  (A) preschool and school age fetal alcohol 
                disorder services, including assessment and 
                behavioral intervention;
                  (B) mental health and substance abuse 
                services (emotional, organic, alcohol, drug, 
                inhalant, and tobacco);
                  (C) identification and treatment of co-
                occurring disorders and comorbidity;
                  (D) prevention of alcohol, drug, inhalant, 
                and tobacco use;
                  (E) early intervention, treatment, and 
                aftercare;
                  (F) promotion of healthy approaches to risk 
                and safety issues; and
                  (G) identification and treatment of neglect 
                and physical, mental, and sexual abuse.
          (3) Adult care.--Behavioral health services for 
        Indians from age 18 through 55, including--
                  (A) early intervention, treatment, and 
                aftercare;
                  (B) mental health and substance abuse 
                services (emotional, alcohol, drug, inhalant, 
                and tobacco), including sex specific services;
                  (C) identification and treatment of co-
                occurring disorders (dual diagnosis) and 
                comorbidity;
                  (D) promotion of healthy approaches for risk-
                related behavior;
                  (E) treatment services for women at risk of 
                giving birth to a child with a fetal alcohol 
                disorder; and
                  (F) sex specific treatment for sexual assault 
                and domestic violence.
          (4) Family care.--Behavioral health services for 
        families, including--
                  (A) early intervention, treatment, and 
                aftercare for affected families;
                  (B) treatment for sexual assault and domestic 
                violence; and
                  (C) promotion of healthy approaches relating 
                to parenting, domestic violence, and other 
                abuse issues.
          (5) Elder care.--Behavioral health services for 
        Indians 56 years of age and older, including--
                  (A) early intervention, treatment, and 
                aftercare;
                  (B) mental health and substance abuse 
                services (emotional, alcohol, drug, inhalant, 
                and tobacco), including sex specific services;
                  (C) identification and treatment of co-
                occurring disorders (dual diagnosis) and 
                comorbidity;
                  (D) promotion of healthy approaches to 
                managing conditions related to aging;
                  (E) sex specific treatment for sexual 
                assault, domestic violence, neglect, physical 
                and mental abuse and exploitation; and
                  (F) identification and treatment of dementias 
                regardless of cause.
  (d) Community Behavioral Health Plan.--
          (1) Establishment.--The governing body of any Indian 
        Tribe, Tribal Organization, or Urban Indian 
        Organization may adopt a resolution for the 
        establishment of a community behavioral health plan 
        providing for the identification and coordination of 
        available resources and programs to identify, prevent, 
        or treat substance abuse, mental illness, or 
        dysfunctional and self-destructive behavior, including 
        child abuse and family violence, among its members or 
        its service population. This plan should include 
        behavioral health services, social services, intensive 
        outpatient services, and continuing aftercare.
          (2) Technical assistance.--At the request of an 
        Indian Tribe, Tribal Organization, or Urban Indian 
        Organization, the Bureau of Indian Affairs and the 
        Service shall cooperate with and provide technical 
        assistance to the Indian Tribe, Tribal Organization, or 
        Urban Indian Organization in the development and 
        implementation of such plan.
          (3) Funding.--The Secretary, acting through the 
        Service, may make funding available to Indian Tribes 
        and Tribal Organizations which adopt a resolution 
        pursuant to paragraph (1) to obtain technical 
        assistance for the development of a community 
        behavioral health plan and to provide administrative 
        support in the implementation of such plan.
  (e) Coordination for Availability of Services.--The 
Secretary, acting through the Service, Indian Tribes, Tribal 
Organizations, and Urban Indian Organizations, shall coordinate 
behavioral health planning, to the extent feasible, with other 
Federal agencies and with State agencies, to encourage 
comprehensive behavioral health services for Indians regardless 
of their place of residence.
  (f) Mental Health Care Need Assessment.--Not later than 1 
year after the date of enactment of the Indian Health Care 
Improvement Act Amendments of 2007, the Secretary, acting 
through the Service, shall make an assessment of the need for 
inpatient mental health care among Indians and the availability 
and cost of inpatient mental health facilities which can meet 
such need. In making such assessment, the Secretary shall 
consider the possible conversion of existing, underused Service 
hospital beds into psychiatric units to meet such need.

SEC. 702. MEMORANDA OF AGREEMENT WITH THE DEPARTMENT OF THE INTERIOR.

  (a) Contents.--Not later than 12 months after the date of 
enactment of the Indian Health Care Improvement Act Amendments 
of 2007, the Secretary, acting through the Service, and the 
Secretary of the Interior shall develop and enter into a 
memoranda of agreement, or review and update any existing 
memoranda of agreement, as required by section 4205 of the 
Indian Alcohol and Substance Abuse Prevention and Treatment Act 
of 1986 (25 U.S.C. 2411) under which the Secretaries address 
the following:
          (1) The scope and nature of mental illness and 
        dysfunctional and self-destructive behavior, including 
        child abuse and family violence, among Indians.
          (2) The existing Federal, tribal, State, local, and 
        private services, resources, and programs available to 
        provide behavioral health services for Indians.
          (3) The unmet need for additional services, 
        resources, and programs necessary to meet the needs 
        identified pursuant to paragraph (1).
          (4)(A) The right of Indians, as citizens of the 
        United States and of the States in which they reside, 
        to have access to behavioral health services to which 
        all citizens have access.
          (B) The right of Indians to participate in, and 
        receive the benefit of, such services.
          (C) The actions necessary to protect the exercise of 
        such right.
          (5) The responsibilities of the Bureau of Indian 
        Affairs and the Service, including mental illness 
        identification, prevention, education, referral, and 
        treatment services (including services through 
        multidisciplinary resource teams), at the central, 
        area, and agency and Service Unit, Service Area, and 
        headquarters levels to address the problems identified 
        in paragraph (1).
          (6) A strategy for the comprehensive coordination of 
        the behavioral health services provided by the Bureau 
        of Indian Affairs and the Service to meet the problems 
        identified pursuant to paragraph (1), including--
                  (A) the coordination of alcohol and substance 
                abuse programs of the Service, the Bureau of 
                Indian Affairs, and Indian Tribes and Tribal 
                Organizations (developed under the Indian 
                Alcohol and Substance Abuse Prevention and 
                Treatment Act of 1986 (25 U.S.C. 2401 et seq.)) 
                with behavioral health initiatives pursuant to 
                this Act, particularly with respect to the 
                referral and treatment of dually diagnosed 
                individuals requiring behavioral health and 
                substance abuse treatment; and
                  (B) ensuring that the Bureau of Indian 
                Affairs and Service programs and services 
                (including multidisciplinary resource teams) 
                addressing child abuse and family violence are 
                coordinated with such non-Federal programs and 
                services.
          (7) Directing appropriate officials of the Bureau of 
        Indian Affairs and the Service, particularly at the 
        agency and Service Unit levels, to cooperate fully with 
        tribal requests made pursuant to community behavioral 
        health plans adopted under section 701(c) and section 
        4206 of the Indian Alcohol and Substance Abuse 
        Prevention and Treatment Act of 1986 (25 U.S.C. 2412).
          (8) Providing for an annual review of such agreement 
        by the Secretaries which shall be provided to Congress 
        and Indian Tribes and Tribal Organizations.
  (b) Specific Provisions Required.--The memoranda of agreement 
updated or entered into pursuant to subsection (a) shall 
include specific provisions pursuant to which the Service shall 
assume responsibility for--
          (1) the determination of the scope of the problem of 
        alcohol and substance abuse among Indians, including 
        the number of Indians within the jurisdiction of the 
        Service who are directly or indirectly affected by 
        alcohol and substance abuse and the financial and human 
        cost;
          (2) an assessment of the existing and needed 
        resources necessary for the prevention of alcohol and 
        substance abuse and the treatment of Indians affected 
        by alcohol and substance abuse; and
          (3) an estimate of the funding necessary to 
        adequately support a program of prevention of alcohol 
        and substance abuse and treatment of Indians affected 
        by alcohol and substance abuse.
  (c) Publication.--Each memorandum of agreement entered into 
or renewed (and amendments or modifications thereto) under 
subsection (a) shall be published in the Federal Register. At 
the same time as publication in the Federal Register, the 
Secretary shall provide a copy of such memoranda, amendment, or 
modification to each Indian Tribe, Tribal Organization, and 
Urban Indian Organization.

SEC. 703. COMPREHENSIVE BEHAVIORAL HEALTH PREVENTION AND TREATMENT 
                    PROGRAM.

  (a) Establishment.--
          (1) In general.--The Secretary, acting through the 
        Service, Indian Tribes, and Tribal Organizations, shall 
        provide a program of comprehensive behavioral health, 
        prevention, treatment, and aftercare, which shall 
        include--
                  (A) prevention, through educational 
                intervention, in Indian communities;
                  (B) acute detoxification, psychiatric 
                hospitalization, residential, and intensive 
                outpatient treatment;
                  (C) community-based rehabilitation and 
                aftercare;
                  (D) community education and involvement, 
                including extensive training of health care, 
                educational, and community-based personnel;
                  (E) specialized residential treatment 
                programs for high-risk populations, including 
                pregnant and postpartum women and their 
                children; and
                  (F) diagnostic services.
          (2) Target populations.--The target population of 
        such programs shall be members of Indian Tribes. 
        Efforts to train and educate key members of the Indian 
        community shall also target employees of health, 
        education, judicial, law enforcement, legal, and social 
        service programs.
  (b) Contract Health Services.--
          (1) In general.--The Secretary, acting through the 
        Service, Indian Tribes, and Tribal Organizations, may 
        enter into contracts with public or private providers 
        of behavioral health treatment services for the purpose 
        of carrying out the program required under subsection 
        (a).
          (2) Provision of assistance.--In carrying out this 
        subsection, the Secretary shall provide assistance to 
        Indian Tribes and Tribal Organizations to develop 
        criteria for the certification of behavioral health 
        service providers and accreditation of service 
        facilities which meet minimum standards for such 
        services and facilities.

SEC. 704. MENTAL HEALTH TECHNICIAN PROGRAM.

  (a) In General.--Under the authority of the Act of November 
2, 1921 (25 U.S.C. 13) (commonly known as the ``Snyder Act''), 
the Secretary shall establish and maintain a mental health 
technician program within the Service which--
          (1) provides for the training of Indians as mental 
        health technicians; and
          (2) employs such technicians in the provision of 
        community-based mental health care that includes 
        identification, prevention, education, referral, and 
        treatment services.
  (b) Paraprofessional Training.--In carrying out subsection 
(a), the Secretary, acting through the Service, Indian Tribes, 
and Tribal Organizations, shall provide high-standard 
paraprofessional training in mental health care necessary to 
provide quality care to the Indian communities to be served. 
Such training shall be based upon a curriculum developed or 
approved by the Secretary which combines education in the 
theory of mental health care with supervised practical 
experience in the provision of such care.
  (c) Supervision and Evaluation of Technicians.--The 
Secretary, acting through the Service, Indian Tribes, and 
Tribal Organizations, shall supervise and evaluate the mental 
health technicians in the training program.
  (d) Traditional Health Care Practices.--The Secretary, acting 
through the Service, shall ensure that the program established 
pursuant to this subsection involves the use and promotion of 
the traditional health care practices of the Indian Tribes to 
be served.

SEC. 705. LICENSING REQUIREMENT FOR MENTAL HEALTH CARE WORKERS.

  (a) In General.--Subject to the provisions of section 221, 
and except as provided in subsection (b), any individual 
employed as a psychologist, social worker, or marriage and 
family therapist for the purpose of providing mental health 
care services to Indians in a clinical setting under this Act 
is required to be licensed as a psychologist, social worker, or 
marriage and family therapist, respectively.
  (b) Trainees.--An individual may be employed as a trainee in 
psychology, social work, or marriage and family therapy to 
provide mental health care services described in subsection (a) 
if such individual--
          (1) works under the direct supervision of a licensed 
        psychologist, social worker, or marriage and family 
        therapist, respectively;
          (2) is enrolled in or has completed at least 2 years 
        of course work at a post-secondary, accredited 
        education program for psychology, social work, marriage 
        and family therapy, or counseling; and
          (3) meets such other training, supervision, and 
        quality review requirements as the Secretary may 
        establish.

SEC. 706. INDIAN WOMEN TREATMENT PROGRAMS.

  (a) Grants.--The Secretary, consistent with section 701, may 
make grants to Indian Tribes, Tribal Organizations, and Urban 
Indian Organizations to develop and implement a comprehensive 
behavioral health program of prevention, intervention, 
treatment, and relapse prevention services that specifically 
addresses the cultural, historical, social, and child care 
needs of Indian women, regardless of age.
  (b) Use of Grant Funds.--A grant made pursuant to this 
section may be used to--
          (1) develop and provide community training, 
        education, and prevention programs for Indian women 
        relating to behavioral health issues, including fetal 
        alcohol disorders;
          (2) identify and provide psychological services, 
        counseling, advocacy, support, and relapse prevention 
        to Indian women and their families; and
          (3) develop prevention and intervention models for 
        Indian women which incorporate traditional health care 
        practices, cultural values, and community and family 
        involvement.
  (c) Criteria.--The Secretary, in consultation with Indian 
Tribes and Tribal Organizations, shall establish criteria for 
the review and approval of applications and proposals for 
funding under this section.
  (d) Earmark of Certain Funds.--Twenty percent of the funds 
appropriated pursuant to this section shall be used to make 
grants to Urban Indian Organizations.

SEC. 707. INDIAN YOUTH PROGRAM.

  (a) Detoxification and Rehabilitation.--The Secretary, acting 
through the Service, consistent with section 701, shall develop 
and implement a program for acute detoxification and treatment 
for Indian youths, including behavioral health services. The 
program shall include regional treatment centers designed to 
include detoxification and rehabilitation for both sexes on a 
referral basis and programs developed and implemented by Indian 
Tribes or Tribal Organizations at the local level under the 
Indian Self-Determination and Education Assistance Act (25 
U.S.C. 450 et seq.). Regional centers shall be integrated with 
the intake and rehabilitation programs based in the referring 
Indian community.
  (b) Alcohol and Substance Abuse Treatment Centers or 
Facilities.--
          (1) Establishment.--
                  (A) In general.--The Secretary, acting 
                through the Service, Indian Tribes, and Tribal 
                Organizations, shall construct, renovate, or, 
                as necessary, purchase, and appropriately staff 
                and operate, at least 1 youth regional 
                treatment center or treatment network in each 
                area under the jurisdiction of an Area Office.
                  (B) Area office in california.--For the 
                purposes of this subsection, the Area Office in 
                California shall be considered to be 2 Area 
                Offices, 1 office whose jurisdiction shall be 
                considered to encompass the northern area of 
                the State of California, and 1 office whose 
                jurisdiction shall be considered to encompass 
                the remainder of the State of California for 
                the purpose of implementing California 
                treatment networks.
          (2) Funding.--For the purpose of staffing and 
        operating such centers or facilities, funding shall be 
        pursuant to the Act of November 2, 1921 (25 U.S.C. 13).
          (3) Location.--A youth treatment center constructed 
        or purchased under this subsection shall be constructed 
        or purchased at a location within the area described in 
        paragraph (1) agreed upon (by appropriate tribal 
        resolution) by a majority of the Indian Tribes to be 
        served by such center.
          (4) Specific provision of funds.--
                  (A) In general.--Notwithstanding any other 
                provision of this title, the Secretary may, 
                from amounts authorized to be appropriated for 
                the purposes of carrying out this section, make 
                funds available to--
                          (i) the Tanana Chiefs Conference, 
                        Incorporated, for the purpose of 
                        leasing, constructing, renovating, 
                        operating, and maintaining a 
                        residential youth treatment facility in 
                        Fairbanks, Alaska; and
                          (ii) the Southeast Alaska Regional 
                        Health Corporation to staff and operate 
                        a residential youth treatment facility 
                        without regard to the proviso set forth 
                        in section 4(l) of the Indian Self-
                        Determination and Education Assistance 
                        Act (25 U.S.C. 450b(l)).
                  (B) Provision of services to eligible 
                youths.--Until additional residential youth 
                treatment facilities are established in Alaska 
                pursuant to this section, the facilities 
                specified in subparagraph (A) shall make every 
                effort to provide services to all eligible 
                Indian youths residing in Alaska.
  (c) Intermediate Adolescent Behavioral Health Services.--
          (1) In general.--The Secretary, acting through the 
        Service, Indian Tribes, and Tribal Organizations, may 
        provide intermediate behavioral health services to 
        Indian children and adolescents, including--
                  (A) pretreatment assistance;
                  (B) inpatient, outpatient, and aftercare 
                services;
                  (C) emergency care;
                  (D) suicide prevention and crisis 
                intervention; and
                  (E) prevention and treatment of mental 
                illness and dysfunctional and self-destructive 
                behavior, including child abuse and family 
                violence.
          (2) Use of funds.--Funds provided under this 
        subsection may be used--
                  (A) to construct or renovate an existing 
                health facility to provide intermediate 
                behavioral health services;
                  (B) to hire behavioral health professionals;
                  (C) to staff, operate, and maintain an 
                intermediate mental health facility, group 
                home, sober housing, transitional housing or 
                similar facilities, or youth shelter where 
                intermediate behavioral health services are 
                being provided;
                  (D) to make renovations and hire appropriate 
                staff to convert existing hospital beds into 
                adolescent psychiatric units; and
                  (E) for intensive home- and community-based 
                services.
          (3) Criteria.--The Secretary, acting through the 
        Service, shall, in consultation with Indian Tribes and 
        Tribal Organizations, establish criteria for the review 
        and approval of applications or proposals for funding 
        made available pursuant to this subsection.
  (d) Federally-Owned Structures.--
          (1) In general.--The Secretary, in consultation with 
        Indian Tribes and Tribal Organizations, shall--
                  (A) identify and use, where appropriate, 
                federally-owned structures suitable for local 
                residential or regional behavioral health 
                treatment for Indian youths; and
                  (B) establish guidelines for determining the 
                suitability of any such federally-owned 
                structure to be used for local residential or 
                regional behavioral health treatment for Indian 
                youths.
          (2) Terms and conditions for use of structure.--Any 
        structure described in paragraph (1) may be used under 
        such terms and conditions as may be agreed upon by the 
        Secretary and the agency having responsibility for the 
        structure and any Indian Tribe or Tribal Organization 
        operating the program.
  (e) Rehabilitation and Aftercare Services.--
          (1) In general.--The Secretary, Indian Tribes, or 
        Tribal Organizations, in cooperation with the Secretary 
        of the Interior, shall develop and implement within 
        each Service Unit, community-based rehabilitation and 
        follow-up services for Indian youths who are having 
        significant behavioral health problems, and require 
        long-term treatment, community reintegration, and 
        monitoring to support the Indian youths after their 
        return to their home community.
          (2) Administration.--Services under paragraph (1) 
        shall be provided by trained staff within the community 
        who can assist the Indian youths in their continuing 
        development of self-image, positive problem-solving 
        skills, and nonalcohol or substance abusing behaviors. 
        Such staff may include alcohol and substance abuse 
        counselors, mental health professionals, and other 
        health professionals and paraprofessionals, including 
        community health representatives.
  (f) Inclusion of Family in Youth Treatment Program.--In 
providing the treatment and other services to Indian youths 
authorized by this section, the Secretary, acting through the 
Service, Indian Tribes, and Tribal Organizations, shall provide 
for the inclusion of family members of such youths in the 
treatment programs or other services as may be appropriate. Not 
less than 10 percent of the funds appropriated for the purposes 
of carrying out subsection (e) shall be used for outpatient 
care of adult family members related to the treatment of an 
Indian youth under that subsection.
  (g) Multidrug Abuse Program.--The Secretary, acting through 
the Service, Indian Tribes, Tribal Organizations, and Urban 
Indian Organizations, shall provide, consistent with section 
701, programs and services to prevent and treat the abuse of 
multiple forms of substances, including alcohol, drugs, 
inhalants, and tobacco, among Indian youths residing in Indian 
communities, on or near reservations, and in urban areas and 
provide appropriate mental health services to address the 
incidence of mental illness among such youths.
  (h) Indian Youth Mental Health.--The Secretary, acting 
through the Service, shall collect data for the report under 
section 801 with respect to--
          (1) the number of Indian youth who are being provided 
        mental health services through the Service and Tribal 
        Health Programs;
          (2) a description of, and costs associated with, the 
        mental health services provided for Indian youth 
        through the Service and Tribal Health Programs;
          (3) the number of youth referred to the Service or 
        Tribal Health Programs for mental health services;
          (4) the number of Indian youth provided residential 
        treatment for mental health and behavioral problems 
        through the Service and Tribal Health Programs, 
        reported separately for on- and off-reservation 
        facilities; and
          (5) the costs of the services described in paragraph 
        (4).

SEC. 708. INDIAN YOUTH TELEMENTAL HEALTH DEMONSTRATION PROJECT.

  (a) Purpose.--The purpose of this section is to authorize the 
Secretary to carry out a demonstration project to test the use 
of telemental health services in suicide prevention, 
intervention and treatment of Indian youth, including through--
          (1) the use of psychotherapy, psychiatric 
        assessments, diagnostic interviews, therapies for 
        mental health conditions predisposing to suicide, and 
        alcohol and substance abuse treatment;
          (2) the provision of clinical expertise to, 
        consultation services with, and medical advice and 
        training for frontline health care providers working 
        with Indian youth;
          (3) training and related support for community 
        leaders, family members and health and education 
        workers who work with Indian youth;
          (4) the development of culturally-relevant 
        educational materials on suicide; and
          (5) data collection and reporting.
  (b) Definitions.--For the purpose of this section, the 
following definitions shall apply:
          (1) Demonstration project.--The term ``demonstration 
        project'' means the Indian youth telemental health 
        demonstration project authorized under subsection (c).
          (2) Telemental health.--The term ``telemental 
        health'' means the use of electronic information and 
        telecommunications technologies to support long 
        distance mental health care, patient and professional-
        related education, public health, and health 
        administration.
  (c) Authorization.--
          (1) In general.--The Secretary is authorized to award 
        grants under the demonstration project for the 
        provision of telemental health services to Indian youth 
        who--
                  (A) have expressed suicidal ideas;
                  (B) have attempted suicide; or
                  (C) have mental health conditions that 
                increase or could increase the risk of suicide.
          (2) Eligibility for grants.--Such grants shall be 
        awarded to Indian Tribes and Tribal Organizations that 
        operate 1 or more facilities--
                  (A) located in Alaska and part of the Alaska 
                Federal Health Care Access Network;
                  (B) reporting active clinical telehealth 
                capabilities; or
                  (C) offering school-based telemental health 
                services relating to psychiatry to Indian 
                youth.
          (3) Grant period.--The Secretary shall award grants 
        under this section for a period of up to 4 years.
          (4) Awarding of grants.--Not more than 5 grants shall 
        be provided under paragraph (1), with priority 
        consideration given to Indian Tribes and Tribal 
        Organizations that--
                  (A) serve a particular community or 
                geographic area where there is a demonstrated 
                need to address Indian youth suicide;
                  (B) enter in to collaborative partnerships 
                with Indian Health Service or Tribal Health 
                Programs or facilities to provide services 
                under this demonstration project;
                  (C) serve an isolated community or geographic 
                area which has limited or no access to 
                behavioral health services; or
                  (D) operate a detention facility at which 
                Indian youth are detained.
  (d) Use of Funds.--
          (1) In general.--An Indian Tribe or Tribal 
        Organization shall use a grant received under 
        subsection (c) for the following purposes:
                  (A) To provide telemental health services to 
                Indian youth, including the provision of--
                          (i) psychotherapy;
                          (ii) psychiatric assessments and 
                        diagnostic interviews, therapies for 
                        mental health conditions predisposing 
                        to suicide, and treatment; and
                          (iii) alcohol and substance abuse 
                        treatment.
                  (B) To provide clinician-interactive medical 
                advice, guidance and training, assistance in 
                diagnosis and interpretation, crisis counseling 
                and intervention, and related assistance to 
                Service, tribal, or urban clinicians and health 
                services providers working with youth being 
                served under this demonstration project.
                  (C) To assist, educate and train community 
                leaders, health education professionals and 
                paraprofessionals, tribal outreach workers, and 
                family members who work with the youth 
                receiving telemental health services under this 
                demonstration project, including with 
                identification of suicidal tendencies, crisis 
                intervention and suicide prevention, emergency 
                skill development, and building and expanding 
                networks among these individuals and with State 
                and local health services providers.
                  (D) To develop and distribute culturally 
                appropriate community educational materials 
                on--
                          (i) suicide prevention;
                          (ii) suicide education;
                          (iii) suicide screening;
                          (iv) suicide intervention; and
                          (v) ways to mobilize communities with 
                        respect to the identification of risk 
                        factors for suicide.
                  (E) For data collection and reporting related 
                to Indian youth suicide prevention efforts.
          (2) Traditional health care practices.--In carrying 
        out the purposes described in paragraph (1), an Indian 
        Tribe or Tribal Organization may use and promote the 
        traditional health care practices of the Indian Tribes 
        of the youth to be served.
  (e) Applications.--To be eligible to receive a grant under 
subsection (c), an Indian Tribe or Tribal Organization shall 
prepare and submit to the Secretary an application, at such 
time, in such manner, and containing such information as the 
Secretary may require, including--
          (1) a description of the project that the Indian 
        Tribe or Tribal Organization will carry out using the 
        funds provided under the grant;
          (2) a description of the manner in which the project 
        funded under the grant would--
                  (A) meet the telemental health care needs of 
                the Indian youth population to be served by the 
                project; or
                  (B) improve the access of the Indian youth 
                population to be served to suicide prevention 
                and treatment services;
          (3) evidence of support for the project from the 
        local community to be served by the project;
          (4) a description of how the families and leadership 
        of the communities or populations to be served by the 
        project would be involved in the development and 
        ongoing operations of the project;
          (5) a plan to involve the tribal community of the 
        youth who are provided services by the project in 
        planning and evaluating the mental health care and 
        suicide prevention efforts provided, in order to ensure 
        the integration of community, clinical, environmental, 
        and cultural components of the treatment; and
          (6) a plan for sustaining the project after Federal 
        assistance for the demonstration project has 
        terminated.
  (f) Collaboration; Reporting to National Clearinghouse.--
          (1) Collaboration.--The Secretary, acting through the 
        Service, shall encourage Indian Tribes and Tribal 
        Organizations receiving grants under this section to 
        collaborate to enable comparisons about best practices 
        across projects.
          (2) Reporting to national clearinghouse.--The 
        Secretary, acting through the Service, shall also 
        encourage Indian Tribes and Tribal Organizations 
        receiving grants under this section to submit relevant, 
        declassified project information to the national 
        clearinghouse authorized under section 701(b)(2) in 
        order to better facilitate program performance and 
        improve suicide prevention, intervention, and treatment 
        services.
  (g) Annual Report.--Each grant recipient shall submit to the 
Secretary an annual report that--
          (1) describes the number of telemental health 
        services provided; and
          (2) includes any other information that the Secretary 
        may require.
  (h) Report to Congress.--Not later than 270 days after the 
termination of the demonstration project, the Secretary shall 
submit to the Committee on Indian Affairs of the Senate and the 
Committee on Natural Resources and Committee on Energy and 
Commerce of the House of Representatives a final report, based 
on the annual reports provided by grant recipients under 
subsection (h), that--
          (1) describes the results of the projects funded by 
        grants awarded under this section, including any data 
        available which indicates the number of attempted 
        suicides;
          (2) evaluates the impact of the telemental health 
        services funded by the grants in reducing the number of 
        completed suicides among Indian youth;
          (3) evaluates whether the demonstration project 
        should be--
                  (A) expanded to provide more than 5 grants; 
                and
                  (B) designated a permanent program; and
          (4) evaluates the benefits of expanding the 
        demonstration project to include Urban Indian 
        Organizations.
  (i) Authorization of Appropriations.--There is authorized to 
be appropriated to carry out this section $1,500,000 for each 
of fiscal years 2008 through 2011.

SEC. 709. INPATIENT AND COMMUNITY-BASED MENTAL HEALTH FACILITIES 
                    DESIGN, CONSTRUCTION, AND STAFFING.

  Not later than 1 year after the date of enactment of the 
Indian Health Care Improvement Act Amendments of 2007, the 
Secretary, acting through the Service, Indian Tribes, and 
Tribal Organizations, may provide, in each area of the Service, 
not less than 1 inpatient mental health care facility, or the 
equivalent, for Indians with behavioral health problems. For 
the purposes of this subsection, California shall be considered 
to be 2 Area Offices, 1 office whose location shall be 
considered to encompass the northern area of the State of 
California and 1 office whose jurisdiction shall be considered 
to encompass the remainder of the State of California. The 
Secretary shall consider the possible conversion of existing, 
underused Service hospital beds into psychiatric units to meet 
such need.

SEC. 710. TRAINING AND COMMUNITY EDUCATION.

  (a) Program.--The Secretary, in cooperation with the 
Secretary of the Interior, shall develop and implement or 
assist Indian Tribes and Tribal Organizations to develop and 
implement, within each Service Unit or tribal program, a 
program of community education and involvement which shall be 
designed to provide concise and timely information to the 
community leadership of each tribal community. Such program 
shall include education about behavioral health issues to 
political leaders, Tribal judges, law enforcement personnel, 
members of tribal health and education boards, health care 
providers including traditional practitioners, and other 
critical members of each tribal community. Such program may 
also include community-based training to develop local capacity 
and tribal community provider training for prevention, 
intervention, treatment, and aftercare.
  (b) Instruction.--The Secretary, acting through the Service, 
shall, either directly or through Indian Tribes and Tribal 
Organizations, provide instruction in the area of behavioral 
health issues, including instruction in crisis intervention and 
family relations in the context of alcohol and substance abuse, 
child sexual abuse, youth alcohol and substance abuse, and the 
causes and effects of fetal alcohol disorders to appropriate 
employees of the Bureau of Indian Affairs and the Service, and 
to personnel in schools or programs operated under any contract 
with the Bureau of Indian Affairs or the Service, including 
supervisors of emergency shelters and halfway houses described 
in section 4213 of the Indian Alcohol and Substance Abuse 
Prevention and Treatment Act of 1986 (25 U.S.C. 2433).
  (c) Training Models.--In carrying out the education and 
training programs required by this section, the Secretary, in 
consultation with Indian Tribes, Tribal Organizations, Indian 
behavioral health experts, and Indian alcohol and substance 
abuse prevention experts, shall develop and provide community-
based training models. Such models shall address--
          (1) the elevated risk of alcohol and behavioral 
        health problems faced by children of alcoholics;
          (2) the cultural, spiritual, and multigenerational 
        aspects of behavioral health problem prevention and 
        recovery; and
          (3) community-based and multidisciplinary strategies 
        for preventing and treating behavioral health problems.

SEC. 711. BEHAVIORAL HEALTH PROGRAM.

  (a) Innovative Programs.--The Secretary, acting through the 
Service, Indian Tribes, and Tribal Organizations, consistent 
with section 701, may plan, develop, implement, and carry out 
programs to deliver innovative community-based behavioral 
health services to Indians.
  (b) Awards; Criteria.--The Secretary may award a grant for a 
project under subsection (a) to an Indian Tribe or Tribal 
Organization and may consider the following criteria:
          (1) The project will address significant unmet 
        behavioral health needs among Indians.
          (2) The project will serve a significant number of 
        Indians.
          (3) The project has the potential to deliver services 
        in an efficient and effective manner.
          (4) The Indian Tribe or Tribal Organization has the 
        administrative and financial capability to administer 
        the project.
          (5) The project may deliver services in a manner 
        consistent with traditional health care practices.
          (6) The project is coordinated with, and avoids 
        duplication of, existing services.
  (c) Equitable Treatment.--For purposes of this subsection, 
the Secretary shall, in evaluating project applications or 
proposals, use the same criteria that the Secretary uses in 
evaluating any other application or proposal for such funding.

SEC. 712. FETAL ALCOHOL DISORDER PROGRAMS.

  (a) Programs.--
          (1) Establishment.--The Secretary, consistent with 
        section 701, acting through the Service, Indian Tribes, 
        and Tribal Organizations, is authorized to establish 
        and operate fetal alcohol disorder programs as provided 
        in this section for the purposes of meeting the health 
        status objectives specified in section 3.
          (2) Use of funds.--
                  (A) In general.--Funding provided pursuant to 
                this section shall be used for the following:
                          (i) To develop and provide for 
                        Indians community and in-school 
                        training, education, and prevention 
                        programs relating to fetal alcohol 
                        disorders.
                          (ii) To identify and provide 
                        behavioral health treatment to high-
                        risk Indian women and high-risk women 
                        pregnant with an Indian's child.
                          (iii) To identify and provide 
                        appropriate psychological services, 
                        educational and vocational support, 
                        counseling, advocacy, and information 
                        to fetal alcohol disorder affected 
                        Indians and their families or 
                        caretakers.
                          (iv) To develop and implement 
                        counseling and support programs in 
                        schools for fetal alcohol disorder 
                        affected Indian children.
                          (v) To develop prevention and 
                        intervention models which incorporate 
                        practitioners of traditional health 
                        care practices, cultural values, and 
                        community involvement.
                          (vi) To develop, print, and 
                        disseminate education and prevention 
                        materials on fetal alcohol disorder.
                          (vii) To develop and implement, in 
                        consultation with Indian Tribes, Tribal 
                        Organizations, and Urban Indian 
                        Organizations, culturally sensitive 
                        assessment and diagnostic tools 
                        including dysmorphology clinics and 
                        multidisciplinary fetal alcohol 
                        disorder clinics for use in Indian 
                        communities and Urban Centers.
                  (B) Additional uses.--In addition to any 
                purpose under subparagraph (A), funding 
                provided pursuant to this section may be used 
                for 1 or more of the following:
                          (i) Early childhood intervention 
                        projects from birth on to mitigate the 
                        effects of fetal alcohol disorder among 
                        Indians.
                          (ii) Community-based support services 
                        for Indians and women pregnant with 
                        Indian children.
                          (iii) Community-based housing for 
                        adult Indians with fetal alcohol 
                        disorder.
          (3) Criteria for applications.--The Secretary shall 
        establish criteria for the review and approval of 
        applications for funding under this section.
  (b) Services.--The Secretary, acting through the Service and 
Indian Tribes, Tribal Organizations, and Urban Indian 
Organizations, shall--
          (1) develop and provide services for the prevention, 
        intervention, treatment, and aftercare for those 
        affected by fetal alcohol disorder in Indian 
        communities; and
          (2) provide supportive services, including services 
        to meet the special educational, vocational, school-to-
        work transition, and independent living needs of 
        adolescent and adult Indians with fetal alcohol 
        disorder.
  (c) Task Force.--The Secretary shall establish a task force 
to be known as the Fetal Alcohol Disorder Task Force to advise 
the Secretary in carrying out subsection (b). Such task force 
shall be composed of representatives from the following:
          (1) The National Institute on Drug Abuse.
          (2) The National Institute on Alcohol and Alcoholism.
          (3) The Office of Substance Abuse Prevention.
          (4) The National Institute of Mental Health.
          (5) The Service.
          (6) The Office of Minority Health of the Department 
        of Health and Human Services.
          (7) The Administration for Native Americans.
          (8) The National Institute of Child Health and Human 
        Development (NICHD).
          (9) The Centers for Disease Control and Prevention.
          (10) The Bureau of Indian Affairs.
          (11) Indian Tribes.
          (12) Tribal Organizations.
          (13) Urban Indian Organizations.
          (14) Indian fetal alcohol disorder experts.
  (d) Applied Research Projects.--The Secretary, acting through 
the Substance Abuse and Mental Health Services Administration, 
shall make grants to Indian Tribes, Tribal Organizations, and 
Urban Indian Organizations for applied research projects which 
propose to elevate the understanding of methods to prevent, 
intervene, treat, or provide rehabilitation and behavioral 
health aftercare for Indians and Urban Indians affected by 
fetal alcohol disorder.
  (e) Funding for Urban Indian Organizations.--Ten percent of 
the funds appropriated pursuant to this section shall be used 
to make grants to Urban Indian Organizations funded under title 
V.

SEC. 713. CHILD SEXUAL ABUSE AND PREVENTION TREATMENT PROGRAMS.

  (a) Establishment.--The Secretary, acting through the 
Service, and the Secretary of the Interior, Indian Tribes, and 
Tribal Organizations, shall establish, consistent with section 
701, in every Service Area, programs involving treatment for--
          (1) victims of sexual abuse who are Indian children 
        or children in an Indian household; and
          (2) perpetrators of child sexual abuse who are Indian 
        or members of an Indian household.
  (b) Use of Funds.--Funding provided pursuant to this section 
shall be used for the following:
          (1) To develop and provide community education and 
        prevention programs related to sexual abuse of Indian 
        children or children in an Indian household.
          (2) To identify and provide behavioral health 
        treatment to victims of sexual abuse who are Indian 
        children or children in an Indian household, and to 
        their family members who are affected by sexual abuse.
          (3) To develop prevention and intervention models 
        which incorporate traditional health care practices, 
        cultural values, and community involvement.
          (4) To develop and implement culturally sensitive 
        assessment and diagnostic tools for use in Indian 
        communities and Urban Centers.
          (5) To identify and provide behavioral health 
        treatment to Indian perpetrators and perpetrators who 
        are members of an Indian household--
                  (A) making efforts to begin offender and 
                behavioral health treatment while the 
                perpetrator is incarcerated or at the earliest 
                possible date if the perpetrator is not 
                incarcerated; and
                  (B) providing treatment after the perpetrator 
                is released, until it is determined that the 
                perpetrator is not a threat to children.
  (c) Coordination.--The programs established under subsection 
(a) shall be carried out in coordination with programs and 
services authorized under the Indian Child Protection and 
Family Violence Prevention Act (25 U.S.C. 3201 et seq.).

SEC. 714. BEHAVIORAL HEALTH RESEARCH.

  The Secretary, in consultation with appropriate Federal 
agencies, shall make grants to, or enter into contracts with, 
Indian Tribes, Tribal Organizations, and Urban Indian 
Organizations or enter into contracts with, or make grants to 
appropriate institutions for, the conduct of research on the 
incidence and prevalence of behavioral health problems among 
Indians served by the Service, Indian Tribes, or Tribal 
Organizations and among Indians in urban areas. Research 
priorities under this section shall include--
          (1) the multifactorial causes of Indian youth 
        suicide, including--
                  (A) protective and risk factors and 
                scientific data that identifies those factors; 
                and
                  (B) the effects of loss of cultural identity 
                and the development of scientific data on those 
                effects;
          (2) the interrelationship and interdependence of 
        behavioral health problems with alcoholism and other 
        substance abuse, suicide, homicides, other injuries, 
        and the incidence of family violence; and
          (3) the development of models of prevention 
        techniques.
The effect of the interrelationships and interdependencies 
referred to in paragraph (2) on children, and the development 
of prevention techniques under paragraph (3) applicable to 
children, shall be emphasized.

SEC. 715. DEFINITIONS.

  For the purpose of this title, the following definitions 
shall apply:
          (1) Assessment.--The term ``assessment'' means the 
        systematic collection, analysis, and dissemination of 
        information on health status, health needs, and health 
        problems.
          (2) Alcohol-related neurodevelopmental disorders or 
        arnd.--The term ``alcohol-related neurodevelopmental 
        disorders'' or ``ARND'' means, with a history of 
        maternal alcohol consumption during pregnancy, central 
        nervous system involvement such as developmental delay, 
        intellectual deficit, or neurologic abnormalities. 
        Behaviorally, there can be problems with irritability, 
        and failure to thrive as infants. As children become 
        older there will likely be hyperactivity, attention 
        deficit, language dysfunction, and perceptual and 
        judgment problems.
          (3) Behavioral health aftercare.--The term 
        ``behavioral health aftercare'' includes those 
        activities and resources used to support recovery 
        following inpatient, residential, intensive substance 
        abuse, or mental health outpatient or outpatient 
        treatment. The purpose is to help prevent or deal with 
        relapse by ensuring that by the time a client or 
        patient is discharged from a level of care, such as 
        outpatient treatment, an aftercare plan has been 
        developed with the client. An aftercare plan may use 
        such resources as a community-based therapeutic group, 
        transitional living facilities, a 12-step sponsor, a 
        local 12-step or other related support group, and other 
        community-based providers.
          (4) Dual diagnosis.--The term ``dual diagnosis'' 
        means coexisting substance abuse and mental illness 
        conditions or diagnosis. Such clients are sometimes 
        referred to as mentally ill chemical abusers (MICAs).
          (5) Fetal alcohol disorders.--The term ``fetal 
        alcohol disorders'' means fetal alcohol syndrome, 
        partial fetal alcohol syndrome and alcohol related 
        neurodevelopmental disorder (ARND).
          (6) Fetal alcohol syndrome or fas.--The term ``fetal 
        alcohol syndrome'' or ``FAS'' means a syndrome in 
        which, with a history of maternal alcohol consumption 
        during pregnancy, the following criteria are met:
                  (A) Central nervous system involvement such 
                as developmental delay, intellectual deficit, 
                microencephaly, or neurologic abnormalities.
                  (B) Craniofacial abnormalities with at least 
                2 of the following: microophthalmia, short 
                palpebral fissures, poorly developed philtrum, 
                thin upper lip, flat nasal bridge, and short 
                upturned nose.
                  (C) Prenatal or postnatal growth delay.
          (7) Partial fas.--The term ``partial FAS'' means, 
        with a history of maternal alcohol consumption during 
        pregnancy, having most of the criteria of FAS, though 
        not meeting a minimum of at least 2 of the following: 
        microophthalmia, short palpebral fissures, poorly 
        developed philtrum, thin upper lip, flat nasal bridge, 
        and short upturned nose.
          (8) Rehabilitation.--The term ``rehabilitation'' 
        means to restore the ability or capacity to engage in 
        usual and customary life activities through education 
        and therapy.
          (9) Substance abuse.--The term ``substance abuse'' 
        includes inhalant abuse.

SEC. 716. AUTHORIZATION OF APPROPRIATIONS.

  There is authorized to be appropriated such sums as may be 
necessary for each fiscal year through fiscal year 2017 to 
carry out the provisions of this title.

                       TITLE VIII--MISCELLANEOUS

SEC. 801. REPORTS.

  For each fiscal year following the date of enactment of the 
Indian Health Care Improvement Act Amendments of 2007, the 
Secretary shall transmit to Congress a report containing the 
following:
          (1) A report on the progress made in meeting the 
        objectives of this Act, including a review of programs 
        established or assisted pursuant to this Act and 
        assessments and recommendations of additional programs 
        or additional assistance necessary to, at a minimum, 
        provide health services to Indians and ensure a health 
        status for Indians, which are at a parity with the 
        health services available to and the health status of 
        the general population.
          (2) A report on whether, and to what extent, new 
        national health care programs, benefits, initiatives, 
        or financing systems have had an impact on the purposes 
        of this Act and any steps that the Secretary may have 
        taken to consult with Indian Tribes, Tribal 
        Organizations, and Urban Indian Organizations to 
        address such impact, including a report on proposed 
        changes in allocation of funding pursuant to section 
        808.
          (3) A report on the use of health services by 
        Indians--
                  (A) on a national and area or other relevant 
                geographical basis;
                  (B) by gender and age;
                  (C) by source of payment and type of service;
                  (D) comparing such rates of use with rates of 
                use among comparable non-Indian populations; 
                and
                  (E) provided under contracts.
          (4) A report of contractors to the Secretary on 
        Health Care Educational Loan Repayments every 6 months 
        required by section 110.
          (5) A general audit report of the Secretary on the 
        Health Care Educational Loan Repayment Program as 
        required by section 110(n).
          (6) A report of the findings and conclusions of 
        demonstration programs on development of educational 
        curricula for substance abuse counseling as required in 
        section 125(f).
          (7) A separate statement which specifies the amount 
        of funds requested to carry out the provisions of 
        section 201.
          (8) A report of the evaluations of health promotion 
        and disease prevention as required in section 203(c).
          (9) A biennial report to Congress on infectious 
        diseases as required by section 212.
          (10) A report on environmental and nuclear health 
        hazards as required by section 215.
          (11) An annual report on the status of all health 
        care facilities needs as required by section 
        301(c)(2)(B) and 301(d).
          (12) Reports on safe water and sanitary waste 
        disposal facilities as required by section 302(h).
          (13) An annual report on the expenditure of non-
        Service funds for renovation as required by sections 
        304(b)(2).
          (14) A report identifying the backlog of maintenance 
        and repair required at Service and tribal facilities 
        required by section 313(a).
          (15) A report providing an accounting of 
        reimbursement funds made available to the Secretary 
        under titles XVIII, XIX, and XXI of the Social Security 
        Act.
          (16) A report on any arrangements for the sharing of 
        medical facilities or services, as authorized by 
        section 406.
          (17) A report on evaluation and renewal of Urban 
        Indian programs under section 505.
          (18) A report on the evaluation of programs as 
        required by section 513(d).
          (19) A report on alcohol and substance abuse as 
        required by section 701(f).
          (20) A report on Indian youth mental health services 
        as required by section 707(h).
          (21) A report on the reallocation of base resources 
        if required by section 808.
          (22) Report regarding patient movement.--A report on 
        the movement of patients between Service Units, 
        including--
                  (A) a list of those Service Units that have a 
                net increase and those that have a net decrease 
                of patients due to patients assigned to one 
                Service Unit voluntarily choosing to receive 
                service at another Service Unit;
                  (B) an analysis of the effect of patient 
                movement on the quality of services for those 
                Service Units experiencing an increase in the 
                number of patients served; and
                  (C) what funding changes are necessary to 
                maintain a consistent quality of service at 
                Service Units that have an increase in the 
                number of patients served.

SEC. 802. REGULATIONS.

  (a) Deadlines.--
          (1) Procedures.--Not later than 90 days after the 
        date of enactment of the Indian Health Care Improvement 
        Act Amendments of 2007, the Secretary shall initiate 
        procedures under subchapter III of chapter 5 of title 
        5, United States Code, to negotiate and promulgate such 
        regulations or amendments thereto that are necessary to 
        carry out titles II (except section 202) and VII, the 
        sections of title III for which negotiated rulemaking 
        is specifically required, and section 807. Unless 
        otherwise required, the Secretary may promulgate 
        regulations to carry out titles I, III, IV, and V, and 
        section 202, using the procedures required by chapter V 
        of title 5, United States Code (commonly known as the 
        ``Administrative Procedure Act'').
          (2) Proposed regulations.--Proposed regulations to 
        implement this Act shall be published in the Federal 
        Register by the Secretary no later than 2 years after 
        the date of enactment of the Indian Health Care 
        Improvement Act Amendments of 2007 and shall have no 
        less than a 120-day comment period.
          (3) Final regulations.--The Secretary shall publish 
        in the Federal Register final regulations to implement 
        this Act by not later than 3 years after the date of 
        enactment of the Indian Health Care Improvement Act 
        Amendments of 2007.
  (b) Committee.--A negotiated rulemaking committee established 
pursuant to section 565 of title 5, United States Code, to 
carry out this section shall have as its members only 
representatives of the Federal Government and representatives 
of Indian Tribes, and Tribal Organizations, a majority of whom 
shall be nominated by and be representatives of Indian Tribes 
and Tribal Organizations from each Service Area.
  (c) Adaptation of Procedures.--The Secretary shall adapt the 
negotiated rulemaking procedures to the unique context of self-
governance and the government-to-government relationship 
between the United States and Indian Tribes.
  (d) Lack of Regulations.--The lack of promulgated regulations 
shall not limit the effect of this Act.
  (e) Inconsistent Regulations.--The provisions of this Act 
shall supersede any conflicting provisions of law in effect on 
the day before the date of enactment of the Indian Health Care 
Improvement Act Amendments of 2007, and the Secretary is 
authorized to repeal any regulation inconsistent with the 
provisions of this Act.

SEC. 803. PLAN OF IMPLEMENTATION.

  Not later than 9 months after the date of enactment of the 
Indian Health Care Improvement Act Amendments of 2007, the 
Secretary, in consultation with Indian Tribes, Tribal 
Organizations, and Urban Indian Organizations, shall submit to 
Congress a plan explaining the manner and schedule, by title 
and section, by which the Secretary will implement the 
provisions of this Act. This consultation may be conducted 
jointly with the annual budget consultation pursuant to the 
Indian Self-Determination and Education Assistance Act (25 
U.S.C. 450 et seq).

SEC. 804. AVAILABILITY OF FUNDS.

  The funds appropriated pursuant to this Act shall remain 
available until expended.

SEC. 805. LIMITATION ON USE OF FUNDS APPROPRIATED TO INDIAN HEALTH 
                    SERVICE.

  Any limitation on the use of funds contained in an Act 
providing appropriations for the Department for a period with 
respect to the performance of abortions shall apply for that 
period with respect to the performance of abortions using funds 
contained in an Act providing appropriations for the Service.

SEC. 806. ELIGIBILITY OF CALIFORNIA INDIANS.

  (a) In General.--The following California Indians shall be 
eligible for health services provided by the Service:
          (1) Any member of a federally recognized Indian 
        Tribe.
          (2) Any descendant of an Indian who was residing in 
        California on June 1, 1852, if such descendant--
                  (A) is a member of the Indian community 
                served by a local program of the Service; and
                  (B) is regarded as an Indian by the community 
                in which such descendant lives.
          (3) Any Indian who holds trust interests in public 
        domain, national forest, or reservation allotments in 
        California.
          (4) Any Indian in California who is listed on the 
        plans for distribution of the assets of rancherias and 
        reservations located within the State of California 
        under the Act of August 18, 1958 (72 Stat. 619), and 
        any descendant of such an Indian.
  (b) Clarification.--Nothing in this section may be construed 
as expanding the eligibility of California Indians for health 
services provided by the Service beyond the scope of 
eligibility for such health services that applied on May 1, 
1986.

SEC. 807. HEALTH SERVICES FOR INELIGIBLE PERSONS.

  (a) Children.--Any individual who--
          (1) has not attained 19 years of age;
          (2) is the natural or adopted child, stepchild, 
        foster child, legal ward, or orphan of an eligible 
        Indian; and
          (3) is not otherwise eligible for health services 
        provided by the Service,
shall be eligible for all health services provided by the 
Service on the same basis and subject to the same rules that 
apply to eligible Indians until such individual attains 19 
years of age. The existing and potential health needs of all 
such individuals shall be taken into consideration by the 
Service in determining the need for, or the allocation of, the 
health resources of the Service. If such an individual has been 
determined to be legally incompetent prior to attaining 19 
years of age, such individual shall remain eligible for such 
services until 1 year after the date of a determination of 
competency.
  (b) Spouses.--Any spouse of an eligible Indian who is not an 
Indian, or who is of Indian descent but is not otherwise 
eligible for the health services provided by the Service, shall 
be eligible for such health services if all such spouses or 
spouses who are married to members of each Indian Tribe being 
served are made eligible, as a class, by an appropriate 
resolution of the governing body of the Indian Tribe or Tribal 
Organization providing such services. The health needs of 
persons made eligible under this paragraph shall not be taken 
into consideration by the Service in determining the need for, 
or allocation of, its health resources.
  (c) Provision of Services to Other Individuals.--
          (1) In general.--The Secretary is authorized to 
        provide health services under this subsection through 
        health programs operated directly by the Service to 
        individuals who reside within the Service Unit and who 
        are not otherwise eligible for such health services 
        if--
                  (A) the Indian Tribes served by such Service 
                Unit request such provision of health services 
                to such individuals; and
                  (B) the Secretary and the served Indian 
                Tribes have jointly determined that--
                          (i) the provision of such health 
                        services will not result in a denial or 
                        diminution of health services to 
                        eligible Indians; and
                          (ii) there is no reasonable 
                        alternative health facilities or 
                        services, within or without the Service 
                        Unit, available to meet the health 
                        needs of such individuals.
          (2) ISDEAA programs.--In the case of health programs 
        and facilities operated under a contract or compact 
        entered into under the Indian Self-Determination and 
        Education Assistance Act (25 U.S.C. 450 et seq.), the 
        governing body of the Indian Tribe or Tribal 
        Organization providing health services under such 
        contract or compact is authorized to determine whether 
        health services should be provided under such contract 
        to individuals who are not eligible for such health 
        services under any other subsection of this section or 
        under any other provision of law. In making such 
        determinations, the governing body of the Indian Tribe 
        or Tribal Organization shall take into account the 
        considerations described in paragraph (1)(B).
          (3) Payment for services.--
                  (A) In general.--Persons receiving health 
                services provided by the Service under this 
                subsection shall be liable for payment of such 
                health services under a schedule of charges 
                prescribed by the Secretary which, in the 
                judgment of the Secretary, results in 
                reimbursement in an amount not less than the 
                actual cost of providing the health services. 
                Notwithstanding section 404 of this Act or any 
                other provision of law, amounts collected under 
                this subsection, including Medicare, Medicaid, 
                or SCHIP reimbursements under titles XVIII, 
                XIX, and XXI of the Social Security Act, shall 
                be credited to the account of the program 
                providing the service and shall be used for the 
                purposes listed in section 401(d)(2) and 
                amounts collected under this subsection shall 
                be available for expenditure within such 
                program.
                  (B) Indigent people.--Health services may be 
                provided by the Secretary through the Service 
                under this subsection to an indigent individual 
                who would not be otherwise eligible for such 
                health services but for the provisions of 
                paragraph (1) only if an agreement has been 
                entered into with a State or local government 
                under which the State or local government 
                agrees to reimburse the Service for the 
                expenses incurred by the Service in providing 
                such health services to such indigent 
                individual.
          (4) Revocation of consent for services.--
                  (A) Single tribe service area.--In the case 
                of a Service Area which serves only 1 Indian 
                Tribe, the authority of the Secretary to 
                provide health services under paragraph (1) 
                shall terminate at the end of the fiscal year 
                succeeding the fiscal year in which the 
                governing body of the Indian Tribe revokes its 
                concurrence to the provision of such health 
                services.
                  (B) Multitribal service area.--In the case of 
                a multitribal Service Area, the authority of 
                the Secretary to provide health services under 
                paragraph (1) shall terminate at the end of the 
                fiscal year succeeding the fiscal year in which 
                at least 51 percent of the number of Indian 
                Tribes in the Service Area revoke their 
                concurrence to the provisions of such health 
                services.
  (d) Other Services.--The Service may provide health services 
under this subsection to individuals who are not eligible for 
health services provided by the Service under any other 
provision of law in order to--
          (1) achieve stability in a medical emergency;
          (2) prevent the spread of a communicable disease or 
        otherwise deal with a public health hazard;
          (3) provide care to non-Indian women pregnant with an 
        eligible Indian's child for the duration of the 
        pregnancy through postpartum; or
          (4) provide care to immediate family members of an 
        eligible individual if such care is directly related to 
        the treatment of the eligible individual.
  (e) Hospital Privileges for Practitioners.--Hospital 
privileges in health facilities operated and maintained by the 
Service or operated under a contract or compact pursuant to the 
Indian Self-Determination and Education Assistance Act (25 
U.S.C. 450 et seq.) may be extended to non-Service health care 
practitioners who provide services to individuals described in 
subsection (a), (b), (c), or (d). Such non-Service health care 
practitioners may, as part of the privileging process, be 
designated as employees of the Federal Government for purposes 
of section 1346(b) and chapter 171 of title 28, United States 
Code (relating to Federal tort claims) only with respect to 
acts or omissions which occur in the course of providing 
services to eligible individuals as a part of the conditions 
under which such hospital privileges are extended.
  (f) Eligible Indian.--For purposes of this section, the term 
``eligible Indian'' means any Indian who is eligible for health 
services provided by the Service without regard to the 
provisions of this section.

SEC. 808. REALLOCATION OF BASE RESOURCES.

  (a) Report Required.--Notwithstanding any other provision of 
law, any allocation of Service funds for a fiscal year that 
reduces by 5 percent or more from the previous fiscal year the 
funding for any recurring program, project, or activity of a 
Service Unit may be implemented only after the Secretary has 
submitted to Congress, under section 801, a report on the 
proposed change in allocation of funding, including the reasons 
for the change and its likely effects.
  (b) Exception.--Subsection (a) shall not apply if the total 
amount appropriated to the Service for a fiscal year is at 
least 5 percent less than the amount appropriated to the 
Service for the previous fiscal year.

SEC. 809. RESULTS OF DEMONSTRATION PROJECTS.

  The Secretary shall provide for the dissemination to Indian 
Tribes, Tribal Organizations, and Urban Indian Organizations of 
the findings and results of demonstration projects conducted 
under this Act.

SEC. 810. PROVISION OF SERVICES IN MONTANA.

  (a) Consistent With Court Decision.--The Secretary, acting 
through the Service, shall provide services and benefits for 
Indians in Montana in a manner consistent with the decision of 
the United States Court of Appeals for the Ninth Circuit in 
McNabb for McNabb v. Bowen, 829 F.2d 787 (9th Cir. 1987).
  (b) Clarification.--The provisions of subsection (a) shall 
not be construed to be an expression of the sense of Congress 
on the application of the decision described in subsection (a) 
with respect to the provision of services or benefits for 
Indians living in any State other than Montana.

SEC. 811. MORATORIUM.

  During the period of the moratorium imposed on implementation 
of the final rule published in the Federal Register on 
September 16, 1987, by the Department of Health and Human 
Services, relating to eligibility for the health care services 
of the Indian Health Service, the Indian Health Service shall 
provide services pursuant to the criteria for eligibility for 
such services that were in effect on September 15, 1987, 
subject to the provisions of sections 806 and 807, until the 
Service has submitted to the Committees on Appropriations of 
the Senate and the House of Representatives a budget request 
reflecting the increased costs associated with the proposed 
final rule, and the request has been included in an 
appropriations Act and enacted into law.

SEC. 812. SEVERABILITY PROVISIONS.

  If any provision of this Act, any amendment made by the Act, 
or the application of such provision or amendment to any person 
or circumstances is held to be invalid, the remainder of this 
Act, the remaining amendments made by this Act, and the 
application of such provisions to persons or circumstances 
other than those to which it is held invalid, shall not be 
affected thereby.

SEC. 813. ESTABLISHMENT OF NATIONAL BIPARTISAN COMMISSION ON INDIAN 
                    HEALTH CARE.

  (a) Establishment.--There is established the National 
Bipartisan Indian Health Care Commission (the ``Commission'').
  (b) Duties of Commission.--The duties of the Commission are 
the following:
          (1) To establish a study committee composed of those 
        members of the Commission appointed by the Director of 
        the Service and at least 4 members of Congress from 
        among the members of the Commission, the duties of 
        which shall be the following:
                  (A) To the extent necessary to carry out its 
                duties, collect and compile data necessary to 
                understand the extent of Indian needs with 
                regard to the provision of health services, 
                regardless of the location of Indians, 
                including holding hearings and soliciting the 
                views of Indians, Indian Tribes, Tribal 
                Organizations, and Urban Indian Organizations, 
                which may include authorizing and making funds 
                available for feasibility studies of various 
                models for providing and funding health 
                services for all Indian beneficiaries, 
                including those who live outside of a 
                reservation, temporarily or permanently.
                  (B) To make legislative recommendations to 
                the Commission regarding the delivery of 
                Federal health care services to Indians. Such 
                recommendations shall include those related to 
                issues of eligibility, benefits, the range of 
                service providers, the cost of such services, 
                financing such services, and the optimal manner 
                in which to provide such services.
                  (C) To determine the effect of the enactment 
                of such recommendations on (i) the existing 
                system of delivery of health services for 
                Indians, and (ii) the sovereign status of 
                Indian Tribes.
                  (D) Not later than 12 months after the 
                appointment of all members of the Commission, 
                to submit a written report of its findings and 
                recommendations to the full Commission. The 
                report shall include a statement of the 
                minority and majority position of the Committee 
                and shall be disseminated, at a minimum, to 
                every Indian Tribe, Tribal Organization, and 
                Urban Indian Organization for comment to the 
                Commission.
                  (E) To report regularly to the full 
                Commission regarding the findings and 
                recommendations developed by the study 
                committee in the course of carrying out its 
                duties under this section.
          (2) To review and analyze the recommendations of the 
        report of the study committee.
          (3) To make legislative recommendations to Congress 
        regarding the delivery of Federal health care services 
        to Indians. Such recommendations shall include those 
        related to issues of eligibility, benefits, the range 
        of service providers, the cost of such services, 
        financing such services, and the optimal manner in 
        which to provide such services.
          (4) Not later than 18 months following the date of 
        appointment of all members of the Commission, submit a 
        written report to Congress regarding the delivery of 
        Federal health care services to Indians. Such 
        recommendations shall include those related to issues 
        of eligibility, benefits, the range of service 
        providers, the cost of such services, financing such 
        services, and the optimal manner in which to provide 
        such services.
  (c) Members.--
          (1) Appointment.--The Commission shall be composed of 
        25 members, appointed as follows:
                  (A) Ten members of Congress, including 3 from 
                the House of Representatives and 2 from the 
                Senate, appointed by their respective majority 
                leaders, and 3 from the House of 
                Representatives and 2 from the Senate, 
                appointed by their respective minority leaders, 
                and who shall be members of the standing 
                committees of Congress that consider 
                legislation affecting health care to Indians.
                  (B) Twelve persons chosen by the 
                congressional members of the Commission, 1 from 
                each Service Area as currently designated by 
                the Director of the Service to be chosen from 
                among 3 nominees from each Service Area put 
                forward by the Indian Tribes within the area, 
                with due regard being given to the experience 
                and expertise of the nominees in the provision 
                of health care to Indians and to a reasonable 
                representation on the commission of members who 
                are familiar with various health care delivery 
                modes and who represent Indian Tribes of 
                various size populations.
                  (C) Three persons appointed by the Director 
                who are knowledgeable about the provision of 
                health care to Indians, at least 1 of whom 
                shall be appointed from among 3 nominees put 
                forward by those programs whose funds are 
                provided in whole or in part by the Service 
                primarily or exclusively for the benefit of 
                Urban Indians.
                  (D) All those persons chosen by the 
                congressional members of the Commission and by 
                the Director shall be members of federally 
                recognized Indian Tribes.
          (2) Chair; vice chair.--The Chair and Vice Chair of 
        the Commission shall be selected by the congressional 
        members of the Commission.
          (3) Terms.--The terms of members of the Commission 
        shall be for the life of the Commission.
          (4) Deadline for appointments.--Congressional members 
        of the Commission shall be appointed not later than 180 
        days after the date of enactment of the Indian Health 
        Care Improvement Act Amendments of 2007, and the 
        remaining members of the Commission shall be appointed 
        not later than 60 days following the appointment of the 
        congressional members.
          (5) Vacancy.--A vacancy in the Commission shall be 
        filled in the manner in which the original appointment 
        was made.
  (d) Compensation.--
          (1) Congressional members.--Each congressional member 
        of the Commission shall receive no additional pay, 
        allowances, or benefits by reason of their service on 
        the Commission and shall receive travel expenses and 
        per diem in lieu of subsistence in accordance with 
        sections 5702 and 5703 of title 5, United States Code.
          (2) Other members.--Remaining members of the 
        Commission, while serving on the business of the 
        Commission (including travel time), shall be entitled 
        to receive compensation at the per diem equivalent of 
        the rate provided for level IV of the Executive 
        Schedule under section 5315 of title 5, United States 
        Code, and while so serving away from home and the 
        member's regular place of business, a member may be 
        allowed travel expenses, as authorized by the Chairman 
        of the Commission. For purpose of pay (other than pay 
        of members of the Commission) and employment benefits, 
        rights, and privileges, all personnel of the Commission 
        shall be treated as if they were employees of the 
        United States Senate.
  (e) Meetings.--The Commission shall meet at the call of the 
Chair.
  (f) Quorum.--A quorum of the Commission shall consist of not 
less than 15 members, provided that no less than 6 of the 
members of Congress who are Commission members are present and 
no less than 9 of the members who are Indians are present.
  (g) Executive Director; Staff; Facilities.--
          (1) Appointment; pay.--The Commission shall appoint 
        an executive director of the Commission. The executive 
        director shall be paid the rate of basic pay for level 
        V of the Executive Schedule.
          (2) Staff appointment.--With the approval of the 
        Commission, the executive director may appoint such 
        personnel as the executive director deems appropriate.
          (3) Staff pay.--The staff of the Commission shall be 
        appointed without regard to the provisions of title 5, 
        United States Code, governing appointments in the 
        competitive service, and shall be paid without regard 
        to the provisions of chapter 51 and subchapter III of 
        chapter 53 of such title (relating to classification 
        and General Schedule pay rates).
          (4) Temporary services.--With the approval of the 
        Commission, the executive director may procure 
        temporary and intermittent services under section 
        3109(b) of title 5, United States Code.
          (5) Facilities.--The Administrator of General 
        Services shall locate suitable office space for the 
        operation of the Commission. The facilities shall serve 
        as the headquarters of the Commission and shall include 
        all necessary equipment and incidentals required for 
        the proper functioning of the Commission.
  (h) Hearings.--(1) For the purpose of carrying out its 
duties, the Commission may hold such hearings and undertake 
such other activities as the Commission determines to be 
necessary to carry out its duties, provided that at least 6 
regional hearings are held in different areas of the United 
States in which large numbers of Indians are present. Such 
hearings are to be held to solicit the views of Indians 
regarding the delivery of health care services to them. To 
constitute a hearing under this subsection, at least 5 members 
of the Commission, including at least 1 member of Congress, 
must be present. Hearings held by the study committee 
established in this section may count toward the number of 
regional hearings required by this subsection.
  (2) Upon request of the Commission, the Comptroller General 
shall conduct such studies or investigations as the Commission 
determines to be necessary to carry out its duties.
  (3)(A) The Director of the Congressional Budget Office or the 
Chief Actuary of the Centers for Medicare & Medicaid Services, 
or both, shall provide to the Commission, upon the request of 
the Commission, such cost estimates as the Commission 
determines to be necessary to carry out its duties.
  (B) The Commission shall reimburse the Director of the 
Congressional Budget Office for expenses relating to the 
employment in the office of that Director of such additional 
staff as may be necessary for the Director to comply with 
requests by the Commission under subparagraph (A).
  (4) Upon the request of the Commission, the head of any 
Federal agency is authorized to detail, without reimbursement, 
any of the personnel of such agency to the Commission to assist 
the Commission in carrying out its duties. Any such detail 
shall not interrupt or otherwise affect the civil service 
status or privileges of the Federal employee.
  (5) Upon the request of the Commission, the head of a Federal 
agency shall provide such technical assistance to the 
Commission as the Commission determines to be necessary to 
carry out its duties.
  (6) The Commission may use the United States mails in the 
same manner and under the same conditions as Federal agencies 
and shall, for purposes of the frank, be considered a 
commission of Congress as described in section 3215 of title 
39, United States Code.
  (7) The Commission may secure directly from any Federal 
agency information necessary to enable it to carry out its 
duties, if the information may be disclosed under section 552 
of title 4, United States Code. Upon request of the Chairman of 
the Commission, the head of such agency shall furnish such 
information to the Commission.
  (8) Upon the request of the Commission, the Administrator of 
General Services shall provide to the Commission on a 
reimbursable basis such administrative support services as the 
Commission may request.
  (9) For purposes of costs relating to printing and binding, 
including the cost of personnel detailed from the Government 
Printing Office, the Commission shall be deemed to be a 
committee of Congress.
  (i) Authorization of Appropriations.--There is authorized to 
be appropriated $4,000,000 to carry out the provisions of this 
section, which sum shall not be deducted from or affect any 
other appropriation for health care for Indian persons.
  (j) Nonapplicability of FACA.--The Federal Advisory Committee 
Act (5 U.S.C. App.) shall not apply to the Commission.

SEC. 814. CONFIDENTIALITY OF MEDICAL QUALITY ASSURANCE RECORDS; 
                    QUALIFIED IMMUNITY FOR PARTICIPANTS.

  (a) Confidentiality of Records.--Medical quality assurance 
records created by or for any Indian Health Program or a health 
program of an Urban Indian Organization as part of a medical 
quality assurance program are confidential and privileged. Such 
records may not be disclosed to any person or entity, except as 
provided in subsection (c).
  (b) Prohibition on Disclosure and Testimony.--
          (1) In general.--No part of any medical quality 
        assurance record described in subsection (a) may be 
        subject to discovery or admitted into evidence in any 
        judicial or administrative proceeding, except as 
        provided in subsection (c).
          (2) Testimony.--A person who reviews or creates 
        medical quality assurance records for any Indian Health 
        Program or Urban Indian Organization who participates 
        in any proceeding that reviews or creates such records 
        may not be permitted or required to testify in any 
        judicial or administrative proceeding with respect to 
        such records or with respect to any finding, 
        recommendation, evaluation, opinion, or action taken by 
        such person or body in connection with such records 
        except as provided in this section.
  (c) Authorized Disclosure and Testimony.--
          (1) In general.--Subject to paragraph (2), a medical 
        quality assurance record described in subsection (a) 
        may be disclosed, and a person referred to in 
        subsection (b) may give testimony in connection with 
        such a record, only as follows:
                  (A) To a Federal executive agency or private 
                organization, if such medical quality assurance 
                record or testimony is needed by such agency or 
                organization to perform licensing or 
                accreditation functions related to any Indian 
                Health Program or to a health program of an 
                Urban Indian Organization to perform 
                monitoring, required by law, of such program or 
                organization.
                  (B) To an administrative or judicial 
                proceeding commenced by a present or former 
                Indian Health Program or Urban Indian 
                Organization provider concerning the 
                termination, suspension, or limitation of 
                clinical privileges of such health care 
                provider.
                  (C) To a governmental board or agency or to a 
                professional health care society or 
                organization, if such medical quality assurance 
                record or testimony is needed by such board, 
                agency, society, or organization to perform 
                licensing, credentialing, or the monitoring of 
                professional standards with respect to any 
                health care provider who is or was an employee 
                of any Indian Health Program or Urban Indian 
                Organization.
                  (D) To a hospital, medical center, or other 
                institution that provides health care services, 
                if such medical quality assurance record or 
                testimony is needed by such institution to 
                assess the professional qualifications of any 
                health care provider who is or was an employee 
                of any Indian Health Program or Urban Indian 
                Organization and who has applied for or been 
                granted authority or employment to provide 
                health care services in or on behalf of such 
                program or organization.
                  (E) To an officer, employee, or contractor of 
                the Indian Health Program or Urban Indian 
                Organization that created the records or for 
                which the records were created. If that 
                officer, employee, or contractor has a need for 
                such record or testimony to perform official 
                duties.
                  (F) To a criminal or civil law enforcement 
                agency or instrumentality charged under 
                applicable law with the protection of the 
                public health or safety, if a qualified 
                representative of such agency or 
                instrumentality makes a written request that 
                such record or testimony be provided for a 
                purpose authorized by law.
                  (G) In an administrative or judicial 
                proceeding commenced by a criminal or civil law 
                enforcement agency or instrumentality referred 
                to in subparagraph (F), but only with respect 
                to the subject of such proceeding.
          (2) Identity of participants.--With the exception of 
        the subject of a quality assurance action, the identity 
        of any person receiving health care services from any 
        Indian Health Program or Urban Indian Organization or 
        the identity of any other person associated with such 
        program or organization for purposes of a medical 
        quality assurance program that is disclosed in a 
        medical quality assurance record described in 
        subsection (a) shall be deleted from that record or 
        document before any disclosure of such record is made 
        outside such program or organization. Such requirement 
        does not apply to the release of information pursuant 
        to section 552a of title 5.
  (d) Disclosure for Certain Purposes.--
          (1) In general.--Nothing in this section shall be 
        construed as authorizing or requiring the withholding 
        from any person or entity aggregate statistical 
        information regarding the results of any Indian Health 
        Program or Urban Indian Organizations's medical quality 
        assurance programs.
          (2) Withholding from congress.--Nothing in this 
        section shall be construed as authority to withhold any 
        medical quality assurance record from a committee of 
        either House of Congress, any joint committee of 
        Congress, or the Government Accountability Office if 
        such record pertains to any matter within their 
        respective jurisdictions.
  (e) Prohibition on Disclosure of Record or Testimony.--A 
person or entity having possession of or access to a record or 
testimony described by this section may not disclose the 
contents of such record or testimony in any manner or for any 
purpose except as provided in this section.
  (f) Exemption From Freedom of Information Act.--Medical 
quality assurance records described in subsection (a) may not 
be made available to any person under section 552 of title 5.
  (g) Limitation on Civil Liability.--A person who participates 
in or provides information to a person or body that reviews or 
creates medical quality assurance records described in 
subsection (a) shall not be civilly liable for such 
participation or for providing such information if the 
participation or provision of information was in good faith 
based on prevailing professional standards at the time the 
medical quality assurance program activity took place.
  (h) Application to Information in Certain Other Records.--
Nothing in this section shall be construed as limiting access 
to the information in a record created and maintained outside a 
medical quality assurance program, including a patient's 
medical records, on the grounds that the information was 
presented during meetings of a review body that are part of a 
medical quality assurance program.
  (i) Regulations.--The Secretary, acting through the Service, 
shall promulgate regulations pursuant to section 802.
  (j) Definitions.--In this section:
          (1) The term ``health care provider'' means any 
        health care professional, including community health 
        aides and practitioners certified under section 121, 
        who are granted clinical practice privileges or 
        employed to provide health care services in an Indian 
        Health Program or health program of an Urban Indian 
        Organization, who is licensed or certified to perform 
        health care services by a governmental board or agency 
        or professional health care society or organization.
          (2) The term ``medical quality assurance program'' 
        means any activity carried out before, on, or after the 
        date of enactment of this Act by or for any Indian 
        Health Program or Urban Indian Organization to assess 
        the quality of medical care, including activities 
        conducted by or on behalf of individuals, Indian Health 
        Program or Urban Indian Organization medical or dental 
        treatment review committees, or other review bodies 
        responsible for quality assurance, credentials, 
        infection control, patient safety, patient care 
        assessment (including treatment procedures, blood, 
        drugs, and therapeutics), medical records, health 
        resources management review and identification and 
        prevention of medical or dental incidents and risks.
          (3) The term ``medical quality assurance record'' 
        means the proceedings, records, minutes, and reports 
        that emanate from quality assurance program activities 
        described in paragraph (2) and are produced or compiled 
        by or for an Indian Health Program or Urban Indian 
        Organization as part of a medical quality assurance 
        program.

SEC. 815. APPROPRIATIONS; AVAILABILITY.

  Any new spending authority (described in subparagraph (A) or 
(B) of section 401(c)(2) of the Congressional Budget Act of 
1974 (Public Law 93-344; 88 Stat. 317)) which is provided under 
this Act shall be effective for any fiscal year only to such 
extent or in such amounts as are provided in appropriation 
Acts.

SEC. 816. AUTHORIZATION OF APPROPRIATIONS.

  There are authorized to be appropriated such sums as may be 
necessary for each fiscal year through fiscal year 2017 to 
carry out this title.

           *       *       *       *       *       *       *

                              ----------                              -

                      TITLE 5, UNITED STATES CODE

-

           *       *       *       *       *       *       *
PART III--EMPLOYEES

           *       *       *       *       *       *       *

SUBPART D--PAY AND ALLOWANCES

           *       *       *       *       *       *       *

CHAPTER 53--PAY RATES AND SYSTEMS

           *       *       *       *       *       *       *

SUBCHAPTER II--EXECUTIVE SCHEDULE PAY RATES

           *       *       *       *       *       *       *

Sec. 5315. Positions at level IV

  Level IV of the Executive Schedule applies to the following 
positions, for which the annual rate of basic pay shall be the 
rate determined with respect to such level under chapter 11 of 
title 2, as adjusted by section 5318 of this title:
          Deputy Administrator of General Services.

           *       *       *       *       *       *       *

          [Assistant Secretaries of Health and Human Services 
        (6)] Assistant Secretaries of Health and Human Services 
        (7).

           *       *       *       *       *       *       *

Sec. 5316. Positions at level V

  Level V of the Executive Schedule applies to the following 
positions, for which the annual rate of basic pay shall be the 
rate determined with respect to such level under chapter 11 of 
title 2, as adjusted by section 5318 of this title:
          Administrator, Bonneville Power Administration, 
        Department of the Interior.

           *       *       *       *       *       *       *

          [Director, Indian Health Service, Department of 
        Health and Human Services.]

           *       *       *       *       *       *       *

                              ----------                              

                     CHILDREN'S HEALTH ACT OF 2000

SEC. 3307. ESTABLISHMENT OF COMMISSION.

  (a) * * *
  (b) Membership.--
          (1) In general.--The Commission established under 
        subsection (a) shall consist of--
                  (A) * * *
                  (C) the [Director of the Indian Health 
                Service] Assistant Secretary for Indian Health 
                and the Commissioner of Indian Affairs, who 
                shall be nonvoting members.

           *       *       *       *       *       *       *

                              ----------                              

               INDIAN LANDS OPEN DUMP CLEANUP ACT OF 1994

           *       *       *       *       *       *       *
SEC. 3. DEFINITIONS.

  For the purposes of this Act, the following definitions shall 
apply:
          [(6)] (1) Alaska native entity.--The term ``Alaska 
        Native entity'' includes native corporations 
        established pursuant to the Alaska Native Claims 
        Settlement Act (43 U.S.C. 1600 et seq.) and any Alaska 
        Native village or municipal entity which owns Alaska 
        Native land.
          [(2) Director.--The term ``Director'' means the 
        Director of the Indian Health Service.]
          [(4)] (2) Alaska native land.--The term ``Alaska 
        Native land'' means (A) land conveyed or to be conveyed 
        pursuant to the Alaska Native Claims Settlement Act (43 
        U.S.C. 1600 et seq.), including any land reconveyed 
        under section 14(c)(3) of that Act (43 U.S.C. 
        1613(c)(3)), and (B) land conveyed pursuant to the Act 
        of November 2, 1966 (16 U.S.C. 1151 et seq.; commonly 
        known as the ``Fur Seal Act of 1966'').
          (3) Assistant secretary.--The term ``Assistant 
        Secretary'' means the Assistant Secretary for Indian 
        Health.
          [(1)] (4) Closure or close.--The term ``closure or 
        close'' means the termination of operations at open 
        dumps on Indian land or Alaska Native land and bringing 
        such dumps into compliance with applicable Federal 
        standards and regulations, or standards promulgated by 
        an Indian tribal government or Alaska Native entity, if 
        such standards are more stringent than the Federal 
        standards and regulations.
          [(3)] (5) Indian land.--The term ``Indian land'' 
        means--
                  (A) land within the limits of any Indian 
                reservation under the jurisdiction of the 
                United States Government, notwithstanding the 
                issuance of any patent, and including rights-
                of-way running through the reservation;
                  (B) dependent Indian communities within the 
                borders of the United States whether within the 
                original or subsequently acquired territory 
                thereof, and whether within or without the 
                limits of a State; and
                  (C) Indian allotments, the Indian titles to 
                which have not been extinguished, including 
                rights-of-way running through such allotments.
          [(5)] (6) Indian tribal government.--The term 
        ``Indian tribal government'' means the governing body 
        of any Indian tribe, band, nation, pueblo, or other 
        organized group or community which is recognized as 
        eligible for the special programs and services provided 
        by the United States to Indians because of their status 
        as Indians.

           *       *       *       *       *       *       *

SEC. 4. INVENTORY OF OPEN DUMPS.

  (a) Study and Inventory.--Not later than 12 months after the 
date of enactment of this Act, the [Director] Assistant 
Secretary shall conduct a study and inventory of open dumps on 
Indian lands and Alaska Native lands. The inventory shall list 
the geographic location of all open dumps, an evaluation of the 
contents of each dump, and an assessment of the relative 
severity of the threat to public health and the environment 
posed by each dump. Such assessment shall be carried out 
cooperatively with the Administrator of the Environmental 
Protection Agency. The [Director] Assistant Secretary shall 
obtain the concurrence of the Administrator in the 
determination of relative severity made by any such assessment.
  (b) Annual Reports.--Upon completion of the study and 
inventory under subsection (a), the [Director] Assistant 
Secretary shall report to the Congress, and update such report 
annually--
          (1) the current priority of Indian and Alaska Native 
        solid waste deficiencies,
          (2) the methodology of determining the priority 
        listing,
          (3) the level of funding needed to effectively close 
        or bring into compliance all open dumps on Indian lands 
        or Alaska Native lands, and
          (4) the progress made in addressing Indian and Alaska 
        Native solid waste deficiencies.
  (c) 10-Year Plan.--The [Director] Assistant Secretary shall 
develop and begin implementation of a 10-year plan to address 
solid waste disposal needs on Indian lands and Alaska Native 
lands. This 10-year plan shall identify--
          (1) * * *

           *       *       *       *       *       *       *

[SEC. 5. AUTHORITY OF THE DIRECTOR OF THE INDIAN HEALTH SERVICE.]

SEC. 5. AUTHORITY OF ASSISTANT SECRETARY FOR INDIAN HEALTH.

  (a) Reservation Inventory.--(1) Upon request by an Indian 
tribal government or Alaska Native entity, the [Director] 
Assistant Secretary shall--
          (A) * * *
          (B) determine the relative severity of the threat to 
        public health and the environment posed by each dump 
        based on information available to the [Director] 
        Assistant Secretary and the Indian tribal government or 
        Alaska Native entity unless the [Director] Assistant 
        Secretary, in consultation with the Indian tribal 
        government or Alaska Native entity, determines that 
        additional actions such as soil testing or water 
        monitoring would be appropriate in the circumstances; 
        and

           *       *       *       *       *       *       *

  (2) The inventory and evaluation authorized under paragraph 
(1)(A) shall be carried out cooperatively with the 
Administrator of the Environmental Protection Agency. The 
[Director] Assistant Secretary shall obtain the concurrence of 
the Administrator in the determination of relative severity 
made under paragraph (1)(B).
  (b) Assistance.--Upon completion of the activities required 
to be performed pursuant to subsection (a), the [Director] 
Assistant Secretary shall, subject to subsection (c), provide 
financial and technical assistance to the Indian tribal 
government or Alaska Native entity to carry out the activities 
necessary to--
          (1) * * *

           *       *       *       *       *       *       *

  (c) Conditions.--All assistance provided pursuant to 
subsection (b) shall be made available on a site-specific basis 
in accordance with priorities developed by the [Director] 
Assistant Secretary. Priorities on specific Indian lands or 
Alaska Native lands shall be developed in consultation with the 
Indian tribal government or Alaska Native entity. The 
priorities shall take into account the relative severity of the 
threat to public health and the environment posed by each open 
dump and the availability of funds necessary for closure and 
postclosure maintenance.

SEC. 6. CONTRACT AUTHORITY.

  (a) Authority of [Director] Assistant Secretary.--To the 
maximum extent feasible, the [Director] Assistant Secretary 
shall carry out duties under this Act through contracts, 
compacts, or memoranda of agreement with Indian tribal 
governments or Alaska Native entities pursuant to the Indian 
Self-Determination and Education Assistance Act (25 U.S.C. 450 
et seq.), section 7 of the Act of August 5, 1954 (42 U.S.C. 
2004a), or section 302 of the Indian Health Care Improvement 
Act (25 U.S.C. 1632).
  (b) Cooperative Agreements.--The [Director] Assistant 
Secretary is authorized, for purposes of carrying out the 
duties of the [Director] Assistant Secretary under this Act, to 
contract with or enter into such cooperative agreements with 
such other Federal agencies as is considered necessary to 
provide cost-sharing for closure and postclosure activities, to 
obtain necessary technical and financial assistance and 
expertise, and for such other purposes as the [Director] 
Assistant Secretary considers necessary.

SEC. 7. TRIBAL DEMONSTRATION PROJECT.

  (a) In General.--The [Director] Assistant Secretary may 
establish and carry out a program providing for demonstration 
projects involving open dumps on Indian land or Alaska Native 
land. It shall be the purpose of such projects to determine if 
there are unique cost factors involved in the cleanup and 
maintenance of open dumps on such land, and the extent to which 
advanced closure planning is necessary. Under the program, the 
[Director] Assistant Secretary is authorized to select no less 
than three Indian tribal governments or Alaska Native entities 
to participate in such demonstration projects.
  (b) Criteria.--Criteria established by the [Director] 
Assistant Secretary for the selection and participation of an 
Indian tribal government or Alaska Native entity in the 
demonstration project shall provide that in order to be 
eligible to participate, an Indian tribal government or Alaska 
Native entity must--
          (1) * * *

           *       *       *       *       *       *       *

SEC. 8. AUTHORIZATION OF APPROPRIATIONS.

  (a) * * *
  (b) Coordination.--The activities required to be performed by 
the [Director] Assistant Secretary under this Act shall be 
coordinated with activities related to solid waste and 
sanitation facilities funded pursuant to other authorizations.

SEC. 9. DISCLAIMERS.

  (a) Authority of [Director] Assistant Secretary.--Nothing in 
this Act shall be construed to alter, diminish, repeal, or 
supersede any authority conferred on the [Director] Assistant 
Secretary pursuant to section 302 of the Indian Health Care 
Improvement Act (25 U.S.C. 1632), and section 7 of the Act of 
August 5, 1954 (42 U.S.C. 2004a).

           *       *       *       *       *       *       *

                              ----------                              

 SECTION 5504 OF THE AUGUSTUS F. HAWKINS-ROBERT T. STAFFORD ELEMENTARY 
          AND SECONDARY SCHOOL IMPROVEMENT AMENDMENTS OF 1988

SEC. 5504. ADMINISTRATIVE PROVISIONS.

  (a) * * *

           *       *       *       *       *       *       *

  (d) Federal Agency Cooperation and Assistance.--
          (1) * * *
          (2) The Commissioner of the Administration for Native 
        Americans of the Department of Health and Human 
        Services and the [Director of the Indian Health 
        Service] Assistant Secretary for Indian Health of the 
        Department of Health and Human Services are authorized 
        to detail personnel to the Task Force, upon request, to 
        enable the Task Force to carry out its functions under 
        this part.

           *       *       *       *       *       *       *

                              ----------                              -

                       REHABILITATION ACT OF 1973

           *       *       *       *       *       *       *
TITLE II--RESEARCH AND TRAINING

           *       *       *       *       *       *       *

                         INTERAGENCY COMMITTEE

Sec. 203. (a)(1) In order to promote coordination and 
cooperation among Federal departments and agencies conducting 
rehabilitation research programs, including programs relating 
to assistive technology research and research that incorporates 
the principles of universal design, there is established within 
the Federal Government an Interagency Committee on Disability 
Research (hereinafter in this section referred to as the 
``Committee''), chaired by the Director and comprised of such 
members as the President may designate, including the following 
(or their designees): the Director, the Commissioner of the 
Rehabilitation Services Administration, the Assistant Secretary 
for Special Education and Rehabilitative Services, the 
Secretary of Education, the Secretary of Veterans Affairs, the 
Director of the National Institutes of Health, the Director of 
the National Institute of Mental Health, the Administrator of 
the National Aeronautics and Space Administration, the 
Secretary of Transportation, the Assistant Secretary of the 
Interior for Indian Affairs, the [Director of the Indian Health 
Service] Assistant Secretary for Indian Health, and the 
Director of the National Science Foundation.

           *       *       *       *       *       *       *

                              ----------                              -

         SECTION 518 OF THE FEDERAL WATER POLLUTION CONTROL ACT

SEC. 518. INDIAN TRIBES.

  (a) * * *
  (b) Assessment of Sewage Treatment Needs; Report.--The 
Administrator, in cooperation with the [Director of the Indian 
Health Service] Assistant Secretary for Indian Health, shall 
assess the need for sewage treatment works to serve Indian 
tribes, the degree to which such needs will be met through 
funds allotted to States under section 205 of this Act and 
priority lists under section 216 of this Act, and any obstacles 
which prevent such needs from being met. Not later than one 
year after the date of the enactment of this section, the 
Administrator shall submit a report to Congress on the 
assessment under this subsection, along with recommendations 
specifying (1) how the Administrator intends to provide 
assistance to Indian tribes to develop waste treatment 
management plans and to construct treatment works under this 
Act, and (2) methods by which the participation in and 
administration of programs under this Act by Indian tribes can 
be maximized.

           *       *       *       *       *       *       *

  (e) Treatment as States.--The Administrator is authorized to 
treat an Indian tribe as a State for purposes of title II and 
sections 104, 106, 303, 305, 308, 309, 314, 319, 401, 402, 404, 
and 406 of this Act to the degree necessary to carry out the 
objectives of this section, but only if--
          (1) * * *

           *       *       *       *       *       *       *

Such treatment as a State may include the direct provision of 
funds reserved under subsection (c) to the governing bodies of 
Indian tribes, and the determination of priorities by Indian 
tribes, where not determined by the Administrator in 
cooperation with the [Director of the Indian Health Service] 
Assistant Secretary for Indian Health. The Administrator, in 
cooperation with the [Director of the Indian Health Service] 
Assistant Secretary for Indian Health, is authorized to make 
grants under title II of this Act in an amount not to exceed 
100 percent of the cost of a project. Not later than 18 months 
after the date of the enactment of this section, the 
Administrator shall, in consultation with Indian tribes, 
promulgate final regulations which specify how Indian tribes 
shall be treated as States for purposes of this Act. The 
Administrator shall, in promulgating such regulations, consult 
affected States sharing common water bodies and provide a 
mechanism for the resolution of any unreasonable consequences 
that may arise as a result of differing water quality standards 
that may be set by States and Indian tribes located on common 
bodies of water. Such mechanism shall provide for explicit 
consideration of relevant factors including, but not limited 
to, the effects of differing water quality permit requirements 
on upstream and downstream dischargers, economic impacts, and 
present and historical uses and quality of the waters subject 
to such standards. Such mechanism should provide for the 
avoidance of such unreasonable consequences in a manner 
consistent with the objective of this Act.

           *       *       *       *       *       *       *

                              ----------                              

                       PUBLIC HEALTH SERVICE ACT

           *       *       *       *       *       *       *
TITLE III--GENERAL POWERS AND DUTIES OF PUBLIC HEALTH SERVICE

           *       *       *       *       *       *       *

Part B--Federal-State Cooperation

           *       *       *       *       *       *       *

              ORAL HEALTH PROMOTION AND DISEASE PREVENTION

Sec. 317M. (a) * * *
  (b) Community Water Fluoridation.--
          (1) In general.--The Secretary, acting through the 
        Director of the Centers for Disease Control and 
        Prevention and in collaboration with the [Director of 
        the Indian Health Service] Assistant Secretary for 
        Indian Health, shall establish a demonstration project 
        that is designed to assist rural water systems in 
        successfully implementing the water fluoridation 
        guidelines of the Centers for Disease Control and 
        Prevention that are entitled ``Engineering and 
        Administrative Recommendations for Water Fluoridation, 
        1995'' (referred to in this subsection as the 
        ``EARWF'').
          (2) Requirements.--
                  (A) Collaboration.--In collaborating under 
                paragraph (1), [the Directors referred to in 
                such paragraph] the Director of the Centers for 
                Disease Control and Prevention and the 
                Assistant Secretary for Indian Health shall 
                ensure that technical assistance and training 
                are provided to tribal programs located in each 
                of the 12 areas of the Indian Health Service. 
                The [Director of the Indian Health Service] 
                Assistant Secretary for Indian Health shall 
                provide coordination and administrative support 
                to tribes under this section.

           *       *       *       *       *       *       *

TITLE IV--NATIONAL RESEARCH INSTITUTES

           *       *       *       *       *       *       *

  Part C--Specific Provisions Respecting National Research Institutes

Subpart 1--National Cancer Institute

           *       *       *       *       *       *       *

SEC. 417C. GRANTS FOR EDUCATION, PREVENTION, AND EARLY DETECTION OF 
                    RADIOGENIC CANCERS AND DISEASES.

  (a) * * *
  (b) In General.--The Secretary, acting through the 
Administrator of the Health Resources and Services 
Administration in consultation with the Director of the 
National Institutes of Health and the [Director of the Indian 
Health Service] Assistant Secretary for Indian Health, may make 
competitive grants to any entity for the purpose of carrying 
out programs to--
          (1) * * *

           *       *       *       *       *       *       *

                              ----------                              -

                        SAFE DRINKING WATER ACT

-TITLE XIV--SAFETY OF PUBLIC WATER SYSTEMS

           *       *       *       *       *       *       *

Part E--General Provisions

           *       *       *       *       *       *       *

                       STATE REVOLVING LOAN FUNDS

Sec. 1452. (a) * * *

           *       *       *       *       *       *       *

  (i) Indian Tribes.--
          (1) * * *
          (2) Use of funds.--Funds reserved pursuant to 
        paragraph (1) shall be used to address the most 
        significant threats to public health associated with 
        public water systems that serve Indian Tribes, as 
        determined by the Administrator in consultation with 
        the [Director of the Indian Health Service] Assistant 
        Secretary for Indian Health and Indian Tribes.

           *       *       *       *       *       *       *

          (4) Needs assessment.--The Administrator, in 
        consultation with the [Director of the Indian Health 
        Service] Assistant Secretary for Indian Health and 
        Indian Tribes, shall, in accordance with a schedule 
        that is consistent with the needs surveys conducted 
        pursuant to subsection (h), prepare surveys and assess 
        the needs of drinking water treatment facilities to 
        serve Indian Tribes, including an evaluation of the 
        public water systems that pose the most significant 
        threats to public health.

           *       *       *       *       *       *       *

                              ----------                              -

                  NATIVE AMERICAN PROGRAMS ACT OF 1974

           *       *       *       *       *       *       *
TITLE VIII--NATIVE AMERICAN PROGRAMS

           *       *       *       *       *       *       *

          ESTABLISHMENT OF ADMINISTRATION FOR NATIVE AMERICANS

Sec. 803B. (a) * * *

           *       *       *       *       *       *       *

  (d)(1) There is established in the Office of the Secretary 
the Intra-Departmental Council on Native American Affairs. The 
Commissioner shall be the chairperson of such Council and shall 
advise the Secretary on all matters affecting Native Americans 
that involve the Department. The [Director of the Indian Health 
Service] Assistant Secretary for Indian Health shall serve as 
vice chairperson of the Council.

           *       *       *       *       *       *       *

                              ----------                              

     SECTION 203 OF THE MICHIGAN INDIAN LAND CLAIMS SETTLEMENT ACT

SEC. 203. LIMITATION.

  (a) * * *
  (b) Consideration.--In any case in which the Secretary, 
acting through the [Director of the Indian Health Service] 
Assistant Secretary for Indian Health, is required to select 
from more than 1 application for a contract or compact 
described in subsection (a), in awarding the contract or 
compact, the Secretary shall take into consideration--
          (1) * * *

           *       *       *       *       *       *       *

                              ----------                              

                        ACT OF DECEMBER 17, 1970

                          (Public Law 91-557)

    AN ACT To authorize the Secretary of the Interior to approve an 
agreement entered into by the Soboba Band of Mission Indians releasing 
a claim against the Metropolitan Water District of Southern California 
 and Eastern Municipal Water District, California, and to provide for 
construction of a water distribution system and a water supply for the 
Soboba Indian Reservation; and to authorize long-term leases of land on 
the reservation.

           *       *       *       *       *       *       *

  Sec. 9.  Nothing in this Act shall preclude the Soboba Band 
of Mission Indians and the Soboba Indian Reservation from being 
provided with sanitation facilities and services under the 
authority of section 7 of the Act of August 5, 1954 (68 Stat. 
674), as amended by the Act of July 31, 1959 (73 Stat. 267).
                              ----------                              

         INDIAN SELF-DETERMINATION AND EDUCATION ASSISTANCE ACT

           *       *       *       *       *       *       *
          TITLE [V] VII--AMERICAN INDIAN EDUCATION FOUNDATION

SEC. [501.] 701. AMERICAN INDIAN EDUCATION FOUNDATION.

  (a) * * *

           *       *       *       *       *       *       *

SEC. [502.] 702. ADMINISTRATIVE SERVICES AND SUPPORT.

  (a) Provision of Support by Secretary.--Subject to subsection 
(b), during the 5-year period beginning on the date that the 
Foundation is established, the Secretary--
          (1) * * *
          (2) may provide funds to reimburse the travel 
        expenses of the members of the Board under [section 
        501] section 701; and

           *       *       *       *       *       *       *

SEC. [503.] 703. DEFINITIONS.

  For the purposes of this title--
          (1) the term ``Bureau funded school'' has the meaning 
        given that term in title XI of the Education Amendments 
        of 1978;
          (2) the term ``Foundation'' means the Foundation 
        established by the Secretary pursuant to [section 501] 
        section 701; and

           *       *       *       *       *       *       *

       TITLE VIII--NATIVE AMERICAN HEALTH AND WELLNESS FOUNDATION

SEC. 801. DEFINITIONS.

  In this title:
          (1) Board.--The term ``Board'' means the Board of 
        Directors of the Foundation.
          (2) Committee.--The term ``Committee'' means the 
        Committee for the Establishment of Native American 
        Health and Wellness Foundation established under 
        section 802(f).
          (3) Foundation.--The term ``Foundation'' means the 
        Native American Health and Wellness Foundation 
        established under section 802.
          (4) Secretary.--The term ``Secretary'' means the 
        Secretary of Health and Human Services.
          (5) Service.--The term ``Service'' means the Indian 
        Health Service of the Department of Health and Human 
        Services.

SEC. 802. NATIVE AMERICAN HEALTH AND WELLNESS FOUNDATION.

  (a) Establishment.--
          (1) In general.--As soon as practicable after the 
        date of enactment of this title, the Secretary shall 
        establish, under the laws of the District of Columbia 
        and in accordance with this title, the Native American 
        Health and Wellness Foundation.
          (2) Funding determinations.--No funds, gift, 
        property, or other item of value (including any 
        interest accrued on such an item) acquired by the 
        Foundation shall--
                  (A) be taken into consideration for purposes 
                of determining Federal appropriations relating 
                to the provision of health care and services to 
                Indians; or
                  (B) otherwise limit, diminish, or affect the 
                Federal responsibility for the provision of 
                health care and services to Indians.
  (b) Perpetual Existence.--The Foundation shall have perpetual 
existence.
  (c) Nature of Corporation.--The Foundation--
          (1) shall be a charitable and nonprofit federally 
        chartered corporation; and
          (2) shall not be an agency or instrumentality of the 
        United States.
  (d) Place of Incorporation and Domicile.--The Foundation 
shall be incorporated and domiciled in the District of 
Columbia.
  (e) Duties.--The Foundation shall--
          (1) encourage, accept, and administer private gifts 
        of real and personal property, and any income from or 
        interest in such gifts, for the benefit of, or in 
        support of, the mission of the Service;
          (2) undertake and conduct such other activities as 
        will further the health and wellness activities and 
        opportunities of Native Americans; and
          (3) participate with and assist Federal, State, and 
        tribal governments, agencies, entities, and individuals 
        in undertaking and conducting activities that will 
        further the health and wellness activities and 
        opportunities of Native Americans.
  (f) Committee for the Establishment of Native American Health 
and Wellness Foundation.--
          (1) In general.--The Secretary shall establish the 
        Committee for the Establishment of Native American 
        Health and Wellness Foundation to assist the Secretary 
        in establishing the Foundation.
          (2) Duties.--Not later than 180 days after the date 
        of enactment of this section, the Committee shall--
                  (A) carry out such activities as are 
                necessary to incorporate the Foundation under 
                the laws of the District of Columbia, including 
                acting as incorporators of the Foundation;
                  (B) ensure that the Foundation qualifies for 
                and maintains the status required to carry out 
                this section, until the Board is established;
                  (C) establish the constitution and initial 
                bylaws of the Foundation;
                  (D) provide for the initial operation of the 
                Foundation, including providing for temporary 
                or interim quarters, equipment, and staff; and
                  (E) appoint the initial members of the Board 
                in accordance with the constitution and initial 
                bylaws of the Foundation.
  (g) Board of Directors.--
          (1) In general.--The Board of Directors shall be the 
        governing body of the Foundation.
          (2) Powers.--The Board may exercise, or provide for 
        the exercise of, the powers of the Foundation.
          (3) Selection.--
                  (A) In general.--Subject to subparagraph (B), 
                the number of members of the Board, the manner 
                of selection of the members (including the 
                filling of vacancies), and the terms of office 
                of the members shall be as provided in the 
                constitution and bylaws of the Foundation.
                  (B) Requirements.--
                          (i) Number of members.--The Board 
                        shall have at least 11 members, who 
                        shall have staggered terms.
                          (ii) Initial voting members.--The 
                        initial voting members of the Board--
                                  (I) shall be appointed by the 
                                Committee not later than 180 
                                days after the date on which 
                                the Foundation is established; 
                                and
                                  (II) shall have staggered 
                                terms.
                          (iii) Qualification.--The members of 
                        the Board shall be United States 
                        citizens who are knowledgeable or 
                        experienced in Native American health 
                        care and related matters.
                  (C) Compensation.--A member of the Board 
                shall not receive compensation for service as a 
                member, but shall be reimbursed for actual and 
                necessary travel and subsistence expenses 
                incurred in the performance of the duties of 
                the Foundation.
  (h) Officers.--
          (1) In general.--The officers of the Foundation shall 
        be--
                  (A) a secretary, elected from among the 
                members of the Board; and
                  (B) any other officers provided for in the 
                constitution and bylaws of the Foundation.
          (2) Chief operating officer.--The secretary of the 
        Foundation may serve, at the direction of the Board, as 
        the chief operating officer of the Foundation, or the 
        Board may appoint a chief operating officer, who shall 
        serve at the direction of the Board.
          (3) Election.--The manner of election, term of 
        office, and duties of the officers of the Foundation 
        shall be as provided in the constitution and bylaws of 
        the Foundation.
  (i) Powers.--The Foundation--
          (1) shall adopt a constitution and bylaws for the 
        management of the property of the Foundation and the 
        regulation of the affairs of the Foundation;
          (2) may adopt and alter a corporate seal;
          (3) may enter into contracts;
          (4) may acquire (through a gift or otherwise), own, 
        lease, encumber, and transfer real or personal property 
        as necessary or convenient to carry out the purposes of 
        the Foundation;
          (5) may sue and be sued; and
          (6) may perform any other act necessary and proper to 
        carry out the purposes of the Foundation.
  (j) Principal Office.--
          (1) In general.--The principal office of the 
        Foundation shall be in the District of Columbia.
          (2) Activities; offices.--The activities of the 
        Foundation may be conducted, and offices may be 
        maintained, throughout the United States in accordance 
        with the constitution and bylaws of the Foundation.
  (k) Service of Process.--The Foundation shall comply with the 
law on service of process of each State in which the Foundation 
is incorporated and of each State in which the Foundation 
carries on activities.
  (l) Liability of Officers, Employees, and Agents.--
          (1) In general.--The Foundation shall be liable for 
        the acts of the officers, employees, and agents of the 
        Foundation acting within the scope of their authority.
          (2) Personal liability.--A member of the Board shall 
        be personally liable only for gross negligence in the 
        performance of the duties of the member.
  (m) Restrictions.--
          (1) Limitation on spending.--Beginning with the 
        fiscal year following the first full fiscal year during 
        which the Foundation is in operation, the 
        administrative costs of the Foundation shall not exceed 
        the percentage described in paragraph (2) of the sum 
        of--
                  (A) the amounts transferred to the Foundation 
                under subsection (o) during the preceding 
                fiscal year; and
                  (B) donations received from private sources 
                during the preceding fiscal year.
          (2) Percentages.--The percentages referred to in 
        paragraph (1) are--
                  (A) for the first fiscal year described in 
                that paragraph, 20 percent;
                  (B) for the following fiscal year, 15 
                percent; and
                  (C) for each fiscal year thereafter, 10 
                percent.
          (3) Appointment and hiring.--The appointment of 
        officers and employees of the Foundation shall be 
        subject to the availability of funds.
          (4) Status.--A member of the Board or officer, 
        employee, or agent of the Foundation shall not by 
        reason of association with the Foundation be considered 
        to be an officer, employee, or agent of the United 
        States.
  (n) Audits.--The Foundation shall comply with section 10101 
of title 36, United States Code, as if the Foundation were a 
corporation under part B of subtitle II of that title.
  (o) Funding.--
          (1) Authorization of appropriations.--There is 
        authorized to be appropriated to carry out subsection 
        (e)(1) $500,000 for each fiscal year, as adjusted to 
        reflect changes in the Consumer Price Index for all-
        urban consumers published by the Department of Labor.
          (2) Transfer of donated funds.--The Secretary shall 
        transfer to the Foundation funds held by the Department 
        of Health and Human Services under the Act of August 5, 
        1954 (42 U.S.C. 2001 et seq.), if the transfer or use 
        of the funds is not prohibited by any term under which 
        the funds were donated.

SEC. 803. ADMINISTRATIVE SERVICES AND SUPPORT.

  (a) Provision of Support by Secretary.--Subject to subsection 
(b), during the 5-year period beginning on the date on which 
the Foundation is established, the Secretary--
          (1) may provide personnel, facilities, and other 
        administrative support services to the Foundation;
          (2) may provide funds for initial operating costs and 
        to reimburse the travel expenses of the members of the 
        Board; and
          (3) shall require and accept reimbursements from the 
        Foundation for--
                  (A) services provided under paragraph (1); 
                and
                  (B) funds provided under paragraph (2).
  (b) Reimbursement.--Reimbursements accepted under subsection 
(a)(3)--
          (1) shall be deposited in the Treasury of the United 
        States to the credit of the applicable appropriations 
        account; and
          (2) shall be chargeable for the cost of providing 
        services described in subsection (a)(1) and travel 
        expenses described in subsection (a)(2).
  (c) Continuation of Certain Services.--The Secretary may 
continue to provide facilities and necessary support services 
to the Foundation after the termination of the 5-year period 
specified in subsection (a) if the facilities and services--
          (1) are available; and
          (2) are provided on reimbursable cost basis.
                              ----------                              

                          SOCIAL SECURITY ACT

           *       *       *       *       *       *       *
     TITLE XI--GENERAL PROVISIONS, PEER REVIEW, AND ADMINISTRATIVE 
                             SIMPLIFICATION

Part A--General Provisions

           *       *       *       *       *       *       *

  EXCLUSION OF CERTAIN INDIVIDUALS AND ENTITIES FROM PARTICIPATION IN 
                MEDICARE AND STATE HEALTH CARE PROGRAMS

Sec. 1128. (a) * * *

           *       *       *       *       *       *       *

  (k) Additional Exclusion waiver authority for affected Indian 
Health Programs.--In addition to the authority granted the 
Secretary under subsections (c)(3)(B) and (d)(3)(B) to waive an 
exclusion under subsection (a)(1), (a)(3), (a)(4), or (b), the 
Secretary may, in the case of an Indian Health Program, waive 
such an exclusion upon the request of the administrator of an 
affected Indian Health Program (as defined in section 4 of the 
Indian Health Care Improvement Act) who determines that the 
exclusion would impose a hardship on individuals entitled to 
benefits under or enrolled in a Federal health care program.

           *       *       *       *       *       *       *

   CRIMINAL PENALTIES FOR ACTS INVOLVING FEDERAL HEALTH CARE PROGRAMS

Sec. 1128B. (a) * * *
  (b)(1) * * *

           *       *       *       *       *       *       *

  (4) Subject to such conditions as the Secretary may 
promulgate from time to time as necessary to prevent fraud and 
abuse, for purposes of paragraphs (1) and (2) and section 
1128A(a), the following transfers shall not be treated as 
remuneration:
          (A) Transfers between indian health programs, indian 
        tribes, tribal organizations, and urban indian 
        organizations.--Transfers of anything of value between 
        or among an Indian Health Program, Indian Tribe, Tribal 
        Organization, or Urban Indian Organization, that are 
        made for the purpose of providing necessary health care 
        items and services to any patient served by such 
        Program, Tribe, or Organization and that consist of--
                  (i) services in connection with the 
                collection, transport, analysis, or 
                interpretation of diagnostic specimens or test 
                data;
                  (ii) inventory or supplies;
                  (iii) staff; or
                  (iv) a waiver of all or part of premiums or 
                cost sharing.
          (B) Transfers between indian health programs, indian 
        tribes, tribal organizations, or urban indian 
        organizations and patients.--Transfers of anything of 
        value between an Indian Health Program, Indian Tribe, 
        Tribal Organization, or Urban Indian Organization and 
        any patient served or eligible for service from an 
        Indian Health Program, Indian Tribe, Tribal 
        Organization, or Urban Indian Organization, including 
        any patient served or eligible for service pursuant to 
        section 807 of the Indian Health Care Improvement Act, 
        but only if such transfers--
                  (i) consist of expenditures related to 
                providing transportation for the patient for 
                the provision of necessary health care items or 
                services, provided that the provision of such 
                transportation is not advertised, nor an 
                incentive of which the value is 
                disproportionately large in relationship to the 
                value of the health care item or service (with 
                respect to the value of the item or service 
                itself or, for preventative items or services, 
                the future health care costs reasonably 
                expected to be avoided);
                  (ii) consist of expenditures related to 
                providing housing to the patient (including a 
                pregnant patient) and immediate family members 
                or an escort necessary to assuring the timely 
                provision of health care items and services to 
                the patient, provided that the provision of 
                such housing is not advertised nor an incentive 
                of which the value is disproportionately large 
                in relationship to the value of the health care 
                item or service (with respect to the value of 
                the item or service itself or, for preventative 
                items or services, the future health care costs 
                reasonably expected to be avoided); or
                  (iii) are for the purpose of paying premiums 
                or cost sharing on behalf of such a patient, 
                provided that the making of such payment is not 
                subject to conditions other than conditions 
                agreed to under a contract for the delivery of 
                contract health services.
          (C) Contract health services.--A transfer of anything 
        of value negotiated as part of a contract entered into 
        between an Indian Health Program, Indian Tribe, Tribal 
        Organization, Urban Indian Organization, or the Indian 
        Health Service and a contract care provider for the 
        delivery of contract health services authorized by the 
        Indian Health Service, provided that--
                  (i) such a transfer is not tied to volume or 
                value of referrals or other business generated 
                by the parties; and
                  (ii) any such transfer is limited to the fair 
                market value of the health care items or 
                services provided or, in the case of a transfer 
                of items or services related to preventative 
                care, the value of the future health care costs 
                reasonably expected to be avoided.
          (D) Other transfers.--Any other transfer of anything 
        of value involving an Indian Health Program, Indian 
        Tribe, Tribal Organization, or Urban Indian 
        Organization, or a patient served or eligible for 
        service from an Indian Health Program, Indian Tribe, 
        Tribal Organization, or Urban Indian Organization, that 
        the Secretary, in consultation with the Attorney 
        General, determines is appropriate, taking into account 
        the special circumstances of such Indian Health 
        Programs, Indian Tribes, Tribal Organizations, and 
        Urban Indian Organizations, and of patients served by 
        such Programs, Tribes, and Organizations.

           *       *       *       *       *       *       *

                    [NATIONAL COMMISSION ON CHILDREN

  [Sec. 1139.
  [(a)(1) There is hereby established a commission to be known 
as the National Commission on Children (in this section 
referred to as the ``Commission'').
  [(b)(1) The Commission shall consist of--
          [(A) 12 members to be appointed by the President,
          [(B) 12 members to be appointed by the Speaker of the 
        House of Representatives, and
          [(C) 12 members to be appointed by the President pro 
        tempore of the Senate.
  [(2) The President, the Speaker, and the President pro 
tempore shall each appoint as members of the Commission--
          [(A) 4 individuals who--
                  [(i) are representatives of organizations 
                providing services to children,
                  [(ii) are involved in activities on behalf of 
                children, or
                  [(iii) have engaged in academic research with 
                respect to the problems and needs of children,
          [(B) 4 individuals who are elected or appointed 
        public officials (at the Federal, State, or local 
        level) involved in issues and programs relating to 
        children, and
          [(C) 4 individuals who are parents or representatives 
        of parents or parents' organizations.
  [(3) The appointments made pursuant to subparagraphs (B) and 
(C) of paragraph (1) shall be made in consultation with the 
chairmen of committees of the House of Representatives and the 
Senate, respectively, having jurisdiction over relevant Federal 
programs.
  [(c)(1) It shall be the duty and function of the Commission 
to serve as a forum on behalf of the children of the Nation and 
to conduct the studies and issue the report required by 
subsection (d).
  [(2) The Commission (and any committees that it may form) 
shall conduct public hearings in different geographic areas of 
the country, both urban and rural, in order to receive the 
views of a broad spectrum of the public on the status of the 
Nation's children and on ways to safeguard and enhance the 
physical, mental, and emotional well-being of all of the 
children of the Nation, including those with physical or mental 
disabilities, and others whose circumstances deny them a full 
share of the opportunities that parents of the Nation may 
rightfully expect for their children.
  [(3) The Commission shall receive testimony from individuals, 
and from representatives of public and private organizations 
and institutions with an interest in the welfare of children, 
including educators, health care professionals, religious 
leaders, providers of social services, representatives of 
organizations with children as members, elected and appointed 
public officials, and from parents and children speaking in 
their own behalf.
  [(d) The Commission shall submit to the President, and to the 
Committees on Finance and Labor and Human Resources of the 
Senate and the Committees on Ways and Means, Education and 
Labor, and Energy and Commerce of the House of Representatives, 
an interim report no later than March 31, 1990, and a final 
report no later than March 31, 1991, setting forth 
recommendations with respect to the following subjects:
          [(1) Questions relating to the health of children 
        that the Commission shall address include--
                  [(A) how to reduce infant mortality,
                  [(B) how to reduce the number of low-birth-
                weight babies,
                  [(C) how to reduce the number of children 
                with chronic illnesses and disabilities,
                  [(D) how to improve the nutrition of 
                children,
                  [(E) how to promote the physical fitness of 
                children,
                  [(F) how to ensure that pregnant women 
                receive adequate prenatal care,
                  [(G) how to ensure that all children have 
                access to both preventive and acute care health 
                services, and
                  [(H) how to improve the quality and 
                availability of health care for children.
          [(2) Questions relating to social and support 
        services for children and their parents that the 
        Commission shall address include--
                  [(A) how to prevent and treat child neglect 
                and abuse,
                  [(B) how to provide help to parents who seek 
                assistance in meeting the problems of their 
                children,
                  [(C) how to provide counseling services for 
                children,
                  [(D) how to strengthen the family unit,
                  [(E) how children can be assured of adequate 
                care while their parents are working or 
                participating in education or training 
                programs,
                  [(F) how to improve foster care and adoption 
                services,
                  [(G) how to reduce drug and alcohol abuse by 
                children and youths, and
                  [(H) how to reduce the incidence of teenage 
                pregnancy.
          [(3) Questions relating to education that the 
        Commission shall address include--
                  [(A) how to encourage academic excellence for 
                all children at all levels of education,
                  [(B) how to use preschool experiences to 
                enhance educational achievement,
                  [(C) how to improve the qualifications of 
                teachers,
                  [(D) how schools can better prepare the 
                Nation's youth to compete in the labor market,
                  [(E) how parents and schools can work 
                together to help children achieve success at 
                each step of the academic ladder,
                  [(F) how to encourage teenagers to complete 
                high school and remain in school to fulfill 
                their academic potential,
                  [(G) how to address the problems of drug and 
                alcohol abuse by young people,
                  [(H) how schools might lend support to 
                efforts aimed at reducing the incidence of 
                teenage pregnancy, and
                  [(I) how schools might better meet the 
                special needs of children who have physical or 
                mental handicaps.
          [(4) Questions relating to income security that the 
        Commission shall address include--
                  [(A) how to reduce poverty among children,
                  [(B) how to ensure that parents support their 
                children to the fullest extent possible through 
                improved child support collection services, 
                including services on behalf of children whose 
                parents are unmarried, and
                  [(C) how to ensure that cash assistance to 
                needy children is adequate.
          [(5) Questions relating to tax policy that the 
        Commission shall address include--
                  [(A) how to assure the equitable tax 
                treatment of families with children,
                  [(B) the effect of existing tax provisions, 
                including the dependent care tax credit, the 
                earned income tax credit, and the targeted jobs 
                tax credit, on children living in poverty,
                  [(C) whether the dependent care tax credit 
                should be refundable and the effect of such a 
                policy,
                  [(D) whether the earned income tax credit 
                should be adjusted for family size and the 
                effect of such a policy, and
                  [(E) whether there are other tax-related 
                policies which would reduce poverty among 
                children.
          [(6) In addition to addressing the questions 
        specified in paragraphs (1) through (5), the Commission 
        shall--
                  [(A) seek to identify ways in which public 
                and private organizations and institutions can 
                work together at the community level to 
                identify deficiencies in existing services for 
                families and children and to develop 
                recommendations to ensure that the needs of 
                families and children are met, using all 
                available resources, in a coordinated and 
                comprehensive manner, and
                  [(B) assess the existing capacities of 
                agencies to collect and analyze data on the 
                status of children and on relevant programs, 
                identify gaps in the data collection system, 
                and recommend ways to improve the collection of 
                data and the coordination among agencies in the 
                collection and utilization of data.
The reports required by this subsection shall be based upon the 
testimony received in the hearings conducted pursuant to 
subsection (c), and upon other data and findings developed by 
the Commission.
  [(e)(1)(A) Members of the Commission shall first be appointed 
not later than 60 days after the date of the enactment of this 
section, for terms ending on March 31, 1991.
  [(B) A vacancy in the Commission shall not affect its powers, 
but shall be filled in the same manner as the vacant position 
was first filled.
  [(2) The Commission shall elect one of its members to serve 
as Chairman of the Commission. The Chairman shall be a 
nonvoting member of the Commission.
  [(3) A majority of the members of the Commission shall 
constitute a quorum for the transaction of business.
  [(4)(A) The Commission shall meet at the call of the 
Chairman, or at the call of a majority of the members of the 
Commission.
  [(B) The Commission shall meet not less than 4 times during 
the period beginning with the date of the enactment of this 
section and ending with September 30, 1990.
  [(5) Decisions of the Commission shall be according to the 
vote of a simple majority of those present and voting at a 
properly called meeting.
  [(6) Members of the Commission shall serve without 
compensation, but shall be reimbursed for travel, subsistence, 
and other necessary expenses incurred in the performance of 
their duties as members of the Commission.
  [(f)(1) The Commission shall appoint an Executive Director of 
the Commission. In addition to the Executive Director, the 
Commission may appoint and fix the compensation of such 
personnel as it deems advisable. Such appointments and 
compensation may be made without regard to title 5, United 
States Code, that govern appointments in the competitive 
services, and the provisions of chapter 51 and subchapter III 
of chapter 53 of such title that relate to classifications and 
the General Schedule pay rates.
  [(2) The Commission may procure such temporary and 
intermittent services of consultants under section 3109(b) of 
title 5, United States Code, as the Commission determines to be 
necessary to carry out the duties of the Commission.
  [(g) In carrying out its duties, the Commission, or any duly 
organized committee thereof, is authorized to hold such 
hearings, sit and act at such times and places, and take such 
testimony, with respect to matters for which it has a 
responsibility under this section, as the Commission or 
committee may deem advisable.
  [(h)(1) The Commission may secure directly from any 
department or agency of the United States such data and 
information as may be necessary to carry out its 
responsibilities.
  [(2) Upon request of the Commission, any such department or 
agency shall furnish any such data or information.
  [(i) The General Services Administration shall provide to the 
Commission, on a reimbursable basis, such administrative 
support services as the Commission may request.
  [(j) There are authorized to be appropriated through fiscal 
year 1991, such sums as may be necessary to carry out this 
section for each of fiscal years 1989 and 1990.
  [(k)(1) The Commission is authorized to accept donations of 
money, property, or personal services. Funds received from 
donations shall be deposited in the Treasury in a separate fund 
created for this purpose. Funds appropriated for the Commission 
and donated funds may be expended for such purposes as official 
reception and representation expenses, public surveys, public 
service announcements, preparation of special papers, analyses, 
and documentaries, and for such other purposes as determined by 
the Commission to be in furtherance of its mission to review 
national issues affecting children.
  [(2) For purposes of Federal income, estate, and gift 
taxation, money and other property accepted under paragraph (1) 
of this subsection shall be considered as a gift or bequest to 
or for the use of the United States.
  [(3) Expenditure of appropriated and donated funds shall be 
subject to such rules and regulations as may be adopted by the 
Commission and shall not be subject to Federal procurement 
requirements.
  [(l) The Commission is authorized to conduct such public 
surveys as it deems necessary in support of its review of 
national issues affecting children and, in conducting such 
surveys, the Commission shall not be deemed to be an ``agency'' 
for the purpose of section 3502 of title 44, United States 
Code.]

SEC. 1139. IMPROVED ACCESS TO, AND DELIVERY OF, HEALTH CARE FOR INDIANS 
                    UNDER TITLES XVIII, XIX, AND XXI.

  (a) Agreements with States for Medicaid and Schip Outreach on 
or Near Reservations To Increase the Enrollment of Indians in 
Those Programs.--
          (1) In general.--In order to improve the access of 
        Indians residing on or near a reservation to obtain 
        benefits under the Medicaid and State children's health 
        insurance programs established under titles XIX and 
        XXI, the Secretary shall encourage the State to take 
        steps to provide for enrollment on or near the 
        reservation. Such steps may include outreach efforts 
        such as the outstationing of eligibility workers, 
        entering into agreements with the Indian Health 
        Service, Indian Tribes, Tribal Organizations, and Urban 
        Indian Organizations to provide outreach, education 
        regarding eligibility and benefits, enrollment, and 
        translation services when such services are 
        appropriate.
          (2) Construction.--Nothing in subparagraph (A) shall 
        be construed as affecting arrangements entered into 
        between States and the Indian Health Service, Indian 
        Tribes, Tribal Organizations, or Urban Indian 
        Organizations for such Service, Tribes, or 
        Organizations to conduct administrative activities 
        under such titles.
  (b) Requirement To Facilitate Cooperation.--The Secretary, 
acting through the Centers for Medicare & Medicaid Services, 
shall take such steps as are necessary to facilitate 
cooperation with, and agreements between, States and the Indian 
Health Service, Indian Tribes, Tribal Organizations, or Urban 
Indian Organizations with respect to the provision of health 
care items and services to Indians under the programs 
established under title XVIII, XIX, or XXI.
  (c) Nondiscrimination in Qualifications for Payment for 
Services under Federal Health Care Programs.--
          (1) Requirement to satisfy generally applicable 
        participation requirements.--
                  (A) In general.--A Federal health care 
                program must accept an entity that is operated 
                by the Indian Health Service, an Indian Tribe, 
                Tribal Organization, or Urban Indian 
                Organization as a provider eligible to receive 
                payment under the program for health care 
                services furnished to an Indian on the same 
                basis as any other provider qualified to 
                participate as a provider of health care 
                services under the program if the entity meets 
                generally applicable State or other 
                requirements for participation as a provider of 
                health care services under the program.
                  (B) Satisfaction of state or local licensure 
                or recognition requirements.--Any requirement 
                for participation as a provider of health care 
                services under a Federal health care program 
                that an entity be licensed or recognized under 
                the State or local law where the entity is 
                located to furnish health care services shall 
                be deemed to have been met in the case of an 
                entity operated by the Indian Health Service, 
                an Indian Tribe, Tribal Organization, or Urban 
                Indian Organization if the entity meets all the 
                applicable standards for such licensure or 
                recognition, regardless of whether the entity 
                obtains a license or other documentation under 
                such State or local law. In accordance with 
                section 221 of the Indian Health Care 
                Improvement Act, the absence of the licensure 
                of a health care professional employed by such 
                an entity under the State or local law where 
                the entity is located shall not be taken into 
                account for purposes of determining whether the 
                entity meets such standards, if the 
                professional is licensed in another State.
          (2) Prohibition on federal payments to entities or 
        individuals excluded from participation in federal 
        health care programs or whose State licenses are under 
        suspension or have been revoked.--
                  (A) Excluded entities.--No entity operated by 
                the Indian Health Service, an Indian Tribe, 
                Tribal Organization, or Urban Indian 
                Organization that has been excluded from 
                participation in any Federal health care 
                program or for which a license is under 
                suspension or has been revoked by the State 
                where the entity is located shall be eligible 
                to receive payment under any such program for 
                health care services furnished to an Indian.
                  (B) Excluded individuals.--No individual who 
                has been excluded from participation in any 
                Federal health care program or whose State 
                license is under suspension or has been revoked 
                shall be eligible to receive payment under any 
                such program for health care services furnished 
                by that individual, directly or through an 
                entity that is otherwise eligible to receive 
                payment for health care services, to an Indian.
                  (C) Federal health care program defined.--In 
                this subsection, the term, ``Federal health 
                care program'' has the meaning given that term 
                in section 1128B(f), except that, for purposes 
                of this subsection, such term shall include the 
                health insurance program under chapter 89 of 
                title 5, United States Code.
  (d) Consultation With Tribal Technical Advisory Group 
(Ttag).--The Secretary shall maintain within the Centers for 
Medicaid & Medicare Services (CMS) a Tribal Technical Advisory 
Group, established in accordance with requirements of the 
charter dated September 30, 2003, and in such group shall 
include a representative of the Urban Indian Organizations and 
the Service. The representative of the Urban Indian 
Organization shall be deemed to be an elected officer of a 
tribal government for purposes of applying section 204(b) of 
the Unfunded Mandates Reform Act of 1995 (2 U.S.C. 1534(b)).
  (e) Annual Report on Indians Served by Health Benefit 
Programs Funded Under This Act.--Beginning January 1, 2007, and 
annually thereafter, the Secretary, acting through the 
Administrator of the Centers for Medicare & Medicaid Services 
and the Director of the Indian Health Service, shall submit a 
report to Congress regarding the enrollment and health status 
of Indians receiving items or services under health benefit 
programs funded under this Act during the preceding year. Each 
such report shall include the following:
          (1) The total number of Indians enrolled in, or 
        receiving items or services under, such programs, 
        disaggregated with respect to each such program.
          (2) The number of Indians described in paragraph (1) 
        that also received health benefits under programs 
        funded by the Indian Health Service.
          (3) General information regarding the health status 
        of the Indians described in paragraph (1), 
        disaggregated with respect to specific diseases or 
        conditions and presented in a manner that is consistent 
        with protections for privacy of individually 
        identifiable health information under section 264(c) of 
        the Health Insurance Portability and Accountability Act 
        of 1996.
          (4) A detailed statement of the status of facilities 
        of the Indian Health Service or an Indian Tribe, Tribal 
        Organization, or an Urban Indian Organization with 
        respect to such facilities' compliance with the 
        applicable conditions and requirements of titles XVIII, 
        XIX, and XXI, and, in the case of title XIX or XXI, 
        under a State plan under such title or under waiver 
        authority, and of the progress being made by such 
        facilities (under plans submitted under section 
        1880(b), 1911(b) or otherwise) toward the achievement 
        and maintenance of such compliance.
          (5) Such other information as the Secretary 
        determines is appropriate.
  (f) Definition of Indian; Indian Tribe; Indian Health 
Program; Tribal Organization; Urban Indian Organization.--In 
this section, the terms ``Indian'', ``Indian Tribe'', ``Indian 
Health Program'', ``Tribal Organization'', and ``Urban Indian 
Organization'' have the meanings given those terms in section 4 
of the Indian Health Care Improvement Act.

           *       *       *       *       *       *       *

TITLE XVIII--HEALTH INSURANCE FOR THE AGED AND DISABLED

           *       *       *       *       *       *       *

Part E--Miscellaneous Provisions

           *       *       *       *       *       *       *

                   [INDIAN HEALTH SERVICE FACILITIES

[Sec. 1880.
  [(a) A hospital or skilled nursing facility of the Indian 
Health Service, whether operated by such Service or by an 
Indian tribe or tribal organization (as those terms are defined 
in section 4 of the Indian Health Care Improvement Act), shall 
be eligible for payments under this title, notwithstanding 
sections 1814(c) and 1835(d), if and for so long as it meets 
all of the conditions and requirements for such payments which 
are applicable generally to hospitals or skilled nursing 
facilities (as the case may be) under this title.
  [(b) Notwithstanding subsection (a), a hospital or skilled 
nursing facility of the Indian Health Service which does not 
meet all of the conditions and requirements of this title which 
are applicable generally to hospitals or skilled nursing 
facilities (as the case may be), but which submits to the 
Secretary within six months after the date of the enactment of 
this section an acceptable plan for achieving compliance with 
such conditions and requirements, shall be deemed to meet such 
conditions and requirements (and to be eligible for payments 
under this title), without regard to the extent of its actual 
compliance with such conditions and requirements, during the 
first 12 months after the month in which such plan is 
submitted.
  [(c) Notwithstanding any other provision of this title, 
payments to which any hospital or skilled nursing facility of 
the Indian Health Service is entitled by reason of this section 
shall be placed in a special fund to be held by the Secretary 
and used by him (to such extent or in such amounts as are 
provided in appropriation Acts) exclusively for the purpose of 
making any improvements in the hospitals and skilled nursing 
facilities of such Service which may be necessary to achieve 
compliance with the applicable conditions and requirements of 
this title. The preceding sentence shall cease to apply when 
the Secretary determines and certifies that substantially all 
of the hospitals and skilled nursing facilities of such Service 
in the United States are in compliance with such conditions and 
requirements.
  [(d) The annual report of the Secretary which is required by 
section 701 of the Indian Health Care Improvement Act shall 
include (along with the matters specified in section 403 of 
such Act) a detailed statement of the status of the hospitals 
and skilled nursing facilities of the Service in terms of their 
compliance with the applicable conditions and requirements of 
this title and of the progress being made by such hospitals and 
facilities (under plans submitted under subsection (b) and 
otherwise) toward the achievement of such compliance.]

SEC. 1880. INDIAN HEALTH PROGRAMS.

  (a) Eligibility for Payments.--Subject to subsection (e), the 
Indian Health Service and an Indian Tribe, Tribal Organization, 
or an Urban Indian Organization shall be eligible for payments 
under this title with respect to items and services furnished 
by the Indian Health Service, Indian Tribe, Tribal 
Organization, or Urban Indian Organization if the furnishing of 
such services meets all the conditions and requirements which 
are applicable generally to the furnishing of items and 
services under this title.
  (b) Compliance With Conditions and Requirements.--Subject to 
subsection (e), a facility of the Indian Health Service or an 
Indian Tribe, Tribal Organization, or an Urban Indian 
Organization which is eligible for payment under subsection (a) 
with respect to the furnishing of items and services, but which 
does not meet all of the conditions and requirements of this 
title which are applicable generally to such facility, shall 
make such improvements as are necessary to achieve or maintain 
compliance with such conditions and requirements in accordance 
with a plan submitted to and accepted by the Secretary for 
achieving or maintaining compliance with such conditions and 
requirements, and shall be deemed to meet such conditions and 
requirements (and to be eligible for payment under this title), 
without regard to the extent of its actual compliance with such 
conditions and requirements, during the first 12 months after 
the month in which such plan is submitted.
  (c) Special Fund for Improvement of IHS Facilities.--For 
provisions relating to the authority of the Secretary to place 
payments to which a facility of the Indian Health Service is 
eligible for payment under this title into a special fund 
established under section 401(c)(1) of the Indian Health Care 
Improvement Act, and the requirement to use amounts paid from 
such fund for making improvements in accordance with subsection 
(b), see subparagraphs (A) and (B) of section 401(c)(1) of such 
Act.
  (d) Direct Billing.--For provisions relating to the authority 
of a Tribal Health Program or an Urban Indian Organization to 
elect to directly bill for, and receive payment for, health 
care items and services provided by such Program or 
Organization for which payment is made under this title, see 
section 401(d) of the Indian Health Care Improvement Act.
  (e)(1) * * *

           *       *       *       *       *       *       *

  (3) Subsection (c) and section 401(c)(1) of the Indian Health 
Care Improvement Act shall not apply to payments made under 
this subsection.
  [(f) For provisions relating to the authority of certain 
Indian tribes, tribal organizations, and Alaska Native health 
organizations to elect to directly bill for, and receive 
payment for, health care services provided by a hospital or 
clinic of such tribes or organizations and for which payment 
may be made under this title, see section 405 of the Indian 
Health Care Improvement Act (25 U.S.C. 1645).]
  (f) Definitions.--In this section, the terms ``Indian Health 
Program'', ``Indian Tribe'', ``Service Unit'', ``Tribal Health 
Program'', ``Tribal Organization'', and ``Urban Indian 
Organization'' have the meanings given those terms in section 4 
of the Indian Health Care Improvement Act.

           *       *       *       *       *       *       *

TITLE XIX--GRANTS TO STATES FOR MEDICAL ASSISTANCE PROGRAMS

           *       *       *       *       *       *       *

                   STATE PLANS FOR MEDICAL ASSISTANCE

  Sec. 1902. (a) A State plan for medical assistance must--
          (1) * * *

           *       *       *       *       *       *       *

          (69) provide that the State must comply with any 
        requirements determined by the Secretary to be 
        necessary for carrying out the Medicaid Integrity 
        Program established under section 1936; [and]
          (70) at the option of the State and notwithstanding 
        paragraphs (1), (10)(B), and (23), provide for the 
        establishment of a non-emergency medical transportation 
        brokerage program in order to more cost-effectively 
        provide transportation for individuals eligible for 
        medical assistance under the State plan who need access 
        to medical care or services and have no other means of 
        transportation which--
                  (A) * * *
                  (B) may be conducted under contract with a 
                broker who--
                          (i) * * *

           *       *       *       *       *       *       *

                          (iv) complies with such requirements 
                        related to prohibitions on referrals 
                        and conflict of interest as the 
                        Secretary shall establish (based on the 
                        prohibitions on physician referrals 
                        under section 1877 and such other 
                        prohibitions and requirements as the 
                        Secretary determines to be 
                        appropriate)[.]; and
          (71) in the case of any State in which the Indian 
        Health Service operates or funds health care programs, 
        or in which 1 or more Indian Health Programs or Urban 
        Indian Organizations (as such terms are defined in 
        section 4 of the Indian Health Care Improvement Act) 
        provide health care in the State for which medical 
        assistance is available under such title, provide for a 
        process under which the State seeks advice on a 
        regular, ongoing basis from designees of such Indian 
        Health Programs and Urban Indian Organizations on 
        matters relating to the application of this title that 
        are likely to have a direct effect on such Indian 
        Health Programs and Urban Indian Organizations and 
        that--
                  (A) shall include solicitation of advice 
                prior to submission of any plan amendments, 
                waiver requests, and proposals for 
                demonstration projects likely to have a direct 
                effect on Indians, Indian Health Programs, or 
                Urban Indian Organizations; and
                  (B) may include appointment of an advisory 
                committee and of a designee of such Indian 
                Health Programs and Urban Indian Organizations 
                to the medical care advisory committee advising 
                the State on its State plan under this title.
Notwithstanding paragraph (5), if on January 1, 1965, and on 
the date on which a State submits its plan for approval under 
this title, the State agency which administered or supervised 
the administration of the plan of such State approved under 
title X (or title XVI, insofar as it relates to the blind) was 
different from the State agency which administered or 
supervised the administration of the State plan approved under 
title I (or title XVI, insofar as it relates to the aged), the 
State agency which administered or supervised the 
administration of such plan approved under title X (or title 
XVI, insofar as it relates to the blind) may be designated to 
administer or supervise the administration of the portion of 
the State plan for medical assistance which relates to blind 
individuals and a different State agency may be established or 
designated to administer or supervise the administration of the 
rest of the State plan for medical assistance; and in such case 
the part of the plan which each such agency administers, or the 
administration of which each such agency supervises, shall be 
regarded as a separate plan for purposes of this title (except 
for purposes of paragraph (10)). The provisions of paragraphs 
(9)(A), (31), and (33) and of section 1903(i)(4) shall not 
apply to a religious nonmedical health care institution (as 
defined in section 1861(ss)(1)).

           *       *       *       *       *       *       *

  (e)(1) * * *

           *       *       *       *       *       *       *

  (13) Notwithstanding any other requirement of this title or 
any other provision of Federal or State law, a State shall 
disregard the following property for purposes of determining 
the eligibility of an individual who is an Indian (as defined 
in section 4 of the Indian Health Care Improvement Act) for 
medical assistance under this title:
          (A) Property, including real property and 
        improvements, that is held in trust, subject to Federal 
        restrictions, or otherwise under the supervision of the 
        Secretary of the Interior, located on a reservation, 
        including any federally recognized Indian Tribe's 
        reservation, pueblo, or colony, including former 
        reservations in Oklahoma, Alaska Native regions 
        established by the Alaska Native Claims Settlement Act, 
        and Indian allotments on or near a reservation as 
        designated and approved by the Bureau of Indian Affairs 
        of the Department of the Interior.
          (B) For any federally recognized Tribe not described 
        in subparagraph (A), property located within the most 
        recent boundaries of a prior Federal reservation.
          (C) Ownership interests in rents, leases, royalties, 
        or usage rights related to natural resources (including 
        extraction of natural resources or harvesting of 
        timber, other plants and plant products, animals, fish, 
        and shellfish) resulting from the exercise of federally 
        protected rights.
          (D) Ownership interests in or usage rights to items 
        not covered by subparagraphs (A) through (C) that have 
        unique religious, spiritual, traditional, or cultural 
        significance or rights that support subsistence or a 
        traditional lifestyle according to applicable tribal 
        law or custom.

           *       *       *       *       *       *       *

                           PAYMENT TO STATES

Sec. 1903. (a) * * *

           *       *       *       *       *       *       *

  (x)(1) * * *

           *       *       *       *       *       *       *

  (3)(A) * * *
  (B) The following are documents described in this 
subparagraph:
          (i) * * *

           *       *       *       *       *       *       *

          (v)(I) Except as provided in subclause (II), a 
        document issued by a federally-recognized Indian tribe 
        evidencing membership or enrollment in, or affiliation 
        with, such tribe.
          (II) With respect to those federally-recognized 
        Indian tribes located within States having an 
        international border whose membership includes 
        individuals who are not citizens of the United States, 
        the Secretary shall, after consulting with such tribes, 
        issue regulations authorizing the presentation of such 
        other forms of documentation (including tribal 
        documentation, if appropriate) that the Secretary 
        determines to be satisfactory documentary evidence of 
        citizenship or nationality for purposes of satisfying 
        the requirement of this subsection.
          [(v)] (vi) Such other document as the Secretary may 
        specify, by regulation, that provides proof of United 
        States citizenship or nationality and that provides a 
        reliable means of documentation of personal identity.

           *       *       *       *       *       *       *

                   [INDIAN HEALTH SERVICE FACILITIES

  [Sec. 1911.
  [(a) A facility of the Indian Health Service (including a 
hospital, nursing facility, or any other type of facility which 
provides services of a type otherwise covered under the State 
plan), whether operated by such Service or by an Indian tribe 
or tribal organization (as those terms are defined in section 4 
of the Indian Health Care Improvement Act), shall be eligible 
for reimbursement for medical assistance provided under a State 
plan if and for so long as it meets all of the conditions and 
requirements which are applicable generally to such facilities 
under this title.
  [(b) Notwithstanding subsection (a), a facility of the Indian 
Health Service (including a hospital, nursing facility, or any 
other type of facility which provides services of a type 
otherwise covered under the State plan) which does not meet all 
of the conditions and requirements of this title which are 
applicable generally to such facility, but which submits to the 
Secretary within six months after the date of the enactment of 
this section an acceptable plan for achieving compliance with 
such conditions and requirements, shall be deemed to meet such 
conditions and requirements (and to be eligible for 
reimbursement under this title), without regard to the extent 
of its actual compliance with such conditions and requirements, 
during the first twelve months after the month in which such 
plan is submitted.
  [(c) The Secretary is authorized to enter into agreements 
with the State agency for the purpose of reimbursing such 
agency for health care and services provided in Indian Health 
Service facilities to Indians who are eligible for medical 
assistance under the State plan.
  [(d) For provisions relating to the authority of certain 
Indian tribes, tribal organizations, and Alaska Native health 
organizations to elect to directly bill for, and receive 
payment for, health care services provided by a hospital or 
clinic of such tribes or organizations and for which payment 
may be made under this title, see section 405 of the Indian 
Health Care Improvement Act (25 U.S.C. 1645).]

SEC. 1911. INDIAN HEALTH PROGRAMS.

  (a) Eligibility for Payment for Medical Assistance.--The 
Indian Health Service and an Indian Tribe, Tribal Organization, 
or an Urban Indian Organization shall be eligible for payment 
for medical assistance provided under a State plan or under 
waiver authority with respect to items and services furnished 
by the Indian Health Service, Indian Tribe, Tribal 
Organization, or Urban Indian Organization if the furnishing of 
such services meets all the conditions and requirements which 
are applicable generally to the furnishing of items and 
services under this title and under such plan or waiver 
authority.
  (b) Compliance With Conditions and Requirements.--A facility 
of the Indian Health Service or an Indian Tribe, Tribal 
Organization, or an Urban Indian Organization which is eligible 
for payment under subsection (a) with respect to the furnishing 
of items and services, but which does not meet all of the 
conditions and requirements of this title and under a State 
plan or waiver authority which are applicable generally to such 
facility, shall make such improvements as are necessary to 
achieve or maintain compliance with such conditions and 
requirements in accordance with a plan submitted to and 
accepted by the Secretary for achieving or maintaining 
compliance with such conditions and requirements, and shall be 
deemed to meet such conditions and requirements (and to be 
eligible for payment under this title), without regard to the 
extent of its actual compliance with such conditions and 
requirements, during the first 12 months after the month in 
which such plan is submitted.
  (c) Authority To Enter Into Agreements.--The Secretary may 
enter into an agreement with a State for the purpose of 
reimbursing the State for medical assistance provided by the 
Indian Health Service, an Indian Tribe, Tribal Organization, or 
an Urban Indian Organization (as so defined), directly, through 
referral, or under contracts or other arrangements between the 
Indian Health Service, an Indian Tribe, Tribal Organization, or 
an Urban Indian Organization and another health care provider 
to Indians who are eligible for medical assistance under the 
State plan or under waiver authority.
  (d) Special Fund for Improvement of IHS Facilities.--For 
provisions relating to the authority of the Secretary to place 
payments to which a facility of the Indian Health Service is 
eligible for payment under this title into a special fund 
established under section 401(c)(1) of the Indian Health Care 
Improvement Act, and the requirement to use amounts paid from 
such fund for making improvements in accordance with subsection 
(b), see subparagraphs (A) and (B) of section 401(c)(1) of such 
Act.
  (e) Direct Billing.--For provisions relating to the authority 
of a Tribal Health Program or an Urban Indian Organization to 
elect to directly bill for, and receive payment for, health 
care items and services provided by such Program or 
Organization for which payment is made under this title, see 
section 401(d) of the Indian Health Care Improvement Act.
  (f) Definitions.--In this section, the terms ``Indian Health 
Program'', ``Indian Tribe'', ``Tribal Health Program'', 
``Tribal Organization'', and ``Urban Indian Organization'' have 
the meanings given those terms in section 4 of the Indian 
Health Care Improvement Act.

           *       *       *       *       *       *       *

USE OF ENROLLMENT FEES, PREMIUMS, DEDUCTIONS, COST SHARING, AND SIMILAR 
                                CHARGES

Sec. 1916. (a) Subject to subsections (g) [and (i)], (i), and 
(j), the State plan shall provide that in the case of 
individuals described in subparagraph (A) or (E)(i) of section 
1902(a)(10) who are eligible under the plan--
  (1)  * * *

           *       *       *       *       *       *       *
-
  (j) No Premiums or Cost Sharing for Indians Furnished Items 
or Services Directly by Indian Health Programs or through 
Referral under the Contract Health Service.--
          (1) No cost sharing for items or services furnished 
        to indians through indian health programs.--
                  (A) In general.--No enrollment fee, premium, 
                or similar charge, and no deduction, copayment, 
                cost sharing, or similar charge shall be 
                imposed against an Indian who is furnished an 
                item or service directly by the Indian Health 
                Service, an Indian Tribe, Tribal Organization, 
                or Urban Indian Organization or through 
                referral under the contract health service for 
                which payment may be made under this title.
                  (B) No reduction in amount of payment to 
                Indian health providers.--Payment due under 
                this title to the Indian Health Service, an 
                Indian Tribe, Tribal Organization, or Urban 
                Indian Organization, or a health care provider 
                through referral under the contract health 
                service for the furnishing of an item or 
                service to an Indian who is eligible for 
                assistance under such title, may not be reduced 
                by the amount of any enrollment fee, premium, 
                or similar charge, or any deduction, copayment, 
                cost sharing, or similar charge that would be 
                due from the Indian but for the operation of 
                subparagraph (A).
          (2) Rule of construction.--Nothing in this subsection 
        shall be construed as restricting the application of 
        any other limitations on the imposition of premiums or 
        cost sharing that may apply to an individual receiving 
        medical assistance under this title who is an Indian.
          (3) Definitions.--In this subsection, the terms 
        ``contract health service'', ``Indian'', ``Indian 
        Tribe'', ``Tribal Organization'', and ``Urban Indian 
        Organization'' have the meanings given those terms in 
        section 4 of the Indian Health Care Improvement Act.

         STATE OPTION FOR ALTERNATIVE PREMIUMS AND COST SHARING

Sec. 1916A.
  (a) State Flexibility.--
          (1) In general.--Notwithstanding sections 1916 and 
        1902(a)(10)(B), but subject to paragraph (2), a State, 
        at its option and through a State plan amendment, may 
        impose premiums and cost sharing for any group of 
        individuals (as specified by the State) and for any 
        type of services (other than drugs for which cost 
        sharing may be imposed under subsection (c) and non-
        emergency services furnished in a hospital emergency 
        department for which cost sharing may be imposed under 
        subsection (e)), and may vary such premiums and cost 
        sharing among such groups or types, consistent with the 
        limitations established under this section. Nothing in 
        this section shall be construed as superseding (or 
        preventing the application of) [section 1916(g)] 
        subsections (g), (i), or (j) of section 1916.

           *       *       *       *       *       *       *

       LIENS, ADJUSTMENTS AND RECOVERIES, AND TRANSFERS OF ASSETS

  Sec. 1917. (a) * * *
  (b)(1) * * *

           *       *       *       *       *       *       *

  (3)(A) The State agency shall establish procedures (in 
accordance with standards specified by the Secretary) under 
which the agency shall waive the application of this subsection 
(other than paragraph (1)(C)) if such application would work an 
undue hardship as determined on the basis of criteria 
established by the Secretary.
  (B) The standards specified by the Secretary under 
subparagraph (A) shall require that the procedures established 
by the State agency under subparagraph (A) exempt income, 
resources, and property that are exempt from the application of 
this subsection as of April 1, 2003, under manual instructions 
issued to carry out this subsection (as in effect on such date) 
because of the Federal responsibility for Indian Tribes and 
Alaska Native Villages. Nothing in this subparagraph shall be 
construed as preventing the Secretary from providing additional 
estate recovery exemptions under this title for Indians.

           *       *       *       *       *       *       *

                  PROVISIONS RELATING TO MANAGED CARE

  Sec. 1932. (a) * * *

           *       *       *       *       *       *       *

  (h) Special Rules With Respect to Indian Enrollees, Indian 
Health Care Providers, and Indian Managed Care Entities.--
          (1) Enrollee option to select an indian health care 
        provider as primary care provider.--In the case of a 
        non-Indian Medicaid managed care entity that--
                  (A) has an Indian enrolled with the entity; 
                and
                  (B) has an Indian health care provider that 
                is participating as a primary care provider 
                within the network of the entity,
        insofar as the Indian is otherwise eligible to receive 
        services from such Indian health care provider and the 
        Indian health care provider has the capacity to provide 
        primary care services to such Indian, the contract with 
        the entity under section 1903(m) or under section 
        1905(t)(3) shall require, as a condition of receiving 
        payment under such contract, that the Indian shall be 
        allowed to choose such Indian health care provider as 
        the Indian's primary care provider under the entity.
          (2) Assurance of payment to indian health care 
        providers for provision of covered services.--Each 
        contract with a managed care entity under section 
        1903(m) or under section 1905(t)(3) shall require any 
        such entity that has a significant percentage of Indian 
        enrollees (as determined by the Secretary), as a 
        condition of receiving payment under such contract to 
        satisfy the following requirements:
                  (A) Demonstration of participating indian 
                health care providers or application of 
                alternative payment arrangements.--Subject to 
                subparagraph (E), to--
                          (i) demonstrate that the number of 
                        Indian health care providers that are 
                        participating providers with respect to 
                        such entity are sufficient to ensure 
                        timely access to covered Medicaid 
                        managed care services for those 
                        enrollees who are eligible to receive 
                        services from such providers; or
                          (ii) agree to pay Indian health care 
                        providers who are not participating 
                        providers with the entity for covered 
                        Medicaid managed care services provided 
                        to those enrollees who are eligible to 
                        receive services from such providers at 
                        a rate equal to the rate negotiated 
                        between such entity and the provider 
                        involved or, if such a rate has not 
                        been negotiated, at a rate that is not 
                        less than the level and amount of 
                        payment which the entity would make for 
                        the services if the services were 
                        furnished by a participating provider 
                        which is not an Indian health care 
                        provider.
                  (B) Prompt payment.--To agree to make prompt 
                payment (in accordance with rules applicable to 
                managed care entities) to Indian health care 
                providers that are participating providers with 
                respect to such entity or, in the case of an 
                entity to which subparagraph (A)(ii) or (E) 
                applies, that the entity is required to pay in 
                accordance with that subparagraph.
                  (C) Satisfaction of claim requirement.--To 
                deem any requirement for the submission of a 
                claim or other documentation for services 
                covered under subparagraph (A) by the enrollee 
                to be satisfied through the submission of a 
                claim or other documentation by an Indian 
                health care provider that is consistent with 
                section 403(h) of the Indian Health Care 
                Improvement Act.
                  (D) Compliance with generally applicable 
                requirements.--
                          (i) In general.--Subject to clause 
                        (ii), as a condition of payment under 
                        subparagraph (A), an Indian health care 
                        provider shall comply with the 
                        generally applicable requirements of 
                        this title, the State plan, and such 
                        entity with respect to covered Medicaid 
                        managed care services provided by the 
                        Indian health care provider to the same 
                        extent that non-Indian providers 
                        participating with the entity must 
                        comply with such requirements.
                          (ii) Limitations on compliance with 
                        managed care entity generally 
                        applicable requirements.--An Indian 
                        health care provider--
                                  (I) shall not be required to 
                                comply with a generally 
                                applicable requirement of a 
                                managed care entity described 
                                in clause (i) as a condition of 
                                payment under subparagraph (A) 
                                if such compliance would 
                                conflict with any other 
                                statutory or regulatory 
                                requirements applicable to the 
                                Indian health care provider; 
                                and
                                  (II) shall only need to 
                                comply with those generally 
                                applicable requirements of a 
                                managed care entity described 
                                in clause (i) as a condition of 
                                payment under subparagraph (A) 
                                that are necessary for the 
                                entity's compliance with the 
                                State plan, such as those 
                                related to care management, 
                                quality assurance, and 
                                utilization management.
                  (E) Application of special payment 
                requirements for federally-qualified health 
                centers and encounter rate for services 
                provided by certain indian health care 
                providers.--
                          (i) Federally-qualified health 
                        centers.--
                                  (I) Managed care entity 
                                payment requirement.--To agree 
                                to pay any Indian health care 
                                provider that is a federally-
                                qualified health center but not 
                                a participating provider with 
                                respect to the entity, for the 
                                provision of covered Medicaid 
                                managed care services by such 
                                provider to an Indian enrollee 
                                of the entity at a rate equal 
                                to the amount of payment that 
                                the entity would pay a 
                                federally-qualified health 
                                center that is a participating 
                                provider with respect to the 
                                entity but is not an Indian 
                                health care provider for such 
                                services.
                                  (II) Continued application of 
                                state requirement to make 
                                supplemental payment.--Nothing 
                                in subclause (I) or 
                                subparagraph (A) or (B) shall 
                                be construed as waiving the 
                                application of section 
                                1902(bb)(5) regarding the State 
                                plan requirement to make any 
                                supplemental payment due under 
                                such section to a federally-
                                qualified health center for 
                                services furnished by such 
                                center to an enrollee of a 
                                managed care entity (regardless 
                                of whether the federally-
                                qualified health center is or 
                                is not a participating provider 
                                with the entity).
                          (ii) Continued application of 
                        encounter rate for services provided by 
                        certain indian health care providers.--
                        If the amount paid by a managed care 
                        entity to an Indian health care 
                        provider that is not a federally-
                        qualified health center and that has 
                        elected to receive payment under this 
                        title as an Indian Health Service 
                        provider under the July 11, 1996, 
                        Memorandum of Agreement between the 
                        Health Care Financing Administration 
                        (now the Centers for Medicare & 
                        Medicaid Services) and the Indian 
                        Health Service for services provided by 
                        such provider to an Indian enrollee 
                        with the managed care entity is less 
                        than the encounter rate that applies to 
                        the provision of such services under 
                        such memorandum, the State plan shall 
                        provide for payment to the Indian 
                        health care provider of the difference 
                        between the applicable encounter rate 
                        under such memorandum and the amount 
                        paid by the managed care entity to the 
                        provider for such services.
                  (F) Construction.--Nothing in this paragraph 
                shall be construed as waiving the application 
                of section 1902(a)(30)(A) (relating to 
                application of standards to assure that 
                payments are consistent with efficiency, 
                economy, and quality of care).
          (3) Offering of managed care through indian medicaid 
        managed care entities.--If--
                  (A) a State elects to provide services 
                through Medicaid managed care entities under 
                its Medicaid managed care program; and
                  (B) an Indian health care provider that is 
                funded in whole or in part by the Indian Health 
                Service, or a consortium composed of 1 or more 
                Tribes, Tribal Organizations, or Urban Indian 
                Organizations, and which also may include the 
                Indian Health Service, has established an 
                Indian Medicaid managed care entity in the 
                State that meets generally applicable standards 
                required of such an entity under such Medicaid 
                managed care program,
        the State shall offer to enter into an agreement with 
        the entity to serve as a Medicaid managed care entity 
        with respect to eligible Indians served by such entity 
        under such program.
          (4) Special rules for indian managed care entities.--
        The following are special rules regarding the 
        application of a Medicaid managed care program to 
        Indian Medicaid managed care entities:
                  (A) Enrollment.--
                          (i) Limitation to indians.--An Indian 
                        Medicaid managed care entity may 
                        restrict enrollment under such program 
                        to Indians and to members of specific 
                        Tribes in the same manner as Indian 
                        Health Programs may restrict the 
                        delivery of services to such Indians 
                        and tribal members.
                          (ii) No less choice of plans.--Under 
                        such program the State may not limit 
                        the choice of an Indian among Medicaid 
                        managed care entities only to Indian 
                        Medicaid managed care entities or to be 
                        more restrictive than the choice of 
                        managed care entities offered to 
                        individuals who are not Indians.
                          (iii) Default enrollment.--
                                  (I) In general.--If such 
                                program of a State requires the 
                                enrollment of Indians in a 
                                Medicaid managed care entity in 
                                order to receive benefits, the 
                                State, taking into 
                                consideration the criteria 
                                specified in subsection 
                                (a)(4)(D)(ii)(I), shall provide 
                                for the enrollment of Indians 
                                described in subclause (II) who 
                                are not otherwise enrolled with 
                                such an entity in an Indian 
                                Medicaid managed care entity 
                                described in such clause.
                                  (II) Indian described.--An 
                                Indian described in this 
                                subclause, with respect to an 
                                Indian Medicaid managed care 
                                entity, is an Indian who, based 
                                upon the service area and 
                                capacity of the entity, is 
                                eligible to be enrolled with 
                                the entity consistent with 
                                subparagraph (A).
                          (iv) Exception to state lock-in.--A 
                        request by an Indian who is enrolled 
                        under such program with a non-Indian 
                        Medicaid managed care entity to change 
                        enrollment with that entity to 
                        enrollment with an Indian Medicaid 
                        managed care entity shall be considered 
                        cause for granting such request under 
                        procedures specified by the Secretary.
                  (B) Flexibility in application of solvency.--
                In applying section 1903(m)(1) to an Indian 
                Medicaid managed care entity--
                          (i) any reference to a ``State'' in 
                        subparagraph (A)(ii) of that section 
                        shall be deemed to be a reference to 
                        the ``Secretary''; and
                          (ii) the entity shall be deemed to be 
                        a public entity described in 
                        subparagraph (C)(ii) of that section.
                  (C) Exceptions to advance directives.--The 
                Secretary may modify or waive the requirements 
                of section 1902(w) (relating to provision of 
                written materials on advance directives) 
                insofar as the Secretary finds that the 
                requirements otherwise imposed are not an 
                appropriate or effective way of communicating 
                the information to Indians.
                  (D) Flexibility in information and 
                marketing.--
                          (i) Materials.--The Secretary may 
                        modify requirements under subsection 
                        (a)(5) to ensure that information 
                        described in that subsection is 
                        provided to enrollees and potential 
                        enrollees of Indian Medicaid managed 
                        care entities in a culturally 
                        appropriate and understandable manner 
                        that clearly communicates to such 
                        enrollees and potential enrollees their 
                        rights, protections, and benefits.
                          (ii) Distribution of marketing 
                        materials.--The provisions of 
                        subsection (d)(2)(B) requiring the 
                        distribution of marketing materials to 
                        an entire service area shall be deemed 
                        satisfied in the case of an Indian 
                        Medicaid managed care entity that 
                        distributes appropriate materials only 
                        to those Indians who are potentially 
                        eligible to enroll with the entity in 
                        the service area.
          (5) Malpractice insurance.--Insofar as, under a 
        Medicaid managed care program, a health care provider 
        is required to have medical malpractice insurance 
        coverage as a condition of contracting as a provider 
        with a Medicaid managed care entity, an Indian health 
        care provider that is--
                  (A) a federally-qualified health center that 
                is covered under the Federal Tort Claims Act 
                (28 U.S.C. 1346(b), 2671 et seq.);
                  (B) providing health care services pursuant 
                to a contract or compact under the Indian Self-
                Determination and Education Assistance Act (25 
                U.S.C. 450 et seq.) that are covered under the 
                Federal Tort Claims Act (28 U.S.C. 1346(b), 
                2671 et seq.); or
                  (C) the Indian Health Service providing 
                health care services that are covered under the 
                Federal Tort Claims Act (28 U.S.C. 1346(b), 
                2671 et seq.);
        are deemed to satisfy such requirement.
          (6) Definitions.--For purposes of this subsection:
                  (A) Indian health care provider.--The term 
                ``Indian health care provider'' means an Indian 
                Health Program or an Urban Indian Organization.
                  (B) Indian; indian health program; service; 
                tribe; tribal organization; urban indian 
                organization.--The terms ``Indian'', ``Indian 
                Health Program'', ``Service'', ``Tribe'', 
                ``tribal organization'', ``Urban Indian 
                Organization'' have the meanings given such 
                terms in section 4 of the Indian Health Care 
                Improvement Act.
                  (C) Indian medicaid managed care entity.--The 
                term ``Indian Medicaid managed care entity'' 
                means a managed care entity that is controlled 
                (within the meaning of the last sentence of 
                section 1903(m)(1)(C)) by the Indian Health 
                Service, a Tribe, Tribal Organization, or Urban 
                Indian Organization, or a consortium, which may 
                be composed of 1 or more Tribes, Tribal 
                Organizations, or Urban Indian Organizations, 
                and which also may include the Service.
                  (D) Non-indian medicaid managed care 
                entity.--The term ``non-Indian Medicaid managed 
                care entity'' means a managed care entity that 
                is not an Indian Medicaid managed care entity.
                  (E) Covered medicaid managed care services.--
                The term ``covered Medicaid managed care 
                services'' means, with respect to an individual 
                enrolled with a managed care entity, items and 
                services that are within the scope of items and 
                services for which benefits are available with 
                respect to the individual under the contract 
                between the entity and the State involved.
                  (F) Medicaid managed care program.--The term 
                ``Medicaid managed care program'' means a 
                program under sections 1903(m) and 1932 and 
                includes a managed care program operating under 
                a waiver under section 1915(b) or 1115 or 
                otherwise.

           *       *       *       *       *       *       *

TITLE XXI--STATE CHILDREN'S HEALTH INSURANCE PROGRAM

           *       *       *       *       *       *       *

SEC. 2102. GENERAL CONTENTS OF STATE CHILD HEALTH PLAN; ELIGIBILITY; 
                    OUTREACH.

  (a) * * *
  (b) General Description of Eligibility Standards and 
Methodology.--
          (1) * * *

           *       *       *       *       *       *       *

          (3) Eligibility screening; coordination with other 
        health coverage programs.--The plan shall include a 
        description of procedures to be used to ensure--
                  (A) * * *

           *       *       *       *       *       *       *

                  (D) the provision of child health assistance 
                to targeted low-income children in the State 
                who are Indians [(as defined in section 4(c) of 
                the Indian Health Care Improvement Act, 25 
                U.S.C. 1603(c))], including how the State will 
                ensure that payments are made to Indian Health 
                Programs and Urban Indian Organizations 
                operating in the State for the provision of 
                such assistance; and

           *       *       *       *       *       *       *

SEC. 2105. PAYMENTS TO STATES.

  (a) * * *

           *       *       *       *       *       *       *

  (c) Limitation on Certain Payments for Certain 
Expenditures.--
          (1) * * *
          (2) Limitation on expenditures not used for medicaid 
        or health insurance assistance.--
                  (A) * * *

           *       *       *       *       *       *       *

                  (C) Nonapplication to expenditures for 
                outreach to increase the enrollment of indian 
                children under this title and title xix.--The 
                limitation under subparagraph (A) on 
                expenditures for items described in subsection 
                (a)(1)(D) shall not apply in the case of 
                expenditures for outreach activities to 
                families of Indian children likely to be 
                eligible for child health assistance under the 
                plan or medical assistance under the State plan 
                under title XIX (or under a waiver of such 
                plan), to inform such families of the 
                availability of, and to assist them in 
                enrolling their children in, such plans, 
                including such activities conducted under 
                grants, contracts, or agreements entered into 
                under section 1139(a).

           *       *       *       *       *       *       *

          (6) Prevention of duplicative payments.--
                  (A) * * *
                  (B) Other federal governmental programs.--
                Except as provided in subparagraph (A) or (B) 
                of subsection (a)(1) or any other provision of 
                law, no payment shall be made to a State under 
                this section for expenditures for child health 
                assistance provided for a targeted low-income 
                child under its plan to the extent that payment 
                has been made or can reasonably be expected to 
                be made promptly (as determined in accordance 
                with regulations) under any other federally 
                operated or financed health care [insurance 
                program, other than an insurance program 
                operated or financed by the Indian Health 
                Service] program, other than a health care 
                program operated or financed by the Indian 
                Health Service or by an Indian Tribe, Tribal 
                Organization, or Urban Indian Organization, as 
                identified by the Secretary. For purposes of 
                this paragraph, rules similar to the rules for 
                overpayments under section 1903(d)(2) shall 
                apply.

           *       *       *       *       *       *       *

SEC. 2107. STRATEGIC OBJECTIVES AND PERFORMANCE GOALS; PLAN 
                    ADMINISTRATION.

  (a) * * *

           *       *       *       *       *       *       *

  (e) Application of Certain General Provisions.--The following 
sections of this Act shall apply to States under this title in 
the same manner as they apply to a State under title XIX:
          (1) Title xix provisions.--
                  (A) * * *
                  (B) Section 1902(a)(71) (relating to the 
                option of certain States to seek advice from 
                designees of Indian Health Programs and Urban 
                Indian Organizations).
                  (C) Section 1902(e)(13) (relating to 
                disregard of certain property for purposes of 
                making eligibility determinations).
                  [(B)] (D) Paragraphs (2), (16), and (17) of 
                section 1903(i) (relating to limitations on 
                payment).
                  [(C)] (E) Section 1903(w) (relating to 
                limitations on provider taxes and donations).
                  (F) Section 1911 (relating to Indian Health 
                Programs, other than subsection (d) of such 
                section).
                  [(D)] (G) Section 1920A (relating to 
                presumptive eligibility for children).
                  (H) Subsections (a)(2)(C) and (h) of section 
                1932.

           *       *       *       *       *       *       *

SEC. 2110. DEFINITIONS.

  (a) * * *

           *       *       *       *       *       *       *

  (c) Additional Definitions.--For purposes of this title:
          (1) * * *

           *       *       *       *       *       *       *

          (9) Indian; indian health program; indian tribe; 
        etc.--The terms ``Indian'', ``Indian Health Program'', 
        ``Indian Tribe'', ``Tribal Organization'', and ``Urban 
        Indian Organization'' have the meanings given those 
        terms in section 4 of the Indian Health Care 
        Improvement Act.

           *       *       *       *       *       *       *

                                  
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