II 

111TH CONGRESS 

1ST SESSION S. 1790 

To amend the Indian Health Care Improvement Act to revise and extend 

that Act, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

OCTOBER 15, 2009 

Mr. DORGAN (for himself, Mr. REID, Ms. MURKOWSKI, Mr. UDALL of New 

Mexico, Mr. WHITEHOUSE, Mr. JOHNSON, Mr. TESTER, Mr. AKAKA, Mr. 

CONRAD, Mr. BEGICH, Mr. FRANKEN, Mr. BURRIS, Mr. INOUYE, Ms. 

STABENOW, Mr. UDALL of Colorado, and Ms. KLOBUCHAR) introduced 

the following bill; which was read twice and referred to the Committee 

on Indian Affairs 

A BILL 

To amend the Indian Health Care Improvement Act to revise 

and extend that Act, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Indian Health Care Improvement Reauthorization and 

6 Extension Act of 2009’’. 

7 (b) TABLE OF CONTENTS.—The table of contents of 

8 this Act is as follows: 


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Sec. 1. Short title; table of contents. 

TITLE I—INDIAN HEALTH CARE IMPROVEMENT ACT 

REAUTHORIZATION AND AMENDMENTS 

Sec. 101. Reauthorization. 

Sec. 102. Findings. 

Sec. 103. Declaration of national Indian health policy. 

Sec. 104. Definitions. 

Subtitle A—Indian Health Manpower 

Sec. 111. Community Health Aide Program. 

Sec. 112. Health professional chronic shortage demonstration programs. 

Sec. 113. Exemption from payment of certain fees. 

Subtitle B—Health Services 

Sec. 121. Other authority for provision of services; shared services for longterm care. 

Sec. 122. Reimbursement from certain third parties of costs of health services. 

Sec. 123. Crediting of reimbursements. 

Sec. 124. Behavioral health training and community education programs. 

Sec. 125. Mammography and other cancer screening. 

Sec. 126. Patient travel costs. 

Sec. 127. Epidemiology centers. 

Sec. 128. Prevention, control, and elimination of communicable and infectious 

diseases. 

Sec. 129. Methods to increase clinician recruitment and retention issues. 

Sec. 130. Offices of Indian Men’s Health and Indian Women’s Health. 

Sec. 131. Contract health service disbursement formula. 

Subtitle C—Health Facilities 

Sec. 141. Indian health care delivery demonstration projects. 

Sec. 142. Tribal management of federally owned quarters. 

Sec. 143. Other funding, equipment, and supplies for facilities. 

Sec. 144. Indian country modular component facilities demonstration program. 

Sec. 145. Mobile health stations demonstration program. 

Subtitle D—Access to Health Services 

Sec. 151. Treatment of payments under Social Security Act health benefits programs. 

Sec. 152. Purchasing health care coverage. 

Sec. 153. 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. 154. Sharing arrangements with Federal agencies. 

Sec. 155. Eligible Indian veteran services. 

Sec. 156. Nondiscrimination under Federal health care programs in qualifications for reimbursement for services. 

Sec. 157. Access to Federal insurance. 

Sec. 158. General exceptions. 

Subtitle E—Health Services for Urban Indians 


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Sec. 161. Requirement to confer with urban Indian organizations. 

Sec. 162. Expanded program authority for urban Indian organizations. 

Sec. 163. Community health representatives. 

Subtitle F—Organizational Improvements 

Sec. 171. Establishment of the Indian Health Service as an agency of the Public Health Service. 

Sec. 172. Office of Direct Service Tribes. 

Sec. 173. Nevada area office. 

Subtitle G—Behavioral Health Programs 

Sec. 181. Behavioral health programs. 

‘‘TITLE VII—BEHAVIORAL HEALTH PROGRAMS 

‘‘Subtitle A—General Programs 

‘‘Sec. 701. Definitions. 

‘‘Sec. 702. Behavioral health prevention and treatment services. 

‘‘Sec. 703. Memoranda of agreement with the Department of Interior. 

‘‘Sec. 704. Comprehensive behavioral health prevention and treatment program. 

‘‘Sec. 705. Mental health technician program. 

‘‘Sec. 706. Licensing requirement for mental health care workers. 

‘‘Sec. 707. Indian women treatment programs. 

‘‘Sec. 708. Indian youth program. 

‘‘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 spectrum disorders programs. 

‘‘Sec. 713. Child sexual abuse and prevention treatment programs. 

‘‘Sec. 714. Domestic and sexual violence prevention and treatment. 

‘‘Sec. 715. Behavioral health research. 

‘‘Subtitle B—Indian Youth Suicide Prevention 

‘‘Sec. 721. Findings and purpose. 

‘‘Sec. 722. Definitions. 

‘‘Sec. 723. Indian youth telemental health demonstration project. 

‘‘Sec. 724. Substance Abuse and Mental Health Services Administration 

grants. 

‘‘Sec. 725. Use of predoctoral psychology and psychiatry interns. 

‘‘Sec. 726. Indian youth life skills development demonstration program. 

Subtitle H—Miscellaneous 

Sec. 191. Confidentiality of medical quality assurance records; qualified immunity for participants. 

Sec. 192. Arizona, North Dakota, and South Dakota as contract health service 

delivery areas; eligibility of California Indians. 

Sec. 193. Methods to increase access to professionals of certain corps. 

Sec. 194. Health services for ineligible persons. 

Sec. 195. Annual budget submission. 

TITLE II—AMENDMENTS TO OTHER ACTS 


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Sec. 201. Solicitation of proposals for safe harbors under the Social Security 

Act for facilities of Indian health programs and urban Indian 

organizations. 

Sec. 202. Annual report regarding Indians served by health benefits programs 

under Social Security Act. 

Sec. 203. Including costs incurred by Service, a federally qualified health center, an AIDS drug assistance program, certain hospitals, or a 

pharmaceutical manufacturer patient assistance program in 

providing prescription drugs toward the annual out of pocket 

threshold under part D. 

Sec. 204. Medicare amendments. 

Sec. 205. Expansion of payments under Medicare, Medicaid, and CHIP for all 

covered services furnished by Indian health programs. 

Sec. 206. Reauthorization of Native Hawaiian health care programs. 

1 TITLE I—INDIAN HEALTH CARE 

2 IMPROVEMENT ACT REAU3 THORIZATION AND AMEND4 MENTS 

5 SEC. 101. REAUTHORIZATION. 

6 (a) IN GENERAL.—Section 825 of the Indian Health 

7 Care Improvement Act (25 U.S.C. 1680o) is amended to 

8 read as follows: 

9 ‘‘SEC. 825. AUTHORIZATION OF APPROPRIATIONS. 

10 ‘‘There are authorized to be appropriated such sums 

11 as are necessary to carry out this Act for fiscal year 2010 

12 and each fiscal year thereafter, to remain available until 

13 expended.’’. 

14 (b) REPEALS.—The following provisions of the In15 dian Health Care Improvement Act are repealed: 

16 (1) Section 123 (25 U.S.C. 1616p). 

17 (2) Paragraph (6) of section 209(m) (25 U.S.C. 

18 1621h(m)). 


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1 (3) Subsection (g) of section 211 (25 U.S.C. 

2 1621j). 

3 (4) Subsection (e) of section 216 (25 U.S.C. 

4 1621o). 

5 (5) Section 224 (25 U.S.C. 1621w). 

6 (6) Section 309 (25 U.S.C. 1638a). 

7 (7) Section 407 (25 U.S.C. 1647). 

8 (8) Subsection (c) of section 512 (25 U.S.C. 

9 1660b). 

10 (9) Section 514 (25 U.S.C. 1660d). 

11 (10) Section 603 (25 U.S.C. 1663). 

12 (11) Section 805 (25 U.S.C. 1675). 

13 (c) CONFORMING AMENDMENTS.— 

14 (1) Section 204(c)(1) of the Indian Health Care 

15 Improvement Act (25 U.S.C. 1621c(c)(1)) is amend16 ed by striking ‘‘through fiscal year 2000’’. 

17 (2) Section 213 of the Indian Health Care Im18 provement Act (25 U.S.C. 1621l) is amended by 

19 striking ‘‘(a) The Secretary’’ and inserting ‘‘The 

20 Secretary’’. 

21 (3) Section 310 of the Indian Health Care Im22 provement Act (25 U.S.C. 1638b) is amended by 

23 striking ‘‘funds provided pursuant to the authoriza24 tion contained in section 309’’ each place it appears 


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1 and inserting ‘‘funds made available to carry out 

2 this title’’. 

3 SEC. 102. FINDINGS. 

4 Section 2 of the Indian Health Care Improvement 

5 Act (25 U.S.C. 1601) is amended— 

6 (1) by redesignating subsections (a), (b), (c), 

7 and (d) as paragraphs (1), (3), (4), and (5), respec8 tively, and indenting the paragraphs appropriately; 

9 and 

10 (2) by inserting after paragraph (1) (as so re11 designated) the following: 

12 ‘‘(2) A major national goal of the United States 

13 is to provide the resources, processes, and structure 

14 that will enable Indian tribes and tribal members to 

15 obtain the quantity and quality of health care serv16 ices and opportunities that will eradicate the health 

17 disparities between Indians and the general popu18 lation of the United States.’’. 

19 SEC. 103. DECLARATION OF NATIONAL INDIAN HEALTH 

20 POLICY. 

21 Section 3 of the Indian Health Care Improvement 

22 Act (25 U.S.C. 1602) is amended to read as follows: 


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1 ‘‘SEC. 3. DECLARATION OF NATIONAL INDIAN HEALTH POL2 ICY. 

3 ‘‘Congress declares that it is the policy of this Nation, 

4 in fulfillment of its special trust responsibilities and legal 

5 obligations to Indians— 

6 ‘‘(1) to ensure the highest possible health status 

7 for Indians and urban Indians and to provide all re8 sources necessary to effect that policy; 

9 ‘‘(2) to raise the health status of Indians and 

10 urban Indians to at least the levels set forth in the 

11 goals contained within the Healthy People 2010 ini12 tiative or successor objectives; 

13 ‘‘(3) to ensure maximum Indian participation in 

14 the direction of health care services so as to render 

15 the persons administering such services and the 

16 services themselves more responsive to the needs and 

17 desires of Indian communities; 

18 ‘‘(4) to increase the proportion of all degrees in 

19 the health professions and allied and associated 

20 health professions awarded to Indians so that the 

21 proportion of Indian health professionals in each 

22 Service area is raised to at least the level of that of 

23 the general population; 

24 ‘‘(5) to require that all actions under this Act 

25 shall be carried out with active and meaningful con26 sultation with Indian tribes and tribal organizations, 


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1 and conference with urban Indian organizations, to 

2 implement this Act and the national policy of Indian 

3 self-determination; 

4 ‘‘(6) to ensure that the United States and In5 dian tribes work in a government-to-government re6 lationship to ensure quality health care for all tribal 

7 members; and 

8 ‘‘(7) to provide funding for programs and facili9 ties operated by Indian tribes and tribal organiza10 tions in amounts that are not less than the amounts 

11 provided to programs and facilities operated directly 

12 by the Service.’’. 

13 SEC. 104. DEFINITIONS. 

14 Section 4 of the Indian Health Care Improvement 

15 Act (25 U.S.C. 1603) is amended— 

16 (1) by striking the matter preceding subsection 

17 (a) and inserting ‘‘In this Act:’’; 

18 (2) in each of subsections (c), (j), (k), and (l), 

19 by redesignating the paragraphs contained in the 

20 subsections as subparagraphs and indenting the sub21 paragraphs appropriately; 

22 (3) by redesignating subsections (a) through (q) 

23 as paragraphs (17), (18), (13), (14), (26), (28), 

24 (27), (29), (1), (20), (11), (7), (19), (10), (21), (8), 

25 and (9), respectively, indenting the paragraphs apVerDate Nov 24 2008 01:56 Oct 17, 2009 Jkt 089200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S1790.IS S1790

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1 propriately, and moving the paragraphs so as to ap2 pear in numerical order; 

3 (4) in each paragraph (as so redesignated), by 

4 inserting a heading the text of which is comprised of 

5 the term defined in the paragraph; 

6 (5) by inserting ‘‘The term’’ after each para7 graph heading; 

8 (6) by inserting after paragraph (1) (as redesig9 nated by paragraph (3)) the following: 

10 ‘‘(2) BEHAVIORAL HEALTH.— 

11 ‘‘(A) IN GENERAL.—The term ‘behavioral 

12 health’ means the blending of substance (alco13 hol, drugs, inhalants, and tobacco) abuse and 

14 mental health prevention and treatment for the 

15 purpose of providing comprehensive services. 

16 ‘‘(B) INCLUSIONS.—The term ‘behavioral 

17 health’ includes the joint development of sub18 stance abuse and mental health treatment plan19 ning and coordinated case management using a 

20 multidisciplinary approach. 

21 ‘‘(3) CALIFORNIA INDIAN.—The term ‘Cali22 fornia Indian’ means any Indian who is eligible for 

23 health services provided by the Service pursuant to 

24 section 809. 


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1 ‘‘(4) COMMUNITY COLLEGE.—The term ‘com2 munity college’ means— 

3 ‘‘(A) a tribal college or university; or 

4 ‘‘(B) a junior or community college. 

5 ‘‘(5) CONTRACT HEALTH SERVICE.—The term 

6 ‘contract health service’ means any health service 

7 that is— 

8 ‘‘(A) delivered based on a referral by, or at 

9 the expense of, an Indian health program; and 

10 ‘‘(B) provided by a public or private med11 ical provider or hospital that is not a provider 

12 or hospital of the Indian health program. 

13 ‘‘(6) DEPARTMENT.—The term ‘Department’, 

14 unless otherwise designated, means the Department 

15 of Health and Human Services.’’; 

16 (7) by striking paragraph (7) (as redesignated 

17 by paragraph (3)) and inserting the following: 

18 ‘‘(7) DISEASE PREVENTION.— 

19 ‘‘(A) IN GENERAL.—The term ‘disease pre20 vention’ means any activity for— 

21 ‘‘(i) the reduction, limitation, and pre22 vention of— 

23 ‘‘(I) disease; and 

24 ‘‘(II) complications of disease; 

25 and 


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1 ‘‘(ii) the reduction of consequences of 

2 disease. 

3 ‘‘(B) INCLUSIONS.—The term ‘disease pre4 vention’ includes an activity for— 

5 ‘‘(i) controlling— 

6 ‘‘(I) the development of diabetes; 

7 ‘‘(II) high blood pressure; 

8 ‘‘(III) infectious agents; 

9 ‘‘(IV) injuries; 

10 ‘‘(V) occupational hazards and 

11 disabilities; 

12 ‘‘(VI) sexually transmittable dis13 eases; or 

14 ‘‘(VII) toxic agents; or 

15 ‘‘(ii) providing— 

16 ‘‘(I) fluoridation of water; or 

17 ‘‘(II) immunizations.’’; 

18 (8) by striking paragraph (9) (as redesignated 

19 by paragraph (3)) and inserting the following: 

20 ‘‘(9) FAS.—The term ‘fetal alcohol syndrome’ 

21 or ‘FAS’ means a syndrome in which, with a history 

22 of maternal alcohol consumption during pregnancy, 

23 the following criteria are met: 

24 ‘‘(A) Central nervous system involvement 

25 such as mental retardation, developmental 


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1 delay, intellectual deficit, microencephaly, or 

2 neurologic abnormalities. 

3 ‘‘(B) Craniofacial abnormalities with at 

4 least 2 of the following: microophthalmia, short 

5 palpebral fissures, poorly developed philtrum, 

6 thin upper lip, flat nasal bridge, and short 

7 upturned nose. 

8 ‘‘(C) Prenatal or postnatal growth delay.’’; 

9 (9) by striking paragraphs (11) and (12) (as 

10 redesignated by paragraph (3)) and inserting the 

11 following: 

12 ‘‘(11) HEALTH PROMOTION.—The term ‘health 

13 promotion’ means any activity for— 

14 ‘‘(A) fostering social, economic, environ15 mental, and personal factors conducive to 

16 health, including raising public awareness re17 garding health matters and enabling individuals 

18 to cope with health problems by increasing 

19 knowledge and providing valid information; 

20 ‘‘(B) encouraging adequate and appro21 priate diet, exercise, and sleep; 

22 ‘‘(C) promoting education and work in ac23 cordance with physical and mental capacity; 

24 ‘‘(D) making available safe water and sani25 tary facilities; 


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1 ‘‘(E) improving the physical, economic, cul2 tural, psychological, and social environment; 

3 ‘‘(F) promoting culturally competent care; 

4 and 

5 ‘‘(G) providing adequate and appropriate 

6 programs, including programs for— 

7 ‘‘(i) abuse prevention (mental and 

8 physical); 

9 ‘‘(ii) community health; 

10 ‘‘(iii) community safety; 

11 ‘‘(iv) consumer health education; 

12 ‘‘(v) diet and nutrition; 

13 ‘‘(vi) immunization and other methods 

14 of prevention of communicable diseases, in15 cluding HIV/AIDS; 

16 ‘‘(vii) environmental health; 

17 ‘‘(viii) exercise and physical fitness; 

18 ‘‘(ix) avoidance of fetal alcohol spec19 trum disorders; 

20 ‘‘(x) first aid and CPR education; 

21 ‘‘(xi) human growth and development; 

22 ‘‘(xii) injury prevention and personal 

23 safety; 

24 ‘‘(xiii) behavioral health; 


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1 ‘‘(xiv) monitoring of disease indicators 

2 between health care provider visits through 

3 appropriate means, including Internet4 based health care management systems; 

5 ‘‘(xv) personal health and wellness 

6 practices; 

7 ‘‘(xvi) personal capacity building; 

8 ‘‘(xvii) prenatal, pregnancy, and in9 fant care; 

10 ‘‘(xviii) psychological well-being; 

11 ‘‘(xix) reproductive health and family 

12 planning; 

13 ‘‘(xx) safe and adequate water; 

14 ‘‘(xxi) healthy work environments; 

15 ‘‘(xxii) elimination, reduction, and 

16 prevention of contaminants that create 

17 unhealthy household conditions (including 

18 mold and other allergens); 

19 ‘‘(xxiii) stress control; 

20 ‘‘(xxiv) substance abuse; 

21 ‘‘(xxv) sanitary facilities; 

22 ‘‘(xxvi) sudden infant death syndrome 

23 prevention; 

24 ‘‘(xxvii) tobacco use cessation and re25 duction; 


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1 ‘‘(xxviii) violence prevention; and 

2 ‘‘(xxix) such other activities identified 

3 by the Service, a tribal health program, or 

4 an urban Indian organization to promote 

5 achievement of any of the objectives re6 ferred to in section 3(2). 

7 ‘‘(12) INDIAN HEALTH PROGRAM.—The term 

8 ‘Indian health program’ means— 

9 ‘‘(A) any health program administered di10 rectly by the Service; 

11 ‘‘(B) any tribal health program; and 

12 ‘‘(C) any Indian tribe or tribal organiza13 tion to which the Secretary provides funding 

14 pursuant to section 23 of the Act of June 25, 

15 1910 (25 U.S.C. 47) (commonly known as the 

16 ‘Buy Indian Act’).’’; 

17 (10) by inserting after paragraph (14) (as re18 designated by paragraph (3)) the following: 

19 ‘‘(15) JUNIOR OR COMMUNITY COLLEGE.—The 

20 term ‘junior or community college’ has the meaning 

21 given the term in section 312(e) of the Higher Edu22 cation Act of 1965 (20 U.S.C. 1058(e)). 

23 ‘‘(16) RESERVATION.— 


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1 ‘‘(A) IN GENERAL.—The term ‘reservation’ 

2 means a reservation, Pueblo, or colony of any 

3 Indian tribe. 

4 ‘‘(B) INCLUSIONS.—The term ‘reservation’ 

5 includes— 

6 ‘‘(i) former reservations in Oklahoma; 

7 ‘‘(ii) Indian allotments; and 

8 ‘‘(iii) Alaska Native Regions estab9 lished pursuant to the Alaska Native 

10 Claims Settlement Act (43 U.S.C. 1601 et 

11 seq.).’’; 

12 (11) by striking paragraph (20) (as redesig13 nated by paragraph (3)) and inserting the following: 

14 ‘‘(20) SERVICE UNIT.—The term ‘Service unit’ 

15 means an administrative entity of the Service or a 

16 tribal health program through which services are 

17 provided, directly or by contract, to eligible Indians 

18 within a defined geographic area.’’; 

19 (12) by inserting after paragraph (21) (as re20 designated by paragraph (3)) the following: 

21 ‘‘(22) TELEHEALTH.—The term ‘telehealth’ has 

22 the meaning given the term in section 330K(a) of 

23 the Public Health Service Act (42 U.S.C. 254c– 

24 16(a)). 


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1 ‘‘(23) TELEMEDICINE.—The term ‘telemedicine’ 

2 means a telecommunications link to an end user 

3 through the use of eligible equipment that electroni4 cally links health professionals or patients and 

5 health professionals at separate sites in order to ex6 change health care information in audio, video, 

7 graphic, or other format for the purpose of providing 

8 improved health care services. 

9 ‘‘(24) TRIBAL COLLEGE OR UNIVERSITY.—The 

10 term ‘tribal college or university’ has the meaning 

11 given the term in section 316(b) of the Higher Edu12 cation Act of 1965 (20 U.S.C. 1059c(b)). 

13 ‘‘(25) TRIBAL HEALTH PROGRAM.—The term 

14 ‘tribal health program’ means an Indian tribe or 

15 tribal organization that operates any health pro16 gram, service, function, activity, or facility funded, 

17 in whole or part, by the Service through, or provided 

18 for in, a contract or compact with the Service under 

19 the Indian Self-Determination and Education Assist20 ance Act (25 U.S.C. 450 et seq.).’’; and 

21 (13) by striking paragraph (26) (as redesig22 nated by paragraph (3)) and inserting the following: 

23 ‘‘(26) TRIBAL ORGANIZATION.—The term ‘trib24 al organization’ has the meaning given the term in 


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1 section 4 of the Indian Self-Determination and Edu2 cation Assistance Act (25 U.S.C. 450b).’’. 

3 Subtitle A—Indian Health 

4 Manpower 

5 SEC. 111. COMMUNITY HEALTH AIDE PROGRAM. 

6 Section 119 of the Indian Health Care Improvement 

7 Act (25 U.S.C. 1616l) is amended to read as follows: 

8 ‘‘SEC. 119. COMMUNITY HEALTH AIDE PROGRAM. 

9 ‘‘(a) GENERAL PURPOSES OF PROGRAM.—Pursuant 

10 to the Act of November 2, 1921 (25 U.S.C. 13) (commonly 

11 known as the ‘Snyder Act’), the Secretary, acting through 

12 the Service, shall develop and operate a Community 

13 Health Aide Program in the State of Alaska under which 

14 the Service— 

15 ‘‘(1) provides for the training of Alaska Natives 

16 as health aides or community health practitioners; 

17 ‘‘(2) uses those aides or practitioners in the 

18 provision of health care, health promotion, and dis19 ease prevention services to Alaska Natives living in 

20 villages in rural Alaska; and 

21 ‘‘(3) provides for the establishment of tele22 conferencing capacity in health clinics located in or 

23 near those villages for use by community health 

24 aides or community health practitioners. 


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1 ‘‘(b) SPECIFIC PROGRAM REQUIREMENTS.—The Sec2 retary, acting through the Community Health Aide Pro3 gram of the Service, shall— 

4 ‘‘(1) using trainers accredited by the Program, 

5 provide a high standard of training to community 

6 health aides and community health practitioners to 

7 ensure that those aides and practitioners provide 

8 quality health care, health promotion, and disease 

9 prevention services to the villages served by the Pro10 gram; 

11 ‘‘(2) in order to provide such training, develop 

12 a curriculum that— 

13 ‘‘(A) combines education regarding the 

14 theory of health care with supervised practical 

15 experience in the provision of health care; 

16 ‘‘(B) provides instruction and practical ex17 perience in the provision of acute care, emer18 gency care, health promotion, disease preven19 tion, and the efficient and effective manage20 ment of clinic pharmacies, supplies, equipment, 

21 and facilities; and 

22 ‘‘(C) promotes the achievement of the 

23 health status objectives specified in section 

24 3(2); 


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1 ‘‘(3) establish and maintain a Community 

2 Health Aide Certification Board to certify as com3 munity health aides or community health practi4 tioners individuals who have successfully completed 

5 the training described in paragraph (1) or can dem6 onstrate equivalent experience; 

7 ‘‘(4) develop and maintain a system that identi8 fies the needs of community health aides and com9 munity health practitioners for continuing education 

10 in the provision of health care, including the areas 

11 described in paragraph (2)(B), and develop pro12 grams that meet the needs for such continuing edu13 cation; 

14 ‘‘(5) develop and maintain a system that pro15 vides close supervision of community health aides 

16 and community health practitioners; 

17 ‘‘(6) develop a system under which the work of 

18 community health aides and community health prac19 titioners is reviewed and evaluated to ensure the pro20 vision of quality health care, health promotion, and 

21 disease prevention services; and 

22 ‘‘(7) ensure that— 

23 ‘‘(A) pulpal therapy (not including 

24 pulpotomies on deciduous teeth) or extraction of 

25 adult teeth can be performed by a dental health 


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1 aide therapist only after consultation with a li2 censed dentist who determines that the proce3 dure is a medical emergency that cannot be re4 solved with palliative treatment; and 

5 ‘‘(B) dental health aide therapists are 

6 strictly prohibited from performing all other 

7 oral or jaw surgeries, subject to the condition 

8 that uncomplicated extractions shall not be con9 sidered oral surgery under this section. 

10 ‘‘(c) PROGRAM REVIEW.— 

11 ‘‘(1) NEUTRAL PANEL.— 

12 ‘‘(A) ESTABLISHMENT.—The Secretary, 

13 acting through the Service, shall establish a 

14 neutral panel to carry out the study under 

15 paragraph (2). 

16 ‘‘(B) MEMBERSHIP.—Members of the neu17 tral panel shall be appointed by the Secretary 

18 from among clinicians, economists, community 

19 practitioners, oral epidemiologists, and Alaska 

20 Natives. 

21 ‘‘(2) STUDY.— 

22 ‘‘(A) IN GENERAL.—The neutral panel es23 tablished under paragraph (1) shall conduct a 

24 study of the dental health aide therapist serv25 ices provided by the Community Health Aide 


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1 Program under this section to ensure that the 

2 quality of care provided through those services 

3 is adequate and appropriate. 

4 ‘‘(B) PARAMETERS OF STUDY.—The Sec5 retary, in consultation with interested parties, 

6 including professional dental organizations, 

7 shall develop the parameters of the study. 

8 ‘‘(C) INCLUSIONS.—The study shall in9 clude a determination by the neutral panel with 

10 respect to— 

11 ‘‘(i) the ability of the dental health 

12 aide therapist services under this section to 

13 address the dental care needs of Alaska 

14 Natives; 

15 ‘‘(ii) the quality of care provided 

16 through those services, including any train17 ing, improvement, or additional oversight 

18 required to improve the quality of care; 

19 and 

20 ‘‘(iii) whether safer and less costly al21 ternatives to the dental health aide thera22 pist services exist. 

23 ‘‘(D) CONSULTATION.—In carrying out the 

24 study under this paragraph, the neutral panel 

25 shall consult with Alaska tribal organizations 


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1 with respect to the adequacy and accuracy of 

2 the study. 

3 ‘‘(3) REPORT.—The neutral panel shall submit 

4 to the Secretary, the Committee on Indian Affairs of 

5 the Senate, and the Committee on Natural Re6 sources of the House of Representatives a report de7 scribing the results of the study under paragraph 

8 (2), including a description of— 

9 ‘‘(A) any determination of the neutral 

10 panel under paragraph (2)(C); and 

11 ‘‘(B) any comments received from Alaska 

12 tribal organizations under paragraph (2)(D). 

13 ‘‘(d) NATIONALIZATION OF PROGRAM.— 

14 ‘‘(1) IN GENERAL.—Except as provided in para15 graph (2), the Secretary, acting through the Service, 

16 may establish a national Community Health Aide 

17 Program in accordance with the program under this 

18 section, as the Secretary determines to be appro19 priate. 

20 ‘‘(2) REQUIREMENT.—In establishing a na21 tional program under paragraph (1), the Secretary 

22 shall not reduce the amounts provided for the Com23 munity Health Aide Program described in sub24 sections (a) and (b).’’. 


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1 SEC. 112. HEALTH PROFESSIONAL CHRONIC SHORTAGE 

2 DEMONSTRATION PROGRAMS. 

3 Title I of the Indian Health Care Improvement Act 

4 (25 U.S.C. 1611 et seq.) (as amended by section 101(b)) 

5 is amended by adding at the end the following: 

6 ‘‘SEC. 123. HEALTH PROFESSIONAL CHRONIC SHORTAGE 

7 DEMONSTRATION PROGRAMS. 

8 ‘‘(a) DEMONSTRATION PROGRAMS.—The Secretary, 

9 acting through the Service, may fund demonstration pro10 grams for Indian health programs to address the chronic 

11 shortages of health professionals. 

12 ‘‘(b) PURPOSES OF PROGRAMS.—The purposes of 

13 demonstration programs under subsection (a) shall be— 

14 ‘‘(1) to provide direct clinical and practical ex15 perience within an Indian health program to health 

16 profession students and residents from medical 

17 schools; 

18 ‘‘(2) to improve the quality of health care for 

19 Indians by ensuring access to qualified health pro20 fessionals; 

21 ‘‘(3) to provide academic and scholarly opportu22 nities for health professionals serving Indians by 

23 identifying all academic and scholarly resources of 

24 the region; and 


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1 ‘‘(4) to provide training and support for alter2 native provider types, such as community health rep3 resentatives, and community health aides. 

4 ‘‘(c) ADVISORY BOARD.—The demonstration pro5 grams established pursuant to subsection (a) shall incor6 porate a program advisory board, which may be composed 

7 of representatives of tribal governments, Indian health 

8 programs, and Indian communities in the areas to be 

9 served by the demonstration programs.’’. 

10 SEC. 113. EXEMPTION FROM PAYMENT OF CERTAIN FEES. 

11 Title I of the Indian Health Care Improvement Act 

12 (25 U.S.C. 1611 et seq.) (as amended by section 112) is 

13 amended by adding at the end the following: 

14 ‘‘SEC. 124. EXEMPTION FROM PAYMENT OF CERTAIN FEES. 

15 ‘‘Employees of a tribal health program or urban In16 dian organization shall be exempt from payment of licens17 ing, registration, and any other fees imposed by a Federal 

18 agency to the same extent that officers of the commis19 sioned corps of the Public Health Service and other em20 ployees of the Service are exempt from those fees.’’. 


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1 Subtitle B—Health Services 

2 SEC. 121. OTHER AUTHORITY FOR PROVISION OF SERV3 ICES; SHARED SERVICES FOR LONG-TERM 

4 CARE. 

5 (a) OTHER AUTHORITY FOR PROVISION OF SERV6 ICES.— 

7 (1) IN GENERAL.—Section 205 of the Indian 

8 Health Care Improvement Act (25 U.S.C. 1621d) is 

9 amended to read as follows: 

10 ‘‘SEC. 205. OTHER AUTHORITY FOR PROVISION OF SERV11 ICES. 

12 ‘‘(a) DEFINITIONS.—In this section: 

13 ‘‘(1) ASSISTED LIVING SERVICE.—The term ‘as14 sisted living service’ means any service provided by 

15 an assisted living facility (as defined in section 

16 232(b) of the National Housing Act (12 U.S.C. 

17 1715w(b))), except that such an assisted living facil18 ity— 

19 ‘‘(A) shall not be required to obtain a li20 cense; but 

21 ‘‘(B) shall meet all applicable standards 

22 for licensure. 

23 ‘‘(2) HOME- AND COMMUNITY-BASED SERV24 ICE.—The term ‘home- and community-based serv25 ice’ means 1 or more of the services specified in 


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1 paragraphs (1) through (9) of section 1929(a) of the 

2 Social Security Act (42 U.S.C. 1396t(a)) (whether 

3 provided by the Service or by an Indian tribe or trib4 al organization pursuant to the Indian Self-Deter5 mination and Education Assistance Act (25 U.S.C. 

6 450 et seq.)) that are or will be provided in accord7 ance with applicable standards. 

8 ‘‘(3) HOSPICE CARE.—The term ‘hospice care’ 

9 means— 

10 ‘‘(A) the items and services specified in 

11 subparagraphs (A) through (H) of section 

12 1861(dd)(1) of the Social Security Act (42 

13 U.S.C. 1395x(dd)(1)); and 

14 ‘‘(B) such other services as an Indian tribe 

15 or tribal organization determines are necessary 

16 and appropriate to provide in furtherance of 

17 that care. 

18 ‘‘(4) LONG-TERM CARE SERVICES.—The term 

19 ‘long-term care services’ has the meaning given the 

20 term ‘qualified long-term care services’ in section 

21 7702B(c) of the Internal Revenue Code of 1986. 

22 ‘‘(b) FUNDING AUTHORIZED.—The Secretary, acting 

23 through the Service, Indian tribes, and tribal organiza24 tions, may provide funding under this Act to meet the ob25 jectives set forth in section 3 through health care-related 


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1 services and programs not otherwise described in this Act 

2 for the following services: 

3 ‘‘(1) Hospice care. 

4 ‘‘(2) Assisted living services. 

5 ‘‘(3) Long-term care services. 

6 ‘‘(4) Home- and community-based services. 

7 ‘‘(c) ELIGIBILITY.—The following individuals shall be 

8 eligible to receive long-term care services under this sec9 tion: 

10 ‘‘(1) Individuals who are unable to perform a 

11 certain number of activities of daily living without 

12 assistance. 

13 ‘‘(2) Individuals with a mental impairment, 

14 such as dementia, Alzheimer’s disease, or another 

15 disabling mental illness, who may be able to perform 

16 activities of daily living under supervision. 

17 ‘‘(3) Such other individuals as an applicable 

18 tribal health program determines to be appropriate. 

19 ‘‘(d) AUTHORIZATION OF CONVENIENT CARE SERV20 ICES.—The Secretary, acting through the Service, Indian 

21 tribes, and tribal organizations, may also provide funding 

22 under this Act to meet the objectives set forth in section 

23 3 for convenient care services programs pursuant to sec24 tion 307(c)(2)(A).’’. 


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1 (2) REPEAL.—Section 821 of the Indian Health 

2 Care Improvement Act (25 U.S.C. 1680k) is re3 pealed. 

4 (b) SHARED SERVICES FOR LONG-TERM CARE.— 

5 Section 822 of the Indian Health Care Improvement Act 

6 (25 U.S.C. 1680l) is amended to read as follows: 

7 ‘‘SEC. 822. SHARED SERVICES FOR LONG-TERM CARE. 

8 ‘‘(a) LONG-TERM CARE.— 

9 ‘‘(1) IN GENERAL.—Notwithstanding any other 

10 provision of law, the Secretary, acting through the 

11 Service, is authorized to provide directly, or enter 

12 into contracts or compacts under the Indian Self-De13 termination and Education Assistance Act (25 

14 U.S.C. 450 et seq.) with Indian tribes or tribal orga15 nizations for, the delivery of long-term care (includ16 ing health care services associated with long-term 

17 care) provided in a facility to Indians. 

18 ‘‘(2) INCLUSIONS.—Each agreement under 

19 paragraph (1) shall provide for the sharing of staff 

20 or other services between the Service or a tribal 

21 health program and a long-term care or related facil22 ity owned and operated (directly or through a con23 tract or compact under the Indian Self-Determina24 tion and Education Assistance Act (25 U.S.C. 450 

25 et seq.)) by the Indian tribe or tribal organization. 


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1 ‘‘(b) CONTENTS OF AGREEMENTS.—An agreement 

2 entered into pursuant to subsection (a)— 

3 ‘‘(1) may, at the request of the Indian tribe or 

4 tribal organization, delegate to the Indian tribe or 

5 tribal organization such powers of supervision and 

6 control over Service employees as the Secretary de7 termines to be necessary to carry out the purposes 

8 of this section; 

9 ‘‘(2) shall provide that expenses (including sala10 ries) relating to services that are shared between the 

11 Service and the tribal health program be allocated 

12 proportionately between the Service and the Indian 

13 tribe or tribal organization; and 

14 ‘‘(3) may authorize the Indian tribe or tribal 

15 organization to construct, renovate, or expand a 

16 long-term care or other similar facility (including the 

17 construction of a facility attached to a Service facil18 ity). 

19 ‘‘(c) MINIMUM REQUIREMENT.—Any nursing facility 

20 provided for under this section shall meet the require21 ments for nursing facilities under section 1919 of the So22 cial Security Act (42 U.S.C. 1396r). 

23 ‘‘(d) OTHER ASSISTANCE.—The Secretary shall pro24 vide such technical and other assistance as may be nec25 essary to enable applicants to comply with this section. 


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1 ‘‘(e) USE OF EXISTING OR UNDERUSED FACILI2 TIES.—The Secretary shall encourage the use of existing 

3 facilities that are underused, or allow the use of swing 

4 beds, for long-term or similar care.’’. 

5 SEC. 122. REIMBURSEMENT FROM CERTAIN THIRD PAR6 TIES OF COSTS OF HEALTH SERVICES. 

7 Section 206 of the Indian Health Care Improvement 

8 Act (25 U.S.C. 1621e) is amended to read as follows: 

9 ‘‘SEC. 206. REIMBURSEMENT FROM CERTAIN THIRD PAR10 TIES OF COSTS OF HEALTH SERVICES. 

11 ‘‘(a) RIGHT OF RECOVERY.—Except as provided in 

12 subsection (f), the United States, an Indian tribe, or tribal 

13 organization shall have the right to recover from an insur14 ance company, health maintenance organization, employee 

15 benefit plan, third-party tortfeasor, or any other respon16 sible or liable third party (including a political subdivision 

17 or local governmental entity of a State) the reasonable 

18 charges billed by the Secretary, an Indian tribe, or tribal 

19 organization in providing health services through the Serv20 ice, an Indian tribe, or tribal organization, or, if higher, 

21 the highest amount the third party would pay for care and 

22 services furnished by providers other than governmental 

23 entities, to any individual to the same extent that such 

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1 ices, would be eligible to receive damages, reimbursement, 

2 or indemnification for such charges or expenses if— 

3 ‘‘(1) such services had been provided by a non4 governmental provider; and 

5 ‘‘(2) such individual had been required to pay 

6 such charges or expenses and did pay such charges 

7 or expenses. 

8 ‘‘(b) LIMITATIONS ON RECOVERIES FROM STATES.— 

9 Subsection (a) shall provide a right of recovery against 

10 any State, only if the injury, illness, or disability for which 

11 health services were provided is covered under— 

12 ‘‘(1) workers’ compensation laws; or 

13 ‘‘(2) a no-fault automobile accident insurance 

14 plan or program. 

15 ‘‘(c) NONAPPLICABILITY OF OTHER LAWS.—No law 

16 of any State, or of any political subdivision of a State and 

17 no provision of any contract, insurance or health mainte18 nance organization policy, employee benefit plan, self-in19 surance plan, managed care plan, or other health care plan 

20 or program entered into or renewed after the date of en21 actment of the Indian Health Care Amendments of 1988, 

22 shall prevent or hinder the right of recovery of the United 

23 States, an Indian tribe, or tribal organization under sub24 section (a). 


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1 ‘‘(d) NO EFFECT ON PRIVATE RIGHTS OF ACTION.— 

2 No action taken by the United States, an Indian tribe, 

3 or tribal organization to enforce the right of recovery pro4 vided under this section shall operate to deny to the in5 jured person the recovery for that portion of the person’s 

6 damage not covered hereunder. 

7 ‘‘(e) ENFORCEMENT.— 

8 ‘‘(1) IN GENERAL.—The United States, an In9 dian tribe, or tribal organization may enforce the 

10 right of recovery provided under subsection (a) by— 

11 ‘‘(A) intervening or joining in any civil ac12 tion or proceeding brought— 

13 ‘‘(i) by the individual for whom health 

14 services were provided by the Secretary, an 

15 Indian tribe, or tribal organization; or 

16 ‘‘(ii) by any representative or heirs of 

17 such individual, or 

18 ‘‘(B) instituting a separate civil action, in19 cluding a civil action for injunctive relief and 

20 other relief and including, with respect to a po21 litical subdivision or local governmental entity 

22 of a State, such an action against an official 

23 thereof. 

24 ‘‘(2) NOTICE.—All reasonable efforts shall be 

25 made to provide notice of action instituted under 


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1 paragraph (1)(B) to the individual to whom health 

2 services were provided, either before or during the 

3 pendency of such action. 

4 ‘‘(3) RECOVERY FROM TORTFEASORS.— 

5 ‘‘(A) IN GENERAL.—In any case in which 

6 an Indian tribe or tribal organization that is 

7 authorized or required under a compact or con8 tract issued pursuant to the Indian Self-Deter9 mination and Education Assistance Act (25 

10 U.S.C. 450 et seq.) to furnish or pay for health 

11 services to a person who is injured or suffers a 

12 disease on or after the date of enactment of the 

13 Indian Health Care Improvement Reauthoriza14 tion and Extension Act of 2009 under cir15 cumstances that establish grounds for a claim 

16 of liability against the tortfeasor with respect to 

17 the injury or disease, the Indian tribe or tribal 

18 organization shall have a right to recover from 

19 the tortfeasor (or an insurer of the tortfeasor) 

20 the reasonable value of the health services so 

21 furnished, paid for, or to be paid for, in accord22 ance with the Federal Medical Care Recovery 

23 Act (42 U.S.C. 2651 et seq.), to the same ex24 tent and under the same circumstances as the 

25 United States may recover under that Act. 


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1 ‘‘(B) TREATMENT.—The right of an In2 dian tribe or tribal organization to recover 

3 under subparagraph (A) shall be independent of 

4 the rights of the injured or diseased person 

5 served by the Indian tribe or tribal organiza6 tion. 

7 ‘‘(f) LIMITATION.—Absent specific written authoriza8 tion by the governing body of an Indian tribe for the pe9 riod of such authorization (which may not be for a period 

10 of more than 1 year and which may be revoked at any 

11 time upon written notice by the governing body to the 

12 Service), the United States shall not have a right of recov13 ery under this section if the injury, illness, or disability 

14 for which health services were provided is covered under 

15 a self-insurance plan funded by an Indian tribe, tribal or16 ganization, or urban Indian organization. Where such au17 thorization is provided, the Service may receive and ex18 pend such amounts for the provision of additional health 

19 services consistent with such authorization. 

20 ‘‘(g) COSTS AND ATTORNEY’S FEES.—In any action 

21 brought to enforce the provisions of this section, a pre22 vailing plaintiff shall be awarded its reasonable attorney’s 

23 fees and costs of litigation. 

24 ‘‘(h) NONAPPLICABILITY OF CLAIMS FILING RE25 QUIREMENTS.—An insurance company, health mainteVerDate Nov 24 2008 01:56 Oct 17, 2009 Jkt 089200 PO 00000 Frm 00035 Fmt 6652 Sfmt 6201 E:\BILLS\S1790.IS S1790

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1 nance organization, self-insurance plan, managed care 

2 plan, or other health care plan or program (under the So3 cial Security Act or otherwise) may not deny a claim for 

4 benefits submitted by the Service or by an Indian tribe 

5 or tribal organization based on the format in which the 

6 claim is submitted if such format complies with the format 

7 required for submission of claims under title XVIII of the 

8 Social Security Act or recognized under section 1175 of 

9 such Act. 

10 ‘‘(i) APPLICATION TO URBAN INDIAN ORGANIZA11 TIONS.—The previous provisions of this section shall apply 

12 to urban Indian organizations with respect to populations 

13 served by such Organizations in the same manner they 

14 apply to Indian tribes and tribal organizations with re15 spect to populations served by such Indian tribes and trib16 al organizations. 

17 ‘‘(j) STATUTE OF LIMITATIONS.—The provisions of 

18 section 2415 of title 28, United States Code, shall apply 

19 to all actions commenced under this section, and the ref20 erences therein to the United States are deemed to include 

21 Indian tribes, tribal organizations, and urban Indian orga22 nizations. 

23 ‘‘(k) SAVINGS.—Nothing in this section shall be con24 strued to limit any right of recovery available to the 

25 United States, an Indian tribe, or tribal organization 


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1 under the provisions of any applicable, Federal, State, or 

2 tribal law, including medical lien laws.’’. 

3 SEC. 123. CREDITING OF REIMBURSEMENTS. 

4 Section 207 of the Indian Health Care Improvement 

5 Act (25 U.S.C. 1621f) is amended to read as follows: 

6 ‘‘SEC. 207. CREDITING OF REIMBURSEMENTS. 

7 ‘‘(a) USE OF AMOUNTS.— 

8 ‘‘(1) RETENTION BY PROGRAM.—Except as pro9 vided in sections 202(a)(2) and 813, all reimburse10 ments received or recovered under any of the pro11 grams described in paragraph (2), including under 

12 section 813, by reason of the provision of health 

13 services by the Service, by an Indian tribe or tribal 

14 organization, or by an urban Indian organization, 

15 shall be credited to the Service, such Indian tribe or 

16 tribal organization, or such urban Indian organiza17 tion, respectively, and may be used as provided in 

18 section 401. In the case of such a service provided 

19 by or through a Service Unit, such amounts shall be 

20 credited to such unit and used for such purposes. 

21 ‘‘(2) PROGRAMS COVERED.—The programs re22 ferred to in paragraph (1) are the following: 

23 ‘‘(A) Titles XVIII, XIX, and XXI of the 

24 Social Security Act. 

25 ‘‘(B) This Act, including section 813. 


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1 ‘‘(C) Public Law 87–693. 

2 ‘‘(D) Any other provision of law. 

3 ‘‘(b) NO OFFSET OF AMOUNTS.—The Service may 

4 not offset or limit any amount obligated to any Service 

5 Unit or entity receiving funding from the Service because 

6 of the receipt of reimbursements under subsection (a).’’. 

7 SEC. 124. BEHAVIORAL HEALTH TRAINING AND COMMU8 NITY EDUCATION PROGRAMS. 

9 Section 209 of the Indian Health Care Improvement 

10 Act (25 U.S.C. 1621h) is amended by striking subsection 

11 (d) and inserting the following: 

12 ‘‘(d) BEHAVIORAL HEALTH TRAINING AND COMMU13 NITY EDUCATION PROGRAMS.— 

14 ‘‘(1) STUDY; LIST.—The Secretary, acting 

15 through the Service, and the Secretary of the Inte16 rior, in consultation with Indian tribes and tribal or17 ganizations, shall conduct a study and compile a list 

18 of the types of staff positions specified in paragraph 

19 (2) whose qualifications include, or should include, 

20 training in the identification, prevention, education, 

21 referral, or treatment of mental illness, or dysfunc22 tional and self destructive behavior. 

23 ‘‘(2) POSITIONS.—The positions referred to in 

24 paragraph (1) are— 


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1 ‘‘(A) staff positions within the Bureau of 

2 Indian Affairs, including existing positions, in 

3 the fields of— 

4 ‘‘(i) elementary and secondary edu5 cation; 

6 ‘‘(ii) social services and family and 

7 child welfare; 

8 ‘‘(iii) law enforcement and judicial 

9 services; and 

10 ‘‘(iv) alcohol and substance abuse; 

11 ‘‘(B) staff positions within the Service; and 

12 ‘‘(C) staff positions similar to those identi13 fied in subparagraphs (A) and (B) established 

14 and maintained by Indian tribes and tribal or15 ganizations (without regard to the funding 

16 source). 

17 ‘‘(3) TRAINING CRITERIA.— 

18 ‘‘(A) IN GENERAL.—The appropriate Sec19 retary shall provide training criteria appropriate 

20 to each type of position identified in paragraphs 

21 (2)(A) and (2)(B) and ensure that appropriate 

22 training has been, or shall be provided to any 

23 individual in any such position. With respect to 

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1 taries shall provide appropriate training to, or 

2 provide funds to, an Indian tribe or tribal orga3 nization for training of appropriate individuals. 

4 In the case of positions funded under a contract 

5 or compact under the Indian Self-Determina6 tion and Education Assistance Act (25 U.S.C. 

7 450 et seq.), the appropriate Secretary shall en8 sure that such training costs are included in the 

9 contract or compact, as the Secretary deter10 mines necessary. 

11 ‘‘(B) POSITION SPECIFIC TRAINING CRI12 TERIA.—Position specific training criteria shall 

13 be culturally relevant to Indians and Indian 

14 tribes and shall ensure that appropriate infor15 mation regarding traditional health care prac16 tices is provided. 

17 ‘‘(4) COMMUNITY EDUCATION ON MENTAL ILL18 NESS.—The Service shall develop and implement, on 

19 request of an Indian tribe, tribal organization, or 

20 urban Indian organization, or assist the Indian tribe, 

21 tribal organization, or urban Indian organization to 

22 develop and implement, a program of community 

23 education on mental illness. In carrying out this 

24 paragraph, the Service shall, upon request of an In25 dian tribe, tribal organization, or urban Indian orgaVerDate Nov 24 2008 01:56 Oct 17, 2009 Jkt 089200 PO 00000 Frm 00040 Fmt 6652 Sfmt 6201 E:\BILLS\S1790.IS S1790

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1 nization, provide technical assistance to the Indian 

2 tribe, tribal organization, or urban Indian organiza3 tion to obtain and develop community educational 

4 materials on the identification, prevention, referral, 

5 and treatment of mental illness and dysfunctional 

6 and self-destructive behavior. 

7 ‘‘(5) PLAN.—Not later than 90 days after the 

8 date of enactment of the Indian Health Care Im9 provement Reauthorization and Extension Act of 

10 2009, the Secretary shall develop a plan under which 

11 the Service will increase the health care staff pro12 viding behavioral health services by at least 500 po13 sitions within 5 years after the date of enactment of 

14 that Act, with at least 200 of such positions devoted 

15 to child, adolescent, and family services. The plan 

16 developed under this paragraph shall be imple17 mented under the Act of November 2, 1921 (25 

18 U.S.C. 13) (commonly known as the ‘Snyder Act’).’’. 

19 SEC. 125. MAMMOGRAPHY AND OTHER CANCER SCREEN20 ING. 

21 Section 212 of the Indian Health Care Improvement 

22 Act (25 U.S.C. 1621k) is amended to read as follows: 


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1 ‘‘SEC. 212. MAMMOGRAPHY AND OTHER CANCER SCREEN2 ING. 

3 ‘‘The Secretary, acting through the Service, shall pro4 vide for screening as follows: 

5 ‘‘(1) SCREENING MAMMOGRAPHY.—Screening 

6 mammography (as defined in section 1861(jj) of the 

7 Social Security Act (42 U.S.C. 1395x(jj))) for In8 dian women at a frequency appropriate to those 

9 women under accepted and appropriate national 

10 standards, and under such terms and conditions as 

11 are consistent with standards established by the Sec12 retary to ensure the safety and accuracy of screen13 ing mammography under part B of title XVIII of 

14 that Act (42 U.S.C. 1395j et seq.). 

15 ‘‘(2) OTHER CANCER SCREENING.— 

16 ‘‘(A) IN GENERAL.—Other cancer screen17 ing that receives an A or B rating as rec18 ommended by the United States Preventive 

19 Services Task Force established under section 

20 915(a)(1) of the Public Health Service Act (42 

21 U.S.C. 299b–4(a)(1)). 

22 ‘‘(B) REQUIREMENT.—The Secretary shall 

23 ensure that screening provided for under this 

24 paragraph complies with the recommendations 

25 of the Task Force referred to in subparagraph 

26 (A) with respect to— 


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1 ‘‘(i) frequency; 

2 ‘‘(ii) the population to be served; 

3 ‘‘(iii) the procedure or technology to 

4 be used; 

5 ‘‘(iv) evidence of effectiveness; and 

6 ‘‘(v) other matters that the Secretary 

7 determines to be appropriate.’’. 

8 SEC. 126. PATIENT TRAVEL COSTS. 

9 Section 213 of the Indian Health Care Improvement 

10 Act (25 U.S.C. 1621l) is amended to read as follows: 

11 ‘‘SEC. 213. PATIENT TRAVEL COSTS. 

12 ‘‘(a) DEFINITION OF QUALIFIED ESCORT.—In this 

13 section, the term ‘qualified escort’ means— 

14 ‘‘(1) an adult escort (including a parent, guard15 ian, or other family member) who is required be16 cause of the physical or mental condition, or age, of 

17 the applicable patient; 

18 ‘‘(2) a health professional for the purpose of 

19 providing necessary medical care during travel by 

20 the applicable patient; or 

21 ‘‘(3) other escorts, as the Secretary or applica22 ble Indian Health Program determines to be appro23 priate. 

24 ‘‘(b) PROVISION OF FUNDS.—The Secretary, acting 

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1 thorized to provide funds for the following patient travel 

2 costs, including qualified escorts, associated with receiving 

3 health care services provided (either through direct or con4 tract care or through a contract or compact under the In5 dian Self-Determination and Education Assistance Act 

6 (25 U.S.C. 450 et seq.)) under this Act— 

7 ‘‘(1) emergency air transportation and non8 emergency air transportation where ground trans9 portation is infeasible; 

10 ‘‘(2) transportation by private vehicle (where no 

11 other means of transportation is available), specially 

12 equipped vehicle, and ambulance; and 

13 ‘‘(3) transportation by such other means as 

14 may be available and required when air or motor ve15 hicle transportation is not available.’’. 

16 SEC. 127. EPIDEMIOLOGY CENTERS. 

17 Section 214 of the Indian Health Care Improvement 

18 Act (25 U.S.C. 1621m) is amended to read as follows: 

19 ‘‘SEC. 214. EPIDEMIOLOGY CENTERS. 

20 ‘‘(a) ESTABLISHMENT OF CENTERS.— 

21 ‘‘(1) IN GENERAL.—The Secretary shall estab22 lish an epidemiology center in each Service area to 

23 carry out the functions described in subsection (b). 

24 ‘‘(2) NEW CENTERS.— 


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1 ‘‘(A) IN GENERAL.—Subject to subpara2 graph (B), any new center established after the 

3 date of enactment of the Indian Health Care 

4 Improvement Reauthorization and Extension 

5 Act of 2009 may be operated under a grant au6 thorized by subsection (d). 

7 ‘‘(B) REQUIREMENT.—Funding provided 

8 in a grant described in subparagraph (A) shall 

9 not be divisible. 

10 ‘‘(b) FUNCTIONS OF CENTERS.—In consultation with 

11 and on the request of Indian tribes, tribal organizations, 

12 and urban Indian organizations, each Service area epide13 miology center established under this section shall, with 

14 respect to the applicable Service area— 

15 ‘‘(1) collect data relating to, and monitor 

16 progress made toward meeting, each of the health 

17 status objectives of the Service, the Indian tribes, 

18 tribal organizations, and urban Indian organizations 

19 in the Service area; 

20 ‘‘(2) evaluate existing delivery systems, data 

21 systems, and other systems that impact the improve22 ment of Indian health; 

23 ‘‘(3) assist Indian tribes, tribal organizations, 

24 and urban Indian organizations in identifying high25 est-priority health status objectives and the services 


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1 needed to achieve those objectives, based on epide2 miological data; 

3 ‘‘(4) make recommendations for the targeting 

4 of services needed by the populations served; 

5 ‘‘(5) make recommendations to improve health 

6 care delivery systems for Indians and urban Indians; 

7 ‘‘(6) provide requested technical assistance to 

8 Indian tribes, tribal organizations, and urban Indian 

9 organizations in the development of local health 

10 service priorities and incidence and prevalence rates 

11 of disease and other illness in the community; and 

12 ‘‘(7) provide disease surveillance and assist In13 dian tribes, tribal organizations, and urban Indian 

14 communities to promote public health. 

15 ‘‘(c) TECHNICAL ASSISTANCE.—The Director of the 

16 Centers for Disease Control and Prevention shall provide 

17 technical assistance to the centers in carrying out this sec18 tion. 

19 ‘‘(d) GRANTS FOR STUDIES.— 

20 ‘‘(1) IN GENERAL.—The Secretary may make 

21 grants to Indian tribes, tribal organizations, Indian 

22 organizations, and eligible intertribal consortia to 

23 conduct epidemiological studies of Indian commu24 nities. 


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1 ‘‘(2) ELIGIBLE INTERTRIBAL CONSORTIA.—An 

2 intertribal consortium or Indian organization shall 

3 be eligible to receive a grant under this subsection 

4 if the intertribal consortium is— 

5 ‘‘(A) incorporated for the primary purpose 

6 of improving Indian health; and 

7 ‘‘(B) representative of the Indian tribes or 

8 urban Indian communities residing in the area 

9 in which the intertribal consortium is located. 

10 ‘‘(3) APPLICATIONS.—An application for a 

11 grant under this subsection shall be submitted in 

12 such manner and at such time as the Secretary shall 

13 prescribe. 

14 ‘‘(4) REQUIREMENTS.—An applicant for a 

15 grant under this subsection shall— 

16 ‘‘(A) demonstrate the technical, adminis17 trative, and financial expertise necessary to 

18 carry out the functions described in paragraph 

19 (5); 

20 ‘‘(B) consult and cooperate with providers 

21 of related health and social services in order to 

22 avoid duplication of existing services; and 

23 ‘‘(C) demonstrate cooperation from Indian 

24 tribes or urban Indian organizations in the area 

25 to be served. 


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1 ‘‘(5) USE OF FUNDS.—A grant provided under 

2 paragraph (1) may be used— 

3 ‘‘(A) to carry out the functions described 

4 in subsection (b); 

5 ‘‘(B) to provide information to, and consult 

6 with, tribal leaders, urban Indian community 

7 leaders, and related health staff regarding 

8 health care and health service management 

9 issues; and 

10 ‘‘(C) in collaboration with Indian tribes, 

11 tribal organizations, and urban Indian organi12 zations, to provide to the Service information 

13 regarding ways to improve the health status of 

14 Indians. 

15 ‘‘(e) ACCESS TO INFORMATION.— 

16 ‘‘(1) IN GENERAL.—An epidemiology center op17 erated by a grantee pursuant to a grant awarded 

18 under subsection (d) shall be treated as a public 

19 health authority (as defined in section 164.501 of 

20 title 45, Code of Federal Regulations (or a successor 

21 regulation)) for purposes of the Health Insurance 

22 Portability and Accountability Act of 1996 (Public 

23 Law 104–191; 110 Stat. 1936). 

24 ‘‘(2) ACCESS TO INFORMATION.—The Secretary 

25 shall grant to each epidemiology center described in 


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1 paragraph (1) access to use of the data, data sets, 

2 monitoring systems, delivery systems, and other pro3 tected health information in the possession of the 

4 Secretary. 

5 ‘‘(3) REQUIREMENT.—The activities of an epi6 demiology center described in paragraph (1) shall be 

7 for the purposes of research and for preventing and 

8 controlling disease, injury, or disability (as those ac9 tivities are described in section 164.512 of title 45, 

10 Code of Federal Regulations (or a successor regula11 tion)), for purposes of the Health Insurance Port12 ability and Accountability Act of 1996 (Public Law 

13 104–191; 110 Stat. 1936). 

14 ‘‘(f) FUNDS NOT DIVISIBLE.—An epidemiology cen15 ter established under this section shall be subject to the 

16 Indian Self-Determination and Education Assistance Act 

17 (25 U.S.C. 450 et seq.), but the funds for the center shall 

18 not be divisible.’’. 

19 SEC. 128. PREVENTION, CONTROL, AND ELIMINATION OF 

20 COMMUNICABLE AND INFECTIOUS DISEASES. 

21 Section 218 of the Indian Health Care Improvement 

22 Act (25 U.S.C. 1621q) is amended to read as follows: 


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1 ‘‘SEC. 218. PREVENTION, CONTROL, AND ELIMINATION OF 

2 COMMUNICABLE AND INFECTIOUS DISEASES. 

3 ‘‘(a) GRANTS AUTHORIZED.—The Secretary, acting 

4 through the Service, and after consultation with the Cen5 ters for Disease Control and Prevention, may make grants 

6 available to Indian tribes and tribal organizations for the 

7 following: 

8 ‘‘(1) Projects for the prevention, control, and 

9 elimination of communicable and infectious diseases, 

10 including tuberculosis, hepatitis, HIV, respiratory 

11 syncytial virus, hanta virus, sexually transmitted dis12 eases, and H. pylori. 

13 ‘‘(2) Public information and education pro14 grams for the prevention, control, and elimination of 

15 communicable and infectious diseases. 

16 ‘‘(3) Education, training, and clinical skills im17 provement activities in the prevention, control, and 

18 elimination of communicable and infectious diseases 

19 for health professionals, including allied health pro20 fessionals. 

21 ‘‘(4) Demonstration projects for the screening, 

22 treatment, and prevention of hepatitis C virus 

23 (HCV). 

24 ‘‘(b) APPLICATION REQUIRED.—The Secretary may 

25 provide funding under subsection (a) only if an application 

26 or proposal for funding is submitted to the Secretary. 


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1 ‘‘(c) COORDINATION WITH HEALTH AGENCIES.—In2 dian tribes and tribal organizations receiving funding 

3 under this section are encouraged to coordinate their ac4 tivities with the Centers for Disease Control and Preven5 tion and State and local health agencies. 

6 ‘‘(d) TECHNICAL ASSISTANCE; REPORT.—In carrying 

7 out this section, the Secretary— 

8 ‘‘(1) may, at the request of an Indian tribe or 

9 tribal organization, provide technical assistance; and 

10 ‘‘(2) shall prepare and submit a report to Con11 gress biennially on the use of funds under this sec12 tion and on the progress made toward the preven13 tion, control, and elimination of communicable and 

14 infectious diseases among Indians and urban Indi15 ans.’’. 

16 SEC. 129. METHODS TO INCREASE CLINICIAN RECRUIT17 MENT AND RETENTION ISSUES. 

18 (a) LICENSING.—Section 221 of the Indian Health 

19 Care Improvement Act (25 U.S.C. 1621t) is amended to 

20 read as follows: 

21 ‘‘SEC. 221. LICENSING. 

22 ‘‘Licensed health professionals employed by a tribal 

23 health program shall be exempt, if licensed in any State, 

24 from the licensing requirements of the State in which the 

25 tribal health program performs the services described in 


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1 the contract or compact of the tribal health program under 

2 the Indian Self-Determination and Education Assistance 

3 Act (25 U.S.C. 450 et seq.).’’. 

4 (b) TREATMENT OF SCHOLARSHIPS FOR CERTAIN

5 PURPOSES.—Title I of the Indian Health Care Improve6 ment Act (25 U.S.C. 1611 et seq.) (as amended by section 

7 113) is amended by adding at the end the following: 

8 ‘‘SEC. 125. TREATMENT OF SCHOLARSHIPS FOR CERTAIN 

9 PURPOSES. 

10 ‘‘A scholarship provided to an individual pursuant to 

11 this title shall be considered to be a qualified scholarship 

12 for purposes of section 117 of the Internal Revenue Code 

13 of 1986.’’. 

14 SEC. 130. OFFICES OF INDIAN MEN’S HEALTH AND INDIAN 

15 WOMEN’S HEALTH. 

16 Section 223 of the Indian Health Care Improvement 

17 Act (25 U.S.C. 1621v) is amended— 

18 (1) by striking the section designation and 

19 heading and all that follows through ‘‘oversee efforts 

20 of the Service to’’ and inserting the following: 

21 ‘‘SEC. 223. OFFICES OF INDIAN MEN’S HEALTH AND INDIAN 

22 WOMEN’S HEALTH. 

23 ‘‘(a) OFFICE OF INDIAN MEN’S HEALTH.— 


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1 ‘‘(1) ESTABLISHMENT.—The Secretary may es2 tablish within the Service an office, to be known as 

3 the ‘Office of Indian Men’s Health’. 

4 ‘‘(2) DIRECTOR.— 

5 ‘‘(A) IN GENERAL.—The Office of Indian 

6 Men’s Health shall be headed by a director, to 

7 be appointed by the Secretary. 

8 ‘‘(B) DUTIES.—The director shall coordi9 nate and promote the health status of Indian 

10 men in the United States. 

11 ‘‘(3) REPORT.—Not later than 2 years after the 

12 date of enactment of the Indian Health Care Im13 provement Reauthorization and Extension Act of 

14 2009, the Secretary, acting through the Service, 

15 shall submit to Congress a report describing— 

16 ‘‘(A) any activity carried out by the direc17 tor as of the date on which the report is pre18 pared; and 

19 ‘‘(B) any finding of the director with re20 spect to the health of Indian men. 

21 ‘‘(b) OFFICE OF INDIAN WOMEN’S HEALTH.—The 

22 Secretary, acting through the Service, shall establish an 

23 office, to be known as the ‘Office of Indian Women’s 

24 Health’, to’’; and 


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1 (2) in subsection (b) (as so redesignated) by in2 serting ‘‘(including urban Indian women)’’ before 

3 ‘‘of all ages’’. 

4 SEC. 131. CONTRACT HEALTH SERVICE DISBURSEMENT 

5 FORMULA. 

6 Title II of the Indian Health Care Improvement Act 

7 (25 U.S.C. 1621 et seq.) is amended by adding at the end 

8 the following: 

9 ‘‘SEC. 226. CONTRACT HEALTH SERVICE DISBURSEMENT 

10 FORMULA. 

11 ‘‘(a) IN GENERAL.—Not later than 90 days after the 

12 date of enactment of this section, the Secretary, acting 

13 through the Service, shall initiate procedures under sub14 chapter III of chapter 5 of title 5, United States Code, 

15 to negotiate and promulgate such regulations or amend16 ments to establish a disbursement formula for contract 

17 health service funds. 

18 ‘‘(b) REGULATIONS.— 

19 ‘‘(1) PROPOSED REGULATIONS.—Proposed reg20 ulations to implement this section shall be published 

21 in the Federal Register by the Secretary no later 

22 than 24 months after the date of enactment of this 

23 section and shall have no less than a 120-day com24 ment period. 


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1 ‘‘(2) EXPIRATION OF AUTHORITY.—The author2 ity to promulgate regulation under paragraph (1) 

3 shall expire 36 months after the date of the enact4 ment of this section. 

5 ‘‘(c) PROCEDURES.— 

6 ‘‘(1) IN GENERAL.—A negotiated rulemaking 

7 committee established pursuant to section 565 of 

8 title 5, United States Code, to carry out this section 

9 shall have as its members only representatives of the 

10 Federal Government and representatives of Indian 

11 tribes and tribal organizations, who shall be nomi12 nated by and be representatives of Indian tribes and 

13 tribal organizations from each Service area. 

14 ‘‘(2) REQUIREMENTS.—The committee shall 

15 confer with, and accommodate participation by, rep16 resentatives of Indian tribes, inter-tribal consortia, 

17 tribal organizations, and individual tribal members. 

18 ‘‘(3) ADAPTATION OF PROCEDURES.—The Sec19 retary shall adapt the negotiated rulemaking proce20 dures to the unique context of self-governance and 

21 the government-to-government relationship between 

22 the United States and Indian tribes.’’. 


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1 Subtitle C—Health Facilities 

2 SEC. 141. INDIAN HEALTH CARE DELIVERY DEMONSTRA3 TION PROJECTS. 

4 Section 307 of the Indian Health Care Improvement 

5 Act (25 U.S.C. 1637) is amended to read as follows: 

6 ‘‘SEC. 307. INDIAN HEALTH CARE DELIVERY DEMONSTRA7 TION PROJECTS. 

8 ‘‘(a) IN GENERAL.—The Secretary, acting through 

9 the Service, is authorized to carry out, or to enter into 

10 contracts under the Indian Self-Determination and Edu11 cation Assistance Act (25 U.S.C. 450 et seq.) with Indian 

12 Tribes or tribal organizations to carry out, a health care 

13 delivery demonstration project to test alternative means 

14 of delivering health care and services to Indians through 

15 facilities. 

16 ‘‘(b) USE OF FUNDS.—The Secretary, in approving 

17 projects pursuant to this section— 

18 ‘‘(1) may authorize such contracts for the con19 struction and renovation of hospitals, health centers, 

20 health stations, and other facilities to deliver health 

21 care services; and 

22 ‘‘(2) is authorized— 

23 ‘‘(A) to waive any leasing prohibition; 

24 ‘‘(B) to permit carryover of funds appro25 priated for the provision of health care services; 


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1 ‘‘(C) to permit the use of other available 

2 funds; 

3 ‘‘(D) to permit the use of funds or prop4 erty donated from any source for project pur5 poses; 

6 ‘‘(E) to provide for the reversion of do7 nated real or personal property to the donor; 

8 and 

9 ‘‘(F) to permit the use of Service funds to 

10 match other funds, including Federal funds. 

11 ‘‘(c) HEALTH CARE DEMONSTRATION PROJECTS.— 

12 ‘‘(1) DEFINITION OF CONVENIENT CARE SERV13 ICE.—In this subsection, the term ‘convenient care 

14 service’ means any primary health care service, such 

15 as urgent care services, nonemergent care services, 

16 prevention services and screenings, and any service 

17 authorized by section 203 or 205(d), that is offered 

18 at an alternative setting. 

19 ‘‘(2) GENERAL PROJECTS.— 

20 ‘‘(A) CRITERIA.—The Secretary may ap21 prove under this section demonstration projects 

22 that meet the following criteria: 

23 ‘‘(i) There is a need for a new facility 

24 or program, such as a program for convenVerDate Nov 24 2008 01:56 Oct 17, 2009 Jkt 089200 PO 00000 Frm 00057 Fmt 6652 Sfmt 6201 E:\BILLS\S1790.IS S1790

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1 ient care services, or the reorientation of 

2 an existing facility or program. 

3 ‘‘(ii) A significant number of Indians, 

4 including Indians with low health status, 

5 will be served by the project. 

6 ‘‘(iii) The project has the potential to 

7 deliver services in an efficient and effective 

8 manner. 

9 ‘‘(iv) The project is economically via10 ble. 

11 ‘‘(v) For projects carried out by an 

12 Indian tribe or tribal organization, the In13 dian tribe or tribal organization has the 

14 administrative and financial capability to 

15 administer the project. 

16 ‘‘(vi) The project is integrated with 

17 providers of related health and social serv18 ices and is coordinated with, and avoids 

19 duplication of, existing services in order to 

20 expand the availability of services. 

21 ‘‘(B) PRIORITY.—In approving demonstra22 tion projects under this paragraph, the Sec23 retary shall give priority to demonstration 

24 projects, to the extent the projects meet the criVerDate Nov 24 2008 01:56 Oct 17, 2009 Jkt 089200 PO 00000 Frm 00058 Fmt 6652 Sfmt 6201 E:\BILLS\S1790.IS S1790

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1 teria described in subparagraph (A), located in 

2 any of the following Service units: 

3 ‘‘(i) Cass Lake, Minnesota. 

4 ‘‘(ii) Mescalero, New Mexico. 

5 ‘‘(iii) Owyhee and Elko, Nevada. 

6 ‘‘(iv) Schurz, Nevada. 

7 ‘‘(v) Ft. Yuma, California. 

8 ‘‘(3) INNOVATIVE HEALTH SERVICES DELIVERY

9 DEMONSTRATION PROJECT.— 

10 ‘‘(A) CRITERIA.—The Secretary shall look 

11 at innovative ways to deliver health care serv12 ices, such as medical, dental, alternative medi13 cine, pharmaceutical, nursing, and clinical lab14 oratory services, in American Indian and Alas15 ka Native communities, including convenient 

16 care service, community health centers, and 

17 other health care models which improve access 

18 to quality health promotion and disease preven19 tion services. 

20 ‘‘(B) APPROVAL.—In addition to projects 

21 described in paragraph (2), in any fiscal year, 

22 the Secretary is authorized to approve not more 

23 than 10 applications for health care delivery 

24 demonstration projects that— 


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1 ‘‘(i) include a convenient care service 

2 program as an alternative means of deliv3 ering health care services to Indians; and 

4 ‘‘(ii) meet the criteria described in 

5 subparagraph (C). 

6 ‘‘(C) CRITERIA.—The Secretary shall ap7 prove under subparagraph (B) demonstration 

8 projects that meet all of the following criteria: 

9 ‘‘(i) The criteria set forth in para10 graph (2)(A). 

11 ‘‘(ii) There is a lack of access to 

12 health care services at existing health care 

13 facilities, which may be due to limited 

14 hours of operation at those facilities or 

15 other factors. 

16 ‘‘(iii) The project— 

17 ‘‘(I) expands the availability of 

18 services; or 

19 ‘‘(II) reduces— 

20 ‘‘(aa) the burden on Con21 tract Health Services; or 

22 ‘‘(bb) the need for emer23 gency room visits. 

24 ‘‘(d) PEER REVIEW PANELS.—The Secretary may 

25 provide for the establishment of peer review panels, as necVerDate Nov 24 2008 01:56 Oct 17, 2009 Jkt 089200 PO 00000 Frm 00060 Fmt 6652 Sfmt 6201 E:\BILLS\S1790.IS S1790

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1 essary, to review and evaluate applications using the cri2 teria described in paragraphs (2)(A) and (3)(C) of sub3 section (c). 

4 ‘‘(e) TECHNICAL ASSISTANCE.—The Secretary shall 

5 provide such technical and other assistance as may be nec6 essary to enable applicants to comply with this section. 

7 ‘‘(f) SERVICE TO INELIGIBLE PERSONS.—Subject to 

8 section 813, the authority to provide services to persons 

9 otherwise ineligible for the health care benefits of the 

10 Service, and the authority to extend hospital privileges in 

11 Service facilities to non-Service health practitioners as 

12 provided in section 813, may be included, subject to the 

13 terms of that section, in any demonstration project ap14 proved pursuant to this section. 

15 ‘‘(g) EQUITABLE TREATMENT.—For purposes of 

16 subsection (c), the Secretary, in evaluating facilities oper17 ated under any contract or compact under the Indian Self18 Determination and Education Assistance Act (25 U.S.C. 

19 450 et seq.), shall use the same criteria that the Secretary 

20 uses in evaluating facilities operated directly by the Serv21 ice. 

22 ‘‘(h) EQUITABLE INTEGRATION OF FACILITIES.— 

23 The Secretary shall ensure that the planning, design, con24 struction, renovation, and expansion needs of Service and 

25 non-Service facilities that are the subject of a contract or 


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1 compact under the Indian Self-Determination and Edu2 cation Assistance Act (25 U.S.C. 450 et seq.) for health 

3 services are fully and equitably integrated into the imple4 mentation of the health care delivery demonstration 

5 projects under this section.’’. 

6 SEC. 142. TRIBAL MANAGEMENT OF FEDERALLY OWNED 

7 QUARTERS. 

8 Title III of the Indian Health Care Improvement Act 

9 (as amended by section 101(b)) is amended by inserting 

10 after section 308 (25 U.S.C. 1638) the following: 

11 ‘‘SEC. 309. TRIBAL MANAGEMENT OF FEDERALLY OWNED 

12 QUARTERS. 

13 ‘‘(a) RENTAL RATES.— 

14 ‘‘(1) ESTABLISHMENT.—Notwithstanding any 

15 other provision of law, a tribal health program that 

16 operates a hospital or other health facility and the 

17 federally owned quarters associated with such a fa18 cility pursuant to a contract or compact under the 

19 Indian Self-Determination and Education Assistance 

20 Act (25 U.S.C. 450 et seq.) may establish the rental 

21 rates charged to the occupants of those quarters, on 

22 providing notice to the Secretary. 

23 ‘‘(2) OBJECTIVES.—In establishing rental rates 

24 under this subsection, a tribal health program shall 

25 attempt— 


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1 ‘‘(A) to base the rental rates on the rea2 sonable value of the quarters to the occupants 

3 of the quarters; and 

4 ‘‘(B) to generate sufficient funds to pru5 dently provide for the operation and mainte6 nance of the quarters, and at the discretion of 

7 the tribal health program, to supply reserve 

8 funds for capital repairs and replacement of the 

9 quarters. 

10 ‘‘(3) EQUITABLE FUNDING.—A federally owned 

11 quarters the rental rates for which are established 

12 by a tribal health program under this subsection 

13 shall remain eligible to receive improvement and re14 pair funds to the same extent that all federally 

15 owned quarters used to house personnel in programs 

16 of the Service are eligible to receive those funds. 

17 ‘‘(4) NOTICE OF RATE CHANGE.—A tribal 

18 health program that establishes a rental rate under 

19 this subsection shall provide occupants of the feder20 ally owned quarters a notice of any change in the 

21 rental rate by not later than the date that is 60 days 

22 notice before the effective date of the change. 

23 ‘‘(5) RATES IN ALASKA.—A rental rate estab24 lished by a tribal health program under this section 

25 for a federally owned quarters in the State of Alaska 


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1 may be based on the cost of comparable private 

2 rental housing in the nearest established community 

3 with a year-round population of 1,500 or more indi4 viduals. 

5 ‘‘(b) DIRECT COLLECTION OF RENT.— 

6 ‘‘(1) IN GENERAL.—Notwithstanding any other 

7 provision of law, and subject to paragraph (2), a 

8 tribal health program may collect rent directly from 

9 Federal employees who occupy federally owned quar10 ters if the tribal health program submits to the Sec11 retary and the employees a notice of the election of 

12 the tribal health program to collect rents directly 

13 from the employees. 

14 ‘‘(2) ACTION BY EMPLOYEES.—On receipt of a 

15 notice described in paragraph (1)— 

16 ‘‘(A) the affected Federal employees shall 

17 pay rent for occupancy of a federally owned 

18 quarters directly to the applicable tribal health 

19 program; and 

20 ‘‘(B) the Secretary shall not have the au21 thority to collect rent from the employees 

22 through payroll deduction or otherwise. 

23 ‘‘(3) USE OF PAYMENTS.—The rent payments 

24 under this subsection— 


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1 ‘‘(A) shall be retained by the applicable 

2 tribal health program in a separate account, 

3 which shall be used by the tribal health pro4 gram for the maintenance (including capital re5 pairs and replacement) and operation of the 

6 quarters, as the tribal health program deter7 mines to be appropriate; and 

8 ‘‘(B) shall not be made payable to, or oth9 erwise be deposited with, the United States. 

10 ‘‘(4) RETROCESSION OF AUTHORITY.—If a trib11 al health program that elected to collect rent directly 

12 under paragraph (1) requests retrocession of the au13 thority of the tribal health program to collect that 

14 rent, the retrocession shall take effect on the earlier 

15 of— 

16 ‘‘(A) the first day of the month that begins 

17 not less than 180 days after the tribal health 

18 program submits the request; and 

19 ‘‘(B) such other date as may be mutually 

20 agreed on by the Secretary and the tribal health 

21 program.’’. 


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1 SEC. 143. OTHER FUNDING, EQUIPMENT, AND SUPPLIES 

2 FOR FACILITIES. 

3 Title III of the Indian Health Care Improvement Act 

4 (25 U.S.C. 1631 et seq.) is amended by adding at the end 

5 the following: 

6 ‘‘SEC. 311. OTHER FUNDING, EQUIPMENT, AND SUPPLIES 

7 FOR FACILITIES. 

8 ‘‘(a) AUTHORIZATION.— 

9 ‘‘(1) AUTHORITY TO TRANSFER FUNDS.—The 

10 head of any Federal agency to which funds, equip11 ment, or other supplies are made available for the 

12 construction or operation of a health care facility 

13 may transfer the funds, equipment, or supplies to 

14 the Secretary for the construction or operation of a 

15 health care facility to achieve— 

16 ‘‘(A) the purposes of this Act; and 

17 ‘‘(B) the purposes for which the funds, 

18 equipment, or supplies were made available to 

19 the Federal agency. 

20 ‘‘(2) AUTHORITY TO ACCEPT FUNDS.—The Sec21 retary may— 

22 ‘‘(A) accept from any source, including 

23 Federal and State agencies, funds, equipment, 

24 or supplies that are available for the construc25 tion or operation of health care facilities; and 


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1 ‘‘(B) use those funds, equipment, and sup2 plies to plan, design, and construct health care 

3 facilities for Indians, including pursuant to a 

4 contract or compact under the Indian Self-De5 termination and Education Assistance Act (25 

6 U.S.C. 450 et seq.). 

7 ‘‘(3) EFFECT OF RECEIPT.—Receipt of funds 

8 by the Secretary under this subsection shall not af9 fect any priority established under section 301. 

10 ‘‘(b) INTERAGENCY AGREEMENTS.—The Secretary 

11 may enter into interagency agreements with Federal or 

12 State agencies and other entities, and accept funds, equip13 ment, or other supplies from those entities, to provide for 

14 the planning, design, and construction of health care fa15 cilities to be administered by Indian health programs to 

16 achieve— 

17 ‘‘(1) the purposes of this Act; and 

18 ‘‘(2) the purposes for which the funds were ap19 propriated or otherwise provided. 

20 ‘‘(c) ESTABLISHMENT OF STANDARDS.—The Sec21 retary, acting through the Service, shall establish, by regu22 lation, standards for the planning, design, and construc23 tion of health care facilities serving Indians under this 

24 Act.’’. 


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1 SEC. 144. INDIAN COUNTRY MODULAR COMPONENT FACILI2 TIES DEMONSTRATION PROGRAM. 

3 Title III of the Indian Health Care Improvement Act 

4 (25 U.S.C. 1631 et seq.) (as amended by section 143) is 

5 amended by adding at the end the following: 

6 ‘‘SEC. 312. INDIAN COUNTRY MODULAR COMPONENT FA7 CILITIES DEMONSTRATION PROGRAM. 

8 ‘‘(a) DEFINITION OF MODULAR COMPONENT

9 HEALTH CARE FACILITY.—In this section, the term ‘mod10 ular component health care facility’ means a health care 

11 facility that is constructed— 

12 ‘‘(1) off-site using prefabricated component 

13 units for subsequent transport to the destination lo14 cation; and 

15 ‘‘(2) represents a more economical method for 

16 provision of health care facility than a traditionally 

17 constructed health care building. 

18 ‘‘(b) ESTABLISHMENT.—The Secretary, acting 

19 through the Service, shall establish a demonstration pro20 gram under which the Secretary shall award no less than 

21 3 grants for purchase, installation and maintenance of 

22 modular component health care facilities in Indian com23 munities for provision of health care services. 

24 ‘‘(c) SELECTION OF LOCATIONS.— 

25 ‘‘(1) PETITIONS.— 


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1 ‘‘(A) SOLICITATION.—The Secretary shall 

2 solicit from Indian tribes petitions for location 

3 of the modular component health care facilities 

4 in the Service areas of the petitioning Indian 

5 tribes. 

6 ‘‘(B) PETITION.—To be eligible to receive 

7 a grant under this section, an Indian tribe or 

8 tribal organization must submit to the Sec9 retary a petition to construct a modular compo10 nent health care facility in the Indian commu11 nity of the Indian tribe, at such time, in such 

12 manner, and containing such information as the 

13 Secretary may require. 

14 ‘‘(2) SELECTION.—In selecting the location of 

15 each modular component health care facility to be 

16 provided under the demonstration program, the Sec17 retary shall give priority to projects already on the 

18 Indian Health Service facilities construction priority 

19 list and petitions which demonstrate that erection of 

20 a modular component health facility— 

21 ‘‘(A) is more economical than construction 

22 of a traditionally constructed health care facil23 ity; 


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1 ‘‘(B) can be constructed and erected on the 

2 selected location in less time than traditional 

3 construction; and 

4 ‘‘(C) can adequately house the health care 

5 services needed by the Indian population to be 

6 served. 

7 ‘‘(3) EFFECT OF SELECTION.—A modular com8 ponent health care facility project selected for par9 ticipation in the demonstration program shall not be 

10 eligible for entry on the facilities construction prior11 ities list entitled ‘IHS Health Care Facilities FY 

12 2011 Planned Construction Budget’ and dated May 

13 7, 2009 (or any successor list). 

14 ‘‘(d) ELIGIBILITY.— 

15 ‘‘(1) IN GENERAL.—An Indian tribe may sub16 mit a petition under subsection (c)(1)(B) regardless 

17 of whether the Indian tribe is a party to any con18 tract or compact under the Indian Self-Determina19 tion and Education Assistance Act (25 U.S.C. 450 

20 et seq.). 

21 ‘‘(2) ADMINISTRATION.—At the election of an 

22 Indian tribe or tribal organization selected for par23 ticipation in the demonstration program, the funds 

24 provided for the project shall be subject to the proviVerDate Nov 24 2008 01:56 Oct 17, 2009 Jkt 089200 PO 00000 Frm 00070 Fmt 6652 Sfmt 6201 E:\BILLS\S1790.IS S1790

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1 sions of the Indian Self-Determination and Edu2 cation Assistance Act. 

3 ‘‘(e) REPORTS.—Not later than 1 year after the date 

4 on which funds are made available for the demonstration 

5 program and annually thereafter, the Secretary shall sub6 mit to Congress a report describing— 

7 ‘‘(1) each activity carried out under the dem8 onstration program, including an evaluation of the 

9 success of the activity; and 

10 ‘‘(2) the potential benefits of increased use of 

11 modular component health care facilities in other In12 dian communities. 

13 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 

14 are authorized to be appropriated $50,000,000 to carry 

15 out the demonstration program under this section for the 

16 first 5 fiscal years, and such sums as may be necessary 

17 to carry out the program in subsequent fiscal years.’’. 

18 SEC. 145. MOBILE HEALTH STATIONS DEMONSTRATION 

19 PROGRAM. 

20 Title III of the Indian Health Care Improvement Act 

21 (25 U.S.C. 1631 et seq.) (as amended by section 144) is 

22 amended by adding at the end the following: 

23 ‘‘SEC. 313. MOBILE HEALTH STATIONS DEMONSTRATION 

24 PROGRAM. 

25 ‘‘(a) DEFINITIONS.—In this section: 


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1 ‘‘(1) ELIGIBLE TRIBAL CONSORTIUM.—The 

2 term ‘eligible tribal consortium’ means a consortium 

3 composed of 2 or more Service units between which 

4 a mobile health station can be transported by road 

5 in up to 8 hours. A Service unit operated by the 

6 Service or by an Indian tribe or tribal organization 

7 shall be equally eligible for participation in such con8 sortium. 

9 ‘‘(2) MOBILE HEALTH STATION.—The term 

10 ‘mobile health station’ means a health care unit 

11 that— 

12 ‘‘(A) is constructed, maintained, and capa13 ble of being transported within a semi-trailer 

14 truck or similar vehicle; 

15 ‘‘(B) is equipped for the provision of 1 or 

16 more specialty health care services; and 

17 ‘‘(C) can be equipped to be docked to a 

18 stationary health care facility when appropriate. 

19 ‘‘(3) SPECIALTY HEALTH CARE SERVICE.— 

20 ‘‘(A) IN GENERAL.—The term ‘specialty 

21 health care service’ means a health care service 

22 which requires the services of a health care pro23 fessional with specialized knowledge or experi24 ence. 


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1 ‘‘(B) INCLUSIONS.—The term ‘specialty 

2 health care service’ includes any service relating 

3 to— 

4 ‘‘(i) dialysis; 

5 ‘‘(ii) surgery; 

6 ‘‘(iii) mammography; 

7 ‘‘(iv) dentistry; or 

8 ‘‘(v) any other specialty health care 

9 service. 

10 ‘‘(b) ESTABLISHMENT.—The Secretary, acting 

11 through the Service, shall establish a demonstration pro12 gram under which the Secretary shall provide at least 3 

13 mobile health station projects. 

14 ‘‘(c) PETITION.—To be eligible to receive a mobile 

15 health station under the demonstration program, an eligi16 ble tribal consortium shall submit to the Secretary, a peti17 tion at such time, in such manner, and containing— 

18 ‘‘(1) a description of the Indian population to 

19 be served; 

20 ‘‘(2) a description of the specialty service or 

21 services for which the mobile health station is re22 quested and the extent to which such service or serv23 ices are currently available to the Indian population 

24 to be served; and 


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1 ‘‘(3) such other information as the Secretary 

2 may require. 

3 ‘‘(d) USE OF FUNDS.—The Secretary shall use 

4 amounts made available to carry out the demonstration 

5 program under this section— 

6 ‘‘(1)(A) to establish, purchase, lease, or main7 tain mobile health stations for the eligible tribal con8 sortia selected for projects; and 

9 ‘‘(B) to provide, through the mobile health sta10 tion, such specialty health care services as the af11 fected eligible tribal consortium determines to be 

12 necessary for the Indian population served; 

13 ‘‘(2) to employ an existing mobile health station 

14 (regardless of whether the mobile health station is 

15 owned or rented and operated by the Service) to pro16 vide specialty health care services to an eligible trib17 al consortium; and 

18 ‘‘(3) to establish, purchase, or maintain docking 

19 equipment for a mobile health station, including the 

20 establishment or maintenance of such equipment at 

21 a modular component health care facility (as defined 

22 in section 312(a)), if applicable. 

23 ‘‘(e) REPORTS.—Not later than 1 year after the date 

24 on which the demonstration program is established under 

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1 ing through the Service, shall submit to Congress a report 

2 describing— 

3 ‘‘(1) each activity carried out under the dem4 onstration program including an evaluation of the 

5 success of the activity; and 

6 ‘‘(2) the potential benefits of increased use of 

7 mobile health stations to provide specialty health 

8 care services for Indian communities. 

9 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 

10 are authorized to be appropriated $5,000,000 per year to 

11 carry out the demonstration program under this section 

12 for the first 5 fiscal years, and such sums as may be need13 ed to carry out the program in subsequent fiscal years.’’. 

14 Subtitle D—Access to Health 

15 Services 

16 SEC. 151. TREATMENT OF PAYMENTS UNDER SOCIAL SECU17 RITY ACT HEALTH BENEFITS PROGRAMS. 

18 Section 401 of the Indian Health Care Improvement 

19 Act (25 U.S.C. 1641) is amended to read as follows: 

20 ‘‘SEC. 401. TREATMENT OF PAYMENTS UNDER SOCIAL SE21 CURITY ACT HEALTH BENEFITS PROGRAMS. 

22 ‘‘(a) DISREGARD OF MEDICARE, MEDICAID, AND

23 CHIP PAYMENTS IN DETERMINING APPROPRIATIONS.— 

24 Any payments received by an Indian health program or 

25 by an urban Indian organization under title XVIII, XIX, 


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1 or XXI of the Social Security Act for services provided 

2 to Indians eligible for benefits under such respective titles 

3 shall not be considered in determining appropriations for 

4 the provision of health care and services to Indians. 

5 ‘‘(b) NONPREFERENTIAL TREATMENT.—Nothing in 

6 this Act authorizes the Secretary to provide services to an 

7 Indian with coverage under title XVIII, XIX, or XI of the 

8 Social Security Act in preference to an Indian without 

9 such coverage. 

10 ‘‘(c) USE OF FUNDS.— 

11 ‘‘(1) SPECIAL FUND.— 

12 ‘‘(A) 100 PERCENT PASS-THROUGH OF

13 PAYMENTS DUE TO FACILITIES.—Notwith14 standing any other provision of law, but subject 

15 to paragraph (2), payments to which a facility 

16 of the Service is entitled by reason of a provi17 sion of title XVIII or XIX of the Social Secu18 rity Act shall be placed in a special fund to be 

19 held by the Secretary. In making payments 

20 from such fund, the Secretary shall ensure that 

21 each Service unit of the Service receives 100 

22 percent of the amount to which the facilities of 

23 the Service, for which such Service unit makes 

24 collections, are entitled by reason of a provision 

25 of either such title. 


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1 ‘‘(B) USE OF FUNDS.—Amounts received 

2 by a facility of the Service under subparagraph 

3 (A) by reason of a provision of title XVIII or 

4 XIX of the Social Security Act shall first be 

5 used (to such extent or in such amounts as are 

6 provided in appropriation Acts) for the purpose 

7 of making any improvements in the programs 

8 of the Service operated by or through such fa9 cility which may be necessary to achieve or 

10 maintain compliance with the applicable condi11 tions and requirements of such respective title. 

12 Any amounts so received that are in excess of 

13 the amount necessary to achieve or maintain 

14 such conditions and requirements shall, subject 

15 to consultation with the Indian tribes being 

16 served by the Service unit, be used for reducing 

17 the health resource deficiencies (as determined 

18 in section 201(c)) of such Indian tribes, includ19 ing the provision of services pursuant to section 

20 205. 

21 ‘‘(2) DIRECT PAYMENT OPTION.—Paragraph 

22 (1) shall not apply to a tribal health program upon 

23 the election of such program under subsection (d) to 

24 receive payments directly. No payment may be made 

25 out of the special fund described in such paragraph 


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1 with respect to reimbursement made for services 

2 provided by such program during the period of such 

3 election. 

4 ‘‘(d) DIRECT BILLING.— 

5 ‘‘(1) IN GENERAL.—Subject to complying with 

6 the requirements of paragraph (2), a tribal health 

7 program may elect to directly bill for, and receive 

8 payment for, health care items and services provided 

9 by such program for which payment is made under 

10 title XVIII, XIX, or XXI of the Social Security Act 

11 or from any other third party payor. 

12 ‘‘(2) DIRECT REIMBURSEMENT.— 

13 ‘‘(A) USE OF FUNDS.—Each tribal health 

14 program making the election described in para15 graph (1) with respect to a program under a 

16 title of the Social Security Act shall be reim17 bursed directly by that program for items and 

18 services furnished without regard to subsection 

19 (c)(1), except that all amounts so reimbursed 

20 shall be used by the tribal health program for 

21 the purpose of making any improvements in fa22 cilities of the tribal health program that may be 

23 necessary to achieve or maintain compliance 

24 with the conditions and requirements applicable 

25 generally to such items and services under the 


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1 program under such title and to provide addi2 tional health care services, improvements in 

3 health care facilities and tribal health pro4 grams, any health care-related purpose (includ5 ing coverage for a service or service within a 

6 contract health service delivery area or any por7 tion of a contract health service delivery area 

8 that would otherwise be provided as a contract 

9 health service), or otherwise to achieve the ob10 jectives provided in section 3 of this Act. 

11 ‘‘(B) AUDITS.—The amounts paid to a 

12 tribal health program making the election de13 scribed in paragraph (1) with respect to a pro14 gram under title XVIII, XIX, or XXI of the So15 cial Security Act shall be subject to all auditing 

16 requirements applicable to the program under 

17 such title, as well as all auditing requirements 

18 applicable to programs administered by an In19 dian health program. Nothing in the preceding 

20 sentence shall be construed as limiting the ap21 plication of auditing requirements applicable to 

22 amounts paid under title XVIII, XIX, or XXI 

23 of the Social Security Act. 

24 ‘‘(C) IDENTIFICATION OF SOURCE OF PAY25 MENTS.—Any tribal health program that reVerDate Nov 24 2008 16:29 Oct 17, 2009 Jkt 089200 PO 00000 Frm 00079 Fmt 6652 Sfmt 6201 E:\BILLS\S1790.IS S1790

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1 ceives reimbursements or payments under title 

2 XVIII, XIX, or XXI of the Social Security Act 

3 shall provide to the Service a list of each pro4 vider enrollment number (or other identifier) 

5 under which such program receives such reim6 bursements or payments. 

7 ‘‘(3) EXAMINATION AND IMPLEMENTATION OF

8 CHANGES.— 

9 ‘‘(A) IN GENERAL.—The Secretary, acting 

10 through the Service and with the assistance of 

11 the Administrator of the Centers for Medicare 

12 & Medicaid Services, shall examine on an ongo13 ing basis and implement any administrative 

14 changes that may be necessary to facilitate di15 rect billing and reimbursement under the pro16 gram established under this subsection, includ17 ing any agreements with States that may be 

18 necessary to provide for direct billing under a 

19 program under title XIX or XXI of the Social 

20 Security Act. 

21 ‘‘(B) COORDINATION OF INFORMATION.— 

22 The Service shall provide the Administrator of 

23 the Centers for Medicare & Medicaid Services 

24 with copies of the lists submitted to the Service 

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1 garding patients served by the Service (and by 

2 tribal health programs, to the extent such data 

3 is available to the Service), and such other in4 formation as the Administrator may require for 

5 purposes of administering title XVIII, XIX, or 

6 XXI of the Social Security Act. 

7 ‘‘(4) WITHDRAWAL FROM PROGRAM.—A tribal 

8 health program that bills directly under the program 

9 established under this subsection may withdraw 

10 from participation in the same manner and under 

11 the same conditions that an Indian tribe or tribal or12 ganization may retrocede a contracted program to 

13 the Secretary under the authority of the Indian Self14 Determination and Education Assistance Act (25 

15 U.S.C. 450 et seq.). All cost accounting and billing 

16 authority under the program established under this 

17 subsection shall be returned to the Secretary upon 

18 the Secretary’s acceptance of the withdrawal of par19 ticipation in this program. 

20 ‘‘(5) TERMINATION FOR FAILURE TO COMPLY

21 WITH REQUIREMENTS.—The Secretary may termi22 nate the participation of a tribal health program or 

23 in the direct billing program established under this 

24 subsection if the Secretary determines that the pro25 gram has failed to comply with the requirements of 


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1 paragraph (2). The Secretary shall provide a tribal 

2 health program with notice of a determination that 

3 the program has failed to comply with any such re4 quirement and a reasonable opportunity to correct 

5 such noncompliance prior to terminating the pro6 gram’s participation in the direct billing program es7 tablished under this subsection. 

8 ‘‘(e) RELATED PROVISIONS UNDER THE SOCIAL SE9 CURITY ACT.—For provisions related to subsections (c) 

10 and (d), see sections 1880, 1911, and 2107(e)(1)(D) of 

11 the Social Security Act.’’. 

12 SEC. 152. PURCHASING HEALTH CARE COVERAGE. 

13 Section 402 of the Indian Health Care Improvement 

14 Act (25 U.S.C. 1642) is amended to read as follows: 

15 ‘‘SEC. 402. PURCHASING HEALTH CARE COVERAGE. 

16 ‘‘(a) IN GENERAL.—Insofar as amounts are made 

17 available under law (including a provision of the Social 

18 Security Act, the Indian Self-Determination and Edu19 cation Assistance Act (25 U.S.C. 450 et seq.), or other 

20 law, other than under section 404) to Indian tribes, tribal 

21 organizations, and urban Indian organizations for health 

22 benefits for Service beneficiaries, Indian tribes, tribal or23 ganizations, and urban Indian organizations may use such 

24 amounts to purchase health benefits coverage (including 

25 coverage for a service, or service within a contract health 


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1 service delivery area, or any portion of a contract health 

2 service delivery area that would otherwise be provided as 

3 a contract health service) for such beneficiaries in any 

4 manner, including through— 

5 ‘‘(1) a tribally owned and operated health care 

6 plan; 

7 ‘‘(2) a State or locally authorized or licensed 

8 health care plan; 

9 ‘‘(3) a health insurance provider or managed 

10 care organization; 

11 ‘‘(4) a self-insured plan; or 

12 ‘‘(5) a high deductible or health savings account 

13 plan. 

14 ‘‘(b) FINANCIAL NEED.—The purchase of coverage 

15 under subsection (a) by an Indian tribe, tribal organiza16 tion, or urban Indian organization may be based on the 

17 financial needs of such beneficiaries (as determined by the 

18 1 or more Indian tribes being served based on a schedule 

19 of income levels developed or implemented by such 1 ore 

20 more Indian tribes). 

21 ‘‘(c) EXPENSES FOR SELF-INSURED PLAN.—In the 

22 case of a self-insured plan under subsection (a)(4), the 

23 amounts may be used for expenses of operating the plan, 

24 including administration and insurance to limit the finan25 cial risks to the entity offering the plan. 


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1 ‘‘(d) CONSTRUCTION.—Nothing in this section shall 

2 be construed as affecting the use of any amounts not re3 ferred to in subsection (a).’’. 

4 SEC. 153. GRANTS TO AND CONTRACTS WITH THE SERVICE, 

5 INDIAN TRIBES, TRIBAL ORGANIZATIONS, 

6 AND URBAN INDIAN ORGANIZATIONS TO FA7 CILITATE OUTREACH, ENROLLMENT, AND 

8 COVERAGE OF INDIANS UNDER SOCIAL SECU9 RITY ACT HEALTH BENEFIT PROGRAMS AND 

10 OTHER HEALTH BENEFITS PROGRAMS. 

11 Section 404 of the Indian Health Care Improvement 

12 Act (25 U.S.C. 1644) is amended to read as follows: 

13 ‘‘SEC. 404. GRANTS TO AND CONTRACTS WITH THE SERV14 ICE, INDIAN TRIBES, TRIBAL ORGANIZA15 TIONS, AND URBAN INDIAN ORGANIZATIONS 

16 TO FACILITATE OUTREACH, ENROLLMENT, 

17 AND COVERAGE OF INDIANS UNDER SOCIAL 

18 SECURITY ACT HEALTH BENEFIT PROGRAMS 

19 AND OTHER HEALTH BENEFITS PROGRAMS. 

20 ‘‘(a) INDIAN TRIBES AND TRIBAL ORGANIZA21 TIONS.—The Secretary, acting through the Service, shall 

22 make grants to or enter into contracts with Indian tribes 

23 and tribal organizations to assist such tribes and tribal 

24 organizations in establishing and administering programs 

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1 grams to provide outreach and enrollment through video, 

2 electronic delivery methods, or telecommunication devices 

3 that allow real-time or time-delayed communication be4 tween individual Indians and the benefit program, to as5 sist individual Indians— 

6 ‘‘(1) to enroll for benefits under a program es7 tablished under title XVIII, XIX, or XXI of the So8 cial Security Act and other health benefits pro9 grams; and 

10 ‘‘(2) with respect to such programs for which 

11 the charging of premiums and cost sharing is not 

12 prohibited under such programs, to pay premiums or 

13 cost sharing for coverage for such benefits, which 

14 may be based on financial need (as determined by 

15 the Indian tribe or tribes or tribal organizations 

16 being served based on a schedule of income levels de17 veloped or implemented by such tribe, tribes, or trib18 al organizations). 

19 ‘‘(b) CONDITIONS.—The Secretary, acting through 

20 the Service, shall place conditions as deemed necessary to 

21 effect the purpose of this section in any grant or contract 

22 which the Secretary makes with any Indian tribe or tribal 

23 organization pursuant to this section. Such conditions 

24 shall include requirements that the Indian tribe or tribal 

25 organization successfully undertake— 


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1 ‘‘(1) to determine the population of Indians eli2 gible for the benefits described in subsection (a); 

3 ‘‘(2) to educate Indians with respect to the ben4 efits available under the respective programs; 

5 ‘‘(3) to provide transportation for such indi6 vidual Indians to the appropriate offices for enroll7 ment or applications for such benefits; and 

8 ‘‘(4) to develop and implement methods of im9 proving the participation of Indians in receiving ben10 efits under such programs. 

11 ‘‘(c) APPLICATION TO URBAN INDIAN ORGANIZA12 TIONS.— 

13 ‘‘(1) IN GENERAL.—The provisions of sub14 section (a) shall apply with respect to grants and 

15 other funding to urban Indian organizations with re16 spect to populations served by such organizations in 

17 the same manner they apply to grants and contracts 

18 with Indian tribes and tribal organizations with re19 spect to programs on or near reservations. 

20 ‘‘(2) REQUIREMENTS.—The Secretary shall in21 clude in the grants or contracts made or provided 

22 under paragraph (1) requirements that are— 

23 ‘‘(A) consistent with the requirements im24 posed by the Secretary under subsection (b); 


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1 ‘‘(B) appropriate to urban Indian organi2 zations and urban Indians; and 

3 ‘‘(C) necessary to effect the purposes of 

4 this section. 

5 ‘‘(d) FACILITATING COOPERATION.—The Secretary, 

6 acting through the Centers for Medicare & Medicaid Serv7 ices, shall develop and disseminate best practices that will 

8 serve to facilitate cooperation with, and agreements be9 tween, States and the Service, Indian tribes, tribal organi10 zations, or urban Indian organizations with respect to the 

11 provision of health care items and services to Indians 

12 under the programs established under title XVIII, XIX, 

13 or XXI of the Social Security Act. 

14 ‘‘(e) AGREEMENTS RELATING TO IMPROVING EN15 ROLLMENT OF INDIANS UNDER SOCIAL SECURITY ACT

16 HEALTH BENEFITS PROGRAMS.—For provisions relating 

17 to agreements of the Secretary, acting through the Serv18 ice, for the collection, preparation, and submission of ap19 plications by Indians for assistance under the Medicaid 

20 and children’s health insurance programs established 

21 under titles XIX and XXI of the Social Security Act, and 

22 benefits under the Medicare program established under 

23 title XVIII of such Act, see subsections (a) and (b) of sec24 tion 1139 of the Social Security Act. 


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1 ‘‘(f) DEFINITION OF PREMIUMS AND COST SHAR2 ING.—In this section: 

3 ‘‘(1) PREMIUM.—The term ‘premium’ includes 

4 any enrollment fee or similar charge. 

5 ‘‘(2) COST SHARING.—The term ‘cost sharing’ 

6 includes any deduction, deductible, copayment, coin7 surance, or similar charge.’’. 

8 SEC. 154. SHARING ARRANGEMENTS WITH FEDERAL AGEN9 CIES. 

10 Section 405 of the Indian Health Care Improvement 

11 Act (25 U.S.C. 1645) is amended to read as follows: 

12 ‘‘SEC. 405. SHARING ARRANGEMENTS WITH FEDERAL AGEN13 CIES. 

14 ‘‘(a) AUTHORITY.— 

15 ‘‘(1) IN GENERAL.—The Secretary may enter 

16 into (or expand) arrangements for the sharing of 

17 medical facilities and services between the Service, 

18 Indian tribes, and tribal organizations and the De19 partment of Veterans Affairs and the Department of 

20 Defense. 

21 ‘‘(2) CONSULTATION BY SECRETARY RE22 QUIRED.—The Secretary may not finalize any ar23 rangement between the Service and a Department 

24 described in paragraph (1) without first consulting 


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1 with the Indian tribes which will be significantly af2 fected by the arrangement. 

3 ‘‘(b) LIMITATIONS.—The Secretary shall not take 

4 any action under this section or under subchapter IV of 

5 chapter 81 of title 38, United States Code, which would 

6 impair— 

7 ‘‘(1) the priority access of any Indian to health 

8 care services provided through the Service and the 

9 eligibility of any Indian to receive health services 

10 through the Service; 

11 ‘‘(2) the quality of health care services provided 

12 to any Indian through the Service; 

13 ‘‘(3) the priority access of any veteran to health 

14 care services provided by the Department of Vet15 erans Affairs; 

16 ‘‘(4) the quality of health care services provided 

17 by the Department of Veterans Affairs or the De18 partment of Defense; or 

19 ‘‘(5) the eligibility of any Indian who is a vet20 eran to receive health services through the Depart21 ment of Veterans Affairs. 

22 ‘‘(c) REIMBURSEMENT.—The Service, Indian tribe, 

23 or tribal organization shall be reimbursed by the Depart24 ment of Veterans Affairs or the Department of Defense 

25 (as the case may be) where services are provided through 


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1 the Service, an Indian tribe, or a tribal organization to 

2 beneficiaries eligible for services from either such Depart3 ment, notwithstanding any other provision of law. 

4 ‘‘(d) CONSTRUCTION.—Nothing in this section may 

5 be construed as creating any right of a non-Indian veteran 

6 to obtain health services from the Service.’’. 

7 SEC. 155. ELIGIBLE INDIAN VETERAN SERVICES. 

8 Title IV of the Indian Health Care Improvement Act 

9 (25 U.S.C. 1641 et seq.) (as amended by section 101(b)) 

10 is amended by adding at the end the following: 

11 ‘‘SEC. 407. ELIGIBLE INDIAN VETERAN SERVICES. 

12 ‘‘(a) FINDINGS; PURPOSE.— 

13 ‘‘(1) FINDINGS.—Congress finds that— 

14 ‘‘(A) collaborations between the Secretary 

15 and the Secretary of Veterans Affairs regarding 

16 the treatment of Indian veterans at facilities of 

17 the Service should be encouraged to the max18 imum extent practicable; and 

19 ‘‘(B) increased enrollment for services of 

20 the Department of Veterans Affairs by veterans 

21 who are members of Indian tribes should be en22 couraged to the maximum extent practicable. 

23 ‘‘(2) PURPOSE.—The purpose of this section is 

24 to reaffirm the goals stated in the document entitled 

25 ‘Memorandum of Understanding Between the VA/ 


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1 Veterans Health Administration And HHS/Indian 

2 Health Service’ and dated February 25, 2003 (relat3 ing to cooperation and resource sharing between the 

4 Veterans Health Administration and Service). 

5 ‘‘(b) DEFINITIONS.—In this section: 

6 ‘‘(1) ELIGIBLE INDIAN VETERAN.—The term 

7 ‘eligible Indian veteran’ means an Indian or Alaska 

8 Native veteran who receives any medical service that 

9 is— 

10 ‘‘(A) authorized under the laws adminis11 tered by the Secretary of Veterans Affairs; and 

12 ‘‘(B) administered at a facility of the Serv13 ice (including a facility operated by an Indian 

14 tribe or tribal organization through a contract 

15 or compact with the Service under the Indian 

16 Self-Determination and Education Assistance 

17 Act (25 U.S.C. 450 et seq.)) pursuant to a local 

18 memorandum of understanding. 

19 ‘‘(2) LOCAL MEMORANDUM OF UNDER20 STANDING.—The term ‘local memorandum of under21 standing’ means a memorandum of understanding 

22 between the Secretary (or a designee, including the 

23 director of any area office of the Service) and the 

24 Secretary of Veterans Affairs (or a designee) to im25 plement the document entitled ‘Memorandum of UnVerDate Nov 24 2008 01:56 Oct 17, 2009 Jkt 089200 PO 00000 Frm 00091 Fmt 6652 Sfmt 6201 E:\BILLS\S1790.IS S1790

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1 derstanding Between the VA/Veterans Health Ad2 ministration And HHS/Indian Health Service’ and 

3 dated February 25, 2003 (relating to cooperation 

4 and resource sharing between the Veterans Health 

5 Administration and Indian Health Service). 

6 ‘‘(c) ELIGIBLE INDIAN VETERANS EXPENSES.— 

7 ‘‘(1) IN GENERAL.—Notwithstanding any other 

8 provision of law, the Secretary shall provide for vet9 eran-related expenses incurred by eligible Indian vet10 erans as described in subsection (b)(1)(B). 

11 ‘‘(2) METHOD OF PAYMENT.—The Secretary 

12 shall establish such guidelines as the Secretary de13 termines to be appropriate regarding the method of 

14 payments to the Secretary of Veterans Affairs under 

15 paragraph (1). 

16 ‘‘(d) TRIBAL APPROVAL OF MEMORANDA.—In nego17 tiating a local memorandum of understanding with the 

18 Secretary of Veterans Affairs regarding the provision of 

19 services to eligible Indian veterans, the Secretary shall 

20 consult with each Indian tribe that would be affected by 

21 the local memorandum of understanding. 

22 ‘‘(e) FUNDING.— 

23 ‘‘(1) TREATMENT.—Expenses incurred by the 

24 Secretary in carrying out subsection (c)(1) shall not 


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1 be considered to be Contract Health Service ex2 penses. 

3 ‘‘(2) USE OF FUNDS.—Of funds made available 

4 to the Secretary in appropriations Acts for the Serv5 ice (excluding funds made available for facilities, 

6 Contract Health Services, or contract support costs), 

7 the Secretary shall use such sums as are necessary 

8 to carry out this section.’’. 

9 SEC. 156. NONDISCRIMINATION UNDER FEDERAL HEALTH 

10 CARE PROGRAMS IN QUALIFICATIONS FOR 

11 REIMBURSEMENT FOR SERVICES. 

12 Title IV of the Indian Health Care Improvement Act 

13 (25 U.S.C. 1641 et seq.) (as amended by section 155) is 

14 amended by adding at the end the following: 

15 ‘‘SEC. 408. NONDISCRIMINATION UNDER FEDERAL HEALTH 

16 CARE PROGRAMS IN QUALIFICATIONS FOR 

17 REIMBURSEMENT FOR SERVICES. 

18 ‘‘(a) REQUIREMENT TO SATISFY GENERALLY APPLI19 CABLE PARTICIPATION REQUIREMENTS.— 

20 ‘‘(1) IN GENERAL.—A Federal health care pro21 gram must accept an entity that is operated by the 

22 Service, an Indian tribe, tribal organization, or 

23 urban Indian organization as a provider eligible to 

24 receive payment under the program for health care 

25 services furnished to an Indian on the same basis as 


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1 any other provider qualified to participate as a pro2 vider of health care services under the program if 

3 the entity meets generally applicable State or other 

4 requirements for participation as a provider of 

5 health care services under the program. 

6 ‘‘(2) SATISFACTION OF STATE OR LOCAL LICEN7 SURE OR RECOGNITION REQUIREMENTS.—Any re8 quirement for participation as a provider of health 

9 care services under a Federal health care program 

10 that an entity be licensed or recognized under the 

11 State or local law where the entity is located to fur12 nish health care services shall be deemed to have 

13 been met in the case of an entity operated by the 

14 Service, an Indian tribe, tribal organization, or 

15 urban Indian organization if the entity meets all the 

16 applicable standards for such licensure or recogni17 tion, regardless of whether the entity obtains a li18 cense or other documentation under such State or 

19 local law. In accordance with section 221, the ab20 sence of the licensure of a health professional em21 ployed by such an entity under the State or local law 

22 where the entity is located shall not be taken into 

23 account for purposes of determining whether the en24 tity meets such standards, if the professional is li25 censed in another State. 


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1 ‘‘(b) APPLICATION OF EXCLUSION FROM PARTICIPA2 TION IN FEDERAL HEALTH CARE PROGRAMS.— 

3 ‘‘(1) EXCLUDED ENTITIES.—No entity operated 

4 by the Service, an Indian tribe, tribal organization, 

5 or urban Indian organization that has been excluded 

6 from participation in any Federal health care pro7 gram or for which a license is under suspension or 

8 has been revoked by the State where the entity is lo9 cated shall be eligible to receive payment or reim10 bursement under any such program for health care 

11 services furnished to an Indian. 

12 ‘‘(2) EXCLUDED INDIVIDUALS.—No individual 

13 who has been excluded from participation in any 

14 Federal health care program or whose State license 

15 is under suspension shall be eligible to receive pay16 ment or reimbursement under any such program for 

17 health care services furnished by that individual, di18 rectly or through an entity that is otherwise eligible 

19 to receive payment for health care services, to an In20 dian. 

21 ‘‘(3) FEDERAL HEALTH CARE PROGRAM DE22 FINED.—In this subsection, the term, ‘Federal 

23 health care program’ has the meaning given that 

24 term in section 1128B(f) of the Social Security Act 

25 (42 U.S.C. 1320a–7b(f)), except that, for purposes 


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1 of this subsection, such term shall include the health 

2 insurance program under chapter 89 of title 5, 

3 United States Code. 

4 ‘‘(c) RELATED PROVISIONS.—For provisions related 

5 to nondiscrimination against providers operated by the 

6 Service, an Indian tribe, tribal organization, or urban In7 dian organization, see section 1139(c) of the Social Secu8 rity Act (42 U.S.C. 1320b–9(c)).’’. 

9 SEC. 157. ACCESS TO FEDERAL INSURANCE. 

10 Title IV of the Indian Health Care Improvement Act 

11 (25 U.S.C. 1641 et seq.) (as amended by section 156) is 

12 amended by adding at the end the following: 

13 ‘‘SEC. 409. ACCESS TO FEDERAL INSURANCE. 

14 ‘‘Notwithstanding the provisions of title 5, United 

15 States Code, Executive order, or administrative regula16 tion, an Indian tribe or tribal organization carrying out 

17 programs under the Indian Self-Determination and Edu18 cation Assistance Act (25 U.S.C. 450 et seq.) or an urban 

19 Indian organization carrying out programs under title V 

20 of this Act shall be entitled to purchase coverage, rights, 

21 and benefits for the employees of such Indian tribe or trib22 al organization, or urban Indian organization, under chap23 ter 89 of title 5, United States Code, and chapter 87 of 

24 such title if necessary employee deductions and agency 

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1 efits for the period of employment with such Indian tribe 

2 or tribal organization, or urban Indian organization, are 

3 currently deposited in the applicable Employee’s Fund 

4 under such title.’’. 

5 SEC. 158. GENERAL EXCEPTIONS. 

6 Title IV of the Indian Health Care Improvement Act 

7 (25 U.S.C. 1641 et seq.) (as amended by section 157) is 

8 amended by adding at the end the following: 

9 ‘‘SEC. 410. GENERAL EXCEPTIONS. 

10 ‘‘The requirements of this title shall not apply to any 

11 excepted benefits described in paragraph (1)(A) or (3) of 

12 section 2791(c) of the Public Health Service Act (42 

13 U.S.C. 300gg–91).’’. 

14 Subtitle E—Health Services for 

15 Urban Indians 

16 SEC. 161. REQUIREMENT TO CONFER WITH URBAN INDIAN 

17 ORGANIZATIONS. 

18 (a) CONFERRING WITH URBAN INDIAN ORGANIZA19 TIONS.—Title V of the Indian Health Care Improvement 

20 Act (25 U.S.C. 1651 et seq.) (as amended by section 

21 101(b)) is amended by adding at the end the following: 


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1 ‘‘SEC. 514. CONFERRING WITH URBAN INDIAN ORGANIZA2 TIONS. 

3 ‘‘(a) DEFINITION OF CONFER.—In this section, the 

4 term ‘confer’ means to engage in an open and free ex5 change of information and opinions that— 

6 ‘‘(1) leads to mutual understanding and com7 prehension; and 

8 ‘‘(2) emphasizes trust, respect, and shared re9 sponsibility. 

10 ‘‘(b) REQUIREMENT.—The Secretary shall ensure 

11 that the Service confers, to the maximum extent prac12 ticable, with urban Indian organizations in carrying out 

13 this Act.’’. 

14 (b) CONTRACTS WITH, AND GRANTS TO, URBAN IN15 DIAN ORGANIZATIONS.—Section 502 of the Indian Health 

16 Care Improvement Act (25 U.S.C. 1652) is amended to 

17 read as follows: 

18 ‘‘SEC. 502. CONTRACTS WITH, AND GRANTS TO, URBAN IN19 DIAN ORGANIZATIONS. 

20 ‘‘(a) IN GENERAL.—Pursuant to the Act of Novem21 ber 2, 1921 (25 U.S.C. 13) (commonly known as the ‘Sny22 der Act’), the Secretary, acting through the Service, shall 

23 enter into contracts with, or make grants to, urban Indian 

24 organizations to assist the urban Indian organizations in 

25 the establishment and administration, within urban cen26 ters, of programs that meet the requirements of this title. 


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1 ‘‘(b) CONDITIONS.—Subject to section 506, the Sec2 retary, acting through the Service, shall include such con3 ditions as the Secretary considers necessary to effect the 

4 purpose of this title in any contract into which the Sec5 retary enters with, or in any grant the Secretary makes 

6 to, any urban Indian organization pursuant to this title.’’. 

7 SEC. 162. EXPANDED PROGRAM AUTHORITY FOR URBAN IN8 DIAN ORGANIZATIONS. 

9 Title V of the Indian Health Care Improvement Act 

10 (25 U.S.C. 1651 et seq.) (as amended by section 161(a)) 

11 is amended by adding at the end the following: 

12 ‘‘SEC. 515. EXPANDED PROGRAM AUTHORITY FOR URBAN 

13 INDIAN ORGANIZATIONS. 

14 ‘‘Notwithstanding any other provision of this Act, the 

15 Secretary, acting through the Service, is authorized to es16 tablish programs, including programs for awarding grants, 

17 for urban Indian organizations that are identical to any 

18 programs established pursuant to sections 218, 702, and 

19 708(g).’’. 

20 SEC. 163. COMMUNITY HEALTH REPRESENTATIVES. 

21 Title V of the Indian Health Care Improvement Act 

22 (25 U.S.C. 1651 et seq.) (as amended by section 162) is 

23 amended by adding at the end the following: 


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1 ‘‘SEC. 516. COMMUNITY HEALTH REPRESENTATIVES. 

2 ‘‘The Secretary, acting through the Service, may 

3 enter into contracts with, and make grants to, urban In4 dian organizations for the employment of Indians trained 

5 as health service providers through the Community Health 

6 Representative Program under section 107 in the provi7 sion of health care, health promotion, and disease preven8 tion services to urban Indians.’’. 

9 Subtitle F—Organizational 

10 Improvements 

11 SEC. 171. ESTABLISHMENT OF THE INDIAN HEALTH SERV12 ICE AS AN AGENCY OF THE PUBLIC HEALTH 

13 SERVICE. 

14 Section 601 of the Indian Health Care Improvement 

15 Act (25 U.S.C. 1661) is amended to read as follows: 

16 ‘‘SEC. 601. ESTABLISHMENT OF THE INDIAN HEALTH SERV17 ICE AS AN AGENCY OF THE PUBLIC HEALTH 

18 SERVICE. 

19 ‘‘(a) ESTABLISHMENT.— 

20 ‘‘(1) IN GENERAL.—In order to more effectively 

21 and efficiently carry out the responsibilities, authori22 ties, and functions of the United States to provide 

23 health care services to Indians and Indian tribes, as 

24 are or may be hereafter provided by Federal statute 

25 or treaties, there is established within the Public 


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1 Health Service of the Department the Indian Health 

2 Service. 

3 ‘‘(2) DIRECTOR.—The Service shall be adminis4 tered by a Director, who shall be appointed by the 

5 President, by and with the advice and consent of the 

6 Senate. The Director shall report to the Secretary. 

7 Effective with respect to an individual appointed by 

8 the President, by and with the advice and consent 

9 of the Senate, after January 1, 2008, the term of 

10 service of the Director shall be 4 years. A Director 

11 may serve more than 1 term. 

12 ‘‘(3) INCUMBENT.—The individual serving in 

13 the position of Director of the Service on the day be14 fore the date of enactment of the Indian Health 

15 Care Improvement Reauthorization and Extension 

16 Act of 2009 shall serve as Director. 

17 ‘‘(4) ADVOCACY AND CONSULTATION.—The po18 sition of Director is established to, in a manner con19 sistent with the government-to-government relation20 ship between the United States and Indian Tribes— 

21 ‘‘(A) facilitate advocacy for the develop22 ment of appropriate Indian health policy; and 

23 ‘‘(B) promote consultation on matters re24 lating to Indian health. 


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1 ‘‘(b) AGENCY.—The Service shall be an agency within 

2 the Public Health Service of the Department, and shall 

3 not be an office, component, or unit of any other agency 

4 of the Department. 

5 ‘‘(c) DUTIES.—The Director shall— 

6 ‘‘(1) perform all functions that were, on the day 

7 before the date of enactment of the Indian Health 

8 Care Improvement Reauthorization and Extension 

9 Act of 2009, carried out by or under the direction 

10 of the individual serving as Director of the Service 

11 on that day; 

12 ‘‘(2) perform all functions of the Secretary re13 lating to the maintenance and operation of hospital 

14 and health facilities for Indians and the planning 

15 for, and provision and utilization of, health services 

16 for Indians; 

17 ‘‘(3) administer all health programs under 

18 which health care is provided to Indians based upon 

19 their status as Indians which are administered by 

20 the Secretary, including programs under— 

21 ‘‘(A) this Act; 

22 ‘‘(B) the Act of November 2, 1921 (25 

23 U.S.C. 13); 

24 ‘‘(C) the Act of August 5, 1954 (42 U.S.C. 

25 2001 et seq.); 


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1 ‘‘(D) the Act of August 16, 1957 (42 

2 U.S.C. 2005 et seq.); and 

3 ‘‘(E) the Indian Self-Determination and 

4 Education Assistance Act (25 U.S.C. 450 et 

5 seq.); 

6 ‘‘(4) administer all scholarship and loan func7 tions carried out under title I; 

8 ‘‘(5) directly advise the Secretary concerning 

9 the development of all policy- and budget-related 

10 matters affecting Indian health; 

11 ‘‘(6) collaborate with the Assistant Secretary 

12 for Health concerning appropriate matters of Indian 

13 health that affect the agencies of the Public Health 

14 Service; 

15 ‘‘(7) advise each Assistant Secretary of the De16 partment concerning matters of Indian health with 

17 respect to which that Assistant Secretary has au18 thority and responsibility; 

19 ‘‘(8) advise the heads of other agencies and pro20 grams of the Department concerning matters of In21 dian health with respect to which those heads have 

22 authority and responsibility; 

23 ‘‘(9) coordinate the activities of the Department 

24 concerning matters of Indian health; and 


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1 ‘‘(10) perform such other functions as the Sec2 retary may designate. 

3 ‘‘(d) AUTHORITY.— 

4 ‘‘(1) IN GENERAL.—The Secretary, acting 

5 through the Director, shall have the authority— 

6 ‘‘(A) except to the extent provided for in 

7 paragraph (2), to appoint and compensate em8 ployees for the Service in accordance with title 

9 5, United States Code; 

10 ‘‘(B) to enter into contracts for the pro11 curement of goods and services to carry out the 

12 functions of the Service; and 

13 ‘‘(C) to manage, expend, and obligate all 

14 funds appropriated for the Service. 

15 ‘‘(2) PERSONNEL ACTIONS.—Notwithstanding 

16 any other provision of law, the provisions of section 

17 12 of the Act of June 18, 1934 (48 Stat. 986; 25 

18 U.S.C. 472), shall apply to all personnel actions 

19 taken with respect to new positions created within 

20 the Service as a result of its establishment under 

21 subsection (a).’’. 

22 SEC. 172. OFFICE OF DIRECT SERVICE TRIBES. 

23 Title VI of the Indian Health Care Improvement Act 

24 (25 U.S.C. 1661 et seq.) (as amended by section 101(b)) 

25 is amended by adding at the end the following: 


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1 ‘‘SEC. 603. OFFICE OF DIRECT SERVICE TRIBES. 

2 ‘‘(a) ESTABLISHMENT.—There is established within 

3 the Service an office, to be known as the ‘Office of Direct 

4 Service Tribes’. 

5 ‘‘(b) TREATMENT.—The Office of Direct Service 

6 Tribes shall be located in the Office of the Director. 

7 ‘‘(c) DUTIES.—The Office of Direct Service Tribes 

8 shall be responsible for— 

9 ‘‘(1) providing Service-wide leadership, guidance 

10 and support for direct service tribes to include stra11 tegic planning and program evaluation; 

12 ‘‘(2) ensuring maximum flexibility to tribal 

13 health and related support systems for Indian bene14 ficiaries; 

15 ‘‘(3) serving as the focal point for consultation 

16 and participation between direct service tribes and 

17 organizations and the Service in the development of 

18 Service policy; 

19 ‘‘(4) holding no less than biannual consultations 

20 with direct service tribes in appropriate locations to 

21 gather information and aid in the development of 

22 health policy; and 

23 ‘‘(5) directing a national program and providing 

24 leadership and advocacy in the development of 

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1 lation, resource allocation, and delegation support 

2 for direct service tribes.’’. 

3 SEC. 173. NEVADA AREA OFFICE. 

4 Title VI of the Indian Health Care Improvement Act 

5 (25 U.S.C. 1661 et seq.) (as amended by section 172) is 

6 amended by adding at the end the following: 

7 ‘‘SEC. 604. NEVADA AREA OFFICE. 

8 ‘‘(a) IN GENERAL.—Not later than 1 year after the 

9 date of enactment of this section, the Secretary of Health 

10 and Human Services, in consultation with Indian tribes, 

11 tribal organizations, and urban Indian organizations in 

12 the State of Nevada, shall submit to Congress a plan ex13 plaining the manner and schedule by which a Nevada area 

14 office, separate and distinct from the Phoenix area office, 

15 can be established in Nevada. 

16 ‘‘(b) FAILURE TO SUBMIT A PLAN.—If the Secretary 

17 fails to submit a plan in accordance with this section, the 

18 Secretary shall withhold such operations funds reserved 

19 for the Phoenix Area Office of the Indian Health Service. 

20 Funds withheld pursuant to this subsection may, at the 

21 discretion of the Secretary, be restored to the Phoenix 

22 Area Office upon compliance with this section.’’. 


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1 Subtitle G—Behavioral Health 

2 Programs 

3 SEC. 181. BEHAVIORAL HEALTH PROGRAMS. 

4 Title VII of the Indian Health Care Improvement Act 

5 (25 U.S.C. 1665 et seq.) is amended to read as follows: 

6 ‘‘TITLE VII—BEHAVIORAL 

7 HEALTH PROGRAMS 

8 ‘‘Subtitle A—General Programs 

9 ‘‘SEC. 701. DEFINITIONS. 

10 ‘‘In this subtitle: 

11 ‘‘(1) ALCOHOL-RELATED

12 NEURODEVELOPMENTAL DISORDERS; ARND.—The 

13 term ‘alcohol-related neurodevelopmental disorders’ 

14 or ‘ARND’ means, with a history of maternal alco15 hol consumption during pregnancy, central nervous 

16 system abnormalities, which may range from minor 

17 intellectual deficits and developmental delays to 

18 mental retardation. ARND children may have behav19 ioral problems, learning disabilities, problems with 

20 executive functioning, and attention disorders. The 

21 neurological defects of ARND may be as severe as 

22 FAS, but facial anomalies and other physical char23 acteristics are not present in ARND, thus making 

24 diagnosis difficult. 


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1 ‘‘(2) ASSESSMENT.—The term ‘assessment’ 

2 means the systematic collection, analysis, and dis3 semination of information on health status, health 

4 needs, and health problems. 

5 ‘‘(3) BEHAVIORAL HEALTH AFTERCARE.—The 

6 term ‘behavioral health aftercare’ includes those ac7 tivities and resources used to support recovery fol8 lowing inpatient, residential, intensive substance 

9 abuse, or mental health outpatient or outpatient 

10 treatment. The purpose is to help prevent or deal 

11 with relapse by ensuring that by the time a client or 

12 patient is discharged from a level of care, such as 

13 outpatient treatment, an aftercare plan has been de14 veloped with the client. An aftercare plan may use 

15 such resources as a community-based therapeutic 

16 group, transitional living facilities, a 12-step spon17 sor, a local 12-step or other related support group, 

18 and other community-based providers. 

19 ‘‘(4) DUAL DIAGNOSIS.—The term ‘dual diag20 nosis’ means coexisting substance abuse and mental 

21 illness conditions or diagnosis. Such clients are 

22 sometimes referred to as mentally ill chemical abus23 ers (MICAs). 

24 ‘‘(5) FETAL ALCOHOL SPECTRUM DIS25 ORDERS.— 


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1 ‘‘(A) IN GENERAL.—The term ‘fetal alco2 hol spectrum disorders’ includes a range of ef3 fects that can occur in an individual whose 

4 mother drank alcohol during pregnancy, includ5 ing physical, mental, behavioral, and/or learning 

6 disabilities with possible lifelong implications. 

7 ‘‘(B) INCLUSIONS.—The term ‘fetal alcohol 

8 spectrum disorders’ may include— 

9 ‘‘(i) fetal alcohol syndrome (FAS); 

10 ‘‘(ii) partial fetal alcohol syndrome 

11 (partial FAS); 

12 ‘‘(iii) alcohol-related birth defects 

13 (ARBD); and 

14 ‘‘(iv) alcohol-related 

15 neurodevelopmental disorders (ARND). 

16 ‘‘(6) FAS OR FETAL ALCOHOL SYNDROME.— 

17 The term ‘FAS’ or ‘fetal alcohol syndrome’ means a 

18 syndrome in which, with a history of maternal alco19 hol consumption during pregnancy, the following cri20 teria are met: 

21 ‘‘(A) Central nervous system involvement, 

22 such as mental retardation, developmental 

23 delay, intellectual deficit, microencephaly, or 

24 neurological abnormalities. 


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1 ‘‘(B) Craniofacial abnormalities with at 

2 least 2 of the following: 

3 ‘‘(i) Microophthalmia. 

4 ‘‘(ii) Short palpebral fissures. 

5 ‘‘(iii) Poorly developed philtrum. 

6 ‘‘(iv) Thin upper lip. 

7 ‘‘(v) Flat nasal bridge. 

8 ‘‘(vi) Short upturned nose. 

9 ‘‘(C) Prenatal or postnatal growth delay. 

10 ‘‘(7) REHABILITATION.—The term ‘rehabilita11 tion’ means medical and health care services that— 

12 ‘‘(A) are recommended by a physician or 

13 licensed practitioner of the healing arts within 

14 the scope of their practice under applicable law; 

15 ‘‘(B) are furnished in a facility, home, or 

16 other setting in accordance with applicable 

17 standards; and 

18 ‘‘(C) have as their purpose any of the fol19 lowing: 

20 ‘‘(i) The maximum attainment of 

21 physical, mental, and developmental func22 tioning. 

23 ‘‘(ii) Averting deterioration in physical 

24 or mental functional status. 


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1 ‘‘(iii) The maintenance of physical or 

2 mental health functional status. 

3 ‘‘(8) SUBSTANCE ABUSE.—The term ‘substance 

4 abuse’ includes inhalant abuse. 

5 ‘‘(9) SYSTEMS OF CARE.—The term ‘Systems of 

6 Care’ means a system for delivering services to chil7 dren and their families that is child-centered, family8 focused and family-driven, community-based, and 

9 culturally competent and responsive to the needs of 

10 the children and families being served. The systems 

11 of care approach values prevention and early identi12 fication, smooth transitions for children and fami13 lies, child and family participation and advocacy, 

14 comprehensive array of services, individualized serv15 ice planning, services in the least restrictive environ16 ment, and integrated services with coordinated plan17 ning across the child-serving systems. 

18 ‘‘SEC. 702. BEHAVIORAL HEALTH PREVENTION AND TREAT19 MENT SERVICES. 

20 ‘‘(a) PURPOSES.—The purposes of this section are as 

21 follows: 

22 ‘‘(1) To authorize and direct the Secretary, act23 ing through the Service, Indian tribes, and tribal or24 ganizations, to develop a comprehensive behavioral 

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1 phasizes collaboration among alcohol and substance 

2 abuse, social services, and mental health programs. 

3 ‘‘(2) To provide information, direction, and 

4 guidance relating to mental illness and dysfunction 

5 and self-destructive behavior, including child abuse 

6 and family violence, to those Federal, tribal, State, 

7 and local agencies responsible for programs in In8 dian communities in areas of health care, education, 

9 social services, child and family welfare, alcohol and 

10 substance abuse, law enforcement, and judicial serv11 ices. 

12 ‘‘(3) To assist Indian tribes to identify services 

13 and resources available to address mental illness and 

14 dysfunctional and self-destructive behavior. 

15 ‘‘(4) To provide authority and opportunities for 

16 Indian tribes and tribal organizations to develop, im17 plement, and coordinate with community-based pro18 grams which include identification, prevention, edu19 cation, referral, and treatment services, including 

20 through multidisciplinary resource teams. 

21 ‘‘(5) To ensure that Indians, as citizens of the 

22 United States and of the States in which they re23 side, have the same access to behavioral health serv24 ices to which all citizens have access. 


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1 ‘‘(6) To modify or supplement existing pro2 grams and authorities in the areas identified in 

3 paragraph (2). 

4 ‘‘(b) PLANS.— 

5 ‘‘(1) DEVELOPMENT.—The Secretary, acting 

6 through the Service, Indian tribes, and tribal organi7 zations, shall encourage Indian tribes and tribal or8 ganizations to develop tribal plans, and urban Indian 

9 organizations to develop local plans, and for all such 

10 groups to participate in developing areawide plans 

11 for Indian Behavioral Health Services. The plans 

12 shall include, to the extent feasible, the following 

13 components: 

14 ‘‘(A) An assessment of the scope of alcohol 

15 or other substance abuse, mental illness, and 

16 dysfunctional and self-destructive behavior, in17 cluding suicide, child abuse, and family vio18 lence, among Indians, including— 

19 ‘‘(i) the number of Indians served who 

20 are directly or indirectly affected by such 

21 illness or behavior; or 

22 ‘‘(ii) an estimate of the financial and 

23 human cost attributable to such illness or 

24 behavior. 


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1 ‘‘(B) An assessment of the existing and 

2 additional resources necessary for the preven3 tion and treatment of such illness and behavior, 

4 including an assessment of the progress toward 

5 achieving the availability of the full continuum 

6 of care described in subsection (c). 

7 ‘‘(C) An estimate of the additional funding 

8 needed by the Service, Indian tribes, tribal or9 ganizations, and urban Indian organizations to 

10 meet their responsibilities under the plans. 

11 ‘‘(2) NATIONAL CLEARINGHOUSE.—The Sec12 retary, acting through the Service, shall coordinate 

13 with existing national clearinghouses and informa14 tion centers to include at the clearinghouses and 

15 centers plans and reports on the outcomes of such 

16 plans developed by Indian tribes, tribal organiza17 tions, urban Indian organizations, and Service areas 

18 relating to behavioral health. The Secretary shall en19 sure access to these plans and outcomes by any In20 dian tribe, tribal organization, urban Indian organi21 zation, or the Service. 

22 ‘‘(3) TECHNICAL ASSISTANCE.—The Secretary 

23 shall provide technical assistance to Indian tribes, 

24 tribal organizations, and urban Indian organizations 

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1 veloping standards of care that may be used and 

2 adopted locally. 

3 ‘‘(c) PROGRAMS.—The Secretary, acting through the 

4 Service, shall provide, to the extent feasible and if funding 

5 is available, programs including the following: 

6 ‘‘(1) COMPREHENSIVE CARE.—A comprehensive 

7 continuum of behavioral health care which pro8 vides— 

9 ‘‘(A) community-based prevention, inter10 vention, outpatient, and behavioral health 

11 aftercare; 

12 ‘‘(B) detoxification (social and medical); 

13 ‘‘(C) acute hospitalization; 

14 ‘‘(D) intensive outpatient/day treatment; 

15 ‘‘(E) residential treatment; 

16 ‘‘(F) transitional living for those needing a 

17 temporary, stable living environment that is 

18 supportive of treatment and recovery goals; 

19 ‘‘(G) emergency shelter; 

20 ‘‘(H) intensive case management; 

21 ‘‘(I) diagnostic services; and 

22 ‘‘(J) promotion of healthy approaches to 

23 risk and safety issues, including injury preven24 tion. 


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1 ‘‘(2) CHILD CARE.—Behavioral health services 

2 for Indians from birth through age 17, including— 

3 ‘‘(A) preschool and school age fetal alcohol 

4 spectrum disorder services, including assess5 ment and behavioral intervention; 

6 ‘‘(B) mental health and substance abuse 

7 services (emotional, organic, alcohol, drug, in8 halant, and tobacco); 

9 ‘‘(C) identification and treatment of co-oc10 curring disorders and comorbidity; 

11 ‘‘(D) prevention of alcohol, drug, inhalant, 

12 and tobacco use; 

13 ‘‘(E) early intervention, treatment, and 

14 aftercare; 

15 ‘‘(F) promotion of healthy approaches to 

16 risk and safety issues; and 

17 ‘‘(G) identification and treatment of ne18 glect and physical, mental, and sexual abuse. 

19 ‘‘(3) ADULT CARE.—Behavioral health services 

20 for Indians from age 18 through 55, including— 

21 ‘‘(A) early intervention, treatment, and 

22 aftercare; 

23 ‘‘(B) mental health and substance abuse 

24 services (emotional, alcohol, drug, inhalant, and 

25 tobacco), including sex specific services; 


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1 ‘‘(C) identification and treatment of co-oc2 curring disorders (dual diagnosis) and comor3 bidity; 

4 ‘‘(D) promotion of healthy approaches for 

5 risk-related behavior; 

6 ‘‘(E) treatment services for women at risk 

7 of giving birth to a child with a fetal alcohol 

8 spectrum disorder; and 

9 ‘‘(F) sex specific treatment for sexual as10 sault and domestic violence. 

11 ‘‘(4) FAMILY CARE.—Behavioral health services 

12 for families, including— 

13 ‘‘(A) early intervention, treatment, and 

14 aftercare for affected families; 

15 ‘‘(B) treatment for sexual assault and do16 mestic violence; and 

17 ‘‘(C) promotion of healthy approaches re18 lating to parenting, domestic violence, and other 

19 abuse issues. 

20 ‘‘(5) ELDER CARE.—Behavioral health services 

21 for Indians 56 years of age and older, including— 

22 ‘‘(A) early intervention, treatment, and 

23 aftercare; 


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1 ‘‘(B) mental health and substance abuse 

2 services (emotional, alcohol, drug, inhalant, and 

3 tobacco), including sex specific services; 

4 ‘‘(C) identification and treatment of co-oc5 curring disorders (dual diagnosis) and comor6 bidity; 

7 ‘‘(D) promotion of healthy approaches to 

8 managing conditions related to aging; 

9 ‘‘(E) sex specific treatment for sexual as10 sault, domestic violence, neglect, physical and 

11 mental abuse and exploitation; and 

12 ‘‘(F) identification and treatment of de13 mentias regardless of cause. 

14 ‘‘(d) COMMUNITY BEHAVIORAL HEALTH PLAN.— 

15 ‘‘(1) ESTABLISHMENT.—The governing body of 

16 any Indian tribe, tribal organization, or urban In17 dian organization may adopt a resolution for the es18 tablishment of a community behavioral health plan 

19 providing for the identification and coordination of 

20 available resources and programs to identify, pre21 vent, or treat substance abuse, mental illness, or 

22 dysfunctional and self-destructive behavior, including 

23 child abuse and family violence, among its members 

24 or its service population. This plan should include 


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1 behavioral health services, social services, intensive 

2 outpatient services, and continuing aftercare. 

3 ‘‘(2) TECHNICAL ASSISTANCE.—At the request 

4 of an Indian tribe, tribal organization, or urban In5 dian organization, the Bureau of Indian Affairs and 

6 the Service shall cooperate with and provide tech7 nical assistance to the Indian tribe, tribal organiza8 tion, or urban Indian organization in the develop9 ment and implementation of such plan. 

10 ‘‘(3) FUNDING.—The Secretary, acting through 

11 the Service, Indian tribes, and tribal organizations, 

12 may make funding available to Indian tribes and 

13 tribal organizations which adopt a resolution pursu14 ant to paragraph (1) to obtain technical assistance 

15 for the development of a community behavioral 

16 health plan and to provide administrative support in 

17 the implementation of such plan. 

18 ‘‘(e) COORDINATION FOR AVAILABILITY OF SERV19 ICES.—The Secretary, acting through the Service, shall 

20 coordinate behavioral health planning, to the extent fea21 sible, with other Federal agencies and with State agencies, 

22 to encourage comprehensive behavioral health services for 

23 Indians regardless of their place of residence. 

24 ‘‘(f) MENTAL HEALTH CARE NEED ASSESSMENT.— 

25 Not later than 1 year after the date of enactment of the 


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1 Indian Health Care Improvement Reauthorization and 

2 Extension Act of 2009, the Secretary, acting through the 

3 Service, shall make an assessment of the need for inpa4 tient mental health care among Indians and the avail5 ability and cost of inpatient mental health facilities which 

6 can meet such need. In making such assessment, the Sec7 retary shall consider the possible conversion of existing, 

8 underused Service hospital beds into psychiatric units to 

9 meet such need. 

10 ‘‘SEC. 703. MEMORANDA OF AGREEMENT WITH THE DE11 PARTMENT OF INTERIOR. 

12 ‘‘(a) CONTENTS.—Not later than 1 year after the 

13 date of enactment of the Indian Health Care Improvement 

14 Reauthorization and Extension Act of 2009, the Sec15 retary, acting through the Service, and the Secretary of 

16 the Interior shall develop and enter into a memoranda of 

17 agreement, or review and update any existing memoranda 

18 of agreement, as required by section 4205 of the Indian 

19 Alcohol and Substance Abuse Prevention and Treatment 

20 Act of 1986 (25 U.S.C. 2411) under which the Secretaries 

21 address the following: 

22 ‘‘(1) The scope and nature of mental illness and 

23 dysfunctional and self-destructive behavior, including 

24 child abuse and family violence, among Indians. 


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1 ‘‘(2) The existing Federal, tribal, State, local, 

2 and private services, resources, and programs avail3 able to provide behavioral health services for Indi4 ans. 

5 ‘‘(3) The unmet need for additional services, re6 sources, and programs necessary to meet the needs 

7 identified pursuant to paragraph (1). 

8 ‘‘(4)(A) The right of Indians, as citizens of the 

9 United States and of the States in which they re10 side, to have access to behavioral health services to 

11 which all citizens have access. 

12 ‘‘(B) The right of Indians to participate in, and 

13 receive the benefit of, such services. 

14 ‘‘(C) The actions necessary to protect the exer15 cise of such right. 

16 ‘‘(5) The responsibilities of the Bureau of In17 dian Affairs and the Service, including mental illness 

18 identification, prevention, education, referral, and 

19 treatment services (including services through multi20 disciplinary resource teams), at the central, area, 

21 and agency and Service unit, Service area, and head22 quarters levels to address the problems identified in 

23 paragraph (1). 

24 ‘‘(6) A strategy for the comprehensive coordina25 tion of the behavioral health services provided by the 


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1 Bureau of Indian Affairs and the Service to meet 

2 the problems identified pursuant to paragraph (1), 

3 including— 

4 ‘‘(A) the coordination of alcohol and sub5 stance abuse programs of the Service, the Bu6 reau of Indian Affairs, and Indian tribes and 

7 tribal organizations (developed under the Indian 

8 Alcohol and Substance Abuse Prevention and 

9 Treatment Act of 1986 (25 U.S.C. 2401 et 

10 seq.)) with behavioral health initiatives pursu11 ant to this Act, particularly with respect to the 

12 referral and treatment of dually diagnosed indi13 viduals requiring behavioral health and sub14 stance abuse treatment; and 

15 ‘‘(B) ensuring that the Bureau of Indian 

16 Affairs and Service programs and services (in17 cluding multidisciplinary resource teams) ad18 dressing child abuse and family violence are co19 ordinated with such non-Federal programs and 

20 services. 

21 ‘‘(7) Directing appropriate officials of the Bu22 reau of Indian Affairs and the Service, particularly 

23 at the agency and Service unit levels, to cooperate 

24 fully with tribal requests made pursuant to commu25 nity behavioral health plans adopted under section 


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1 702(c) and section 4206 of the Indian Alcohol and 

2 Substance Abuse Prevention and Treatment Act of 

3 1986 (25 U.S.C. 2412). 

4 ‘‘(8) Providing for an annual review of such 

5 agreement by the Secretaries which shall be provided 

6 to Congress and Indian tribes and tribal organiza7 tions. 

8 ‘‘(b) SPECIFIC PROVISIONS REQUIRED.—The memo9 randa of agreement updated or entered into pursuant to 

10 subsection (a) shall include specific provisions pursuant to 

11 which the Service shall assume responsibility for— 

12 ‘‘(1) the determination of the scope of the prob13 lem of alcohol and substance abuse among Indians, 

14 including the number of Indians within the jurisdic15 tion of the Service who are directly or indirectly af16 fected by alcohol and substance abuse and the finan17 cial and human cost; 

18 ‘‘(2) an assessment of the existing and needed 

19 resources necessary for the prevention of alcohol and 

20 substance abuse and the treatment of Indians af21 fected by alcohol and substance abuse; and 

22 ‘‘(3) an estimate of the funding necessary to 

23 adequately support a program of prevention of alco24 hol and substance abuse and treatment of Indians 

25 affected by alcohol and substance abuse. 


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1 ‘‘(c) PUBLICATION.—Each memorandum of agree2 ment entered into or renewed (and amendments or modi3 fications thereto) under subsection (a) shall be published 

4 in the Federal Register. At the same time as publication 

5 in the Federal Register, the Secretary shall provide a copy 

6 of such memoranda, amendment, or modification to each 

7 Indian tribe, tribal organization, and urban Indian organi8 zation. 

9 ‘‘SEC. 704. COMPREHENSIVE BEHAVIORAL HEALTH PRE10 VENTION AND TREATMENT PROGRAM. 

11 ‘‘(a) ESTABLISHMENT.— 

12 ‘‘(1) IN GENERAL.—The Secretary, acting 

13 through the Service, shall provide a program of com14 prehensive behavioral health, prevention, treatment, 

15 and aftercare, including Systems of Care, which 

16 shall include— 

17 ‘‘(A) prevention, through educational inter18 vention, in Indian communities; 

19 ‘‘(B) acute detoxification, psychiatric hos20 pitalization, residential, and intensive outpatient 

21 treatment; 

22 ‘‘(C) community-based rehabilitation and 

23 aftercare; 

24 ‘‘(D) community education and involve25 ment, including extensive training of health 


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1 care, educational, and community-based per2 sonnel; 

3 ‘‘(E) specialized residential treatment pro4 grams for high-risk populations, including preg5 nant and postpartum women and their children; 

6 and 

7 ‘‘(F) diagnostic services. 

8 ‘‘(2) TARGET POPULATIONS.—The target popu9 lation of such programs shall be members of Indian 

10 tribes. Efforts to train and educate key members of 

11 the Indian community shall also target employees of 

12 health, education, judicial, law enforcement, legal, 

13 and social service programs. 

14 ‘‘(b) CONTRACT HEALTH SERVICES.— 

15 ‘‘(1) IN GENERAL.—The Secretary, acting 

16 through the Service, may enter into contracts with 

17 public or private providers of behavioral health treat18 ment services for the purpose of carrying out the 

19 program required under subsection (a). 

20 ‘‘(2) PROVISION OF ASSISTANCE.—In carrying 

21 out this subsection, the Secretary shall provide as22 sistance to Indian tribes and tribal organizations to 

23 develop criteria for the certification of behavioral 

24 health service providers and accreditation of service 


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1 facilities which meet minimum standards for such 

2 services and facilities. 

3 ‘‘SEC. 705. MENTAL HEALTH TECHNICIAN PROGRAM. 

4 ‘‘(a) IN GENERAL.—Pursuant to the Act of Novem5 ber 2, 1921 (25 U.S.C. 13) (commonly known as the ‘Sny6 der Act’), the Secretary shall establish and maintain a 

7 mental health technician program within the Service 

8 which— 

9 ‘‘(1) provides for the training of Indians as 

10 mental health technicians; and 

11 ‘‘(2) employs such technicians in the provision 

12 of community-based mental health care that includes 

13 identification, prevention, education, referral, and 

14 treatment services. 

15 ‘‘(b) PARAPROFESSIONAL TRAINING.—In carrying 

16 out subsection (a), the Secretary, acting through the Serv17 ice, shall provide high-standard paraprofessional training 

18 in mental health care necessary to provide quality care to 

19 the Indian communities to be served. Such training shall 

20 be based upon a curriculum developed or approved by the 

21 Secretary which combines education in the theory of men22 tal health care with supervised practical experience in the 

23 provision of such care. 

24 ‘‘(c) SUPERVISION AND EVALUATION OF TECHNI25 CIANS.—The Secretary, acting through the Service, shall 


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1 supervise and evaluate the mental health technicians in 

2 the training program. 

3 ‘‘(d) TRADITIONAL HEALTH CARE PRACTICES.—The 

4 Secretary, acting through the Service, shall ensure that 

5 the program established pursuant to this subsection in6 volves the use and promotion of the traditional health care 

7 practices of the Indian tribes to be served. 

8 ‘‘SEC. 706. LICENSING REQUIREMENT FOR MENTAL 

9 HEALTH CARE WORKERS. 

10 ‘‘(a) IN GENERAL.—Subject to section 221, and ex11 cept as provided in subsection (b), any individual employed 

12 as a psychologist, social worker, or marriage and family 

13 therapist for the purpose of providing mental health care 

14 services to Indians in a clinical setting under this Act is 

15 required to be licensed as a psychologist, social worker, 

16 or marriage and family therapist, respectively. 

17 ‘‘(b) TRAINEES.—An individual may be employed as 

18 a trainee in psychology, social work, or marriage and fam19 ily therapy to provide mental health care services de20 scribed in subsection (a) if such individual— 

21 ‘‘(1) works under the direct supervision of a li22 censed psychologist, social worker, or marriage and 

23 family therapist, respectively; 

24 ‘‘(2) is enrolled in or has completed at least 2 

25 years of course work at a post-secondary, accredited 


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1 education program for psychology, social work, mar2 riage and family therapy, or counseling; and 

3 ‘‘(3) meets such other training, supervision, and 

4 quality review requirements as the Secretary may es5 tablish. 

6 ‘‘SEC. 707. INDIAN WOMEN TREATMENT PROGRAMS. 

7 ‘‘(a) GRANTS.—The Secretary, consistent with sec8 tion 702, may make grants to Indian tribes, tribal organi9 zations, and urban Indian organizations to develop and 

10 implement a comprehensive behavioral health program of 

11 prevention, intervention, treatment, and relapse preven12 tion services that specifically addresses the cultural, his13 torical, social, and child care needs of Indian women, re14 gardless of age. 

15 ‘‘(b) USE OF GRANT FUNDS.—A grant made pursu16 ant to this section may be used— 

17 ‘‘(1) to develop and provide community train18 ing, education, and prevention programs for Indian 

19 women relating to behavioral health issues, including 

20 fetal alcohol spectrum disorders; 

21 ‘‘(2) to identify and provide psychological serv22 ices, counseling, advocacy, support, and relapse pre23 vention to Indian women and their families; and 

24 ‘‘(3) to develop prevention and intervention 

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1 tional health care practices, cultural values, and 

2 community and family involvement. 

3 ‘‘(c) CRITERIA.—The Secretary, in consultation with 

4 Indian tribes and tribal organizations, shall establish cri5 teria for the review and approval of applications and pro6 posals for funding under this section. 

7 ‘‘(d) ALLOCATION OF FUNDS FOR URBAN INDIAN

8 ORGANIZATIONS.—20 percent of the funds appropriated 

9 pursuant to this section shall be used to make grants to 

10 urban Indian organizations. 

11 ‘‘SEC. 708. INDIAN YOUTH PROGRAM. 

12 ‘‘(a) DETOXIFICATION AND REHABILITATION.—The 

13 Secretary, acting through the Service, consistent with sec14 tion 702, shall develop and implement a program for acute 

15 detoxification and treatment for Indian youths, including 

16 behavioral health services. The program shall include re17 gional treatment centers designed to include detoxification 

18 and rehabilitation for both sexes on a referral basis and 

19 programs developed and implemented by Indian tribes or 

20 tribal organizations at the local level under the Indian 

21 Self-Determination and Education Assistance Act (25 

22 U.S.C. 450 et seq.). Regional centers shall be integrated 

23 with the intake and rehabilitation programs based in the 

24 referring Indian community. 


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1 ‘‘(b) ALCOHOL AND SUBSTANCE ABUSE TREATMENT

2 CENTERS OR FACILITIES.— 

3 ‘‘(1) ESTABLISHMENT.— 

4 ‘‘(A) IN GENERAL.—The Secretary, acting 

5 through the Service, shall construct, renovate, 

6 or, as necessary, purchase, and appropriately 

7 staff and operate, at least 1 youth regional 

8 treatment center or treatment network in each 

9 area under the jurisdiction of an area office. 

10 ‘‘(B) AREA OFFICE IN CALIFORNIA.—For 

11 the purposes of this subsection, the area office 

12 in California shall be considered to be 2 area 

13 offices, 1 office whose jurisdiction shall be con14 sidered to encompass the northern area of the 

15 State of California, and 1 office whose jurisdic16 tion shall be considered to encompass the re17 mainder of the State of California for the pur18 pose of implementing California treatment net19 works. 

20 ‘‘(2) FUNDING.—For the purpose of staffing 

21 and operating such centers or facilities, funding 

22 shall be pursuant to the Act of November 2, 1921 

23 (25 U.S.C. 13). 

24 ‘‘(3) LOCATION.—A youth treatment center 

25 constructed or purchased under this subsection shall 


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1 be constructed or purchased at a location within the 

2 area described in paragraph (1) agreed upon (by ap3 propriate tribal resolution) by a majority of the In4 dian tribes to be served by such center. 

5 ‘‘(4) SPECIFIC PROVISION OF FUNDS.— 

6 ‘‘(A) IN GENERAL.—Notwithstanding any 

7 other provision of this title, the Secretary may, 

8 from amounts authorized to be appropriated for 

9 the purposes of carrying out this section, make 

10 funds available to— 

11 ‘‘(i) the Tanana Chiefs Conference, 

12 Incorporated, for the purpose of leasing, 

13 constructing, renovating, operating, and 

14 maintaining a residential youth treatment 

15 facility in Fairbanks, Alaska; and 

16 ‘‘(ii) the Southeast Alaska Regional 

17 Health Corporation to staff and operate a 

18 residential youth treatment facility without 

19 regard to the proviso set forth in section 

20 4(l) of the Indian Self-Determination and 

21 Education Assistance Act (25 U.S.C. 

22 450b(l)). 

23 ‘‘(B) PROVISION OF SERVICES TO ELIGI24 BLE YOUTHS.—Until additional residential 

25 youth treatment facilities are established in 


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1 Alaska pursuant to this section, the facilities 

2 specified in subparagraph (A) shall make every 

3 effort to provide services to all eligible Indian 

4 youths residing in Alaska. 

5 ‘‘(c) INTERMEDIATE ADOLESCENT BEHAVIORAL

6 HEALTH SERVICES.— 

7 ‘‘(1) IN GENERAL.—The Secretary, acting 

8 through the Service, may provide intermediate be9 havioral health services, which may incorporate Sys10 tems of Care, to Indian children and adolescents, in11 cluding— 

12 ‘‘(A) pretreatment assistance; 

13 ‘‘(B) inpatient, outpatient, and aftercare 

14 services; 

15 ‘‘(C) emergency care; 

16 ‘‘(D) suicide prevention and crisis interven17 tion; and 

18 ‘‘(E) prevention and treatment of mental 

19 illness and dysfunctional and self-destructive 

20 behavior, including child abuse and family vio21 lence. 

22 ‘‘(2) USE OF FUNDS.—Funds provided under 

23 this subsection may be used— 


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1 ‘‘(A) to construct or renovate an existing 

2 health facility to provide intermediate behav3 ioral health services; 

4 ‘‘(B) to hire behavioral health profes5 sionals; 

6 ‘‘(C) to staff, operate, and maintain an in7 termediate mental health facility, group home, 

8 sober housing, transitional housing or similar 

9 facilities, or youth shelter where intermediate 

10 behavioral health services are being provided; 

11 ‘‘(D) to make renovations and hire appro12 priate staff to convert existing hospital beds 

13 into adolescent psychiatric units; and 

14 ‘‘(E) for intensive home- and community15 based services. 

16 ‘‘(3) CRITERIA.—The Secretary, acting through 

17 the Service, shall, in consultation with Indian tribes 

18 and tribal organizations, establish criteria for the re19 view and approval of applications or proposals for 

20 funding made available pursuant to this subsection. 

21 ‘‘(d) FEDERALLY OWNED STRUCTURES.— 

22 ‘‘(1) IN GENERAL.—The Secretary, in consulta23 tion with Indian tribes and tribal organizations, 

24 shall— 


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1 ‘‘(A) identify and use, where appropriate, 

2 federally owned structures suitable for local res3 idential or regional behavioral health treatment 

4 for Indian youths; and 

5 ‘‘(B) establish guidelines for determining 

6 the suitability of any such federally owned 

7 structure to be used for local residential or re8 gional behavioral health treatment for Indian 

9 youths. 

10 ‘‘(2) TERMS AND CONDITIONS FOR USE OF

11 STRUCTURE.—Any structure described in paragraph 

12 (1) may be used under such terms and conditions as 

13 may be agreed upon by the Secretary and the agency 

14 having responsibility for the structure and any In15 dian tribe or tribal organization operating the pro16 gram. 

17 ‘‘(e) REHABILITATION AND AFTERCARE SERVICES.— 

18 ‘‘(1) IN GENERAL.—The Secretary, Indian 

19 tribes, or tribal organizations, in cooperation with 

20 the Secretary of the Interior, shall develop and im21 plement within each Service unit, community-based 

22 rehabilitation and follow-up services for Indian 

23 youths who are having significant behavioral health 

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1 dian youths after their return to their home commu2 nity. 

3 ‘‘(2) ADMINISTRATION.—Services under para4 graph (1) shall be provided by trained staff within 

5 the community who can assist the Indian youths in 

6 their continuing development of self-image, positive 

7 problem-solving skills, and nonalcohol or substance 

8 abusing behaviors. Such staff may include alcohol 

9 and substance abuse counselors, mental health pro10 fessionals, and other health professionals and para11 professionals, including community health represent12 atives. 

13 ‘‘(f) INCLUSION OF FAMILY IN YOUTH TREATMENT

14 PROGRAM.—In providing the treatment and other services 

15 to Indian youths authorized by this section, the Secretary, 

16 acting through the Service, shall provide for the inclusion 

17 of family members of such youths in the treatment pro18 grams or other services as may be appropriate. Not less 

19 than 10 percent of the funds appropriated for the pur20 poses of carrying out subsection (e) shall be used for out21 patient care of adult family members related to the treat22 ment of an Indian youth under that subsection. 

23 ‘‘(g) MULTIDRUG ABUSE PROGRAM.—The Secretary, 

24 acting through the Service, shall provide, consistent with 

25 section 702, programs and services to prevent and treat 


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1 the abuse of multiple forms of substances, including alco2 hol, drugs, inhalants, and tobacco, among Indian youths 

3 residing in Indian communities, on or near reservations, 

4 and in urban areas and provide appropriate mental health 

5 services to address the incidence of mental illness among 

6 such youths. 

7 ‘‘(h) INDIAN YOUTH MENTAL HEALTH.—The Sec8 retary, acting through the Service, shall collect data for 

9 the report under section 801 with respect to— 

10 ‘‘(1) the number of Indian youth who are being 

11 provided mental health services through the Service 

12 and tribal health programs; 

13 ‘‘(2) a description of, and costs associated with, 

14 the mental health services provided for Indian youth 

15 through the Service and tribal health programs; 

16 ‘‘(3) the number of youth referred to the Serv17 ice or tribal health programs for mental health serv18 ices; 

19 ‘‘(4) the number of Indian youth provided resi20 dential treatment for mental health and behavioral 

21 problems through the Service and tribal health pro22 grams, reported separately for on- and off-reserva23 tion facilities; and 

24 ‘‘(5) the costs of the services described in para25 graph (4). 


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1 ‘‘SEC. 709. INPATIENT AND COMMUNITY-BASED MENTAL 

2 HEALTH FACILITIES DESIGN, CONSTRUC3 TION, AND STAFFING. 

4 ‘‘Not later than 1 year after the date of enactment 

5 of the Indian Health Care Improvement Reauthorization 

6 and Extension Act of 2009, the Secretary, acting through 

7 the Service, may provide, in each area of the Service, not 

8 less than 1 inpatient mental health care facility, or the 

9 equivalent, for Indians with behavioral health problems. 

10 For the purposes of this subsection, California shall be 

11 considered to be 2 area offices, 1 office whose location 

12 shall be considered to encompass the northern area of the 

13 State of California and 1 office whose jurisdiction shall 

14 be considered to encompass the remainder of the State 

15 of California. The Secretary shall consider the possible 

16 conversion of existing, underused Service hospital beds 

17 into psychiatric units to meet such need. 

18 ‘‘SEC. 710. TRAINING AND COMMUNITY EDUCATION. 

19 ‘‘(a) PROGRAM.—The Secretary, in cooperation with 

20 the Secretary of the Interior, shall develop and implement 

21 or assist Indian tribes and tribal organizations to develop 

22 and implement, within each Service unit or tribal program, 

23 a program of community education and involvement which 

24 shall be designed to provide concise and timely information 

25 to the community leadership of each tribal community. 

26 Such program shall include education about behavioral 


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1 health issues to political leaders, tribal judges, law en2 forcement personnel, members of tribal health and edu3 cation boards, health care providers including traditional 

4 practitioners, and other critical members of each tribal 

5 community. Such program may also include community6 based training to develop local capacity and tribal commu7 nity provider training for prevention, intervention, treat8 ment, and aftercare. 

9 ‘‘(b) INSTRUCTION.—The Secretary, acting through 

10 the Service, shall provide instruction in the area of behav11 ioral health issues, including instruction in crisis interven12 tion and family relations in the context of alcohol and sub13 stance abuse, child sexual abuse, youth alcohol and sub14 stance abuse, and the causes and effects of fetal alcohol 

15 spectrum disorders to appropriate employees of the Bu16 reau of Indian Affairs and the Service, and to personnel 

17 in schools or programs operated under any contract with 

18 the Bureau of Indian Affairs or the Service, including su19 pervisors of emergency shelters and halfway houses de20 scribed in section 4213 of the Indian Alcohol and Sub21 stance Abuse Prevention and Treatment Act of 1986 (25 

22 U.S.C. 2433). 

23 ‘‘(c) TRAINING MODELS.—In carrying out the edu24 cation and training programs required by this section, the 

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1 zations, Indian behavioral health experts, and Indian alco2 hol and substance abuse prevention experts, shall develop 

3 and provide community-based training models. Such mod4 els shall address— 

5 ‘‘(1) the elevated risk of alcohol and behavioral 

6 health problems faced by children of alcoholics; 

7 ‘‘(2) the cultural, spiritual, and 

8 multigenerational aspects of behavioral health prob9 lem prevention and recovery; and 

10 ‘‘(3) community-based and multidisciplinary 

11 strategies, including Systems of Care, for preventing 

12 and treating behavioral health problems. 

13 ‘‘SEC. 711. BEHAVIORAL HEALTH PROGRAM. 

14 ‘‘(a) INNOVATIVE PROGRAMS.—The Secretary, acting 

15 through the Service, consistent with section 702, may 

16 plan, develop, implement, and carry out programs to de17 liver innovative community-based behavioral health serv18 ices to Indians. 

19 ‘‘(b) AWARDS; CRITERIA.—The Secretary may award 

20 a grant for a project under subsection (a) to an Indian 

21 tribe or tribal organization and may consider the following 

22 criteria: 

23 ‘‘(1) The project will address significant unmet 

24 behavioral health needs among Indians. 


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1 ‘‘(2) The project will serve a significant number 

2 of Indians. 

3 ‘‘(3) The project has the potential to deliver 

4 services in an efficient and effective manner. 

5 ‘‘(4) The Indian tribe or tribal organization has 

6 the administrative and financial capability to admin7 ister the project. 

8 ‘‘(5) The project may deliver services in a man9 ner consistent with traditional health care practices. 

10 ‘‘(6) The project is coordinated with, and avoids 

11 duplication of, existing services. 

12 ‘‘(c) EQUITABLE TREATMENT.—For purposes of this 

13 subsection, the Secretary shall, in evaluating project appli14 cations or proposals, use the same criteria that the Sec15 retary uses in evaluating any other application or proposal 

16 for such funding. 

17 ‘‘SEC. 712. FETAL ALCOHOL SPECTRUM DISORDERS PRO18 GRAMS. 

19 ‘‘(a) PROGRAMS.— 

20 ‘‘(1) ESTABLISHMENT.—The Secretary, con21 sistent with section 701, acting through the Service, 

22 Indian Tribes, and Tribal Organizations, is author23 ized to establish and operate fetal alcohol spectrum 

24 disorders programs as provided in this section for 


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1 the purposes of meeting the health status objectives 

2 specified in section 3. 

3 ‘‘(2) USE OF FUNDS.— 

4 ‘‘(A) IN GENERAL.—Funding provided 

5 pursuant to this section shall be used for the 

6 following: 

7 ‘‘(i) To develop and provide for Indi8 ans community and in-school training, edu9 cation, and prevention programs relating 

10 to fetal alcohol spectrum disorders. 

11 ‘‘(ii) To identify and provide behav12 ioral health treatment to high-risk Indian 

13 women and high-risk women pregnant with 

14 an Indian’s child. 

15 ‘‘(iii) To identify and provide appro16 priate psychological services, educational 

17 and vocational support, counseling, advo18 cacy, and information to fetal alcohol spec19 trum disorders-affected Indians and their 

20 families or caretakers. 

21 ‘‘(iv) To develop and implement coun22 seling and support programs in schools for 

23 fetal alcohol spectrum disorders-affected 

24 Indian children. 


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1 ‘‘(v) To develop prevention and inter2 vention models which incorporate practi3 tioners of traditional health care practices, 

4 cultural values, and community involve5 ment. 

6 ‘‘(vi) To develop, print, and dissemi7 nate education and prevention materials on 

8 fetal alcohol spectrum disorders. 

9 ‘‘(vii) To develop and implement, in 

10 consultation with Indian Tribes and Tribal 

11 Organizations, and in conference with 

12 urban Indian Organizations, culturally sen13 sitive assessment and diagnostic tools in14 cluding dysmorphology clinics and multi15 disciplinary fetal alcohol spectrum dis16 orders clinics for use in Indian commu17 nities and urban Centers. 

18 ‘‘(viii) To develop and provide training 

19 on fetal alcohol spectrum disorders to pro20 fessionals providing services to Indians, in21 cluding medical and allied health practi22 tioners, social service providers, educators, 

23 and law enforcement, court officials and 

24 corrections personnel in the juvenile and 

25 criminal justice systems. 


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1 ‘‘(B) ADDITIONAL USES.—In addition to 

2 any purpose under subparagraph (A), funding 

3 provided pursuant to this section may be used 

4 for 1 or more of the following: 

5 ‘‘(i) Early childhood intervention 

6 projects from birth on to mitigate the ef7 fects of fetal alcohol spectrum disorders 

8 among Indians. 

9 ‘‘(ii) Community-based support serv10 ices for Indians and women pregnant with 

11 Indian children. 

12 ‘‘(iii) Community-based housing for 

13 adult Indians with fetal alcohol spectrum 

14 disorders. 

15 ‘‘(3) CRITERIA FOR APPLICATIONS.—The Sec16 retary shall establish criteria for the review and ap17 proval of applications for funding under this section. 

18 ‘‘(b) SERVICES.—The Secretary, acting through the 

19 Service, Indian Tribes, and Tribal Organizations, shall— 

20 ‘‘(1) develop and provide services for the pre21 vention, intervention, treatment, and aftercare for 

22 those affected by fetal alcohol spectrum disorders in 

23 Indian communities; and 

24 ‘‘(2) provide supportive services, including serv25 ices to meet the special educational, vocational, 


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1 school-to-work transition, and independent living 

2 needs of adolescent and adult Indians with fetal al3 cohol spectrum disorders. 

4 ‘‘(c) APPLIED RESEARCH PROJECTS.—The Sec5 retary, acting through the Substance Abuse and Mental 

6 Health Services Administration, shall make grants to In7 dian Tribes, Tribal Organizations, and urban Indian Or8 ganizations for applied research projects which propose to 

9 elevate the understanding of methods to prevent, inter10 vene, treat, or provide rehabilitation and behavioral health 

11 aftercare for Indians and urban Indians affected by fetal 

12 alcohol spectrum disorders. 

13 ‘‘(d) FUNDING FOR URBAN INDIAN ORGANIZA14 TIONS.—Ten percent of the funds appropriated pursuant 

15 to this section shall be used to make grants to urban In16 dian Organizations funded under title V. 

17 ‘‘SEC. 713. CHILD SEXUAL ABUSE AND PREVENTION TREAT18 MENT PROGRAMS. 

19 ‘‘(a) ESTABLISHMENT.—The Secretary, acting 

20 through the Service, shall establish, consistent with section 

21 702, in every Service area, programs involving treatment 

22 for— 

23 ‘‘(1) victims of sexual abuse who are Indian 

24 children or children in an Indian household; and 


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1 ‘‘(2) perpetrators of child sexual abuse who are 

2 Indian or members of an Indian household. 

3 ‘‘(b) USE OF FUNDS.—Funding provided pursuant to 

4 this section shall be used for the following: 

5 ‘‘(1) To develop and provide community edu6 cation and prevention programs related to sexual 

7 abuse of Indian children or children in an Indian 

8 household. 

9 ‘‘(2) To identify and provide behavioral health 

10 treatment to victims of sexual abuse who are Indian 

11 children or children in an Indian household, and to 

12 their family members who are affected by sexual 

13 abuse. 

14 ‘‘(3) To develop prevention and intervention 

15 models which incorporate traditional health care 

16 practices, cultural values, and community involve17 ment. 

18 ‘‘(4) To develop and implement culturally sen19 sitive assessment and diagnostic tools for use in In20 dian communities and urban centers. 

21 ‘‘(5) To identify and provide behavioral health 

22 treatment to Indian perpetrators and perpetrators 

23 who are members of an Indian household— 

24 ‘‘(A) making efforts to begin offender and 

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1 trator is incarcerated or at the earliest possible 

2 date if the perpetrator is not incarcerated; and 

3 ‘‘(B) providing treatment after the perpe4 trator is released, until it is determined that the 

5 perpetrator is not a threat to children. 

6 ‘‘(c) COORDINATION.—The programs established 

7 under subsection (a) shall be carried out in coordination 

8 with programs and services authorized under the Indian 

9 Child Protection and Family Violence Prevention Act (25 

10 U.S.C. 3201 et seq.). 

11 ‘‘SEC. 714. DOMESTIC AND SEXUAL VIOLENCE PREVENTION 

12 AND TREATMENT. 

13 ‘‘(a) IN GENERAL.—The Secretary, in accordance 

14 with section 702, is authorized to establish in each Service 

15 area programs involving the prevention and treatment 

16 of— 

17 ‘‘(1) Indian victims of domestic violence or sex18 ual abuse; and 

19 ‘‘(2) perpetrators of domestic violence or sexual 

20 abuse who are Indian or members of an Indian 

21 household. 

22 ‘‘(b) USE OF FUNDS.—Funds made available to carry 

23 out this section shall be used— 


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1 ‘‘(1) to develop and implement prevention pro2 grams and community education programs relating 

3 to domestic violence and sexual abuse; 

4 ‘‘(2) to provide behavioral health services, in5 cluding victim support services, and medical treat6 ment (including examinations performed by sexual 

7 assault nurse examiners) to Indian victims of domes8 tic violence or sexual abuse; 

9 ‘‘(3) to purchase rape kits; 

10 ‘‘(4) to develop prevention and intervention 

11 models, which may incorporate traditional health 

12 care practices; and 

13 ‘‘(5) to identify and provide behavioral health 

14 treatment to perpetrators who are Indian or mem15 bers of an Indian household. 

16 ‘‘(c) TRAINING AND CERTIFICATION.— 

17 ‘‘(1) IN GENERAL.—Not later than 1 year after 

18 the date of enactment of the Indian Health Care Im19 provement Reauthorization and Extension Act of 

20 2009, the Secretary shall establish appropriate pro21 tocols, policies, procedures, standards of practice, 

22 and, if not available elsewhere, training curricula 

23 and training and certification requirements for serv24 ices for victims of domestic violence and sexual 

25 abuse. 


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1 ‘‘(2) REPORT.—Not later than 18 months after 

2 the date of enactment of the Indian Health Care Im3 provement Reauthorization and Extension Act of 

4 2009, the Secretary shall submit to the Committee 

5 on Indian Affairs of the Senate and the Committee 

6 on Natural Resources of the House of Representa7 tives a report that describes the means and extent 

8 to which the Secretary has carried out paragraph 

9 (1). 

10 ‘‘(d) COORDINATION.— 

11 ‘‘(1) IN GENERAL.—The Secretary, in coordina12 tion with the Attorney General, Federal and tribal 

13 law enforcement agencies, Indian health programs, 

14 and domestic violence or sexual assault victim orga15 nizations, shall develop appropriate victim services 

16 and victim advocate training programs— 

17 ‘‘(A) to improve domestic violence or sex18 ual abuse responses; 

19 ‘‘(B) to improve forensic examinations and 

20 collection; 

21 ‘‘(C) to identify problems or obstacles in 

22 the prosecution of domestic violence or sexual 

23 abuse; and 

24 ‘‘(D) to meet other needs or carry out 

25 other activities required to prevent, treat, and 


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1 improve prosecutions of domestic violence and 

2 sexual abuse. 

3 ‘‘(2) REPORT.—Not later than 2 years after the 

4 date of enactment of the Indian Health Care Im5 provement Reauthorization and Extension Act of 

6 2009, the Secretary shall submit to the Committee 

7 on Indian Affairs of the Senate and the Committee 

8 on Natural Resources of the House of Representa9 tives a report that describes, with respect to the 

10 matters described in paragraph (1), the improve11 ments made and needed, problems or obstacles iden12 tified, and costs necessary to address the problems 

13 or obstacles, and any other recommendations that 

14 the Secretary determines to be appropriate. 

15 ‘‘SEC. 715. BEHAVIORAL HEALTH RESEARCH. 

16 ‘‘(a) IN GENERAL.—The Secretary, in consultation 

17 with appropriate Federal agencies, shall make grants to, 

18 or enter into contracts with, Indian tribes, tribal organiza19 tions, and urban Indian organizations or enter into con20 tracts with, or make grants to appropriate institutions for, 

21 the conduct of research on the incidence and prevalence 

22 of behavioral health problems among Indians served by the 

23 Service, Indian tribes, or tribal organizations and among 

24 Indians in urban areas. Research priorities under this sec25 tion shall include— 


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1 ‘‘(1) the multifactorial causes of Indian youth 

2 suicide, including— 

3 ‘‘(A) protective and risk factors and sci4 entific data that identifies those factors; and 

5 ‘‘(B) the effects of loss of cultural identity 

6 and the development of scientific data on those 

7 effects; 

8 ‘‘(2) the interrelationship and interdependence 

9 of behavioral health problems with alcoholism and 

10 other substance abuse, suicide, homicides, other in11 juries, and the incidence of family violence; and 

12 ‘‘(3) the development of models of prevention 

13 techniques. 

14 ‘‘(b) EMPHASIS.—The effect of the interrelationships 

15 and interdependencies referred to in subsection (a)(2) on 

16 children, and the development of prevention techniques 

17 under subsection (a)(3) applicable to children, shall be em18 phasized. 

19 ‘‘Subtitle B—Indian Youth Suicide 

20 Prevention 

21 ‘‘SEC. 721. FINDINGS AND PURPOSE. 

22 ‘‘(a) FINDINGS.—Congress finds that— 

23 ‘‘(1)(A) the rate of suicide of American Indians 

24 and Alaska Natives is 1.9 times higher than the na25 tional average rate; and 


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1 ‘‘(B) the rate of suicide of Indian and Alaska 

2 Native youth aged 15 through 24 is— 

3 ‘‘(i) 3.5 times the national average rate; 

4 and 

5 ‘‘(ii) the highest rate of any population 

6 group in the United States; 

7 ‘‘(2) many risk behaviors and contributing fac8 tors for suicide are more prevalent in Indian country 

9 than in other areas, including— 

10 ‘‘(A) history of previous suicide attempts; 

11 ‘‘(B) family history of suicide; 

12 ‘‘(C) history of depression or other mental 

13 illness; 

14 ‘‘(D) alcohol or drug abuse; 

15 ‘‘(E) health disparities; 

16 ‘‘(F) stressful life events and losses; 

17 ‘‘(G) easy access to lethal methods; 

18 ‘‘(H) exposure to the suicidal behavior of 

19 others; 

20 ‘‘(I) isolation; and 

21 ‘‘(J) incarceration; 

22 ‘‘(3) according to national data for 2005, sui23 cide was the second-leading cause of death for Indi24 ans and Alaska Natives of both sexes aged 10 

25 through 34; 


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1 ‘‘(4)(A) the suicide rates of Indian and Alaska 

2 Native males aged 15 through 24 are— 

3 ‘‘(i) as compared to suicide rates of males 

4 of any other racial group, up to 4 times greater; 

5 and 

6 ‘‘(ii) as compared to suicide rates of fe7 males of any other racial group, up to 11 times 

8 greater; and 

9 ‘‘(B) data demonstrates that, over their life10 times, females attempt suicide 2 to 3 times more 

11 often than males; 

12 ‘‘(5)(A) Indian tribes, especially Indian tribes 

13 located in the Great Plains, have experienced epi14 demic levels of suicide, up to 10 times the national 

15 average; and 

16 ‘‘(B) suicide clustering in Indian country affects 

17 entire tribal communities; 

18 ‘‘(6) death rates for Indians and Alaska Natives 

19 are statistically underestimated because many areas 

20 of Indian country lack the proper resources to iden21 tify and monitor the presence of disease; 

22 ‘‘(7)(A) the Indian Health Service experiences 

23 health professional shortages, with physician vacancy 

24 rates of approximately 17 percent, and nursing va25 cancy rates of approximately 18 percent, in 2007; 


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1 ‘‘(B) 90 percent of all teens who die by suicide 

2 suffer from a diagnosable mental illness at time of 

3 death; 

‘‘(C) more than 1 4 ⁄2 of teens who die by suicide 

5 have never been seen by a mental health provider; 

6 and 

‘‘(D) 1 7 ⁄3 of health needs in Indian country re8 late to mental health; 

9 ‘‘(8) often, the lack of resources of Indian 

10 tribes and the remote nature of Indian reservations 

11 make it difficult to meet the requirements necessary 

12 to access Federal assistance, including grants; 

13 ‘‘(9) the Substance Abuse and Mental Health 

14 Services Administration and the Service have estab15 lished specific initiatives to combat youth suicide in 

16 Indian country and among Indians and Alaska Na17 tives throughout the United States, including the 

18 National Suicide Prevention Initiative of the Service, 

19 which has worked with Service, tribal, and urban In20 dian health programs since 2003; 

21 ‘‘(10) the National Strategy for Suicide Preven22 tion was established in 2001 through a Department 

23 of Health and Human Services collaboration 

24 among— 


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1 ‘‘(A) the Substance Abuse and Mental 

2 Health Services Administration; 

3 ‘‘(B) the Service; 

4 ‘‘(C) the Centers for Disease Control and 

5 Prevention; 

6 ‘‘(D) the National Institutes of Health; 

7 and 

8 ‘‘(E) the Health Resources and Services 

9 Administration; and 

10 ‘‘(11) the Service and other agencies of the De11 partment of Health and Human Services use infor12 mation technology and other programs to address 

13 the suicide prevention and mental health needs of 

14 Indians and Alaska Natives. 

15 ‘‘(b) PURPOSES.—The purposes of this subtitle are— 

16 ‘‘(1) to authorize the Secretary to carry out a 

17 demonstration project to test the use of telemental 

18 health services in suicide prevention, intervention, 

19 and treatment of Indian youth, including through— 

20 ‘‘(A) the use of psychotherapy, psychiatric 

21 assessments, diagnostic interviews, therapies for 

22 mental health conditions predisposing to sui23 cide, and alcohol and substance abuse treat24 ment; 


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1 ‘‘(B) the provision of clinical expertise to, 

2 consultation services with, and medical advice 

3 and training for frontline health care providers 

4 working with Indian youth; 

5 ‘‘(C) training and related support for com6 munity leaders, family members, and health 

7 and education workers who work with Indian 

8 youth; 

9 ‘‘(D) the development of culturally relevant 

10 educational materials on suicide; and 

11 ‘‘(E) data collection and reporting; 

12 ‘‘(2) to encourage Indian tribes, tribal organiza13 tions, and other mental health care providers serving 

14 residents of Indian country to obtain the services of 

15 predoctoral psychology and psychiatry interns; and 

16 ‘‘(3) to enhance the provision of mental health 

17 care services to Indian youth through existing grant 

18 programs of the Substance Abuse and Mental 

19 Health Services Administration. 

20 ‘‘SEC. 722. DEFINITIONS. 

21 ‘‘In this subtitle: 

22 ‘‘(1) ADMINISTRATION.—The term ‘Administra23 tion’ means the Substance Abuse and Mental Health 

24 Services Administration. 


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1 ‘‘(2) DEMONSTRATION PROJECT.—The term 

2 ‘demonstration project’ means the Indian youth tele3 mental health demonstration project authorized 

4 under section 723(a). 

5 ‘‘(3) INDIAN COUNTRY.—The term ‘Indian 

6 country’ has the meaning given the term in section 

7 1151 of title 18, United States Code. 

8 ‘‘(4) TELEMENTAL HEALTH.—The term ‘tele9 mental health’ means the use of electronic informa10 tion and telecommunications technologies to support 

11 long-distance mental health care, patient and profes12 sional-related education, public health, and health 

13 administration. 

14 ‘‘SEC. 723. INDIAN YOUTH TELEMENTAL HEALTH DEM15 ONSTRATION PROJECT. 

16 ‘‘(a) AUTHORIZATION.— 

17 ‘‘(1) IN GENERAL.—The Secretary, acting 

18 through the Service, is authorized to carry out a 

19 demonstration project to award grants for the provi20 sion of telemental health services to Indian youth 

21 who— 

22 ‘‘(A) have expressed suicidal ideas; 

23 ‘‘(B) have attempted suicide; or 

24 ‘‘(C) have mental health conditions that in25 crease or could increase the risk of suicide. 


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1 ‘‘(2) ELIGIBILITY FOR GRANTS.—Grants under 

2 paragraph (1) shall be awarded to Indian tribes and 

3 tribal organizations that operate 1 or more facili4 ties— 

5 ‘‘(A) located in an area with documented 

6 disproportionately high rates of suicide; 

7 ‘‘(B) reporting active clinical telehealth ca8 pabilities; or 

9 ‘‘(C) offering school-based telemental 

10 health services to Indian youth. 

11 ‘‘(3) GRANT PERIOD.—The Secretary shall 

12 award grants under this section for a period of up 

13 to 4 years. 

14 ‘‘(4) MAXIMUM NUMBER OF GRANTS.—Not 

15 more than 5 grants shall be provided under para16 graph (1), with priority consideration given to In17 dian tribes and tribal organizations that— 

18 ‘‘(A) serve a particular community or geo19 graphic area in which there is a demonstrated 

20 need to address Indian youth suicide; 

21 ‘‘(B) enter into collaborative partnerships 

22 with Service or other tribal health programs or 

23 facilities to provide services under this dem24 onstration project; 


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1 ‘‘(C) serve an isolated community or geo2 graphic area that has limited or no access to 

3 behavioral health services; or 

4 ‘‘(D) operate a detention facility at which 

5 Indian youth are detained. 

6 ‘‘(5) CONSULTATION WITH ADMINISTRATION.— 

7 In developing and carrying out the demonstration 

8 project under this subsection, the Secretary shall 

9 consult with the Administration as the Federal agen10 cy focused on mental health issues, including suicide. 

11 ‘‘(b) USE OF FUNDS.— 

12 ‘‘(1) IN GENERAL.—An Indian tribe or tribal 

13 organization shall use a grant received under sub14 section (a) for the following purposes: 

15 ‘‘(A) To provide telemental health services 

16 to Indian youth, including the provision of— 

17 ‘‘(i) psychotherapy; 

18 ‘‘(ii) psychiatric assessments and di19 agnostic interviews, therapies for mental 

20 health conditions predisposing to suicide, 

21 and treatment; and 

22 ‘‘(iii) alcohol and substance abuse 

23 treatment. 

24 ‘‘(B) To provide clinician-interactive med25 ical advice, guidance and training, assistance in 


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1 diagnosis and interpretation, crisis counseling 

2 and intervention, and related assistance to 

3 Service or tribal clinicians and health services 

4 providers working with youth being served 

5 under the demonstration project. 

6 ‘‘(C) To assist, educate, and train commu7 nity leaders, health education professionals and 

8 paraprofessionals, tribal outreach workers, and 

9 family members who work with the youth re10 ceiving telemental health services under the 

11 demonstration project, including with identifica12 tion of suicidal tendencies, crisis intervention 

13 and suicide prevention, emergency skill develop14 ment, and building and expanding networks 

15 among those individuals and with State and 

16 local health services providers. 

17 ‘‘(D) To develop and distribute culturally 

18 appropriate community educational materials 

19 regarding— 

20 ‘‘(i) suicide prevention; 

21 ‘‘(ii) suicide education; 

22 ‘‘(iii) suicide screening; 

23 ‘‘(iv) suicide intervention; and 


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1 ‘‘(v) ways to mobilize communities 

2 with respect to the identification of risk 

3 factors for suicide. 

4 ‘‘(E) To conduct data collection and re5 porting relating to Indian youth suicide preven6 tion efforts. 

7 ‘‘(2) TRADITIONAL HEALTH CARE PRAC8 TICES.—In carrying out the purposes described in 

9 paragraph (1), an Indian tribe or tribal organization 

10 may use and promote the traditional health care 

11 practices of the Indian tribes of the youth to be 

12 served. 

13 ‘‘(c) APPLICATIONS.— 

14 ‘‘(1) IN GENERAL.—Subject to paragraph (2), 

15 to be eligible to receive a grant under subsection (a), 

16 an Indian tribe or tribal organization shall prepare 

17 and submit to the Secretary an application, at such 

18 time, in such manner, and containing such informa19 tion as the Secretary may require, including— 

20 ‘‘(A) a description of the project that the 

21 Indian tribe or tribal organization will carry out 

22 using the funds provided under the grant; 

23 ‘‘(B) a description of the manner in which 

24 the project funded under the grant would— 


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1 ‘‘(i) meet the telemental health care 

2 needs of the Indian youth population to be 

3 served by the project; or 

4 ‘‘(ii) improve the access of the Indian 

5 youth population to be served to suicide 

6 prevention and treatment services; 

7 ‘‘(C) evidence of support for the project 

8 from the local community to be served by the 

9 project; 

10 ‘‘(D) a description of how the families and 

11 leadership of the communities or populations to 

12 be served by the project would be involved in 

13 the development and ongoing operations of the 

14 project; 

15 ‘‘(E) a plan to involve the tribal commu16 nity of the youth who are provided services by 

17 the project in planning and evaluating the men18 tal health care and suicide prevention efforts 

19 provided, in order to ensure the integration of 

20 community, clinical, environmental, and cultural 

21 components of the treatment; and 

22 ‘‘(F) a plan for sustaining the project after 

23 Federal assistance for the demonstration 

24 project has terminated. 


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1 ‘‘(2) EFFICIENCY OF GRANT APPLICATION

2 PROCESS.—The Secretary shall carry out such meas3 ures as the Secretary determines to be necessary to 

4 maximize the time and workload efficiency of the 

5 process by which Indian tribes and tribal organiza6 tions apply for grants under paragraph (1). 

7 ‘‘(d) COLLABORATION.—The Secretary, acting 

8 through the Service, shall encourage Indian tribes and 

9 tribal organizations receiving grants under this section to 

10 collaborate to enable comparisons regarding best practices 

11 across projects. 

12 ‘‘(e) ANNUAL REPORT.—Each grant recipient shall 

13 submit to the Secretary an annual report that— 

14 ‘‘(1) describes the number of telemental health 

15 services provided; and 

16 ‘‘(2) includes any other information that the 

17 Secretary may require. 

18 ‘‘(f) REPORTS TO CONGRESS.— 

19 ‘‘(1) INITIAL REPORT.— 

20 ‘‘(A) IN GENERAL.—Not later than 2 years 

21 after the date on which the first grant is award22 ed under this section, the Secretary shall sub23 mit to the Committee on Indian Affairs of the 

24 Senate and the Committee on Natural Re25 sources and the Committee on Energy and 


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1 Commerce of the House of Representatives a 

2 report that— 

3 ‘‘(i) describes each project funded by 

4 a grant under this section during the pre5 ceding 2-year period, including a descrip6 tion of the level of success achieved by the 

7 project; and 

8 ‘‘(ii) evaluates whether the demonstra9 tion project should be continued during the 

10 period beginning on the date of termi11 nation of funding for the demonstration 

12 project under subsection (g) and ending on 

13 the date on which the final report is sub14 mitted under paragraph (2). 

15 ‘‘(B) CONTINUATION OF DEMONSTRATION

16 PROJECT.—On a determination by the Sec17 retary under clause (ii) of subparagraph (A) 

18 that the demonstration project should be con19 tinued, the Secretary may carry out the dem20 onstration project during the period described 

21 in that clause using such sums otherwise made 

22 available to the Secretary as the Secretary de23 termines to be appropriate. 

24 ‘‘(2) FINAL REPORT.—Not later than 270 days 

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1 onstration project under subsection (g), the Sec2 retary shall submit to the Committee on Indian Af3 fairs of the Senate and the Committee on Natural 

4 Resources and the Committee on Energy and Com5 merce of the House of Representatives a final report 

6 that— 

7 ‘‘(A) describes the results of the projects 

8 funded by grants awarded under this section, 

9 including any data available that indicate the 

10 number of attempted suicides; 

11 ‘‘(B) evaluates the impact of the tele12 mental health services funded by the grants in 

13 reducing the number of completed suicides 

14 among Indian youth; 

15 ‘‘(C) evaluates whether the demonstration 

16 project should be— 

17 ‘‘(i) expanded to provide more than 5 

18 grants; and 

19 ‘‘(ii) designated as a permanent pro20 gram; and 

21 ‘‘(D) evaluates the benefits of expanding 

22 the demonstration project to include urban In23 dian organizations. 


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1 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There 

2 is authorized to be appropriated to carry out this section 

3 $1,500,000 for each of fiscal years 2010 through 2013. 

4 ‘‘SEC. 724. SUBSTANCE ABUSE AND MENTAL HEALTH SERV5 ICES ADMINISTRATION GRANTS. 

6 ‘‘(a) GRANT APPLICATIONS.— 

7 ‘‘(1) EFFICIENCY OF GRANT APPLICATION

8 PROCESS.—The Secretary, acting through the Ad9 ministration, shall carry out such measures as the 

10 Secretary determines to be necessary to maximize 

11 the time and workload efficiency of the process by 

12 which Indian tribes and tribal organizations apply 

13 for grants under any program administered by the 

14 Administration, including by providing methods 

15 other than electronic methods of submitting applica16 tions for those grants, if necessary. 

17 ‘‘(2) PRIORITY FOR CERTAIN GRANTS.— 

18 ‘‘(A) IN GENERAL.—To fulfill the trust re19 sponsibility of the United States to Indian 

20 tribes, in awarding relevant grants pursuant to 

21 a program described in subparagraph (B), the 

22 Secretary shall take into consideration the 

23 needs of Indian tribes or tribal organizations, 

24 as applicable, that serve populations with docu25 mented high suicide rates, regardless of whether 


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1 those Indian tribes or tribal organizations pos2 sess adequate personnel or infrastructure to ful3 fill all applicable requirements of the relevant 

4 program. 

5 ‘‘(B) DESCRIPTION OF GRANT PRO6 GRAMS.—A grant program referred to in sub7 paragraph (A) is a grant program— 

8 ‘‘(i) administered by the Administra9 tion to fund activities relating to mental 

10 health, suicide prevention, or suicide-re11 lated risk factors; and 

12 ‘‘(ii) under which an Indian tribe or 

13 tribal organization is an eligible recipient. 

14 ‘‘(3) CLARIFICATION REGARDING INDIAN

15 TRIBES AND TRIBAL ORGANIZATIONS.—Notwith16 standing any other provision of law, in applying for 

17 a grant under any program administered by the Ad18 ministration, no Indian tribe or tribal organization 

19 shall be required to apply through a State or State 

20 agency. 

21 ‘‘(4) REQUIREMENTS FOR AFFECTED

22 STATES.— 

23 ‘‘(A) DEFINITIONS.—In this paragraph: 

24 ‘‘(i) AFFECTED STATE.—The term 

25 ‘affected State’ means a State— 


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1 ‘‘(I) the boundaries of which in2 clude 1 or more Indian tribes; and 

3 ‘‘(II) the application for a grant 

4 under any program administered by 

5 the Administration of which includes 

6 statewide data. 

7 ‘‘(ii) INDIAN POPULATION.—The term 

8 ‘Indian population’ means the total num9 ber of residents of an affected State who 

10 are members of 1 or more Indian tribes or 

11 tribal communities located within the af12 fected State. 

13 ‘‘(B) REQUIREMENTS.—As a condition of 

14 receipt of a grant under any program adminis15 tered by the Administration, each affected State 

16 shall— 

17 ‘‘(i) describe in the grant applica18 tion— 

19 ‘‘(I) the Indian population of the 

20 affected State; and 

21 ‘‘(II) the contribution of that In22 dian population to the statewide data 

23 used by the affected State in the ap24 plication; and 


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1 ‘‘(ii) demonstrate to the satisfaction 

2 of the Secretary that— 

3 ‘‘(I) of the total amount of the 

4 grant, the affected State will allocate 

5 for use for the Indian population of 

6 the affected State an amount equal to 

7 the proportion that— 

8 ‘‘(aa) the Indian population 

9 of the affected State; bears to 

10 ‘‘(bb) the total population of 

11 the affected State; and 

12 ‘‘(II) the affected State will offer 

13 to enter into a partnership with each 

14 Indian tribe or tribal organization, as 

15 applicable, located within the affected 

16 State to carry out youth suicide pre17 vention and treatment measures for 

18 members of the Indian tribe. 

19 ‘‘(C) REPORT.—Not later than 1 year 

20 after the date of receipt of a grant described in 

21 subparagraph (B), an affected State shall sub22 mit to the Secretary a report describing the 

23 measures carried out by the affected State to 

24 ensure compliance with the requirements of 

25 subparagraph (B)(ii). 


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1 ‘‘(b) NO NON-FEDERAL SHARE REQUIREMENT.— 

2 Notwithstanding any other provision of law, no Indian 

3 tribe or tribal organization shall be required to provide a 

4 non-Federal share of the cost of any project or activity 

5 carried out using a grant provided under any program ad6 ministered by the Administration. 

7 ‘‘(c) OUTREACH FOR RURAL AND ISOLATED INDIAN

8 TRIBES.—Due to the rural, isolated nature of most Indian 

9 reservations and communities (especially those reserva10 tions and communities in the Great Plains region), the 

11 Secretary shall conduct outreach activities, with a par12 ticular emphasis on the provision of telemental health 

13 services, to achieve the purposes of this subtitle with re14 spect to Indian tribes located in rural, isolated areas. 

15 ‘‘(d) PROVISION OF OTHER ASSISTANCE.— 

16 ‘‘(1) IN GENERAL.—The Secretary, acting 

17 through the Administration, shall carry out such 

18 measures (including monitoring and the provision of 

19 required assistance) as the Secretary determines to 

20 be necessary to ensure the provision of adequate sui21 cide prevention and mental health services to Indian 

22 tribes described in paragraph (2), regardless of 

23 whether those Indian tribes possess adequate per24 sonnel or infrastructure— 


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1 ‘‘(A) to submit an application for a grant 

2 under any program administered by the Admin3 istration, including due to problems relating to 

4 access to the Internet or other electronic means 

5 that may have resulted in previous obstacles to 

6 submission of a grant application; or 

7 ‘‘(B) to fulfill all applicable requirements 

8 of the relevant program. 

9 ‘‘(2) DESCRIPTION OF INDIAN TRIBES.—An In10 dian tribe referred to in paragraph (1) is an Indian 

11 tribe— 

12 ‘‘(A) the members of which experience— 

13 ‘‘(i) a high rate of youth suicide; 

14 ‘‘(ii) low socioeconomic status; and 

15 ‘‘(iii) extreme health disparity; 

16 ‘‘(B) that is located in a remote and iso17 lated area; and 

18 ‘‘(C) that lacks technology and commu19 nication infrastructure. 

20 ‘‘(3) AUTHORIZATION OF APPROPRIATIONS.— 

21 There are authorized to be appropriated to the Sec22 retary such sums as the Secretary determines to be 

23 necessary to carry out this subsection. 

24 ‘‘(e) EARLY INTERVENTION AND ASSESSMENT SERV25 ICES.— 


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1 ‘‘(1) DEFINITION OF AFFECTED ENTITY.—In 

2 this subsection, the term ‘affected entity’ means any 

3 entity— 

4 ‘‘(A) that receives a grant for suicide inter5 vention, prevention, or treatment under a pro6 gram administered by the Administration; and 

7 ‘‘(B) the population to be served by which 

8 includes Indian youth. 

9 ‘‘(2) REQUIREMENT.—The Secretary, acting 

10 through the Administration, shall ensure that each 

11 affected entity carrying out a youth suicide early 

12 intervention and prevention strategy described in 

13 section 520E(c)(1) of the Public Health Service Act 

14 (42 U.S.C. 290bb–36(c)(1)), or any other youth sui15 cide-related early intervention and assessment activ16 ity, provides training or education to individuals who 

17 interact frequently with the Indian youth to be 

18 served by the affected entity (including parents, 

19 teachers, coaches, and mentors) on identifying warn20 ing signs of Indian youth who are at risk of commit21 ting suicide. 

22 ‘‘SEC. 725. USE OF PREDOCTORAL PSYCHOLOGY AND PSY23 CHIATRY INTERNS. 

24 ‘‘The Secretary shall carry out such activities as the 

25 Secretary determines to be necessary to encourage Indian 


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1 tribes, tribal organizations, and other mental health care 

2 providers serving residents of Indian country to obtain the 

3 services of predoctoral psychology and psychiatry in4 terns— 

5 ‘‘(1) to increase the quantity of patients served 

6 by the Indian tribes, tribal organizations, and other 

7 mental health care providers; and 

8 ‘‘(2) for purposes of recruitment and retention. 

9 ‘‘SEC. 726. INDIAN YOUTH LIFE SKILLS DEVELOPMENT 

10 DEMONSTRATION PROGRAM. 

11 ‘‘(a) PURPOSE.—The purpose of this section is to au12 thorize the Secretary, acting through the Administration, 

13 to carry out a demonstration program to test the effective14 ness of a culturally compatible, school-based, life skills 

15 curriculum for the prevention of Indian and Alaska Native 

16 adolescent suicide, including through— 

17 ‘‘(1) the establishment of tribal partnerships to 

18 develop and implement such a curriculum, in co19 operation with— 

20 ‘‘(A) mental health professionals, with a 

21 priority for tribal partnerships cooperating with 

22 mental health professionals employed by the 

23 Service; 

24 ‘‘(B) tribal or local school agencies; and 

25 ‘‘(C) parent and community groups; 


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1 ‘‘(2) the provision by the Administration or the 

2 Service of— 

3 ‘‘(A) technical expertise; and 

4 ‘‘(B) clinicians, analysts, and educators, as 

5 appropriate; 

6 ‘‘(3) training for teachers, school administra7 tors, and community members to implement the cur8 riculum; 

9 ‘‘(4) the establishment of advisory councils com10 posed of parents, educators, community members, 

11 trained peers, and others to provide advice regarding 

12 the curriculum and other components of the dem13 onstration program; 

14 ‘‘(5) the development of culturally appropriate 

15 support measures to supplement the effectiveness of 

16 the curriculum; and 

17 ‘‘(6) projects modeled after evidence-based 

18 projects, such as programs evaluated and published 

19 in relevant literature. 

20 ‘‘(b) DEMONSTRATION GRANT PROGRAM.— 

21 ‘‘(1) DEFINITIONS.—In this subsection: 

22 ‘‘(A) CURRICULUM.—The term ‘cur23 riculum’ means the culturally compatible, 

24 school-based, life skills curriculum for the pre25 vention of Indian and Alaska Native adolescent 


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1 suicide identified by the Secretary under para2 graph (2)(A). 

3 ‘‘(B) ELIGIBLE ENTITY.—The term ‘eligi4 ble entity’ means— 

5 ‘‘(i) an Indian tribe; 

6 ‘‘(ii) a tribal organization; 

7 ‘‘(iii) any other tribally authorized en8 tity; and 

9 ‘‘(iv) any partnership composed of 2 

10 or more entities described in clause (i), (ii), 

11 or (iii). 

12 ‘‘(2) ESTABLISHMENT.—The Secretary, acting 

13 through the Administration, may establish and carry 

14 out a demonstration program under which the Sec15 retary shall— 

16 ‘‘(A) identify a culturally compatible, 

17 school-based, life skills curriculum for the pre18 vention of Indian and Alaska Native adolescent 

19 suicide; 

20 ‘‘(B) identify the Indian tribes that are at 

21 greatest risk for adolescent suicide; 

22 ‘‘(C) invite those Indian tribes to partici23 pate in the demonstration program by— 


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1 ‘‘(i) responding to a comprehensive 

2 program requirement request of the Sec3 retary; or 

4 ‘‘(ii) submitting, through an eligible 

5 entity, an application in accordance with 

6 paragraph (4); and 

7 ‘‘(D) provide grants to the Indian tribes 

8 identified under subparagraph (B) and eligible 

9 entities to implement the curriculum with re10 spect to Indian and Alaska Native youths 

11 who— 

12 ‘‘(i) are between the ages of 10 and 

13 19; and 

14 ‘‘(ii) attend school in a region that is 

15 at risk of high youth suicide rates, as de16 termined by the Administration. 

17 ‘‘(3) REQUIREMENTS.— 

18 ‘‘(A) TERM.—The term of a grant pro19 vided under the demonstration program under 

20 this section shall be not less than 4 years. 

21 ‘‘(B) MAXIMUM NUMBER.—The Secretary 

22 may provide not more than 5 grants under the 

23 demonstration program under this section. 

24 ‘‘(C) AMOUNT.—The grants provided 

25 under this section shall be of equal amounts. 


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1 ‘‘(D) CERTAIN SCHOOLS.—In selecting eli2 gible entities to receive grants under this sec3 tion, the Secretary shall ensure that not less 

4 than 1 demonstration program shall be carried 

5 out at each of— 

6 ‘‘(i) a school operated by the Bureau 

7 of Indian Education; 

8 ‘‘(ii) a Tribal school; and 

9 ‘‘(iii) a school receiving payments 

10 under section 8002 or 8003 of the Elemen11 tary and Secondary Education Act of 1965 

12 (20 U.S.C. 7702, 7703). 

13 ‘‘(4) APPLICATIONS.—To be eligible to receive a 

14 grant under the demonstration program, an eligible 

15 entity shall submit to the Secretary an application, 

16 at such time, in such manner, and containing such 

17 information as the Secretary may require, includ18 ing— 

19 ‘‘(A) an assurance that, in implementing 

20 the curriculum, the eligible entity will collabo21 rate with 1 or more local educational agencies, 

22 including elementary schools, middle schools, 

23 and high schools; 

24 ‘‘(B) an assurance that the eligible entity 

25 will collaborate, for the purpose of curriculum 


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1 development, implementation, and training and 

2 technical assistance, with 1 or more— 

3 ‘‘(i) nonprofit entities with dem4 onstrated expertise regarding the develop5 ment of culturally sensitive, school-based, 

6 youth suicide prevention and intervention 

7 programs; or 

8 ‘‘(ii) institutions of higher education 

9 with demonstrated interest and knowledge 

10 regarding culturally sensitive, school-based, 

11 life skills youth suicide prevention and 

12 intervention programs; 

13 ‘‘(C) an assurance that the curriculum will 

14 be carried out in an academic setting in con15 junction with at least 1 classroom teacher not 

16 less frequently than twice each school week for 

17 the duration of the academic year; 

18 ‘‘(D) a description of the methods by 

19 which curriculum participants will be— 

20 ‘‘(i) screened for mental health at-risk 

21 indicators; and 

22 ‘‘(ii) if needed and on a case-by-case 

23 basis, referred to a mental health clinician 

24 for further assessment and treatment and 

25 with crisis response capability; and 


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1 ‘‘(E) an assurance that supportive services 

2 will be provided to curriculum participants iden3 tified as high-risk participants, including refer4 ral, counseling, and follow-up services for— 

5 ‘‘(i) drug or alcohol abuse; 

6 ‘‘(ii) sexual or domestic abuse; and 

7 ‘‘(iii) depression and other relevant 

8 mental health concerns. 

9 ‘‘(5) USE OF FUNDS.—An Indian tribe identi10 fied under paragraph (2)(B) or an eligible entity 

11 may use a grant provided under this subsection— 

12 ‘‘(A) to develop and implement the cur13 riculum in a school-based setting; 

14 ‘‘(B) to establish an advisory council— 

15 ‘‘(i) to advise the Indian tribe or eligi16 ble entity regarding curriculum develop17 ment; and 

18 ‘‘(ii) to provide support services iden19 tified as necessary by the community being 

20 served by the Indian tribe or eligible enti21 ty; 

22 ‘‘(C) to appoint and train a school- and 

23 community-based cultural resource liaison, who 

24 will act as an intermediary among the Indian 

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1 ministrators, and the advisory council estab2 lished by the Indian tribe or eligible entity; 

3 ‘‘(D) to establish an on-site, school-based, 

4 MA- or PhD-level mental health practitioner 

5 (employed by the Service, if practicable) to 

6 work with tribal educators and other personnel; 

7 ‘‘(E) to provide for the training of peer 

8 counselors to assist in carrying out the cur9 riculum; 

10 ‘‘(F) to procure technical and training sup11 port from nonprofit or State entities or institu12 tions of higher education identified by the com13 munity being served by the Indian tribe or eligi14 ble entity as the best suited to develop and im15 plement the curriculum; 

16 ‘‘(G) to train teachers and school adminis17 trators to effectively carry out the curriculum; 

18 ‘‘(H) to establish an effective referral pro19 cedure and network; 

20 ‘‘(I) to identify and develop culturally com21 patible curriculum support measures; 

22 ‘‘(J) to obtain educational materials and 

23 other resources from the Administration or 

24 other appropriate entities to ensure the success 

25 of the demonstration program; and 


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1 ‘‘(K) to evaluate the effectiveness of the 

2 curriculum in preventing Indian and Alaska 

3 Native adolescent suicide. 

4 ‘‘(c) EVALUATIONS.—Using such amounts made 

5 available pursuant to subsection (e) as the Secretary de6 termines to be appropriate, the Secretary shall conduct, 

7 directly or through a grant, contract, or cooperative agree8 ment with an entity that has experience regarding the de9 velopment and operation of successful culturally compat10 ible, school-based, life skills suicide prevention and inter11 vention programs or evaluations, an annual evaluation of 

12 the demonstration program under this section, including 

13 an evaluation of— 

14 ‘‘(1) the effectiveness of the curriculum in pre15 venting Indian and Alaska Native adolescent suicide; 

16 ‘‘(2) areas for program improvement; and 

17 ‘‘(3) additional development of the goals and 

18 objectives of the demonstration program. 

19 ‘‘(d) REPORT TO CONGRESS.— 

20 ‘‘(1) IN GENERAL.—Subject to paragraph (2), 

21 not later than 180 days after the date of termination 

22 of the demonstration program, the Secretary shall 

23 submit to the Committee on Indian Affairs and the 

24 Committee on Health, Education, Labor, and Pen25 sions of the Senate and the Committee on Natural 


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1 Resources and the Committee on Education and 

2 Labor of the House of Representatives a final report 

3 that— 

4 ‘‘(A) describes the results of the program 

5 of each Indian tribe or eligible entity under this 

6 section; 

7 ‘‘(B) evaluates the effectiveness of the cur8 riculum in preventing Indian and Alaska Native 

9 adolescent suicide; 

10 ‘‘(C) makes recommendations regarding— 

11 ‘‘(i) the expansion of the demonstra12 tion program under this section to addi13 tional eligible entities; 

14 ‘‘(ii) designating the demonstration 

15 program as a permanent program; and 

16 ‘‘(iii) identifying and distributing the 

17 curriculum through the Suicide Prevention 

18 Resource Center of the Administration; 

19 and 

20 ‘‘(D) incorporates any public comments re21 ceived under paragraph (2). 

22 ‘‘(2) PUBLIC COMMENT.—The Secretary shall 

23 provide a notice of the report under paragraph (1) 

24 and an opportunity for public comment on the reVerDate Nov 24 2008 01:56 Oct 17, 2009 Jkt 089200 PO 00000 Frm 00181 Fmt 6652 Sfmt 6201 E:\BILLS\S1790.IS S1790

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1 port for a period of not less than 90 days before 

2 submitting the report to Congress. 

3 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 

4 is authorized to be appropriated to carry out this section 

5 $1,000,000 for each of fiscal years 2010 through 2014.’’. 

6 Subtitle H—Miscellaneous 

7 SEC. 191. CONFIDENTIALITY OF MEDICAL QUALITY ASSUR8 ANCE RECORDS; QUALIFIED IMMUNITY FOR 

9 PARTICIPANTS. 

10 Title VIII of the Indian Health Care Improvement 

11 Act (as amended by section 101(b)) is amended by insert12 ing after section 804 (25 U.S.C. 1674) the following: 

13 ‘‘SEC. 805. CONFIDENTIALITY OF MEDICAL QUALITY ASSUR14 ANCE RECORDS; QUALIFIED IMMUNITY FOR 

15 PARTICIPANTS. 

16 ‘‘(a) DEFINITIONS.—In this section: 

17 ‘‘(1) HEALTH CARE PROVIDER.—The term 

18 ‘health care provider’ means any health care profes19 sional, including community health aides and practi20 tioners certified under section 119, who is— 

21 ‘‘(A) granted clinical practice privileges or 

22 employed to provide health care services at— 

23 ‘‘(i) an Indian health program; or 

24 ‘‘(ii) a health program of an urban In25 dian organization; and 


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1 ‘‘(B) licensed or certified to perform health 

2 care services by a governmental board or agen3 cy or professional health care society or organi4 zation. 

5 ‘‘(2) MEDICAL QUALITY ASSURANCE PRO6 GRAM.—The term ‘medical quality assurance pro7 gram’ means any activity carried out before, on, or 

8 after the date of enactment of the Indian Health 

9 Care Improvement Reauthorization and Extension 

10 Act of 2009 by or for any Indian health program or 

11 urban Indian organization to assess the quality of 

12 medical care, including activities conducted by or on 

13 behalf of individuals, Indian health program or 

14 urban Indian organization medical or dental treat15 ment review committees, or other review bodies re16 sponsible for quality assurance, credentials, infection 

17 control, patient safety, patient care assessment (in18 cluding treatment procedures, blood, drugs, and 

19 therapeutics), medical records, health resources 

20 management review, and identification and preven21 tion of medical or dental incidents and risks. 

22 ‘‘(3) MEDICAL QUALITY ASSURANCE RECORD.— 

23 The term ‘medical quality assurance record’ means 

24 the proceedings, records, minutes, and reports 

25 that— 


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1 ‘‘(A) emanate from quality assurance pro2 gram activities described in paragraph (2); and 

3 ‘‘(B) are produced or compiled by or for an 

4 Indian health program or urban Indian organi5 zation as part of a medical quality assurance 

6 program. 

7 ‘‘(b) CONFIDENTIALITY OF RECORDS.—Medical qual8 ity assurance records created by or for any Indian health 

9 program or a health program of an urban Indian organiza10 tion as part of a medical quality assurance program are 

11 confidential and privileged. Such records may not be dis12 closed to any person or entity, except as provided in sub13 section (d). 

14 ‘‘(c) PROHIBITION ON DISCLOSURE AND TESTI15 MONY.— 

16 ‘‘(1) IN GENERAL.—No part of any medical 

17 quality assurance record described in subsection (b) 

18 may be subject to discovery or admitted into evi19 dence in any judicial or administrative proceeding, 

20 except as provided in subsection (d). 

21 ‘‘(2) TESTIMONY.—An individual who reviews 

22 or creates medical quality assurance records for any 

23 Indian health program or urban Indian organization 

24 who participates in any proceeding that reviews or 

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1 quired to testify in any judicial or administrative 

2 proceeding with respect to such records or with re3 spect to any finding, recommendation, evaluation, 

4 opinion, or action taken by such person or body in 

5 connection with such records except as provided in 

6 this section. 

7 ‘‘(d) AUTHORIZED DISCLOSURE AND TESTIMONY.— 

8 ‘‘(1) IN GENERAL.—Subject to paragraph (2), a 

9 medical quality assurance record described in sub10 section (b) may be disclosed, and an individual re11 ferred to in subsection (c) may give testimony in 

12 connection with such a record, only as follows: 

13 ‘‘(A) To a Federal agency or private orga14 nization, if such medical quality assurance 

15 record or testimony is needed by such agency or 

16 organization to perform licensing or accredita17 tion functions related to any Indian health pro18 gram or to a health program of an urban In19 dian organization to perform monitoring, re20 quired by law, of such program or organization. 

21 ‘‘(B) To an administrative or judicial pro22 ceeding commenced by a present or former In23 dian health program or urban Indian organiza24 tion provider concerning the termination, susVerDate Nov 24 2008 01:56 Oct 17, 2009 Jkt 089200 PO 00000 Frm 00185 Fmt 6652 Sfmt 6201 E:\BILLS\S1790.IS S1790

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1 pension, or limitation of clinical privileges of 

2 such health care provider. 

3 ‘‘(C) To a governmental board or agency 

4 or to a professional health care society or orga5 nization, if such medical quality assurance 

6 record or testimony is needed by such board, 

7 agency, society, or organization to perform li8 censing, credentialing, or the monitoring of pro9 fessional standards with respect to any health 

10 care provider who is or was an employee of any 

11 Indian health program or urban Indian organi12 zation. 

13 ‘‘(D) To a hospital, medical center, or 

14 other institution that provides health care serv15 ices, if such medical quality assurance record or 

16 testimony is needed by such institution to as17 sess the professional qualifications of any health 

18 care provider who is or was an employee of any 

19 Indian health program or urban Indian organi20 zation and who has applied for or been granted 

21 authority or employment to provide health care 

22 services in or on behalf of such program or or23 ganization. 

24 ‘‘(E) To an officer, employee, or contractor 

25 of the Indian health program or urban Indian 


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1 organization that created the records or for 

2 which the records were created. If that officer, 

3 employee, or contractor has a need for such 

4 record or testimony to perform official duties. 

5 ‘‘(F) To a criminal or civil law enforce6 ment agency or instrumentality charged under 

7 applicable law with the protection of the public 

8 health or safety, if a qualified representative of 

9 such agency or instrumentality makes a written 

10 request that such record or testimony be pro11 vided for a purpose authorized by law. 

12 ‘‘(G) In an administrative or judicial pro13 ceeding commenced by a criminal or civil law 

14 enforcement agency or instrumentality referred 

15 to in subparagraph (F), but only with respect 

16 to the subject of such proceeding. 

17 ‘‘(2) IDENTITY OF PARTICIPANTS.—With the 

18 exception of the subject of a quality assurance ac19 tion, the identity of any person receiving health care 

20 services from any Indian health program or urban 

21 Indian organization or the identity of any other per22 son associated with such program or organization 

23 for purposes of a medical quality assurance program 

24 that is disclosed in a medical quality assurance 

25 record described in subsection (b) shall be deleted 


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1 from that record or document before any disclosure 

2 of such record is made outside such program or or3 ganization. 

4 ‘‘(e) DISCLOSURE FOR CERTAIN PURPOSES.— 

5 ‘‘(1) IN GENERAL.—Nothing in this section 

6 shall be construed as authorizing or requiring the 

7 withholding from any person or entity aggregate sta8 tistical information regarding the results of any In9 dian health program or urban Indian organization’s 

10 medical quality assurance programs. 

11 ‘‘(2) WITHHOLDING FROM CONGRESS.—Noth12 ing in this section shall be construed as authority to 

13 withhold any medical quality assurance record from 

14 a committee of either House of Congress, any joint 

15 committee of Congress, or the Government Account16 ability Office if such record pertains to any matter 

17 within their respective jurisdictions. 

18 ‘‘(f) PROHIBITION ON DISCLOSURE OF RECORD OR

19 TESTIMONY.—An individual or entity having possession of 

20 or access to a record or testimony described by this section 

21 may not disclose the contents of such record or testimony 

22 in any manner or for any purpose except as provided in 

23 this section. 

24 ‘‘(g) EXEMPTION FROM FREEDOM OF INFORMATION

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1 section (b) may not be made available to any person under 

2 section 552 of title 5, United States Code. 

3 ‘‘(h) LIMITATION ON CIVIL LIABILITY.—An indi4 vidual who participates in or provides information to a 

5 person or body that reviews or creates medical quality as6 surance records described in subsection (b) shall not be 

7 civilly liable for such participation or for providing such 

8 information if the participation or provision of information 

9 was in good faith based on prevailing professional stand10 ards at the time the medical quality assurance program 

11 activity took place. 

12 ‘‘(i) APPLICATION TO INFORMATION IN CERTAIN

13 OTHER RECORDS.—Nothing in this section shall be con14 strued as limiting access to the information in a record 

15 created and maintained outside a medical quality assur16 ance program, including a patient’s medical records, on 

17 the grounds that the information was presented during 

18 meetings of a review body that are part of a medical qual19 ity assurance program. 

20 ‘‘(j) REGULATIONS.—The Secretary, acting through 

21 the Service, shall promulgate regulations pursuant to sec22 tion 802. 

23 ‘‘(k) CONTINUED PROTECTION.—Disclosure under 

24 subsection (d) does not permit redisclosure except to the 

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1 section (d) or is otherwise authorized to be disclosed under 

2 this section. 

3 ‘‘(l) INCONSISTENCIES.—To the extent that the pro4 tections under part C of title IX of the Public Health Serv5 ice Act (42 U.S.C. 229b–21 et seq.) (as amended by the 

6 Patient Safety and Quality Improvement Act of 2005 

7 (Public Law 109–41; 119 Stat. 424)) and this section are 

8 inconsistent, the provisions of whichever is more protective 

9 shall control. 

10 ‘‘(m) RELATIONSHIP TO OTHER LAW.—This section 

11 shall continue in force and effect, except as otherwise spe12 cifically provided in any Federal law enacted after the date 

13 of enactment of the Indian Health Care Improvement Re14 authorization and Extension Act of 2009.’’. 

15 SEC. 192. ARIZONA, NORTH DAKOTA, AND SOUTH DAKOTA 

16 AS CONTRACT HEALTH SERVICE DELIVERY 

17 AREAS; ELIGIBILITY OF CALIFORNIA INDI18 ANS. 

19 Title VIII of the Indian Health Care Improvement 

20 Act is amended— 

21 (1) by striking section 808 (25 U.S.C. 1678) 

22 and inserting the following: 


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1 ‘‘SEC. 808. ARIZONA AS CONTRACT HEALTH SERVICE DELIV2 ERY AREA. 

3 ‘‘(a) IN GENERAL.—The State of Arizona shall be 

4 designated as a contract health service delivery area by 

5 the Service for the purpose of providing contract health 

6 care services to members of Indian tribes in the State of 

7 Arizona. 

8 ‘‘(b) MAINTENANCE OF SERVICES.—The Service 

9 shall not curtail any health care services provided to Indi10 ans residing on reservations in the State of Arizona if the 

11 curtailment is due to the provision of contract services in 

12 that State pursuant to the designation of the State as a 

13 contract health service delivery area by subsection (a).’’; 

14 (2) by inserting after section 808 (25 U.S.C. 

15 1678) the following: 

16 ‘‘SEC. 808A. NORTH DAKOTA AND SOUTH DAKOTA AS CON17 TRACT HEALTH SERVICE DELIVERY AREA. 

18 ‘‘(a) IN GENERAL.—The States of North Dakota and 

19 South Dakota shall be designated as a contract health 

20 service delivery area by the Service for the purpose of pro21 viding contract health care services to members of Indian 

22 tribes in the States of North Dakota and South Dakota. 

23 ‘‘(b) MAINTENANCE OF SERVICES.—The Service 

24 shall not curtail any health care services provided to Indi25 ans residing on any reservation, or in any county that has 

26 a common boundary with any reservation, in the State of 


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1 North Dakota or South Dakota if the curtailment is due 

2 to the provision of contract services in those States pursu3 ant to the designation of the States as a contract health 

4 service delivery area by subsection (a).’’; and 

5 (3) by striking section 809 (25 U.S.C. 1679) 

6 and inserting the following: 

7 ‘‘SEC. 809. ELIGIBILITY OF CALIFORNIA INDIANS. 

8 ‘‘(a) IN GENERAL.—The following California Indians 

9 shall be eligible for health services provided by the Service: 

10 ‘‘(1) Any member of a federally recognized In11 dian tribe. 

12 ‘‘(2) Any descendant of an Indian who was re13 siding in California on June 1, 1852, if such de14 scendant— 

15 ‘‘(A) is a member of the Indian community 

16 served by a local program of the Service; and 

17 ‘‘(B) is regarded as an Indian by the com18 munity in which such descendant lives. 

19 ‘‘(3) Any Indian who holds trust interests in 

20 public domain, national forest, or reservation allot21 ments in California. 

22 ‘‘(4) Any Indian in California who is listed on 

23 the plans for distribution of the assets of rancherias 

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1 fornia under the Act of August 18, 1958 (72 Stat. 

2 619), and any descendant of such an Indian. 

3 ‘‘(b) CLARIFICATION.—Nothing in this section may 

4 be construed as expanding the eligibility of California Indi5 ans for health services provided by the Service beyond the 

6 scope of eligibility for such health services that applied on 

7 May 1, 1986.’’. 

8 SEC. 193. METHODS TO INCREASE ACCESS TO PROFES9 SIONALS OF CERTAIN CORPS. 

10 Section 812 of the Indian Health Care Improvement 

11 Act (25 U.S.C. 1680b) is amended to read as follows: 

12 ‘‘SEC. 812. NATIONAL HEALTH SERVICE CORPS. 

13 ‘‘(a) NO REDUCTION IN SERVICES.—The Secretary 

14 shall not remove a member of the National Health Service 

15 Corps from an Indian health program or urban Indian or16 ganization or withdraw funding used to support such a 

17 member, unless the Secretary, acting through the Service, 

18 has ensured that the Indians receiving services from the 

19 member will experience no reduction in services. 

20 ‘‘(b) TREATMENT OF INDIAN HEALTH PROGRAMS.— 

21 At the request of an Indian health program, the services 

22 of a member of the National Health Service Corps as23 signed to the Indian health program may be limited to 

24 the individuals who are eligible for services from that In25 dian health program.’’. 


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1 SEC. 194. HEALTH SERVICES FOR INELIGIBLE PERSONS. 

2 Section 813 of the Indian Health Care Improvement 

3 Act (25 U.S.C. 1680c) is amended to read as follows: 

4 ‘‘SEC. 813. HEALTH SERVICES FOR INELIGIBLE PERSONS. 

5 ‘‘(a) CHILDREN.—Any individual who— 

6 ‘‘(1) has not attained 19 years of age; 

7 ‘‘(2) is the natural or adopted child, stepchild, 

8 foster child, legal ward, or orphan of an eligible In9 dian; and 

10 ‘‘(3) is not otherwise eligible for health services 

11 provided by the Service, 

12 shall be eligible for all health services provided by the 

13 Service on the same basis and subject to the same rules 

14 that apply to eligible Indians until such individual attains 

15 19 years of age. The existing and potential health needs 

16 of all such individuals shall be taken into consideration 

17 by the Service in determining the need for, or the alloca18 tion of, the health resources of the Service. If such an indi19 vidual has been determined to be legally incompetent prior 

20 to attaining 19 years of age, such individual shall remain 

21 eligible for such services until 1 year after the date of a 

22 determination of competency. 

23 ‘‘(b) SPOUSES.—Any spouse of an eligible Indian who 

24 is not an Indian, or who is of Indian descent but is not 

25 otherwise eligible for the health services provided by the 

26 Service, shall be eligible for such health services if all such 


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1 spouses or spouses who are married to members of each 

2 Indian tribe being served are made eligible, as a class, by 

3 an appropriate resolution of the governing body of the In4 dian tribe or tribal organization providing such services. 

5 The health needs of persons made eligible under this para6 graph shall not be taken into consideration by the Service 

7 in determining the need for, or allocation of, its health 

8 resources. 

9 ‘‘(c) HEALTH FACILITIES PROVIDING HEALTH

10 SERVICES.— 

11 ‘‘(1) IN GENERAL.—The Secretary is authorized 

12 to provide health services under this subsection 

13 through health facilities operated directly by the 

14 Service to individuals who reside within the Service 

15 unit and who are not otherwise eligible for such 

16 health services if— 

17 ‘‘(A) the Indian tribes served by such Serv18 ice unit requests such provision of health serv19 ices to such individuals, and 

20 ‘‘(B) the Secretary and the served Indian 

21 tribes have jointly determined that the provision 

22 of such health services will not result in a de23 nial or diminution of health services to eligible 

24 Indians. 


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1 ‘‘(2) ISDEAA PROGRAMS.—In the case of 

2 health facilities operated under a contract or com3 pact entered into under the Indian Self-Determina4 tion and Education Assistance Act (25 U.S.C. 450 

5 et seq.), the governing body of the Indian tribe or 

6 tribal organization providing health services under 

7 such contract or compact is authorized to determine 

8 whether health services should be provided under 

9 such contract or compact to individuals who are not 

10 eligible for such health services under any other sub11 section of this section or under any other provision 

12 of law. In making such determinations, the gov13 erning body of the Indian tribe or tribal organization 

14 shall take into account the consideration described in 

15 paragraph (1)(B). Any services provided by the In16 dian tribe or tribal organization pursuant to a deter17 mination made under this subparagraph shall be 

18 deemed to be provided under the agreement entered 

19 into by the Indian tribe or tribal organization under 

20 the Indian Self-Determination and Education Assist21 ance Act. The provisions of section 314 of Public 

22 Law 101–512 (104 Stat. 1959), as amended by sec23 tion 308 of Public Law 103–138 (107 Stat. 1416), 

24 shall apply to any services provided by the Indian 


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1 tribe or tribal organization pursuant to a determina2 tion made under this subparagraph. 

3 ‘‘(3) PAYMENT FOR SERVICES.— 

4 ‘‘(A) IN GENERAL.—Persons receiving 

5 health services provided by the Service under 

6 this subsection shall be liable for payment of 

7 such health services under a schedule of charges 

8 prescribed by the Secretary which, in the judg9 ment of the Secretary, results in reimbursement 

10 in an amount not less than the actual cost of 

11 providing the health services. Notwithstanding 

12 section 207 of this Act or any other provision 

13 of law, amounts collected under this subsection, 

14 including Medicare, Medicaid, or children’s 

15 health insurance program reimbursements 

16 under titles XVIII, XIX, and XXI of the Social 

17 Security Act (42 U.S.C. 1395 et seq.), shall be 

18 credited to the account of the program pro19 viding the service and shall be used for the pur20 poses listed in section 401(d)(2) and amounts 

21 collected under this subsection shall be available 

22 for expenditure within such program. 

23 ‘‘(B) INDIGENT PEOPLE.—Health services 

24 may be provided by the Secretary through the 

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1 dividual who would not be otherwise eligible for 

2 such health services but for the provisions of 

3 paragraph (1) only if an agreement has been 

4 entered into with a State or local government 

5 under which the State or local government 

6 agrees to reimburse the Service for the expenses 

7 incurred by the Service in providing such health 

8 services to such indigent individual. 

9 ‘‘(4) REVOCATION OF CONSENT FOR SERV10 ICES.— 

11 ‘‘(A) SINGLE TRIBE SERVICE AREA.—In 

12 the case of a Service Area which serves only 1 

13 Indian tribe, the authority of the Secretary to 

14 provide health services under paragraph (1) 

15 shall terminate at the end of the fiscal year suc16 ceeding the fiscal year in which the governing 

17 body of the Indian tribe revokes its concurrence 

18 to the provision of such health services. 

19 ‘‘(B) MULTITRIBAL SERVICE AREA.—In 

20 the case of a multitribal Service Area, the au21 thority of the Secretary to provide health serv22 ices under paragraph (1) shall terminate at the 

23 end of the fiscal year succeeding the fiscal year 

24 in which at least 51 percent of the number of 

25 Indian tribes in the Service Area revoke their 


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1 concurrence to the provisions of such health 

2 services. 

3 ‘‘(d) OTHER SERVICES.—The Service may provide 

4 health services under this subsection to individuals who 

5 are not eligible for health services provided by the Service 

6 under any other provision of law in order to— 

7 ‘‘(1) achieve stability in a medical emergency; 

8 ‘‘(2) prevent the spread of a communicable dis9 ease or otherwise deal with a public health hazard; 

10 ‘‘(3) provide care to non-Indian women preg11 nant with an eligible Indian’s child for the duration 

12 of the pregnancy through postpartum; or 

13 ‘‘(4) provide care to immediate family members 

14 of an eligible individual if such care is directly re15 lated to the treatment of the eligible individual. 

16 ‘‘(e) HOSPITAL PRIVILEGES FOR PRACTITIONERS.— 

17 ‘‘(1) IN GENERAL.—Hospital privileges in 

18 health facilities operated and maintained by the 

19 Service or operated under a contract or compact 

20 pursuant to the Indian Self-Determination and Edu21 cation Assistance Act (25 U.S.C. 450 et seq.) may 

22 be extended to non-Service health care practitioners 

23 who provide services to individuals described in sub24 section (a), (b), (c), or (d). Such non-Service health 

25 care practitioners may, as part of the privileging 


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1 process, be designated as employees of the Federal 

2 Government for purposes of section 1346(b) and 

3 chapter 171 of title 28, United States Code (relating 

4 to Federal tort claims) only with respect to acts or 

5 omissions which occur in the course of providing 

6 services to eligible individuals as a part of the condi7 tions under which such hospital privileges are ex8 tended. 

9 ‘‘(2) DEFINITION.—For purposes of this sub10 section, the term ‘non-Service health care practi11 tioner’ means a practitioner who is not— 

12 ‘‘(A) an employee of the Service; or 

13 ‘‘(B) an employee of an Indian tribe or 

14 tribal organization operating a contract or com15 pact under the Indian Self-Determination and 

16 Education Assistance Act (25 U.S.C. 450 et 

17 seq.) or an individual who provides health care 

18 services pursuant to a personal services con19 tract with such Indian tribe or tribal organiza20 tion. 

21 ‘‘(f) ELIGIBLE INDIAN.—For purposes of this sec22 tion, the term ‘eligible Indian’ means any Indian who is 

23 eligible for health services provided by the Service without 

24 regard to the provisions of this section.’’. 


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1 SEC. 195. ANNUAL BUDGET SUBMISSION. 

2 Title VIII of the Indian Health Care Improvement 

3 Act (25 U.S.C. 1671 et seq.) is amended by adding at 

4 the end the following: 

5 ‘‘SEC. 826. ANNUAL BUDGET SUBMISSION. 

6 ‘‘Effective beginning with the submission of the an7 nual budget request to Congress for fiscal year 2011, the 

8 President shall include, in the amount requested and the 

9 budget justification, amounts that reflect any changes 

10 in— 

11 ‘‘(1) the cost of health care services, as indexed 

12 for United States dollar inflation (as measured by 

13 the Consumer Price Index); and 

14 ‘‘(2) the size of the population served by the 

15 Service.’’. 

16 TITLE II—AMENDMENTS TO 

17 OTHER ACTS 

18 SEC. 201. SOLICITATION OF PROPOSALS FOR SAFE HAR19 BORS UNDER THE SOCIAL SECURITY ACT 

20 FOR FACILITIES OF INDIAN HEALTH PRO21 GRAMS AND URBAN INDIAN ORGANIZATIONS. 

22 The Secretary of Health and Human Services, acting 

23 through the Office of the Inspector General of the Depart24 ment of Health and Human Services, shall publish a no25 tice, described in section 1128D(a)(1)(A) of the Social Se26 curity Act (42 U.S.C. 1320a–7d(a)(1)(A)), soliciting a 


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1 proposal, not later than July 1, 2010, on the development 

2 of safe harbors described in such section relating to health 

3 care items and services provided by facilities of Indian 

4 health programs or an urban Indian organization (as such 

5 terms are defined in section 4 of the Indian Health Care 

6 Improvement Act). Such a safe harbor may relate to areas 

7 such as transportation, housing, or cost-sharing, assist8 ance provided through such facilities or contract health 

9 services for Indians. 

10 SEC. 202. ANNUAL REPORT REGARDING INDIANS SERVED 

11 BY HEALTH BENEFITS PROGRAMS UNDER SO12 CIAL SECURITY ACT. 

13 Section 1139 of the Social Security Act (42 U.S.C. 

14 1320b–9) is amended— 

15 (1) by redesignating subsection (c) as sub16 section (d); and 

17 (2) by inserting after subsection (b) the fol18 lowing: 

19 ‘‘(c) ANNUAL REPORTS ON INDIANS SERVED BY

20 HEALTH BENEFIT PROGRAMS.— 

21 ‘‘(1) IN GENERAL.—Beginning on January 1, 

22 2011, and annually thereafter, the Secretary, acting 

23 through the Administration of the Centers for Medi24 care & Medicaid Services and the Assistant Sec25 retary for Indian Health, shall submit to Congress 


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1 a report regarding the enrollment and health status 

2 of Indians receiving items or services under health 

3 benefit programs funded under this Act during the 

4 preceding year. 

5 ‘‘(2) INCLUSIONS.—Each report under para6 graph (1) shall include the following: 

7 ‘‘(A) The total number of Indians enrolled 

8 in, or receiving items or services under, such 

9 programs, disaggregated with respect to each 

10 such program. 

11 ‘‘(B) The number of Indians described in 

12 paragraph (1) that also received health benefits 

13 under programs funded by the Indian Health 

14 Service. 

15 ‘‘(C) General information regarding the 

16 health status of the Indians described in para17 graph (1), disaggregated with respect to specific 

18 diseases or conditions and presented in a man19 ner that is consistent with protections for pri20 vacy of individually identifiable health informa21 tion under section 264(c) of the Health Insur22 ance Portability and Accountability Act of 1996 

23 (42 U.S.C. 1320d–2 note). 

24 ‘‘(D) A detailed statement of the status of 

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1 dian tribe, tribal organization or urban Indian 

2 organization with respect to the compliance by 

3 such facilities with the applicable conditions and 

4 requirements of titles XVIII, XIX, and XXI, 

5 and, in the case of title XIX or XXI, under a 

6 State plan under such title or under waiver au7 thority, and of the progress being made by such 

8 facilities under plans submitted under section 

9 1880(b) or 1911(b) or otherwise toward the 

10 achievement and maintenance of such compli11 ance. 

12 ‘‘(E) Such other information as the Sec13 retary determines is appropriate.’’. 

14 SEC. 203. INCLUDING COSTS INCURRED BY SERVICE, A 

15 FEDERALLY QUALIFIED HEALTH CENTER, AN 

16 AIDS DRUG ASSISTANCE PROGRAM, CERTAIN 

17 HOSPITALS, OR A PHARMACEUTICAL MANU18 FACTURER PATIENT ASSISTANCE PROGRAM 

19 IN PROVIDING PRESCRIPTION DRUGS TO20 WARD THE ANNUAL OUT OF POCKET 

21 THRESHOLD UNDER PART D. 

22 (a) IN GENERAL.—Section 1860D–2(b)(4)(C) of the 

23 Social Security Act (42 U.S.C. 1395w–102(b)(4)(C)) is 

24 amended— 

25 (1) in clause (i), by striking ‘‘and’’ at the end; 


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1 (2) in clause (ii)— 

2 (A) by striking ‘‘such costs shall be treated 

3 as incurred only if’’ and inserting ‘‘subject to 

4 clause (iii), such costs shall be treated as in5 curred if’’; 

6 (B) by striking ‘‘, under section 1860D– 

7 14, or under a State Pharmaceutical Assistance 

8 Program’’; 

9 (C) by striking ‘‘(other than under such 

10 section or such a Program)’’; and 

11 (D) by striking the period at the end and 

12 inserting ‘‘; and’’; and 

13 (3) by inserting after clause (ii) the following 

14 new clause: 

15 ‘‘(iii) such costs shall be treated as in16 curred and shall not be considered to be 

17 reimbursed under clause (ii) if such costs 

18 are borne or paid— 

19 ‘‘(I) under section 1860D–14; 

20 ‘‘(II) under a State Pharma21 ceutical Assistance Program; 

22 ‘‘(III) by the Indian Health Serv23 ice, an Indian tribe or tribal organiza24 tion, or an urban Indian organization 


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1 (as defined in section 4 of the Indian 

2 Health Care Improvement Act); 

3 ‘‘(IV) by a Federally qualified 

4 health center (as defined in section 

5 1861(aa)(4)); 

6 ‘‘(V) under an AIDS Drug As7 sistance Program under part B of 

8 title XXVI of the Public Health Serv9 ice Act; 

10 ‘‘(VI) by a subsection (d) hos11 pital (as defined in section 

12 1886(d)(1)(B)) that meets the re13 quirements of clauses (i) and (ii) of 

14 section 340B(a)(4)(L) of the Public 

15 Health Service Act; or 

16 ‘‘(VII) by a pharmaceutical man17 ufacturer patient assistance program, 

18 either directly or through the distribu19 tion or donation of covered part D 

20 drugs, which shall be valued at the 

21 negotiated price of such covered part 

22 D drug under the enrollee’s prescrip23 tion drug plan or MA–PD plan as of 

24 the date that the drug was distributed 

25 or donated.’’. 


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1 (b) EFFECTIVE DATE.—The amendments made by 

2 subsection (a) shall apply to costs incurred on or after 

3 January 1, 2010. 

4 SEC. 204. MEDICARE AMENDMENTS. 

5 (a) IN GENERAL.—Section 1880 of the Social Secu6 rity Act (42 U.S.C. 1395qq) is amended— 

7 (1) by redesignating subsection (f) as sub8 section (g); and 

9 (2) by inserting after subsection (e) the fol10 lowing: 

11 ‘‘(f) PROHIBITION.—Payments made pursuant to this 

12 section shall not be reduced as a result of any beneficiary 

13 deductible, coinsurance, or other charge under section 

14 1813.’’. 

15 (b) PAYMENT OF BENEFITS.—Section 1833(a)(1)(B) 

16 of the Social Security Act (42 U.S.C. 1395l(a)(1)(B)) is 

17 amended by inserting ‘‘or 1880(e)’’ after ‘‘section 

18 1861(s)(10)(A)’’. 

19 SEC. 205. EXPANSION OF PAYMENTS UNDER MEDICARE, 

20 MEDICAID, AND CHIP FOR ALL COVERED 

21 SERVICES FURNISHED BY INDIAN HEALTH 

22 PROGRAMS. 

23 (a) MEDICAID.— 


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1 (1) EXPANSION TO ALL COVERED SERVICES.— 

2 Section 1911 of the Social Security Act (42 U.S.C. 

3 1396j) is amended— 

4 (A) by amending the heading to read as 

5 follows: 

6 ‘‘SEC. 1911. INDIAN HEALTH PROGRAMS.’’; 

7 and 

8 (B) by amending subsection (a) to read as 

9 follows: 

10 ‘‘(a) ELIGIBILITY FOR PAYMENT FOR MEDICAL AS11 SISTANCE.—The Indian Health Service and an Indian 

12 tribe, tribal organization, or an urban Indian organization 

13 shall be eligible for payment for medical assistance pro14 vided under a State plan or under waiver authority with 

15 respect to items and services furnished by the Indian 

16 Health Service, Indian tribe, tribal organization, or urban 

17 Indian organization if the furnishing of such services 

18 meets all the conditions and requirements which are appli19 cable generally to the furnishing of items and services 

20 under this title and under such plan or waiver authority.’’. 

21 (2) COMPLIANCE WITH CONDITIONS AND RE22 QUIREMENTS.—Subsection (b) of such section is 

23 amended to read as follows: 

24 ‘‘(b) COMPLIANCE WITH CONDITIONS AND REQUIRE25 MENTS.—A facility of the Indian Health Service or an InVerDate Nov 24 2008 01:56 Oct 17, 2009 Jkt 089200 PO 00000 Frm 00208 Fmt 6652 Sfmt 6201 E:\BILLS\S1790.IS S1790

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1 dian tribe, tribal organization, or an urban Indian organi2 zation which is eligible for payment under subsection (a) 

3 with respect to the furnishing of items and services, but 

4 which does not meet all of the conditions and requirements 

5 of this title and under a State plan or waiver authority 

6 which are applicable generally to such facility, shall make 

7 such improvements as are necessary to achieve or main8 tain compliance with such conditions and requirements in 

9 accordance with a plan submitted to and accepted by the 

10 Secretary for achieving or maintaining compliance with 

11 such conditions and requirements, and shall be deemed to 

12 meet such conditions and requirements (and to be eligible 

13 for payment under this title), without regard to the extent 

14 of its actual compliance with such conditions and require15 ments, during the first 12 months after the month in 

16 which such plan is submitted.’’. 

17 (3) REVISION OF AUTHORITY TO ENTER INTO

18 AGREEMENTS.—Subsection (c) of such section is 

19 amended to read as follows: 

20 ‘‘(c) AUTHORITY TO ENTER INTO AGREEMENTS.— 

21 The Secretary may enter into an agreement with a State 

22 for the purpose of reimbursing the State for medical as23 sistance provided by the Indian Health Service, an Indian 

24 tribe, tribal organization, or an urban Indian organization 

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1 tracts or other arrangements between the Indian Health 

2 Service, an Indian tribe, tribal organization, or an urban 

3 Indian organization and another health care provider to 

4 Indians who are eligible for medical assistance under the 

5 State plan or under waiver authority.’’. 

6 (4) CROSS-REFERENCES TO SPECIAL FUND FOR

7 IMPROVEMENT OF IHS FACILITIES; DIRECT BILLING

8 OPTION; DEFINITIONS.—Such section is further 

9 amended by striking subsection (d) and adding at 

10 the end the following new subsections: 

11 ‘‘(d) SPECIAL FUND FOR IMPROVEMENT OF IHS FA12 CILITIES.—For provisions relating to the authority of the 

13 Secretary to place payments to which a facility of the In14 dian Health Service is eligible for payment under this title 

15 into a special fund established under section 401(c)(1) of 

16 the Indian Health Care Improvement Act, and the require17 ment to use amounts paid from such fund for making im18 provements in accordance with subsection (b), see sub19 paragraphs (A) and (B) of section 401(c)(1) of such Act. 

20 ‘‘(e) DIRECT BILLING OPTION.—For provisions re21 lating to the authority of a tribal health program or an 

22 urban Indian organization to elect to directly bill for, and 

23 receive payment for, health care items and services pro24 vided by such Program or Organization for which payment 


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1 is made under this title, see section 401(d) of the Indian 

2 Health Care Improvement Act. 

3 ‘‘(f) DEFINITIONS.—In this section, the terms ‘In4 dian health program’, ‘Indian tribe’, ‘tribal health pro5 gram’, ‘tribal organization’, and ‘urban Indian organiza6 tion’ have the meanings given those terms in section 4 

7 of the Indian Health Care Improvement Act.’’. 

8 (b) MEDICARE.— 

9 (1) EXPANSION TO ALL COVERED SERVICES.— 

10 Section 1880 of such Act (42 U.S.C. 1395qq) is 

11 amended— 

12 (A) by amending the heading to read as 

13 follows: 

14 ‘‘SEC. 1880. INDIAN HEALTH PROGRAMS.’’; 

15 and 

16 (B) by amending subsection (a) to read as 

17 follows: 

18 ‘‘(a) ELIGIBILITY FOR PAYMENTS.—Subject to sub19 section (e), the Indian Health Service and an Indian tribe, 

20 tribal organization, or an urban Indian organization shall 

21 be eligible for payments under this title with respect to 

22 items and services furnished by the Indian Health Service, 

23 Indian tribe, tribal organization, or urban Indian organi24 zation if the furnishing of such services meets all the conVerDate Nov 24 2008 01:56 Oct 17, 2009 Jkt 089200 PO 00000 Frm 00211 Fmt 6652 Sfmt 6201 E:\BILLS\S1790.IS S1790

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1 ditions and requirements which are applicable generally to 

2 the furnishing of items and services under this title.’’. 

3 (2) COMPLIANCE WITH CONDITIONS AND RE4 QUIREMENTS.—Subsection (b) of such section is 

5 amended to read as follows: 

6 ‘‘(b) COMPLIANCE WITH CONDITIONS AND REQUIRE7 MENTS.—Subject to subsection (e), a facility of the Indian 

8 Health Service or an Indian tribe, tribal organization, or 

9 an urban Indian organization which is eligible for payment 

10 under subsection (a) with respect to the furnishing of 

11 items and services, but which does not meet all of the con12 ditions and requirements of this title which are applicable 

13 generally to such facility, shall make such improvements 

14 as are necessary to achieve or maintain compliance with 

15 such conditions and requirements in accordance with a 

16 plan submitted to and accepted by the Secretary for 

17 achieving or maintaining compliance with such conditions 

18 and requirements, and shall be deemed to meet such con19 ditions and requirements (and to be eligible for payment 

20 under this title), without regard to the extent of its actual 

21 compliance with such conditions and requirements, during 

22 the first 12 months after the month in which such plan 

23 is submitted.’’. 


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1 (3) CROSS-REFERENCES TO SPECIAL FUND FOR

2 IMPROVEMENT OF IHS FACILITIES; DIRECT BILLING

3 OPTION; DEFINITIONS.— 

4 (A) IN GENERAL.—Such section is further 

5 amended by striking subsections (c) and (d) 

6 and inserting the following new subsections: 

7 ‘‘(c) SPECIAL FUND FOR IMPROVEMENT OF IHS FA8 CILITIES.—For provisions relating to the authority of the 

9 Secretary to place payments to which a facility of the In10 dian Health Service is eligible for payment under this title 

11 into a special fund established under section 401(c)(1) of 

12 the Indian Health Care Improvement Act, and the require13 ment to use amounts paid from such fund for making im14 provements in accordance with subsection (b), see sub15 paragraphs (A) and (B) of section 401(c)(1) of such Act. 

16 ‘‘(d) DIRECT BILLING OPTION.—For provisions re17 lating to the authority of a tribal health program or an 

18 urban Indian organization to elect to directly bill for, and 

19 receive payment for, health care items and services pro20 vided by such program or organization for which payment 

21 is made under this title, see section 401(d) of the Indian 

22 Health Care Improvement Act.’’. 

23 (B) CONFORMING AMENDMENT.—Para24 graph (3) of section 1880(e) of such Act (42 

25 U.S.C. 1395qq(e)) is amended by inserting 


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1 ‘‘and section 401(c)(1) of the Indian Health 

2 Care Improvement Act’’ after ‘‘Subsection (c)’’. 

3 (4) DEFINITIONS.—Such section is further 

4 amended by amending subsection (g) (as redesig5 nated by section 204(a)(1) of this Act) to read as 

6 follows: 

7 ‘‘(g) DEFINITIONS.—In this section, the terms ‘In8 dian health program’, ‘Indian tribe’, ‘Service Unit’, ‘tribal 

9 health program’, ‘tribal organization’, and ‘urban Indian 

10 organization’ have the meanings given those terms in sec11 tion 4 of the Indian Health Care Improvement Act.’’. 

12 (c) APPLICATION TO CHIP.—Section 2107(e)(1) of 

13 the Social Security Act (42 U.S.C. 1397gg(e)(1)) is 

14 amended— 

15 (1) by redesignating subparagraph (D) as sub16 paragraph (E); and 

17 (2) by inserting after subparagraph (C), the fol18 lowing new subparagraph: 

19 ‘‘(D) Section 1911 (relating to Indian 

20 health programs, other than subsection (d) of 

21 such section).’’. 

22 SEC. 206. REAUTHORIZATION OF NATIVE HAWAIIAN 

23 HEALTH CARE PROGRAMS. 

24 (a) REAUTHORIZATION.—The Native Hawaiian 

25 Health Care Act of 1988 (42 U.S.C. 11701 et seq.) is 


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1 amended by striking ‘‘2001’’ each place it appears in sec2 tions 6(h)(1), 7(b), and 10(c) (42 U.S.C. 11705(h)(1), 

3 11706(b), 11709(c)) and inserting ‘‘2019’’. 

4 (b) HEALTH AND EDUCATION.— 

5 (1) IN GENERAL.—Section 6(c) of the Native 

6 Hawaiian Health Care Act of 1988 (42 U.S.C. 

7 11705) is amended by adding at the end the fol8 lowing: 

9 ‘‘(4) HEALTH AND EDUCATION.—In order to 

10 enable privately funded organizations to continue to 

11 supplement public efforts to provide educational pro12 grams designed to improve the health, capability, 

13 and well-being of Native Hawaiians and to continue 

14 to provide health services to Native Hawaiians, not15 withstanding any other provision of Federal or State 

16 law, it shall be lawful for the private educational or17 ganization identified in section 7202(16) of the Ele18 mentary and Secondary Education Act of 1965 (20 

19 U.S.C. 7512(16)) to continue to offer its educational 

20 programs and services to Native Hawaiians (as de21 fined in section 7207 of that Act (20 U.S.C. 7517)) 

22 first and to others only after the need for such pro23 grams and services by Native Hawaiians has been 

24 met.’’. 


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1 (2) EFFECTIVE DATE.—The amendment made 

2 by paragraph (1) takes effect on December 5, 2006. 

3 (c) DEFINITION OF HEALTH PROMOTION.—Section 

4 12(2) of the Native Hawaiian Health Care Act of 1988 

5 (42 U.S.C. 11711(2)) is amended— 

6 (1) in subparagraph (F), by striking ‘‘and’’ at 

7 the end; 

8 (2) in subparagraph (G), by striking the period 

9 at the end and inserting ‘‘, and’’; and 

10 (3) by adding at the end the following: 

11 ‘‘(H) educational programs with the mis12 sion of improving the health, capability, and 

13 well-being of Native Hawaiians.’’. 

Æ 


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