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[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[S. 1790 Introduced in Senate (IS)]

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.

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Indian Health Care 
Improvement Reauthorization and Extension Act of 2009''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

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 long-term 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

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

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.

    TITLE I--INDIAN HEALTH CARE IMPROVEMENT ACT REAUTHORIZATION AND 
                               AMENDMENTS

SEC. 101. REAUTHORIZATION.

    (a) In General.--Section 825 of the Indian Health Care Improvement 
Act (25 U.S.C. 1680o) is amended to read as follows:

``SEC. 825. AUTHORIZATION OF APPROPRIATIONS.

    ``There are authorized to be appropriated such sums as are 
necessary to carry out this Act for fiscal year 2010 and each fiscal 
year thereafter, to remain available until expended.''.
    (b) Repeals.--The following provisions of the Indian Health Care 
Improvement Act are repealed:
            (1) Section 123 (25 U.S.C. 1616p).
            (2) Paragraph (6) of section 209(m) (25 U.S.C. 1621h(m)).
            (3) Subsection (g) of section 211 (25 U.S.C. 1621j).
            (4) Subsection (e) of section 216 (25 U.S.C. 1621o).
            (5) Section 224 (25 U.S.C. 1621w).
            (6) Section 309 (25 U.S.C. 1638a).
            (7) Section 407 (25 U.S.C. 1647).
            (8) Subsection (c) of section 512 (25 U.S.C. 1660b).
            (9) Section 514 (25 U.S.C. 1660d).
            (10) Section 603 (25 U.S.C. 1663).
            (11) Section 805 (25 U.S.C. 1675).
    (c) Conforming Amendments.--
            (1) Section 204(c)(1) of the Indian Health Care Improvement 
        Act (25 U.S.C. 1621c(c)(1)) is amended by striking ``through 
        fiscal year 2000''.
            (2) Section 213 of the Indian Health Care Improvement Act 
        (25 U.S.C. 1621l) is amended by striking ``(a) The Secretary'' 
        and inserting ``The Secretary''.
            (3) Section 310 of the Indian Health Care Improvement Act 
        (25 U.S.C. 1638b) is amended by striking ``funds provided 
        pursuant to the authorization contained in section 309'' each 
        place it appears and inserting ``funds made available to carry 
        out this title''.

SEC. 102. FINDINGS.

    Section 2 of the Indian Health Care Improvement Act (25 U.S.C. 
1601) is amended--
            (1) by redesignating subsections (a), (b), (c), and (d) as 
        paragraphs (1), (3), (4), and (5), respectively, and indenting 
        the paragraphs appropriately; and
            (2) by inserting after paragraph (1) (as so redesignated) 
        the following:
            ``(2) A major national goal of the United States is to 
        provide the resources, processes, and structure that will 
        enable Indian tribes and tribal members to obtain the quantity 
        and quality of health care services and opportunities that will 
        eradicate the health disparities between Indians and the 
        general population of the United States.''.

SEC. 103. DECLARATION OF NATIONAL INDIAN HEALTH POLICY.

    Section 3 of the Indian Health Care Improvement Act (25 U.S.C. 
1602) is amended to read as follows:

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

    ``Congress declares that it is the policy of this Nation, in 
fulfillment of its special trust responsibilities and legal obligations 
to Indians--
            ``(1) to ensure the highest possible health status for 
        Indians and urban Indians and to provide all resources 
        necessary to effect that policy;
            ``(2) to raise the health status of Indians and urban 
        Indians to at least the levels set forth in the goals contained 
        within the Healthy People 2010 initiative or successor 
        objectives;
            ``(3) to ensure maximum Indian participation in the 
        direction of health care services so as to render the persons 
        administering such services and the services themselves more 
        responsive to the needs and desires of Indian communities;
            ``(4) to increase the proportion of all degrees in the 
        health professions and allied and associated health professions 
        awarded to Indians so that the proportion of Indian health 
        professionals in each Service area is raised to at least the 
        level of that of the general population;
            ``(5) to require that all actions under this Act shall be 
        carried out with active and meaningful consultation with Indian 
        tribes and tribal organizations, and conference with urban 
        Indian organizations, to implement this Act and the national 
        policy of Indian self-determination;
            ``(6) to ensure that the United States and Indian tribes 
        work in a government-to-government relationship to ensure 
        quality health care for all tribal members; and
            ``(7) to provide funding for programs and facilities 
        operated by Indian tribes and tribal organizations in amounts 
        that are not less than the amounts provided to programs and 
        facilities operated directly by the Service.''.

SEC. 104. DEFINITIONS.

    Section 4 of the Indian Health Care Improvement Act (25 U.S.C. 
1603) is amended--
            (1) by striking the matter preceding subsection (a) and 
        inserting ``In this Act:'';
            (2) in each of subsections (c), (j), (k), and (l), by 
        redesignating the paragraphs contained in the subsections as 
        subparagraphs and indenting the subparagraphs appropriately;
            (3) by redesignating subsections (a) through (q) as 
        paragraphs (17), (18), (13), (14), (26), (28), (27), (29), (1), 
        (20), (11), (7), (19), (10), (21), (8), and (9), respectively, 
        indenting the paragraphs appropriately, and moving the 
        paragraphs so as to appear in numerical order;
            (4) in each paragraph (as so redesignated), by inserting a 
        heading the text of which is comprised of the term defined in 
        the paragraph;
            (5) by inserting ``The term'' after each paragraph heading;
            (6) by inserting after paragraph (1) (as redesignated by 
        paragraph (3)) the following:
            ``(2) Behavioral health.--
                    ``(A) In general.--The term `behavioral health' 
                means the blending of substance (alcohol, drugs, 
                inhalants, and tobacco) abuse and mental health 
                prevention and treatment for the purpose of providing 
                comprehensive services.
                    ``(B) Inclusions.--The term `behavioral health' 
                includes the joint development of substance abuse and 
                mental health treatment planning and coordinated case 
                management using a multidisciplinary approach.
            ``(3) California indian.--The term `California Indian' 
        means any Indian who is eligible for health services provided 
        by the Service pursuant to section 809.
            ``(4) Community college.--The term `community college' 
        means--
                    ``(A) a tribal college or university; or
                    ``(B) a junior or community college.
            ``(5) Contract health service.--The term `contract health 
        service' means any health service that is--
                    ``(A) delivered based on a referral by, or at the 
                expense of, an Indian health program; and
                    ``(B) provided by a public or private medical 
                provider or hospital that is not a provider or hospital 
                of the Indian health program.
            ``(6) Department.--The term `Department', unless otherwise 
        designated, means the Department of Health and Human 
        Services.'';
            (7) by striking paragraph (7) (as redesignated by paragraph 
        (3)) and inserting the following:
            ``(7) Disease prevention.--
                    ``(A) In general.--The term `disease prevention' 
                means any activity for--
                            ``(i) the reduction, limitation, and 
                        prevention of--
                                    ``(I) disease; and
                                    ``(II) complications of disease; 
                                and
                            ``(ii) the reduction of consequences of 
                        disease.
                    ``(B) Inclusions.--The term `disease prevention' 
                includes an activity for--
                            ``(i) controlling--
                                    ``(I) the development of diabetes;
                                    ``(II) high blood pressure;
                                    ``(III) infectious agents;
                                    ``(IV) injuries;
                                    ``(V) occupational hazards and 
                                disabilities;
                                    ``(VI) sexually transmittable 
                                diseases; or
                                    ``(VII) toxic agents; or
                            ``(ii) providing--
                                    ``(I) fluoridation of water; or
                                    ``(II) immunizations.'';
            (8) by striking paragraph (9) (as redesignated by paragraph 
        (3)) and inserting the following:
            ``(9) FAS.--The term `fetal alcohol syndrome' or `FAS' 
        means a syndrome in which, with a history of maternal alcohol 
        consumption during pregnancy, the following criteria are met:
                    ``(A) Central nervous system involvement such as 
                mental retardation, developmental delay, intellectual 
                deficit, microencephaly, or neurologic abnormalities.
                    ``(B) Craniofacial abnormalities with at least 2 of 
                the following: microophthalmia, short palpebral 
                fissures, poorly developed philtrum, thin upper lip, 
                flat nasal bridge, and short upturned nose.
                    ``(C) Prenatal or postnatal growth delay.'';
            (9) by striking paragraphs (11) and (12) (as redesignated 
        by paragraph (3)) and inserting the following:
            ``(11) Health promotion.--The term `health promotion' means 
        any activity for--
                    ``(A) fostering social, economic, environmental, 
                and personal factors conducive to health, including 
                raising public awareness regarding health matters and 
                enabling individuals to cope with health problems by 
                increasing knowledge and providing valid information;
                    ``(B) encouraging adequate and appropriate diet, 
                exercise, and sleep;
                    ``(C) promoting education and work in accordance 
                with physical and mental capacity;
                    ``(D) making available safe water and sanitary 
                facilities;
                    ``(E) improving the physical, economic, cultural, 
                psychological, and social environment;
                    ``(F) promoting culturally competent care; and
                    ``(G) providing adequate and appropriate programs, 
                including programs for--
                            ``(i) abuse prevention (mental and 
                        physical);
                            ``(ii) community health;
                            ``(iii) community safety;
                            ``(iv) consumer health education;
                            ``(v) diet and nutrition;
                            ``(vi) immunization and other methods of 
                        prevention of communicable diseases, including 
                        HIV/AIDS;
                            ``(vii) environmental health;
                            ``(viii) exercise and physical fitness;
                            ``(ix) avoidance of fetal alcohol spectrum 
                        disorders;
                            ``(x) first aid and CPR education;
                            ``(xi) human growth and development;
                            ``(xii) injury prevention and personal 
                        safety;
                            ``(xiii) behavioral health;
                            ``(xiv) monitoring of disease indicators 
                        between health care provider visits through 
                        appropriate means, including Internet-based 
                        health care management systems;
                            ``(xv) personal health and wellness 
                        practices;
                            ``(xvi) personal capacity building;
                            ``(xvii) prenatal, pregnancy, and infant 
                        care;
                            ``(xviii) psychological well-being;
                            ``(xix) reproductive health and family 
                        planning;
                            ``(xx) safe and adequate water;
                            ``(xxi) healthy work environments;
                            ``(xxii) elimination, reduction, and 
                        prevention of contaminants that create 
                        unhealthy household conditions (including mold 
                        and other allergens);
                            ``(xxiii) stress control;
                            ``(xxiv) substance abuse;
                            ``(xxv) sanitary facilities;
                            ``(xxvi) sudden infant death syndrome 
                        prevention;
                            ``(xxvii) tobacco use cessation and 
                        reduction;
                            ``(xxviii) violence prevention; and
                            ``(xxix) such other activities identified 
                        by the Service, a tribal health program, or an 
                        urban Indian organization to promote 
                        achievement of any of the objectives referred 
                        to in section 3(2).
            ``(12) Indian health program.--The term `Indian health 
        program' means--
                    ``(A) any health program administered directly by 
                the Service;
                    ``(B) any tribal health program; and
                    ``(C) any Indian tribe or tribal organization to 
                which the Secretary provides funding pursuant to 
                section 23 of the Act of June 25, 1910 (25 U.S.C. 47) 
                (commonly known as the `Buy Indian Act').'';
            (10) by inserting after paragraph (14) (as redesignated by 
        paragraph (3)) the following:
            ``(15) Junior or community college.--The term `junior or 
        community college' has the meaning given the term in section 
        312(e) of the Higher Education Act of 1965 (20 U.S.C. 1058(e)).
            ``(16) Reservation.--
                    ``(A) In general.--The term `reservation' means a 
                reservation, Pueblo, or colony of any Indian tribe.
                    ``(B) Inclusions.--The term `reservation' 
                includes--
                            ``(i) former reservations in Oklahoma;
                            ``(ii) Indian allotments; and
                            ``(iii) Alaska Native Regions established 
                        pursuant to the Alaska Native Claims Settlement 
                        Act (43 U.S.C. 1601 et seq.).'';
            (11) by striking paragraph (20) (as redesignated by 
        paragraph (3)) and inserting the following:
            ``(20) Service unit.--The term `Service unit' means an 
        administrative entity of the Service or a tribal health program 
        through which services are provided, directly or by contract, 
        to eligible Indians within a defined geographic area.'';
            (12) by inserting after paragraph (21) (as redesignated by 
        paragraph (3)) the following:
            ``(22) Telehealth.--The term `telehealth' has the meaning 
        given the term in section 330K(a) of the Public Health Service 
        Act (42 U.S.C. 254c-16(a)).
            ``(23) Telemedicine.--The term `telemedicine' means a 
        telecommunications link to an end user through the use of 
        eligible equipment that electronically links health 
        professionals or patients and health professionals at separate 
        sites in order to exchange health care information in audio, 
        video, graphic, or other format for the purpose of providing 
        improved health care services.
            ``(24) Tribal college or university.--The term `tribal 
        college or university' has the meaning given the term in 
        section 316(b) of the Higher Education Act of 1965 (20 U.S.C. 
        1059c(b)).
            ``(25) Tribal health program.--The term `tribal health 
        program' means an Indian tribe or tribal organization that 
        operates any health program, service, function, activity, or 
        facility funded, in whole or part, by the Service through, or 
        provided for in, a contract or compact with the Service under 
        the Indian Self-Determination and Education Assistance Act (25 
        U.S.C. 450 et seq.).''; and
            (13) by striking paragraph (26) (as redesignated by 
        paragraph (3)) and inserting the following:
            ``(26) Tribal organization.--The term `tribal organization' 
        has the meaning given the term in section 4 of the Indian Self-
        Determination and Education Assistance Act (25 U.S.C. 450b).''.

                   Subtitle A--Indian Health Manpower

SEC. 111. COMMUNITY HEALTH AIDE PROGRAM.

    Section 119 of the Indian Health Care Improvement Act (25 U.S.C. 
1616l) is amended to read as follows:

``SEC. 119. COMMUNITY HEALTH AIDE PROGRAM.

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

SEC. 112. HEALTH PROFESSIONAL CHRONIC SHORTAGE DEMONSTRATION PROGRAMS.

    Title I of the Indian Health Care Improvement Act (25 U.S.C. 1611 
et seq.) (as amended by section 101(b)) is amended by adding at the end 
the following:

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

    ``(a) Demonstration Programs.--The Secretary, acting through the 
Service, may fund demonstration programs for Indian health programs to 
address the chronic shortages of health professionals.
    ``(b) Purposes of Programs.--The purposes of demonstration programs 
under subsection (a) shall be--
            ``(1) to provide direct clinical and practical experience 
        within an Indian health program to health profession students 
        and residents from medical schools;
            ``(2) to improve the quality of health care for Indians by 
        ensuring access to qualified health professionals;
            ``(3) to provide academic and scholarly opportunities for 
        health professionals serving Indians by identifying all 
        academic and scholarly resources of the region; and
            ``(4) to provide training and support for alternative 
        provider types, such as community health representatives, and 
        community health aides.
    ``(c) Advisory Board.--The demonstration programs established 
pursuant to subsection (a) shall incorporate a program advisory board, 
which may be composed of representatives of tribal governments, Indian 
health programs, and Indian communities in the areas to be served by 
the demonstration programs.''.

SEC. 113. EXEMPTION FROM PAYMENT OF CERTAIN FEES.

    Title I of the Indian Health Care Improvement Act (25 U.S.C. 1611 
et seq.) (as amended by section 112) is amended by adding at the end 
the following:

``SEC. 124. EXEMPTION FROM PAYMENT OF CERTAIN FEES.

    ``Employees of a tribal health program or urban Indian organization 
shall be exempt from payment of licensing, registration, and any other 
fees imposed by a Federal agency to the same extent that officers of 
the commissioned corps of the Public Health Service and other employees 
of the Service are exempt from those fees.''.

                      Subtitle B--Health Services

SEC. 121. OTHER AUTHORITY FOR PROVISION OF SERVICES; SHARED SERVICES 
              FOR LONG-TERM CARE.

    (a) Other Authority for Provision of Services.--
            (1) In general.--Section 205 of the Indian Health Care 
        Improvement Act (25 U.S.C. 1621d) is amended to read as 
        follows:

``SEC. 205. OTHER AUTHORITY FOR PROVISION OF SERVICES.

    ``(a) Definitions.--In this section:
            ``(1) Assisted living service.--The term `assisted living 
        service' means any service provided by an assisted living 
        facility (as defined in section 232(b) of the National Housing 
        Act (12 U.S.C. 1715w(b))), except that such an assisted living 
        facility--
                    ``(A) shall not be required to obtain a license; 
                but
                    ``(B) shall meet all applicable standards for 
                licensure.
            ``(2) Home- and community-based service.--The term `home- 
        and community-based service' means 1 or more of the services 
        specified in paragraphs (1) through (9) of section 1929(a) of 
        the Social Security Act (42 U.S.C. 1396t(a)) (whether provided 
        by the Service or by an Indian tribe or tribal organization 
        pursuant to the Indian Self-Determination and Education 
        Assistance Act (25 U.S.C. 450 et seq.)) that are or will be 
        provided in accordance with applicable standards.
            ``(3) Hospice care.--The term `hospice care' means--
                    ``(A) the items and services specified in 
                subparagraphs (A) through (H) of section 1861(dd)(1) of 
                the Social Security Act (42 U.S.C. 1395x(dd)(1)); and
                    ``(B) such other services as an Indian tribe or 
                tribal organization determines are necessary and 
                appropriate to provide in furtherance of that care.
            ``(4) Long-term care services.--The term `long-term care 
        services' has the meaning given the term `qualified long-term 
        care services' in section 7702B(c) of the Internal Revenue Code 
        of 1986.
    ``(b) Funding Authorized.--The Secretary, acting through the 
Service, Indian tribes, and tribal organizations, may provide funding 
under this Act to meet the objectives set forth in section 3 through 
health care-related services and programs not otherwise described in 
this Act for the following services:
            ``(1) Hospice care.
            ``(2) Assisted living services.
            ``(3) Long-term care services.
            ``(4) Home- and community-based services.
    ``(c) Eligibility.--The following individuals shall be eligible to 
receive long-term care services under this section:
            ``(1) Individuals who are unable to perform a certain 
        number of activities of daily living without assistance.
            ``(2) Individuals with a mental impairment, such as 
        dementia, Alzheimer's disease, or another disabling mental 
        illness, who may be able to perform activities of daily living 
        under supervision.
            ``(3) Such other individuals as an applicable tribal health 
        program determines to be appropriate.
    ``(d) Authorization of Convenient Care Services.--The Secretary, 
acting through the Service, Indian tribes, and tribal organizations, 
may also provide funding under this Act to meet the objectives set 
forth in section 3 for convenient care services programs pursuant to 
section 307(c)(2)(A).''.
            (2) Repeal.--Section 821 of the Indian Health Care 
        Improvement Act (25 U.S.C. 1680k) is repealed.
    (b) Shared Services for Long-Term Care.--Section 822 of the Indian 
Health Care Improvement Act (25 U.S.C. 1680l) is amended to read as 
follows:

``SEC. 822. SHARED SERVICES FOR LONG-TERM CARE.

    ``(a) Long-Term Care.--
            ``(1) In general.--Notwithstanding any other provision of 
        law, the Secretary, acting through the Service, is authorized 
        to provide directly, or enter into contracts or compacts under 
        the Indian Self-Determination and Education Assistance Act (25 
        U.S.C. 450 et seq.) with Indian tribes or tribal organizations 
        for, the delivery of long-term care (including health care 
        services associated with long-term care) provided in a facility 
        to Indians.
            ``(2) Inclusions.--Each agreement under paragraph (1) shall 
        provide for the sharing of staff or other services between the 
        Service or a tribal health program and a long-term care or 
        related facility owned and operated (directly or through a 
        contract or compact under the Indian Self-Determination and 
        Education Assistance Act (25 U.S.C. 450 et seq.)) by the Indian 
        tribe or tribal organization.
    ``(b) Contents of Agreements.--An agreement entered into pursuant 
to subsection (a)--
            ``(1) may, at the request of the Indian tribe or tribal 
        organization, delegate to the Indian tribe or tribal 
        organization such powers of supervision and control over 
        Service employees as the Secretary determines to be necessary 
        to carry out the purposes of this section;
            ``(2) shall provide that expenses (including salaries) 
        relating to services that are shared between the Service and 
        the tribal health program be allocated proportionately between 
        the Service and the Indian tribe or tribal organization; and
            ``(3) may authorize the Indian tribe or tribal organization 
        to construct, renovate, or expand a long-term care or other 
        similar facility (including the construction of a facility 
        attached to a Service facility).
    ``(c) Minimum Requirement.--Any nursing facility provided for under 
this section shall meet the requirements for nursing facilities under 
section 1919 of the Social Security Act (42 U.S.C. 1396r).
    ``(d) Other Assistance.--The Secretary shall provide such technical 
and other assistance as may be necessary to enable applicants to comply 
with this section.
    ``(e) Use of Existing or Underused Facilities.--The Secretary shall 
encourage the use of existing facilities that are underused, or allow 
the use of swing beds, for long-term or similar care.''.

SEC. 122. REIMBURSEMENT FROM CERTAIN THIRD PARTIES OF COSTS OF HEALTH 
              SERVICES.

    Section 206 of the Indian Health Care Improvement Act (25 U.S.C. 
1621e) is amended to read as follows:

``SEC. 206. REIMBURSEMENT FROM CERTAIN THIRD PARTIES OF COSTS OF HEALTH 
              SERVICES.

    ``(a) Right of Recovery.--Except as provided in subsection (f), the 
United States, an Indian tribe, or tribal organization shall have the 
right to recover from an insurance company, health maintenance 
organization, employee benefit plan, third-party tortfeasor, or any 
other responsible or liable third party (including a political 
subdivision or local governmental entity of a State) the reasonable 
charges billed by the Secretary, an Indian tribe, or tribal 
organization in providing health services through the Service, an 
Indian tribe, or tribal organization, or, if higher, the highest amount 
the third party would pay for care and services furnished by providers 
other than governmental entities, to any individual to the same extent 
that such individual, or any nongovernmental provider of such services, 
would be eligible to receive damages, reimbursement, or indemnification 
for such charges or expenses if--
            ``(1) such services had been provided by a nongovernmental 
        provider; and
            ``(2) such individual had been required to pay such charges 
        or expenses and did pay such charges or expenses.
    ``(b) Limitations on Recoveries From States.--Subsection (a) shall 
provide a right of recovery against any State, only if the injury, 
illness, or disability for which health services were provided is 
covered under--
            ``(1) workers' compensation laws; or
            ``(2) a no-fault automobile accident insurance plan or 
        program.
    ``(c) Nonapplicability of Other Laws.--No law of any State, or of 
any political subdivision of a State and no provision of any contract, 
insurance or health maintenance organization policy, employee benefit 
plan, self-insurance plan, managed care plan, or other health care plan 
or program entered into or renewed after the date of enactment of the 
Indian Health Care Amendments of 1988, shall prevent or hinder the 
right of recovery of the United States, an Indian tribe, or tribal 
organization under subsection (a).
    ``(d) No Effect on Private Rights of Action.--No action taken by 
the United States, an Indian tribe, or tribal organization to enforce 
the right of recovery provided under this section shall operate to deny 
to the injured person the recovery for that portion of the person's 
damage not covered hereunder.
    ``(e) Enforcement.--
            ``(1) In general.--The United States, an Indian tribe, or 
        tribal organization may enforce the right of recovery provided 
        under subsection (a) by--
                    ``(A) intervening or joining in any civil action or 
                proceeding brought--
                            ``(i) by the individual for whom health 
                        services were provided by the Secretary, an 
                        Indian tribe, or tribal organization; or
                            ``(ii) by any representative or heirs of 
                        such individual, or
                    ``(B) instituting a separate civil action, 
                including a civil action for injunctive relief and 
                other relief and including, with respect to a political 
                subdivision or local governmental entity of a State, 
                such an action against an official thereof.
            ``(2) Notice.--All reasonable efforts shall be made to 
        provide notice of action instituted under paragraph (1)(B) to 
        the individual to whom health services were provided, either 
        before or during the pendency of such action.
            ``(3) Recovery from tortfeasors.--
                    ``(A) In general.--In any case in which an Indian 
                tribe or tribal organization that is authorized or 
                required under a compact or contract issued pursuant to 
                the Indian Self-Determination and Education Assistance 
                Act (25 U.S.C. 450 et seq.) to furnish or pay for 
                health services to a person who is injured or suffers a 
                disease on or after the date of enactment of the Indian 
                Health Care Improvement Reauthorization and Extension 
                Act of 2009 under circumstances that establish grounds 
                for a claim of liability against the tortfeasor with 
                respect to the injury or disease, the Indian tribe or 
                tribal organization shall have a right to recover from 
                the tortfeasor (or an insurer of the tortfeasor) the 
                reasonable value of the health services so furnished, 
                paid for, or to be paid for, in accordance with the 
                Federal Medical Care Recovery Act (42 U.S.C. 2651 et 
                seq.), to the same extent and under the same 
                circumstances as the United States may recover under 
                that Act.
                    ``(B) Treatment.--The right of an Indian tribe or 
                tribal organization to recover under subparagraph (A) 
                shall be independent of the rights of the injured or 
                diseased person served by the Indian tribe or tribal 
                organization.
    ``(f) Limitation.--Absent specific written authorization by the 
governing body of an Indian tribe for the period of such authorization 
(which may not be for a period of more than 1 year and which may be 
revoked at any time upon written notice by the governing body to the 
Service), the United States shall not have a right of recovery under 
this section if the injury, illness, or disability for which health 
services were provided is covered under a self-insurance plan funded by 
an Indian tribe, tribal organization, or urban Indian organization. 
Where such authorization is provided, the Service may receive and 
expend such amounts for the provision of additional health services 
consistent with such authorization.
    ``(g) Costs and Attorney's Fees.--In any action brought to enforce 
the provisions of this section, a prevailing plaintiff shall be awarded 
its reasonable attorney's fees and costs of litigation.
    ``(h) Nonapplicability of Claims Filing Requirements.--An insurance 
company, health maintenance organization, self-insurance plan, managed 
care plan, or other health care plan or program (under the Social 
Security Act or otherwise) may not deny a claim for benefits submitted 
by the Service or by an Indian tribe or tribal organization based on 
the format in which the claim is submitted if such format complies with 
the format required for submission of claims under title XVIII of the 
Social Security Act or recognized under section 1175 of such Act.
    ``(i) Application to Urban Indian Organizations.--The previous 
provisions of this section shall apply to urban Indian organizations 
with respect to populations served by such Organizations in the same 
manner they apply to Indian tribes and tribal organizations with 
respect to populations served by such Indian tribes and tribal 
organizations.
    ``(j) Statute of Limitations.--The provisions of section 2415 of 
title 28, United States Code, shall apply to all actions commenced 
under this section, and the references therein to the United States are 
deemed to include Indian tribes, tribal organizations, and urban Indian 
organizations.
    ``(k) Savings.--Nothing in this section shall be construed to limit 
any right of recovery available to the United States, an Indian tribe, 
or tribal organization under the provisions of any applicable, Federal, 
State, or tribal law, including medical lien laws.''.

SEC. 123. CREDITING OF REIMBURSEMENTS.

    Section 207 of the Indian Health Care Improvement Act (25 U.S.C. 
1621f) is amended to read as follows:

``SEC. 207. CREDITING OF REIMBURSEMENTS.

    ``(a) Use of Amounts.--
            ``(1) Retention by program.--Except as provided in sections 
        202(a)(2) and 813, all reimbursements received or recovered 
        under any of the programs described in paragraph (2), including 
        under section 813, by reason of the provision of health 
        services by the Service, by an Indian tribe or tribal 
        organization, or by an urban Indian organization, shall be 
        credited to the Service, such Indian tribe or tribal 
        organization, or such urban Indian organization, respectively, 
        and may be used as provided in section 401. In the case of such 
        a service provided by or through a Service Unit, such amounts 
        shall be credited to such unit and used for such purposes.
            ``(2) Programs covered.--The programs referred to in 
        paragraph (1) are the following:
                    ``(A) Titles XVIII, XIX, and XXI of the Social 
                Security Act.
                    ``(B) This Act, including section 813.
                    ``(C) Public Law 87-693.
                    ``(D) Any other provision of law.
    ``(b) No Offset of Amounts.--The Service may not offset or limit 
any amount obligated to any Service Unit or entity receiving funding 
from the Service because of the receipt of reimbursements under 
subsection (a).''.

SEC. 124. BEHAVIORAL HEALTH TRAINING AND COMMUNITY EDUCATION PROGRAMS.

    Section 209 of the Indian Health Care Improvement Act (25 U.S.C. 
1621h) is amended by striking subsection (d) and inserting the 
following:
    ``(d) Behavioral Health Training and Community Education 
Programs.--
            ``(1) Study; list.--The Secretary, acting through the 
        Service, and the Secretary of the Interior, in consultation 
        with Indian tribes and tribal organizations, shall conduct a 
        study and compile a list of the types of staff positions 
        specified in paragraph (2) whose qualifications include, or 
        should include, training in the identification, prevention, 
        education, referral, or treatment of mental illness, or 
        dysfunctional and self destructive behavior.
            ``(2) Positions.--The positions referred to in paragraph 
        (1) are--
                    ``(A) staff positions within the Bureau of Indian 
                Affairs, including existing positions, in the fields 
                of--
                            ``(i) elementary and secondary education;
                            ``(ii) social services and family and child 
                        welfare;
                            ``(iii) law enforcement and judicial 
                        services; and
                            ``(iv) alcohol and substance abuse;
                    ``(B) staff positions within the Service; and
                    ``(C) staff positions similar to those identified 
                in subparagraphs (A) and (B) established and maintained 
                by Indian tribes and tribal organizations (without 
                regard to the funding source).
            ``(3) Training criteria.--
                    ``(A) In general.--The appropriate Secretary shall 
                provide training criteria appropriate to each type of 
                position identified in paragraphs (2)(A) and (2)(B) and 
                ensure that appropriate training has been, or shall be 
                provided to any individual in any such position. With 
                respect to any such individual in a position identified 
                pursuant to paragraph (2)(C), the respective 
                Secretaries shall provide appropriate training to, or 
                provide funds to, an Indian tribe or tribal 
                organization for training of appropriate individuals. 
                In the case of positions funded under a contract or 
                compact under the Indian Self-Determination and 
                Education Assistance Act (25 U.S.C. 450 et seq.), the 
                appropriate Secretary shall ensure that such training 
                costs are included in the contract or compact, as the 
                Secretary determines necessary.
                    ``(B) Position specific training criteria.--
                Position specific training criteria shall be culturally 
                relevant to Indians and Indian tribes and shall ensure 
                that appropriate information regarding traditional 
                health care practices is provided.
            ``(4) Community education on mental illness.--The Service 
        shall develop and implement, on request of an Indian tribe, 
        tribal organization, or urban Indian organization, or assist 
        the Indian tribe, tribal organization, or urban Indian 
        organization to develop and implement, a program of community 
        education on mental illness. In carrying out this paragraph, 
        the Service shall, upon request of an Indian tribe, tribal 
        organization, or urban Indian organization, provide technical 
        assistance to the Indian tribe, tribal organization, or urban 
        Indian organization to obtain and develop community educational 
        materials on the identification, prevention, referral, and 
        treatment of mental illness and dysfunctional and self-
        destructive behavior.
            ``(5) Plan.--Not later than 90 days after the date of 
        enactment of the Indian Health Care Improvement Reauthorization 
        and Extension Act of 2009, the Secretary shall develop a plan 
        under which the Service will increase the health care staff 
        providing behavioral health services by at least 500 positions 
        within 5 years after the date of enactment of that Act, with at 
        least 200 of such positions devoted to child, adolescent, and 
        family services. The plan developed under this paragraph shall 
        be implemented under the Act of November 2, 1921 (25 U.S.C. 13) 
        (commonly known as the `Snyder Act').''.

SEC. 125. MAMMOGRAPHY AND OTHER CANCER SCREENING.

    Section 212 of the Indian Health Care Improvement Act (25 U.S.C. 
1621k) is amended to read as follows:

``SEC. 212. MAMMOGRAPHY AND OTHER CANCER SCREENING.

    ``The Secretary, acting through the Service, shall provide for 
screening as follows:
            ``(1) Screening mammography.--Screening mammography (as 
        defined in section 1861(jj) of the Social Security Act (42 
        U.S.C. 1395x(jj))) for Indian women at a frequency appropriate 
        to those women under accepted and appropriate national 
        standards, and under such terms and conditions as are 
        consistent with standards established by the Secretary to 
        ensure the safety and accuracy of screening mammography under 
        part B of title XVIII of that Act (42 U.S.C. 1395j et seq.).
            ``(2) Other cancer screening.--
                    ``(A) In general.--Other cancer screening that 
                receives an A or B rating as recommended by the United 
                States Preventive Services Task Force established under 
                section 915(a)(1) of the Public Health Service Act (42 
                U.S.C. 299b-4(a)(1)).
                    ``(B) Requirement.--The Secretary shall ensure that 
                screening provided for under this paragraph complies 
                with the recommendations of the Task Force referred to 
                in subparagraph (A) with respect to--
                            ``(i) frequency;
                            ``(ii) the population to be served;
                            ``(iii) the procedure or technology to be 
                        used;
                            ``(iv) evidence of effectiveness; and
                            ``(v) other matters that the Secretary 
                        determines to be appropriate.''.

SEC. 126. PATIENT TRAVEL COSTS.

    Section 213 of the Indian Health Care Improvement Act (25 U.S.C. 
1621l) is amended to read as follows:

``SEC. 213. PATIENT TRAVEL COSTS.

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

SEC. 127. EPIDEMIOLOGY CENTERS.

    Section 214 of the Indian Health Care Improvement Act (25 U.S.C. 
1621m) is amended to read as follows:

``SEC. 214. EPIDEMIOLOGY CENTERS.

    ``(a) Establishment of Centers.--
            ``(1) In general.--The Secretary shall establish an 
        epidemiology center in each Service area to carry out the 
        functions described in subsection (b).
            ``(2) New centers.--
                    ``(A) In general.--Subject to subparagraph (B), any 
                new center established after the date of enactment of 
                the Indian Health Care Improvement Reauthorization and 
                Extension Act of 2009 may be operated under a grant 
                authorized by subsection (d).
                    ``(B) Requirement.--Funding provided in a grant 
                described in subparagraph (A) shall not be divisible.
    ``(b) Functions of Centers.--In consultation with and on the 
request of Indian tribes, tribal organizations, and urban Indian 
organizations, each Service area epidemiology center established under 
this section shall, with respect to the applicable Service area--
            ``(1) collect data relating to, and monitor progress made 
        toward meeting, each of the health status objectives of the 
        Service, the Indian tribes, tribal organizations, and urban 
        Indian organizations in the Service area;
            ``(2) evaluate existing delivery systems, data systems, and 
        other systems that impact the improvement of Indian health;
            ``(3) assist Indian tribes, tribal organizations, and urban 
        Indian organizations in identifying highest-priority health 
        status objectives and the services needed to achieve those 
        objectives, based on epidemiological data;
            ``(4) make recommendations for the targeting of services 
        needed by the populations served;
            ``(5) make recommendations to improve health care delivery 
        systems for Indians and urban Indians;
            ``(6) provide requested technical assistance to Indian 
        tribes, tribal organizations, and urban Indian organizations in 
        the development of local health service priorities and 
        incidence and prevalence rates of disease and other illness in 
        the community; and
            ``(7) provide disease surveillance and assist Indian 
        tribes, tribal organizations, and urban Indian communities to 
        promote public health.
    ``(c) Technical Assistance.--The Director of the Centers for 
Disease Control and Prevention shall provide technical assistance to 
the centers in carrying out this section.
    ``(d) Grants for Studies.--
            ``(1) In general.--The Secretary may make grants to Indian 
        tribes, tribal organizations, Indian organizations, and 
        eligible intertribal consortia to conduct epidemiological 
        studies of Indian communities.
            ``(2) Eligible intertribal consortia.--An intertribal 
        consortium or Indian organization shall be eligible to receive 
        a grant under this subsection if the intertribal consortium 
        is--
                    ``(A) incorporated for the primary purpose of 
                improving Indian health; and
                    ``(B) representative of the Indian tribes or urban 
                Indian communities residing in the area in which the 
                intertribal consortium is located.
            ``(3) Applications.--An application for a grant under this 
        subsection shall be submitted in such manner and at such time 
        as the Secretary shall prescribe.
            ``(4) Requirements.--An applicant for a grant under this 
        subsection shall--
                    ``(A) demonstrate the technical, administrative, 
                and financial expertise necessary to carry out the 
                functions described in paragraph (5);
                    ``(B) consult and cooperate with providers of 
                related health and social services in order to avoid 
                duplication of existing services; and
                    ``(C) demonstrate cooperation from Indian tribes or 
                urban Indian organizations in the area to be served.
            ``(5) Use of funds.--A grant provided under paragraph (1) 
        may be used--
                    ``(A) to carry out the functions described in 
                subsection (b);
                    ``(B) to provide information to, and consult with, 
                tribal leaders, urban Indian community leaders, and 
                related health staff regarding health care and health 
                service management issues; and
                    ``(C) in collaboration with Indian tribes, tribal 
                organizations, and urban Indian organizations, to 
                provide to the Service information regarding ways to 
                improve the health status of Indians.
    ``(e) Access to Information.--
            ``(1) In general.--An epidemiology center operated by a 
        grantee pursuant to a grant awarded under subsection (d) shall 
        be treated as a public health authority (as defined in section 
        164.501 of title 45, Code of Federal Regulations (or a 
        successor regulation)) for purposes of the Health Insurance 
        Portability and Accountability Act of 1996 (Public Law 104-191; 
        110 Stat. 1936).
            ``(2) Access to information.--The Secretary shall grant to 
        each epidemiology center described in paragraph (1) access to 
        use of the data, data sets, monitoring systems, delivery 
        systems, and other protected health information in the 
        possession of the Secretary.
            ``(3) Requirement.--The activities of an epidemiology 
        center described in paragraph (1) shall be for the purposes of 
        research and for preventing and controlling disease, injury, or 
        disability (as those activities are described in section 
        164.512 of title 45, Code of Federal Regulations (or a 
        successor regulation)), for purposes of the Health Insurance 
        Portability and Accountability Act of 1996 (Public Law 104-191; 
        110 Stat. 1936).
    ``(f) Funds Not Divisible.--An epidemiology center established 
under this section shall be subject to the Indian Self-Determination 
and Education Assistance Act (25 U.S.C. 450 et seq.), but the funds for 
the center shall not be divisible.''.

SEC. 128. PREVENTION, CONTROL, AND ELIMINATION OF COMMUNICABLE AND 
              INFECTIOUS DISEASES.

    Section 218 of the Indian Health Care Improvement Act (25 U.S.C. 
1621q) is amended to read as follows:

``SEC. 218. PREVENTION, CONTROL, AND ELIMINATION OF COMMUNICABLE AND 
              INFECTIOUS DISEASES.

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

SEC. 129. METHODS TO INCREASE CLINICIAN RECRUITMENT AND RETENTION 
              ISSUES.

    (a) Licensing.--Section 221 of the Indian Health Care Improvement 
Act (25 U.S.C. 1621t) is amended to read as follows:

``SEC. 221. LICENSING.

    ``Licensed health professionals employed by a tribal health program 
shall be exempt, if licensed in any State, from the licensing 
requirements of the State in which the tribal health program performs 
the services described in the contract or compact of the tribal health 
program under the Indian Self-Determination and Education Assistance 
Act (25 U.S.C. 450 et seq.).''.
    (b) Treatment of Scholarships for Certain Purposes.--Title I of the 
Indian Health Care Improvement Act (25 U.S.C. 1611 et seq.) (as amended 
by section 113) is amended by adding at the end the following:

``SEC. 125. TREATMENT OF SCHOLARSHIPS FOR CERTAIN PURPOSES.

    ``A scholarship provided to an individual pursuant to this title 
shall be considered to be a qualified scholarship for purposes of 
section 117 of the Internal Revenue Code of 1986.''.

SEC. 130. OFFICES OF INDIAN MEN'S HEALTH AND INDIAN WOMEN'S HEALTH.

    Section 223 of the Indian Health Care Improvement Act (25 U.S.C. 
1621v) is amended--
            (1) by striking the section designation and heading and all 
        that follows through ``oversee efforts of the Service to'' and 
        inserting the following:

``SEC. 223. OFFICES OF INDIAN MEN'S HEALTH AND INDIAN WOMEN'S HEALTH.

    ``(a) Office of Indian Men's Health.--
            ``(1) Establishment.--The Secretary may establish within 
        the Service an office, to be known as the `Office of Indian 
        Men's Health'.
            ``(2) Director.--
                    ``(A) In general.--The Office of Indian Men's 
                Health shall be headed by a director, to be appointed 
                by the Secretary.
                    ``(B) Duties.--The director shall coordinate and 
                promote the health status of Indian men in the United 
                States.
            ``(3) Report.--Not later than 2 years after the date of 
        enactment of the Indian Health Care Improvement Reauthorization 
        and Extension Act of 2009, the Secretary, acting through the 
        Service, shall submit to Congress a report describing--
                    ``(A) any activity carried out by the director as 
                of the date on which the report is prepared; and
                    ``(B) any finding of the director with respect to 
                the health of Indian men.
    ``(b) Office of Indian Women's Health.--The Secretary, acting 
through the Service, shall establish an office, to be known as the 
`Office of Indian Women's Health', to''; and
            (2) in subsection (b) (as so redesignated) by inserting 
        ``(including urban Indian women)'' before ``of all ages''.

SEC. 131. CONTRACT HEALTH SERVICE DISBURSEMENT FORMULA.

    Title II of the Indian Health Care Improvement Act (25 U.S.C. 1621 
et seq.) is amended by adding at the end the following:

``SEC. 226. CONTRACT HEALTH SERVICE DISBURSEMENT FORMULA.

    ``(a) In General.--Not later than 90 days after the date of 
enactment of this section, the Secretary, acting through the Service, 
shall initiate procedures under subchapter III of chapter 5 of title 5, 
United States Code, to negotiate and promulgate such regulations or 
amendments to establish a disbursement formula for contract health 
service funds.
    ``(b) Regulations.--
            ``(1) Proposed regulations.--Proposed regulations to 
        implement this section shall be published in the Federal 
        Register by the Secretary no later than 24 months after the 
        date of enactment of this section and shall have no less than a 
        120-day comment period.
            ``(2) Expiration of authority.--The authority to promulgate 
        regulation under paragraph (1) shall expire 36 months after the 
        date of the enactment of this section.
    ``(c) Procedures.--
            ``(1) In general.--A negotiated rulemaking committee 
        established pursuant to section 565 of title 5, United States 
        Code, to carry out this section shall have as its members only 
        representatives of the Federal Government and representatives 
        of Indian tribes and tribal organizations, who shall be 
        nominated by and be representatives of Indian tribes and tribal 
        organizations from each Service area.
            ``(2) Requirements.--The committee shall confer with, and 
        accommodate participation by, representatives of Indian tribes, 
        inter-tribal consortia, tribal organizations, and individual 
        tribal members.
            ``(3) Adaptation of procedures.--The Secretary shall adapt 
        the negotiated rulemaking procedures to the unique context of 
        self-governance and the government-to-government relationship 
        between the United States and Indian tribes.''.

                     Subtitle C--Health Facilities

SEC. 141. INDIAN HEALTH CARE DELIVERY DEMONSTRATION PROJECTS.

    Section 307 of the Indian Health Care Improvement Act (25 U.S.C. 
1637) is amended to read as follows:

``SEC. 307. INDIAN HEALTH CARE DELIVERY DEMONSTRATION PROJECTS.

    ``(a) In General.--The Secretary, acting through the Service, is 
authorized to carry out, or to enter into contracts under the Indian 
Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.) 
with Indian Tribes or tribal organizations to carry out, a health care 
delivery demonstration project to test alternative means of delivering 
health care and services to Indians through facilities.
    ``(b) Use of Funds.--The Secretary, in approving projects pursuant 
to this section--
            ``(1) may authorize such contracts for the construction and 
        renovation of hospitals, health centers, health stations, and 
        other facilities to deliver health care services; and
            ``(2) is authorized--
                    ``(A) to waive any leasing prohibition;
                    ``(B) to permit carryover of funds appropriated for 
                the provision of health care services;
                    ``(C) to permit the use of other available funds;
                    ``(D) to permit the use of funds or property 
                donated from any source for project purposes;
                    ``(E) to provide for the reversion of donated real 
                or personal property to the donor; and
                    ``(F) to permit the use of Service funds to match 
                other funds, including Federal funds.
    ``(c) Health Care Demonstration Projects.--
            ``(1) Definition of convenient care service.--In this 
        subsection, the term `convenient care service' means any 
        primary health care service, such as urgent care services, 
        nonemergent care services, prevention services and screenings, 
        and any service authorized by section 203 or 205(d), that is 
        offered at an alternative setting.
            ``(2) General projects.--
                    ``(A) Criteria.--The Secretary may approve under 
                this section demonstration projects that meet the 
                following criteria:
                            ``(i) There is a need for a new facility or 
                        program, such as a program for convenient care 
                        services, or the reorientation of an existing 
                        facility or program.
                            ``(ii) A significant number of Indians, 
                        including Indians with low health status, will 
                        be served by the project.
                            ``(iii) The project has the potential to 
                        deliver services in an efficient and effective 
                        manner.
                            ``(iv) The project is economically viable.
                            ``(v) For projects carried out by an Indian 
                        tribe or tribal organization, the Indian tribe 
                        or tribal organization has the administrative 
                        and financial capability to administer the 
                        project.
                            ``(vi) The project is integrated with 
                        providers of related health and social services 
                        and is coordinated with, and avoids duplication 
                        of, existing services in order to expand the 
                        availability of services.
                    ``(B) Priority.--In approving demonstration 
                projects under this paragraph, the Secretary shall give 
                priority to demonstration projects, to the extent the 
                projects meet the criteria described in subparagraph 
                (A), located in any of the following Service units:
                            ``(i) Cass Lake, Minnesota.
                            ``(ii) Mescalero, New Mexico.
                            ``(iii) Owyhee and Elko, Nevada.
                            ``(iv) Schurz, Nevada.
                            ``(v) Ft. Yuma, California.
            ``(3) Innovative health services delivery demonstration 
        project.--
                    ``(A) Criteria.--The Secretary shall look at 
                innovative ways to deliver health care services, such 
                as medical, dental, alternative medicine, 
                pharmaceutical, nursing, and clinical laboratory 
                services, in American Indian and Alaska Native 
                communities, including convenient care service, 
                community health centers, and other health care models 
                which improve access to quality health promotion and 
                disease prevention services.
                    ``(B) Approval.--In addition to projects described 
                in paragraph (2), in any fiscal year, the Secretary is 
                authorized to approve not more than 10 applications for 
                health care delivery demonstration projects that--
                            ``(i) include a convenient care service 
                        program as an alternative means of delivering 
                        health care services to Indians; and
                            ``(ii) meet the criteria described in 
                        subparagraph (C).
                    ``(C) Criteria.--The Secretary shall approve under 
                subparagraph (B) demonstration projects that meet all 
                of the following criteria:
                            ``(i) The criteria set forth in paragraph 
                        (2)(A).
                            ``(ii) There is a lack of access to health 
                        care services at existing health care 
                        facilities, which may be due to limited hours 
                        of operation at those facilities or other 
                        factors.
                            ``(iii) The project--
                                    ``(I) expands the availability of 
                                services; or
                                    ``(II) reduces--
                                            ``(aa) the burden on 
                                        Contract Health Services; or
                                            ``(bb) the need for 
                                        emergency room visits.
    ``(d) Peer Review Panels.--The Secretary may provide for the 
establishment of peer review panels, as necessary, to review and 
evaluate applications using the criteria described in paragraphs (2)(A) 
and (3)(C) of subsection (c).
    ``(e) Technical Assistance.--The Secretary shall provide such 
technical and other assistance as may be necessary to enable applicants 
to comply with this section.
    ``(f) Service to Ineligible Persons.--Subject to section 813, the 
authority to provide services to persons otherwise ineligible for the 
health care benefits of the Service, and the authority to extend 
hospital privileges in Service facilities to non-Service health 
practitioners as provided in section 813, may be included, subject to 
the terms of that section, in any demonstration project approved 
pursuant to this section.
    ``(g) Equitable Treatment.--For purposes of subsection (c), the 
Secretary, in evaluating facilities operated under any contract or 
compact under the Indian Self-Determination and Education Assistance 
Act (25 U.S.C. 450 et seq.), shall use the same criteria that the 
Secretary uses in evaluating facilities operated directly by the 
Service.
    ``(h) Equitable Integration of Facilities.--The Secretary shall 
ensure that the planning, design, construction, renovation, and 
expansion needs of Service and non-Service facilities that are the 
subject of a contract or compact under the Indian Self-Determination 
and Education Assistance Act (25 U.S.C. 450 et seq.) for health 
services are fully and equitably integrated into the implementation of 
the health care delivery demonstration projects under this section.''.

SEC. 142. TRIBAL MANAGEMENT OF FEDERALLY OWNED QUARTERS.

    Title III of the Indian Health Care Improvement Act (as amended by 
section 101(b)) is amended by inserting after section 308 (25 U.S.C. 
1638) the following:

``SEC. 309. TRIBAL MANAGEMENT OF FEDERALLY OWNED QUARTERS.

    ``(a) Rental Rates.--
            ``(1) Establishment.--Notwithstanding any other provision 
        of law, a tribal health program that operates a hospital or 
        other health facility and the federally owned quarters 
        associated with such a facility pursuant to a contract or 
        compact under the Indian Self-Determination and Education 
        Assistance Act (25 U.S.C. 450 et seq.) may establish the rental 
        rates charged to the occupants of those quarters, on providing 
        notice to the Secretary.
            ``(2) Objectives.--In establishing rental rates under this 
        subsection, a tribal health program shall attempt--
                    ``(A) to base the rental rates on the reasonable 
                value of the quarters to the occupants of the quarters; 
                and
                    ``(B) to generate sufficient funds to prudently 
                provide for the operation and maintenance of the 
                quarters, and at the discretion of the tribal health 
                program, to supply reserve funds for capital repairs 
                and replacement of the quarters.
            ``(3) Equitable funding.--A federally owned quarters the 
        rental rates for which are established by a tribal health 
        program under this subsection shall remain eligible to receive 
        improvement and repair funds to the same extent that all 
        federally owned quarters used to house personnel in programs of 
        the Service are eligible to receive those funds.
            ``(4) Notice of rate change.--A tribal health program that 
        establishes a rental rate under this subsection shall provide 
        occupants of the federally owned quarters a notice of any 
        change in the rental rate by not later than the date that is 60 
        days notice before the effective date of the change.
            ``(5) Rates in alaska.--A rental rate established by a 
        tribal health program under this section for a federally owned 
        quarters in the State of Alaska may be based on the cost of 
        comparable private rental housing in the nearest established 
        community with a year-round population of 1,500 or more 
        individuals.
    ``(b) Direct Collection of Rent.--
            ``(1) In general.--Notwithstanding any other provision of 
        law, and subject to paragraph (2), a tribal health program may 
        collect rent directly from Federal employees who occupy 
        federally owned quarters if the tribal health program submits 
        to the Secretary and the employees a notice of the election of 
        the tribal health program to collect rents directly from the 
        employees.
            ``(2) Action by employees.--On receipt of a notice 
        described in paragraph (1)--
                    ``(A) the affected Federal employees shall pay rent 
                for occupancy of a federally owned quarters directly to 
                the applicable tribal health program; and
                    ``(B) the Secretary shall not have the authority to 
                collect rent from the employees through payroll 
                deduction or otherwise.
            ``(3) Use of payments.--The rent payments under this 
        subsection--
                    ``(A) shall be retained by the applicable tribal 
                health program in a separate account, which shall be 
                used by the tribal health program for the maintenance 
                (including capital repairs and replacement) and 
                operation of the quarters, as the tribal health program 
                determines to be appropriate; and
                    ``(B) shall not be made payable to, or otherwise be 
                deposited with, the United States.
            ``(4) Retrocession of authority.--If a tribal health 
        program that elected to collect rent directly under paragraph 
        (1) requests retrocession of the authority of the tribal health 
        program to collect that rent, the retrocession shall take 
        effect on the earlier of--
                    ``(A) the first day of the month that begins not 
                less than 180 days after the tribal health program 
                submits the request; and
                    ``(B) such other date as may be mutually agreed on 
                by the Secretary and the tribal health program.''.

SEC. 143. OTHER FUNDING, EQUIPMENT, AND SUPPLIES FOR FACILITIES.

    Title III of the Indian Health Care Improvement Act (25 U.S.C. 1631 
et seq.) is amended by adding at the end the following:

``SEC. 311. OTHER FUNDING, EQUIPMENT, AND SUPPLIES FOR FACILITIES.

    ``(a) Authorization.--
            ``(1) Authority to transfer funds.--The head of any Federal 
        agency to which funds, equipment, or other supplies are made 
        available for the construction or operation of a health care 
        facility may transfer the funds, equipment, or supplies to the 
        Secretary for the construction or operation of a health care 
        facility to achieve--
                    ``(A) the purposes of this Act; and
                    ``(B) the purposes for which the funds, equipment, 
                or supplies were made available to the Federal agency.
            ``(2) Authority to accept funds.--The Secretary may--
                    ``(A) accept from any source, including Federal and 
                State agencies, funds, equipment, or supplies that are 
                available for the construction or operation of health 
                care facilities; and
                    ``(B) use those funds, equipment, and supplies to 
                plan, design, and construct health care facilities for 
                Indians, including pursuant to a contract or compact 
                under the Indian Self-Determination and Education 
                Assistance Act (25 U.S.C. 450 et seq.).
            ``(3) Effect of receipt.--Receipt of funds by the Secretary 
        under this subsection shall not affect any priority established 
        under section 301.
    ``(b) Interagency Agreements.--The Secretary may enter into 
interagency agreements with Federal or State agencies and other 
entities, and accept funds, equipment, or other supplies from those 
entities, to provide for the planning, design, and construction of 
health care facilities to be administered by Indian health programs to 
achieve--
            ``(1) the purposes of this Act; and
            ``(2) the purposes for which the funds were appropriated or 
        otherwise provided.
    ``(c) Establishment of Standards.--The Secretary, acting through 
the Service, shall establish, by regulation, standards for the 
planning, design, and construction of health care facilities serving 
Indians under this Act.''.

SEC. 144. INDIAN COUNTRY MODULAR COMPONENT FACILITIES DEMONSTRATION 
              PROGRAM.

    Title III of the Indian Health Care Improvement Act (25 U.S.C. 1631 
et seq.) (as amended by section 143) is amended by adding at the end 
the following:

``SEC. 312. INDIAN COUNTRY MODULAR COMPONENT FACILITIES DEMONSTRATION 
              PROGRAM.

    ``(a) Definition of Modular Component Health Care Facility.--In 
this section, the term `modular component health care facility' means a 
health care facility that is constructed--
            ``(1) off-site using prefabricated component units for 
        subsequent transport to the destination location; and
            ``(2) represents a more economical method for provision of 
        health care facility than a traditionally constructed health 
        care building.
    ``(b) Establishment.--The Secretary, acting through the Service, 
shall establish a demonstration program under which the Secretary shall 
award no less than 3 grants for purchase, installation and maintenance 
of modular component health care facilities in Indian communities for 
provision of health care services.
    ``(c) Selection of Locations.--
            ``(1) Petitions.--
                    ``(A) Solicitation.--The Secretary shall solicit 
                from Indian tribes petitions for location of the 
                modular component health care facilities in the Service 
                areas of the petitioning Indian tribes.
                    ``(B) Petition.--To be eligible to receive a grant 
                under this section, an Indian tribe or tribal 
                organization must submit to the Secretary a petition to 
                construct a modular component health care facility in 
                the Indian community of the Indian tribe, at such time, 
                in such manner, and containing such information as the 
                Secretary may require.
            ``(2) Selection.--In selecting the location of each modular 
        component health care facility to be provided under the 
        demonstration program, the Secretary shall give priority to 
        projects already on the Indian Health Service facilities 
        construction priority list and petitions which demonstrate that 
        erection of a modular component health facility--
                    ``(A) is more economical than construction of a 
                traditionally constructed health care facility;
                    ``(B) can be constructed and erected on the 
                selected location in less time than traditional 
                construction; and
                    ``(C) can adequately house the health care services 
                needed by the Indian population to be served.
            ``(3) Effect of selection.--A modular component health care 
        facility project selected for participation in the 
        demonstration program shall not be eligible for entry on the 
        facilities construction priorities list entitled `IHS Health 
        Care Facilities FY 2011 Planned Construction Budget' and dated 
        May 7, 2009 (or any successor list).
    ``(d) Eligibility.--
            ``(1) In general.--An Indian tribe may submit a petition 
        under subsection (c)(1)(B) regardless of whether the Indian 
        tribe is a party to any contract or compact under the Indian 
        Self-Determination and Education Assistance Act (25 U.S.C. 450 
        et seq.).
            ``(2) Administration.--At the election of an Indian tribe 
        or tribal organization selected for participation in the 
        demonstration program, the funds provided for the project shall 
        be subject to the provisions of the Indian Self-Determination 
        and Education Assistance Act.
    ``(e) Reports.--Not later than 1 year after the date on which funds 
are made available for the demonstration program and annually 
thereafter, the Secretary shall submit to Congress a report 
describing--
            ``(1) each activity carried out under the demonstration 
        program, including an evaluation of the success of the 
        activity; and
            ``(2) the potential benefits of increased use of modular 
        component health care facilities in other Indian communities.
    ``(f) Authorization of Appropriations.--There are authorized to be 
appropriated $50,000,000 to carry out the demonstration program under 
this section for the first 5 fiscal years, and such sums as may be 
necessary to carry out the program in subsequent fiscal years.''.

SEC. 145. MOBILE HEALTH STATIONS DEMONSTRATION PROGRAM.

    Title III of the Indian Health Care Improvement Act (25 U.S.C. 1631 
et seq.) (as amended by section 144) is amended by adding at the end 
the following:

``SEC. 313. MOBILE HEALTH STATIONS DEMONSTRATION PROGRAM.

    ``(a) Definitions.--In this section:
            ``(1) Eligible tribal consortium.--The term `eligible 
        tribal consortium' means a consortium composed of 2 or more 
        Service units between which a mobile health station can be 
        transported by road in up to 8 hours. A Service unit operated 
        by the Service or by an Indian tribe or tribal organization 
        shall be equally eligible for participation in such consortium.
            ``(2) Mobile health station.--The term `mobile health 
        station' means a health care unit that--
                    ``(A) is constructed, maintained, and capable of 
                being transported within a semi-trailer truck or 
                similar vehicle;
                    ``(B) is equipped for the provision of 1 or more 
                specialty health care services; and
                    ``(C) can be equipped to be docked to a stationary 
                health care facility when appropriate.
            ``(3) Specialty health care service.--
                    ``(A) In general.--The term `specialty health care 
                service' means a health care service which requires the 
                services of a health care professional with specialized 
                knowledge or experience.
                    ``(B) Inclusions.--The term `specialty health care 
                service' includes any service relating to--
                            ``(i) dialysis;
                            ``(ii) surgery;
                            ``(iii) mammography;
                            ``(iv) dentistry; or
                            ``(v) any other specialty health care 
                        service.
    ``(b) Establishment.--The Secretary, acting through the Service, 
shall establish a demonstration program under which the Secretary shall 
provide at least 3 mobile health station projects.
    ``(c) Petition.--To be eligible to receive a mobile health station 
under the demonstration program, an eligible tribal consortium shall 
submit to the Secretary, a petition at such time, in such manner, and 
containing--
            ``(1) a description of the Indian population to be served;
            ``(2) a description of the specialty service or services 
        for which the mobile health station is requested and the extent 
        to which such service or services are currently available to 
        the Indian population to be served; and
            ``(3) such other information as the Secretary may require.
    ``(d) Use of Funds.--The Secretary shall use amounts made available 
to carry out the demonstration program under this section--
            ``(1)(A) to establish, purchase, lease, or maintain mobile 
        health stations for the eligible tribal consortia selected for 
        projects; and
            ``(B) to provide, through the mobile health station, such 
        specialty health care services as the affected eligible tribal 
        consortium determines to be necessary for the Indian population 
        served;
            ``(2) to employ an existing mobile health station 
        (regardless of whether the mobile health station is owned or 
        rented and operated by the Service) to provide specialty health 
        care services to an eligible tribal consortium; and
            ``(3) to establish, purchase, or maintain docking equipment 
        for a mobile health station, including the establishment or 
        maintenance of such equipment at a modular component health 
        care facility (as defined in section 312(a)), if applicable.
    ``(e) Reports.--Not later than 1 year after the date on which the 
demonstration program is established under subsection (b) and annually 
thereafter, the Secretary, acting through the Service, shall submit to 
Congress a report describing--
            ``(1) each activity carried out under the demonstration 
        program including an evaluation of the success of the activity; 
        and
            ``(2) the potential benefits of increased use of mobile 
        health stations to provide specialty health care services for 
        Indian communities.
    ``(f) Authorization of Appropriations.--There are authorized to be 
appropriated $5,000,000 per year to carry out the demonstration program 
under this section for the first 5 fiscal years, and such sums as may 
be needed to carry out the program in subsequent fiscal years.''.

                 Subtitle D--Access to Health Services

SEC. 151. TREATMENT OF PAYMENTS UNDER SOCIAL SECURITY ACT HEALTH 
              BENEFITS PROGRAMS.

    Section 401 of the Indian Health Care Improvement Act (25 U.S.C. 
1641) is amended to read as follows:

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

    ``(a) Disregard of Medicare, Medicaid, and CHIP Payments in 
Determining Appropriations.--Any payments received by an Indian health 
program or by an urban Indian organization under title XVIII, XIX, or 
XXI of the Social Security Act for services provided to Indians 
eligible for benefits under such respective titles shall not be 
considered in determining appropriations for the provision of health 
care and services to Indians.
    ``(b) Nonpreferential Treatment.--Nothing in this Act authorizes 
the Secretary to provide services to an Indian with coverage under 
title XVIII, XIX, or XI of the Social Security Act in preference to an 
Indian without such coverage.
    ``(c) Use of Funds.--
            ``(1) Special fund.--
                    ``(A) 100 percent pass-through of payments due to 
                facilities.--Notwithstanding any other provision of 
                law, but subject to paragraph (2), payments to which a 
                facility of the Service is entitled by reason of a 
                provision of title XVIII or XIX of the Social Security 
                Act shall be placed in a special fund to be held by the 
                Secretary. In making payments from such fund, the 
                Secretary shall ensure that each Service unit of the 
                Service receives 100 percent of the amount to which the 
                facilities of the Service, for which such Service unit 
                makes collections, are entitled by reason of a 
                provision of either such title.
                    ``(B) Use of funds.--Amounts received by a facility 
                of the Service under subparagraph (A) by reason of a 
                provision of title XVIII or XIX of the Social Security 
                Act shall first be used (to such extent or in such 
                amounts as are provided in appropriation Acts) for the 
                purpose of making any improvements in the programs of 
                the Service operated by or through such facility which 
                may be necessary to achieve or maintain compliance with 
                the applicable conditions and requirements of such 
                respective title. Any amounts so received that are in 
                excess of the amount necessary to achieve or maintain 
                such conditions and requirements shall, subject to 
                consultation with the Indian tribes being served by the 
                Service unit, be used for reducing the health resource 
                deficiencies (as determined in section 201(c)) of such 
                Indian tribes, including the provision of services 
                pursuant to section 205.
            ``(2) Direct payment option.--Paragraph (1) shall not apply 
        to a tribal health program upon the election of such program 
        under subsection (d) to receive payments directly. No payment 
        may be made out of the special fund described in such paragraph 
        with respect to reimbursement made for services provided by 
        such program during the period of such election.
    ``(d) Direct Billing.--
            ``(1) In general.--Subject to complying with the 
        requirements of paragraph (2), a tribal health program may 
        elect to directly bill for, and receive payment for, health 
        care items and services provided by such program for which 
        payment is made under title XVIII, XIX, or XXI of the Social 
        Security Act or from any other third party payor.
            ``(2) Direct reimbursement.--
                    ``(A) Use of funds.--Each tribal health program 
                making the election described in paragraph (1) with 
                respect to a program under a title of the Social 
                Security Act shall be reimbursed directly by that 
                program for items and services furnished without regard 
                to subsection (c)(1), except that all amounts so 
                reimbursed shall be used by the tribal health program 
                for the purpose of making any improvements in 
                facilities of the tribal health program that may be 
                necessary to achieve or maintain compliance with the 
                conditions and requirements applicable generally to 
                such items and services under the program under such 
                title and to provide additional health care services, 
                improvements in health care facilities and tribal 
                health programs, any health care-related purpose 
                (including coverage for a service or service within a 
                contract health service delivery area or any portion of 
                a contract health service delivery area that would 
                otherwise be provided as a contract health service), or 
                otherwise to achieve the objectives provided in section 
                3 of this Act.
                    ``(B) Audits.--The amounts paid to a tribal health 
                program making the election described in paragraph (1) 
                with respect to a program under title XVIII, XIX, or 
                XXI of the Social Security Act shall be subject to all 
                auditing requirements applicable to the program under 
                such title, as well as all auditing requirements 
                applicable to programs administered by an Indian health 
                program. Nothing in the preceding sentence shall be 
                construed as limiting the application of auditing 
                requirements applicable to amounts paid under title 
                XVIII, XIX, or XXI of the Social Security Act.
                    ``(C) Identification of source of payments.--Any 
                tribal health program that receives reimbursements or 
                payments under title XVIII, XIX, or XXI of the Social 
                Security Act shall provide to the Service a list of 
                each provider enrollment number (or other identifier) 
                under which such program receives such reimbursements 
                or payments.
            ``(3) Examination and implementation of changes.--
                    ``(A) In general.--The Secretary, acting through 
                the Service and with the assistance of the 
                Administrator of the Centers for Medicare & Medicaid 
                Services, shall examine on an ongoing basis and 
                implement any administrative changes that may be 
                necessary to facilitate direct billing and 
                reimbursement under the program established under this 
                subsection, including any agreements with States that 
                may be necessary to provide for direct billing under a 
                program under title XIX or XXI of the Social Security 
                Act.
                    ``(B) Coordination of information.--The Service 
                shall provide the Administrator of the Centers for 
                Medicare & Medicaid Services with copies of the lists 
                submitted to the Service under paragraph (2)(C), 
                enrollment data regarding patients served by the 
                Service (and by tribal health programs, to the extent 
                such data is available to the Service), and such other 
                information as the Administrator may require for 
                purposes of administering title XVIII, XIX, or XXI of 
                the Social Security Act.
            ``(4) Withdrawal from program.--A tribal health program 
        that bills directly under the program established under this 
        subsection may withdraw from participation in the same manner 
        and under the same conditions that an Indian tribe or tribal 
        organization may retrocede a contracted program to the 
        Secretary under the authority of the Indian Self-Determination 
        and Education Assistance Act (25 U.S.C. 450 et seq.). All cost 
        accounting and billing authority under the program established 
        under this subsection shall be returned to the Secretary upon 
        the Secretary's acceptance of the withdrawal of participation 
        in this program.
            ``(5) Termination for failure to comply with 
        requirements.--The Secretary may terminate the participation of 
        a tribal health program or in the direct billing program 
        established under this subsection if the Secretary determines 
        that the program has failed to comply with the requirements of 
        paragraph (2). The Secretary shall provide a tribal health 
        program with notice of a determination that the program has 
        failed to comply with any such requirement and a reasonable 
        opportunity to correct such noncompliance prior to terminating 
        the program's participation in the direct billing program 
        established under this subsection.
    ``(e) Related Provisions Under the Social Security Act.--For 
provisions related to subsections (c) and (d), see sections 1880, 1911, 
and 2107(e)(1)(D) of the Social Security Act.''.

SEC. 152. PURCHASING HEALTH CARE COVERAGE.

    Section 402 of the Indian Health Care Improvement Act (25 U.S.C. 
1642) is amended to read as follows:

``SEC. 402. PURCHASING HEALTH CARE COVERAGE.

    ``(a) In General.--Insofar as amounts are made available under law 
(including a provision of the Social Security Act, the Indian Self-
Determination and Education Assistance Act (25 U.S.C. 450 et seq.), or 
other law, other than under section 404) to Indian tribes, tribal 
organizations, and urban Indian organizations for health benefits for 
Service beneficiaries, Indian tribes, tribal organizations, and urban 
Indian organizations may use such amounts to purchase health benefits 
coverage (including coverage for a service, or service within a 
contract health service delivery area, or any portion of a contract 
health service delivery area that would otherwise be provided as a 
contract health service) for such beneficiaries in any manner, 
including through--
            ``(1) a tribally owned and operated health care plan;
            ``(2) a State or locally authorized or licensed health care 
        plan;
            ``(3) a health insurance provider or managed care 
        organization;
            ``(4) a self-insured plan; or
            ``(5) a high deductible or health savings account plan.
    ``(b) Financial Need.--The purchase of coverage under subsection 
(a) by an Indian tribe, tribal organization, or urban Indian 
organization may be based on the financial needs of such beneficiaries 
(as determined by the 1 or more Indian tribes being served based on a 
schedule of income levels developed or implemented by such 1 ore more 
Indian tribes).
    ``(c) Expenses for Self-Insured Plan.--In the case of a self-
insured plan under subsection (a)(4), the amounts may be used for 
expenses of operating the plan, including administration and insurance 
to limit the financial risks to the entity offering the plan.
    ``(d) Construction.--Nothing in this section shall be construed as 
affecting the use of any amounts not referred to in subsection (a).''.

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.

    Section 404 of the Indian Health Care Improvement Act (25 U.S.C. 
1644) is amended to read as follows:

``SEC. 404. GRANTS TO AND CONTRACTS WITH THE SERVICE, INDIAN TRIBES, 
              TRIBAL ORGANIZATIONS, AND URBAN INDIAN ORGANIZATIONS TO 
              FACILITATE OUTREACH, ENROLLMENT, AND COVERAGE OF INDIANS 
              UNDER SOCIAL SECURITY ACT HEALTH BENEFIT PROGRAMS AND 
              OTHER HEALTH BENEFITS PROGRAMS.

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

SEC. 154. SHARING ARRANGEMENTS WITH FEDERAL AGENCIES.

    Section 405 of the Indian Health Care Improvement Act (25 U.S.C. 
1645) is amended to read as follows:

``SEC. 405. SHARING ARRANGEMENTS WITH FEDERAL AGENCIES.

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

SEC. 155. ELIGIBLE INDIAN VETERAN SERVICES.

    Title IV of the Indian Health Care Improvement Act (25 U.S.C. 1641 
et seq.) (as amended by section 101(b)) is amended by adding at the end 
the following:

``SEC. 407. ELIGIBLE INDIAN VETERAN SERVICES.

    ``(a) Findings; Purpose.--
            ``(1) Findings.--Congress finds that--
                    ``(A) collaborations between the Secretary and the 
                Secretary of Veterans Affairs regarding the treatment 
                of Indian veterans at facilities of the Service should 
                be encouraged to the maximum extent practicable; and
                    ``(B) increased enrollment for services of the 
                Department of Veterans Affairs by veterans who are 
                members of Indian tribes should be encouraged to the 
                maximum extent practicable.
            ``(2) Purpose.--The purpose of this section is to reaffirm 
        the goals stated in the document entitled `Memorandum of 
        Understanding Between the VA/Veterans Health Administration And 
        HHS/Indian Health Service' and dated February 25, 2003 
        (relating to cooperation and resource sharing between the 
        Veterans Health Administration and Service).
    ``(b) Definitions.--In this section:
            ``(1) Eligible indian veteran.--The term `eligible Indian 
        veteran' means an Indian or Alaska Native veteran who receives 
        any medical service that is--
                    ``(A) authorized under the laws administered by the 
                Secretary of Veterans Affairs; and
                    ``(B) administered at a facility of the Service 
                (including a facility operated by an Indian tribe or 
                tribal organization through a contract or compact with 
                the Service under the Indian Self-Determination and 
                Education Assistance Act (25 U.S.C. 450 et seq.)) 
                pursuant to a local memorandum of understanding.
            ``(2) Local memorandum of understanding.--The term `local 
        memorandum of understanding' means a memorandum of 
        understanding between the Secretary (or a designee, including 
        the director of any area office of the Service) and the 
        Secretary of Veterans Affairs (or a designee) to implement the 
        document entitled `Memorandum of Understanding Between the VA/
        Veterans Health Administration And HHS/Indian Health Service' 
        and dated February 25, 2003 (relating to cooperation and 
        resource sharing between the Veterans Health Administration and 
        Indian Health Service).
    ``(c) Eligible Indian Veterans Expenses.--
            ``(1) In general.--Notwithstanding any other provision of 
        law, the Secretary shall provide for veteran-related expenses 
        incurred by eligible Indian veterans as described in subsection 
        (b)(1)(B).
            ``(2) Method of payment.--The Secretary shall establish 
        such guidelines as the Secretary determines to be appropriate 
        regarding the method of payments to the Secretary of Veterans 
        Affairs under paragraph (1).
    ``(d) Tribal Approval of Memoranda.--In negotiating a local 
memorandum of understanding with the Secretary of Veterans Affairs 
regarding the provision of services to eligible Indian veterans, the 
Secretary shall consult with each Indian tribe that would be affected 
by the local memorandum of understanding.
    ``(e) Funding.--
            ``(1) Treatment.--Expenses incurred by the Secretary in 
        carrying out subsection (c)(1) shall not be considered to be 
        Contract Health Service expenses.
            ``(2) Use of funds.--Of funds made available to the 
        Secretary in appropriations Acts for the Service (excluding 
        funds made available for facilities, Contract Health Services, 
        or contract support costs), the Secretary shall use such sums 
        as are necessary to carry out this section.''.

SEC. 156. NONDISCRIMINATION UNDER FEDERAL HEALTH CARE PROGRAMS IN 
              QUALIFICATIONS FOR REIMBURSEMENT FOR SERVICES.

    Title IV of the Indian Health Care Improvement Act (25 U.S.C. 1641 
et seq.) (as amended by section 155) is amended by adding at the end 
the following:

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

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

SEC. 157. ACCESS TO FEDERAL INSURANCE.

    Title IV of the Indian Health Care Improvement Act (25 U.S.C. 1641 
et seq.) (as amended by section 156) is amended by adding at the end 
the following:

``SEC. 409. ACCESS TO FEDERAL INSURANCE.

    ``Notwithstanding the provisions of title 5, United States Code, 
Executive order, or administrative regulation, an Indian tribe or 
tribal organization carrying out programs under the Indian Self-
Determination and Education Assistance Act (25 U.S.C. 450 et seq.) or 
an urban Indian organization carrying out programs under title V of 
this Act shall be entitled to purchase coverage, rights, and benefits 
for the employees of such Indian tribe or tribal organization, or urban 
Indian organization, under chapter 89 of title 5, United States Code, 
and chapter 87 of such title if necessary employee deductions and 
agency contributions in payment for the coverage, rights, and benefits 
for the period of employment with such Indian tribe or tribal 
organization, or urban Indian organization, are currently deposited in 
the applicable Employee's Fund under such title.''.

SEC. 158. GENERAL EXCEPTIONS.

    Title IV of the Indian Health Care Improvement Act (25 U.S.C. 1641 
et seq.) (as amended by section 157) is amended by adding at the end 
the following:

``SEC. 410. GENERAL EXCEPTIONS.

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

             Subtitle E--Health Services for Urban Indians

SEC. 161. REQUIREMENT TO CONFER WITH URBAN INDIAN ORGANIZATIONS.

    (a) Conferring With Urban Indian Organizations.--Title V of the 
Indian Health Care Improvement Act (25 U.S.C. 1651 et seq.) (as amended 
by section 101(b)) is amended by adding at the end the following:

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

    ``(a) Definition of Confer.--In this section, the term `confer' 
means to engage in an open and free exchange of information and 
opinions that--
            ``(1) leads to mutual understanding and comprehension; and
            ``(2) emphasizes trust, respect, and shared responsibility.
    ``(b) Requirement.--The Secretary shall ensure that the Service 
confers, to the maximum extent practicable, with urban Indian 
organizations in carrying out this Act.''.
    (b) Contracts With, and Grants To, Urban Indian Organizations.--
Section 502 of the Indian Health Care Improvement Act (25 U.S.C. 1652) 
is amended to read as follows:

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

    ``(a) In General.--Pursuant to the Act of November 2, 1921 (25 
U.S.C. 13) (commonly known as the `Snyder Act'), the Secretary, acting 
through the Service, shall enter into contracts with, or make grants 
to, urban Indian organizations to assist the urban Indian organizations 
in the establishment and administration, within urban centers, of 
programs that meet the requirements of this title.
    ``(b) Conditions.--Subject to section 506, the Secretary, acting 
through the Service, shall include such conditions as the Secretary 
considers necessary to effect the purpose of this title in any contract 
into which the Secretary enters with, or in any grant the Secretary 
makes to, any urban Indian organization pursuant to this title.''.

SEC. 162. EXPANDED PROGRAM AUTHORITY FOR URBAN INDIAN ORGANIZATIONS.

    Title V of the Indian Health Care Improvement Act (25 U.S.C. 1651 
et seq.) (as amended by section 161(a)) is amended by adding at the end 
the following:

``SEC. 515. EXPANDED PROGRAM AUTHORITY FOR URBAN INDIAN ORGANIZATIONS.

    ``Notwithstanding any other provision of this Act, the Secretary, 
acting through the Service, is authorized to establish programs, 
including programs for awarding grants, for urban Indian organizations 
that are identical to any programs established pursuant to sections 
218, 702, and 708(g).''.

SEC. 163. COMMUNITY HEALTH REPRESENTATIVES.

    Title V of the Indian Health Care Improvement Act (25 U.S.C. 1651 
et seq.) (as amended by section 162) is amended by adding at the end 
the following:

``SEC. 516. COMMUNITY HEALTH REPRESENTATIVES.

    ``The Secretary, acting through the Service, may enter into 
contracts with, and make grants to, urban Indian organizations for the 
employment of Indians trained as health service providers through the 
Community Health Representative Program under section 107 in the 
provision of health care, health promotion, and disease prevention 
services to urban Indians.''.

                Subtitle F--Organizational Improvements

SEC. 171. ESTABLISHMENT OF THE INDIAN HEALTH SERVICE AS AN AGENCY OF 
              THE PUBLIC HEALTH SERVICE.

    Section 601 of the Indian Health Care Improvement Act (25 U.S.C. 
1661) is amended to read as follows:

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

    ``(a) Establishment.--
            ``(1) In general.--In order to more effectively and 
        efficiently carry out the responsibilities, authorities, and 
        functions of the United States to provide health care services 
        to Indians and Indian tribes, as are or may be hereafter 
        provided by Federal statute or treaties, there is established 
        within the Public Health Service of the Department the Indian 
        Health Service.
            ``(2) Director.--The Service shall be administered by a 
        Director, who shall be appointed by the President, by and with 
        the advice and consent of the Senate. The Director shall report 
        to the Secretary. Effective with respect to an individual 
        appointed by the President, by and with the advice and consent 
        of the Senate, after January 1, 2008, the term of service of 
        the Director shall be 4 years. A Director may serve more than 1 
        term.
            ``(3) Incumbent.--The individual serving in the position of 
        Director of the Service on the day before the date of enactment 
        of the Indian Health Care Improvement Reauthorization and 
        Extension Act of 2009 shall serve as Director.
            ``(4) Advocacy and consultation.--The position of Director 
        is established to, in a manner consistent with the government-
        to-government relationship between the United States and Indian 
        Tribes--
                    ``(A) facilitate advocacy for the development of 
                appropriate Indian health policy; and
                    ``(B) promote consultation on matters relating to 
                Indian health.
    ``(b) Agency.--The Service shall be an agency within the Public 
Health Service of the Department, and shall not be an office, 
component, or unit of any other agency of the Department.
    ``(c) Duties.--The Director shall--
            ``(1) perform all functions that were, on the day before 
        the date of enactment of the Indian Health Care Improvement 
        Reauthorization and Extension Act of 2009, carried out by or 
        under the direction of the individual serving as Director of 
        the Service on that day;
            ``(2) perform all functions of the Secretary relating to 
        the maintenance and operation of hospital and health facilities 
        for Indians and the planning for, and provision and utilization 
        of, health services for Indians;
            ``(3) administer all health programs under which health 
        care is provided to Indians based upon their status as Indians 
        which are administered by the Secretary, including programs 
        under--
                    ``(A) this Act;
                    ``(B) the Act of November 2, 1921 (25 U.S.C. 13);
                    ``(C) the Act of August 5, 1954 (42 U.S.C. 2001 et 
                seq.);
                    ``(D) the Act of August 16, 1957 (42 U.S.C. 2005 et 
                seq.); and
                    ``(E) the Indian Self-Determination and Education 
                Assistance Act (25 U.S.C. 450 et seq.);
            ``(4) administer all scholarship and loan functions carried 
        out under title I;
            ``(5) directly advise the Secretary concerning the 
        development of all policy- and budget-related matters affecting 
        Indian health;
            ``(6) collaborate with the Assistant Secretary for Health 
        concerning appropriate matters of Indian health that affect the 
        agencies of the Public Health Service;
            ``(7) advise each Assistant Secretary of the Department 
        concerning matters of Indian health with respect to which that 
        Assistant Secretary has authority and responsibility;
            ``(8) advise the heads of other agencies and programs of 
        the Department concerning matters of Indian health with respect 
        to which those heads have authority and responsibility;
            ``(9) coordinate the activities of the Department 
        concerning matters of Indian health; and
            ``(10) perform such other functions as the Secretary may 
        designate.
    ``(d) Authority.--
            ``(1) In general.--The Secretary, acting through the 
        Director, shall have the authority--
                    ``(A) except to the extent provided for in 
                paragraph (2), to appoint and compensate employees for 
                the Service in accordance with title 5, United States 
                Code;
                    ``(B) to enter into contracts for the procurement 
                of goods and services to carry out the functions of the 
                Service; and
                    ``(C) to manage, expend, and obligate all funds 
                appropriated for the Service.
            ``(2) Personnel actions.--Notwithstanding any other 
        provision of law, the provisions of section 12 of the Act of 
        June 18, 1934 (48 Stat. 986; 25 U.S.C. 472), shall apply to all 
        personnel actions taken with respect to new positions created 
        within the Service as a result of its establishment under 
        subsection (a).''.

SEC. 172. OFFICE OF DIRECT SERVICE TRIBES.

    Title VI of the Indian Health Care Improvement Act (25 U.S.C. 1661 
et seq.) (as amended by section 101(b)) is amended by adding at the end 
the following:

``SEC. 603. OFFICE OF DIRECT SERVICE TRIBES.

    ``(a) Establishment.--There is established within the Service an 
office, to be known as the `Office of Direct Service Tribes'.
    ``(b) Treatment.--The Office of Direct Service Tribes shall be 
located in the Office of the Director.
    ``(c) Duties.--The Office of Direct Service Tribes shall be 
responsible for--
            ``(1) providing Service-wide leadership, guidance and 
        support for direct service tribes to include strategic planning 
        and program evaluation;
            ``(2) ensuring maximum flexibility to tribal health and 
        related support systems for Indian beneficiaries;
            ``(3) serving as the focal point for consultation and 
        participation between direct service tribes and organizations 
        and the Service in the development of Service policy;
            ``(4) holding no less than biannual consultations with 
        direct service tribes in appropriate locations to gather 
        information and aid in the development of health policy; and
            ``(5) directing a national program and providing leadership 
        and advocacy in the development of health policy, program 
        management, budget formulation, resource allocation, and 
        delegation support for direct service tribes.''.

SEC. 173. NEVADA AREA OFFICE.

    Title VI of the Indian Health Care Improvement Act (25 U.S.C. 1661 
et seq.) (as amended by section 172) is amended by adding at the end 
the following:

``SEC. 604. NEVADA AREA OFFICE.

    ``(a) In General.--Not later than 1 year after the date of 
enactment of this section, the Secretary of Health and Human Services, 
in consultation with Indian tribes, tribal organizations, and urban 
Indian organizations in the State of Nevada, shall submit to Congress a 
plan explaining the manner and schedule by which a Nevada area office, 
separate and distinct from the Phoenix area office, can be established 
in Nevada.
    ``(b) Failure to Submit a Plan.--If the Secretary fails to submit a 
plan in accordance with this section, the Secretary shall withhold such 
operations funds reserved for the Phoenix Area Office of the Indian 
Health Service. Funds withheld pursuant to this subsection may, at the 
discretion of the Secretary, be restored to the Phoenix Area Office 
upon compliance with this section.''.

                 Subtitle G--Behavioral Health Programs

SEC. 181. BEHAVIORAL HEALTH PROGRAMS.

    Title VII of the Indian Health Care Improvement Act (25 U.S.C. 1665 
et seq.) is amended to read as follows:

                ``TITLE VII--BEHAVIORAL HEALTH PROGRAMS

                     ``Subtitle A--General Programs

``SEC. 701. DEFINITIONS.

    ``In this subtitle:
            ``(1) Alcohol-related neurodevelopmental disorders; arnd.--
        The term `alcohol-related neurodevelopmental disorders' or 
        `ARND' means, with a history of maternal alcohol consumption 
        during pregnancy, central nervous system abnormalities, which 
        may range from minor intellectual deficits and developmental 
        delays to mental retardation. ARND children may have behavioral 
        problems, learning disabilities, problems with executive 
        functioning, and attention disorders. The neurological defects 
        of ARND may be as severe as FAS, but facial anomalies and other 
        physical characteristics are not present in ARND, thus making 
        diagnosis difficult.
            ``(2) Assessment.--The term `assessment' means the 
        systematic collection, analysis, and dissemination of 
        information on health status, health needs, and health 
        problems.
            ``(3) Behavioral health aftercare.--The term `behavioral 
        health aftercare' includes those activities and resources used 
        to support recovery following inpatient, residential, intensive 
        substance abuse, or mental health outpatient or outpatient 
        treatment. The purpose is to help prevent or deal with relapse 
        by ensuring that by the time a client or patient is discharged 
        from a level of care, such as outpatient treatment, an 
        aftercare plan has been developed with the client. An aftercare 
        plan may use such resources as a community-based therapeutic 
        group, transitional living facilities, a 12-step sponsor, a 
        local 12-step or other related support group, and other 
        community-based providers.
            ``(4) Dual diagnosis.--The term `dual diagnosis' means 
        coexisting substance abuse and mental illness conditions or 
        diagnosis. Such clients are sometimes referred to as mentally 
        ill chemical abusers (MICAs).
            ``(5) Fetal alcohol spectrum disorders.--
                    ``(A) In general.--The term `fetal alcohol spectrum 
                disorders' includes a range of effects that can occur 
                in an individual whose mother drank alcohol during 
                pregnancy, including physical, mental, behavioral, and/
                or learning disabilities with possible lifelong 
                implications.
                    ``(B) Inclusions.--The term `fetal alcohol spectrum 
                disorders' may include--
                            ``(i) fetal alcohol syndrome (FAS);
                            ``(ii) partial fetal alcohol syndrome 
                        (partial FAS);
                            ``(iii) alcohol-related birth defects 
                        (ARBD); and
                            ``(iv) alcohol-related neurodevelopmental 
                        disorders (ARND).
            ``(6) FAS or fetal alcohol syndrome.--The term `FAS' or 
        `fetal alcohol syndrome' means a syndrome in which, with a 
        history of maternal alcohol consumption during pregnancy, the 
        following criteria are met:
                    ``(A) Central nervous system involvement, such as 
                mental retardation, developmental delay, intellectual 
                deficit, microencephaly, or neurological abnormalities.
                    ``(B) Craniofacial abnormalities with at least 2 of 
                the following:
                            ``(i) Microophthalmia.
                            ``(ii) Short palpebral fissures.
                            ``(iii) Poorly developed philtrum.
                            ``(iv) Thin upper lip.
                            ``(v) Flat nasal bridge.
                            ``(vi) Short upturned nose.
                    ``(C) Prenatal or postnatal growth delay.
            ``(7) Rehabilitation.--The term `rehabilitation' means 
        medical and health care services that--
                    ``(A) are recommended by a physician or licensed 
                practitioner of the healing arts within the scope of 
                their practice under applicable law;
                    ``(B) are furnished in a facility, home, or other 
                setting in accordance with applicable standards; and
                    ``(C) have as their purpose any of the following:
                            ``(i) The maximum attainment of physical, 
                        mental, and developmental functioning.
                            ``(ii) Averting deterioration in physical 
                        or mental functional status.
                            ``(iii) The maintenance of physical or 
                        mental health functional status.
            ``(8) Substance abuse.--The term `substance abuse' includes 
        inhalant abuse.
            ``(9) Systems of care.--The term `Systems of Care' means a 
        system for delivering services to children and their families 
        that is child-centered, family-focused and family-driven, 
        community-based, and culturally competent and responsive to the 
        needs of the children and families being served. The systems of 
        care approach values prevention and early identification, 
        smooth transitions for children and families, child and family 
        participation and advocacy, comprehensive array of services, 
        individualized service planning, services in the least 
        restrictive environment, and integrated services with 
        coordinated planning across the child-serving systems.

``SEC. 702. BEHAVIORAL HEALTH PREVENTION AND TREATMENT SERVICES.

    ``(a) Purposes.--The purposes of this section are as follows:
            ``(1) To authorize and direct the Secretary, acting through 
        the Service, Indian tribes, and tribal organizations, to 
        develop a comprehensive behavioral health prevention and 
        treatment program which emphasizes collaboration among alcohol 
        and substance abuse, social services, and mental health 
        programs.
            ``(2) To provide information, direction, and guidance 
        relating to mental illness and dysfunction and self-destructive 
        behavior, including child abuse and family violence, to those 
        Federal, tribal, State, and local agencies responsible for 
        programs in Indian communities in areas of health care, 
        education, social services, child and family welfare, alcohol 
        and substance abuse, law enforcement, and judicial services.
            ``(3) To assist Indian tribes to identify services and 
        resources available to address mental illness and dysfunctional 
        and self-destructive behavior.
            ``(4) To provide authority and opportunities for Indian 
        tribes and tribal organizations to develop, implement, and 
        coordinate with community-based programs which include 
        identification, prevention, education, referral, and treatment 
        services, including through multidisciplinary resource teams.
            ``(5) To ensure that Indians, as citizens of the United 
        States and of the States in which they reside, have the same 
        access to behavioral health services to which all citizens have 
        access.
            ``(6) To modify or supplement existing programs and 
        authorities in the areas identified in paragraph (2).
    ``(b) Plans.--
            ``(1) Development.--The Secretary, acting through the 
        Service, Indian tribes, and tribal organizations, shall 
        encourage Indian tribes and tribal organizations to develop 
        tribal plans, and urban Indian organizations to develop local 
        plans, and for all such groups to participate in developing 
        areawide plans for Indian Behavioral Health Services. The plans 
        shall include, to the extent feasible, the following 
        components:
                    ``(A) An assessment of the scope of alcohol or 
                other substance abuse, mental illness, and 
                dysfunctional and self-destructive behavior, including 
                suicide, child abuse, and family violence, among 
                Indians, including--
                            ``(i) the number of Indians served who are 
                        directly or indirectly affected by such illness 
                        or behavior; or
                            ``(ii) an estimate of the financial and 
                        human cost attributable to such illness or 
                        behavior.
                    ``(B) An assessment of the existing and additional 
                resources necessary for the prevention and treatment of 
                such illness and behavior, including an assessment of 
                the progress toward achieving the availability of the 
                full continuum of care described in subsection (c).
                    ``(C) An estimate of the additional funding needed 
                by the Service, Indian tribes, tribal organizations, 
                and urban Indian organizations to meet their 
                responsibilities under the plans.
            ``(2) National clearinghouse.--The Secretary, acting 
        through the Service, shall coordinate with existing national 
        clearinghouses and information centers to include at the 
        clearinghouses and centers plans and reports on the outcomes of 
        such plans developed by Indian tribes, tribal organizations, 
        urban Indian organizations, and Service areas relating to 
        behavioral health. The Secretary shall ensure access to these 
        plans and outcomes by any Indian tribe, tribal organization, 
        urban Indian organization, or the Service.
            ``(3) Technical assistance.--The Secretary shall provide 
        technical assistance to Indian tribes, tribal organizations, 
        and urban Indian organizations in preparation of plans under 
        this section and in developing standards of care that may be 
        used and adopted locally.
    ``(c) Programs.--The Secretary, acting through the Service, shall 
provide, to the extent feasible and if funding is available, programs 
including the following:
            ``(1) Comprehensive care.--A comprehensive continuum of 
        behavioral health care which provides--
                    ``(A) community-based prevention, intervention, 
                outpatient, and behavioral health aftercare;
                    ``(B) detoxification (social and medical);
                    ``(C) acute hospitalization;
                    ``(D) intensive outpatient/day treatment;
                    ``(E) residential treatment;
                    ``(F) transitional living for those needing a 
                temporary, stable living environment that is supportive 
                of treatment and recovery goals;
                    ``(G) emergency shelter;
                    ``(H) intensive case management;
                    ``(I) diagnostic services; and
                    ``(J) promotion of healthy approaches to risk and 
                safety issues, including injury prevention.
            ``(2) Child care.--Behavioral health services for Indians 
        from birth through age 17, including--
                    ``(A) preschool and school age fetal alcohol 
                spectrum disorder services, including assessment and 
                behavioral intervention;
                    ``(B) mental health and substance abuse services 
                (emotional, organic, alcohol, drug, inhalant, and 
                tobacco);
                    ``(C) identification and treatment of co-occurring 
                disorders and comorbidity;
                    ``(D) prevention of alcohol, drug, inhalant, and 
                tobacco use;
                    ``(E) early intervention, treatment, and aftercare;
                    ``(F) promotion of healthy approaches to risk and 
                safety issues; and
                    ``(G) identification and treatment of neglect and 
                physical, mental, and sexual abuse.
            ``(3) Adult care.--Behavioral health services for Indians 
        from age 18 through 55, including--
                    ``(A) early intervention, treatment, and aftercare;
                    ``(B) mental health and substance abuse services 
                (emotional, alcohol, drug, inhalant, and tobacco), 
                including sex specific services;
                    ``(C) identification and treatment of co-occurring 
                disorders (dual diagnosis) and comorbidity;
                    ``(D) promotion of healthy approaches for risk-
                related behavior;
                    ``(E) treatment services for women at risk of 
                giving birth to a child with a fetal alcohol spectrum 
                disorder; and
                    ``(F) sex specific treatment for sexual assault and 
                domestic violence.
            ``(4) Family care.--Behavioral health services for 
        families, including--
                    ``(A) early intervention, treatment, and aftercare 
                for affected families;
                    ``(B) treatment for sexual assault and domestic 
                violence; and
                    ``(C) promotion of healthy approaches relating to 
                parenting, domestic violence, and other abuse issues.
            ``(5) Elder care.--Behavioral health services for Indians 
        56 years of age and older, including--
                    ``(A) early intervention, treatment, and aftercare;
                    ``(B) mental health and substance abuse services 
                (emotional, alcohol, drug, inhalant, and tobacco), 
                including sex specific services;
                    ``(C) identification and treatment of co-occurring 
                disorders (dual diagnosis) and comorbidity;
                    ``(D) promotion of healthy approaches to managing 
                conditions related to aging;
                    ``(E) sex specific treatment for sexual assault, 
                domestic violence, neglect, physical and mental abuse 
                and exploitation; and
                    ``(F) identification and treatment of dementias 
                regardless of cause.
    ``(d) Community Behavioral Health Plan.--
            ``(1) Establishment.--The governing body of any Indian 
        tribe, tribal organization, or urban Indian organization may 
        adopt a resolution for the establishment of a community 
        behavioral health plan providing for the identification and 
        coordination of available resources and programs to identify, 
        prevent, or treat substance abuse, mental illness, or 
        dysfunctional and self-destructive behavior, including child 
        abuse and family violence, among its members or its service 
        population. This plan should include behavioral health 
        services, social services, intensive outpatient services, and 
        continuing aftercare.
            ``(2) Technical assistance.--At the request of an Indian 
        tribe, tribal organization, or urban Indian organization, the 
        Bureau of Indian Affairs and the Service shall cooperate with 
        and provide technical assistance to the Indian tribe, tribal 
        organization, or urban Indian organization in the development 
        and implementation of such plan.
            ``(3) Funding.--The Secretary, acting through the Service, 
        Indian tribes, and tribal organizations, may make funding 
        available to Indian tribes and tribal organizations which adopt 
        a resolution pursuant to paragraph (1) to obtain technical 
        assistance for the development of a community behavioral health 
        plan and to provide administrative support in the 
        implementation of such plan.
    ``(e) Coordination for Availability of Services.--The Secretary, 
acting through the Service, shall coordinate behavioral health 
planning, to the extent feasible, with other Federal agencies and with 
State agencies, to encourage comprehensive behavioral health services 
for Indians regardless of their place of residence.
    ``(f) Mental Health Care Need Assessment.--Not later than 1 year 
after the date of enactment of the Indian Health Care Improvement 
Reauthorization and Extension Act of 2009, the Secretary, acting 
through the Service, shall make an assessment of the need for inpatient 
mental health care among Indians and the availability and cost of 
inpatient mental health facilities which can meet such need. In making 
such assessment, the Secretary shall consider the possible conversion 
of existing, underused Service hospital beds into psychiatric units to 
meet such need.

``SEC. 703. MEMORANDA OF AGREEMENT WITH THE DEPARTMENT OF INTERIOR.

    ``(a) Contents.--Not later than 1 year after the date of enactment 
of the Indian Health Care Improvement Reauthorization and Extension Act 
of 2009, the Secretary, acting through the Service, and the Secretary 
of the Interior shall develop and enter into a memoranda of agreement, 
or review and update any existing memoranda of agreement, as required 
by section 4205 of the Indian Alcohol and Substance Abuse Prevention 
and Treatment Act of 1986 (25 U.S.C. 2411) under which the Secretaries 
address the following:
            ``(1) The scope and nature of mental illness and 
        dysfunctional and self-destructive behavior, including child 
        abuse and family violence, among Indians.
            ``(2) The existing Federal, tribal, State, local, and 
        private services, resources, and programs available to provide 
        behavioral health services for Indians.
            ``(3) The unmet need for additional services, resources, 
        and programs necessary to meet the needs identified pursuant to 
        paragraph (1).
            ``(4)(A) The right of Indians, as citizens of the United 
        States and of the States in which they reside, to have access 
        to behavioral health services to which all citizens have 
        access.
            ``(B) The right of Indians to participate in, and receive 
        the benefit of, such services.
            ``(C) The actions necessary to protect the exercise of such 
        right.
            ``(5) The responsibilities of the Bureau of Indian Affairs 
        and the Service, including mental illness identification, 
        prevention, education, referral, and treatment services 
        (including services through multidisciplinary resource teams), 
        at the central, area, and agency and Service unit, Service 
        area, and headquarters levels to address the problems 
        identified in paragraph (1).
            ``(6) A strategy for the comprehensive coordination of the 
        behavioral health services provided by the Bureau of Indian 
        Affairs and the Service to meet the problems identified 
        pursuant to paragraph (1), including--
                    ``(A) the coordination of alcohol and substance 
                abuse programs of the Service, the Bureau of Indian 
                Affairs, and Indian tribes and tribal organizations 
                (developed under the Indian Alcohol and Substance Abuse 
                Prevention and Treatment Act of 1986 (25 U.S.C. 2401 et 
                seq.)) with behavioral health initiatives pursuant to 
                this Act, particularly with respect to the referral and 
                treatment of dually diagnosed individuals requiring 
                behavioral health and substance abuse treatment; and
                    ``(B) ensuring that the Bureau of Indian Affairs 
                and Service programs and services (including 
                multidisciplinary resource teams) addressing child 
                abuse and family violence are coordinated with such 
                non-Federal programs and services.
            ``(7) Directing appropriate officials of the Bureau of 
        Indian Affairs and the Service, particularly at the agency and 
        Service unit levels, to cooperate fully with tribal requests 
        made pursuant to community behavioral health plans adopted 
        under section 702(c) and section 4206 of the Indian Alcohol and 
        Substance Abuse Prevention and Treatment Act of 1986 (25 U.S.C. 
        2412).
            ``(8) Providing for an annual review of such agreement by 
        the Secretaries which shall be provided to Congress and Indian 
        tribes and tribal organizations.
    ``(b) Specific Provisions Required.--The memoranda of agreement 
updated or entered into pursuant to subsection (a) shall include 
specific provisions pursuant to which the Service shall assume 
responsibility for--
            ``(1) the determination of the scope of the problem of 
        alcohol and substance abuse among Indians, including the number 
        of Indians within the jurisdiction of the Service who are 
        directly or indirectly affected by alcohol and substance abuse 
        and the financial and human cost;
            ``(2) an assessment of the existing and needed resources 
        necessary for the prevention of alcohol and substance abuse and 
        the treatment of Indians affected by alcohol and substance 
        abuse; and
            ``(3) an estimate of the funding necessary to adequately 
        support a program of prevention of alcohol and substance abuse 
        and treatment of Indians affected by alcohol and substance 
        abuse.
    ``(c) Publication.--Each memorandum of agreement entered into or 
renewed (and amendments or modifications thereto) under subsection (a) 
shall be published in the Federal Register. At the same time as 
publication in the Federal Register, the Secretary shall provide a copy 
of such memoranda, amendment, or modification to each Indian tribe, 
tribal organization, and urban Indian organization.

``SEC. 704. COMPREHENSIVE BEHAVIORAL HEALTH PREVENTION AND TREATMENT 
              PROGRAM.

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

``SEC. 705. MENTAL HEALTH TECHNICIAN PROGRAM.

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

``SEC. 706. LICENSING REQUIREMENT FOR MENTAL HEALTH CARE WORKERS.

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

``SEC. 707. INDIAN WOMEN TREATMENT PROGRAMS.

    ``(a) Grants.--The Secretary, consistent with section 702, may make 
grants to Indian tribes, tribal organizations, and urban Indian 
organizations to develop and implement a comprehensive behavioral 
health program of prevention, intervention, treatment, and relapse 
prevention services that specifically addresses the cultural, 
historical, social, and child care needs of Indian women, regardless of 
age.
    ``(b) Use of Grant Funds.--A grant made pursuant to this section 
may be used--
            ``(1) to develop and provide community training, education, 
        and prevention programs for Indian women relating to behavioral 
        health issues, including fetal alcohol spectrum disorders;
            ``(2) to identify and provide psychological services, 
        counseling, advocacy, support, and relapse prevention to Indian 
        women and their families; and
            ``(3) to develop prevention and intervention models for 
        Indian women which incorporate traditional health care 
        practices, cultural values, and community and family 
        involvement.
    ``(c) Criteria.--The Secretary, in consultation with Indian tribes 
and tribal organizations, shall establish criteria for the review and 
approval of applications and proposals for funding under this section.
    ``(d) Allocation of Funds for Urban Indian Organizations.--20 
percent of the funds appropriated pursuant to this section shall be 
used to make grants to urban Indian organizations.

``SEC. 708. INDIAN YOUTH PROGRAM.

    ``(a) Detoxification and Rehabilitation.--The Secretary, acting 
through the Service, consistent with section 702, shall develop and 
implement a program for acute detoxification and treatment for Indian 
youths, including behavioral health services. The program shall include 
regional treatment centers designed to include detoxification and 
rehabilitation for both sexes on a referral basis and programs 
developed and implemented by Indian tribes or tribal organizations at 
the local level under the Indian Self-Determination and Education 
Assistance Act (25 U.S.C. 450 et seq.). Regional centers shall be 
integrated with the intake and rehabilitation programs based in the 
referring Indian community.
    ``(b) Alcohol and Substance Abuse Treatment Centers or 
Facilities.--
            ``(1) Establishment.--
                    ``(A) In general.--The Secretary, acting through 
                the Service, shall construct, renovate, or, as 
                necessary, purchase, and appropriately staff and 
                operate, at least 1 youth regional treatment center or 
                treatment network in each area under the jurisdiction 
                of an area office.
                    ``(B) Area office in california.--For the purposes 
                of this subsection, the area office in California shall 
                be considered to be 2 area offices, 1 office whose 
                jurisdiction shall be considered to encompass the 
                northern area of the State of California, and 1 office 
                whose jurisdiction shall be considered to encompass the 
                remainder of the State of California for the purpose of 
                implementing California treatment networks.
            ``(2) Funding.--For the purpose of staffing and operating 
        such centers or facilities, funding shall be pursuant to the 
        Act of November 2, 1921 (25 U.S.C. 13).
            ``(3) Location.--A youth treatment center constructed or 
        purchased under this subsection shall be constructed or 
        purchased at a location within the area described in paragraph 
        (1) agreed upon (by appropriate tribal resolution) by a 
        majority of the Indian tribes to be served by such center.
            ``(4) Specific provision of funds.--
                    ``(A) In general.--Notwithstanding any other 
                provision of this title, the Secretary may, from 
                amounts authorized to be appropriated for the purposes 
                of carrying out this section, make funds available to--
                            ``(i) the Tanana Chiefs Conference, 
                        Incorporated, for the purpose of leasing, 
                        constructing, renovating, operating, and 
                        maintaining a residential youth treatment 
                        facility in Fairbanks, Alaska; and
                            ``(ii) the Southeast Alaska Regional Health 
                        Corporation to staff and operate a residential 
                        youth treatment facility without regard to the 
                        proviso set forth in section 4(l) of the Indian 
                        Self-Determination and Education Assistance Act 
                        (25 U.S.C. 450b(l)).
                    ``(B) Provision of services to eligible youths.--
                Until additional residential youth treatment facilities 
                are established in Alaska pursuant to this section, the 
                facilities specified in subparagraph (A) shall make 
                every effort to provide services to all eligible Indian 
                youths residing in Alaska.
    ``(c) Intermediate Adolescent Behavioral Health Services.--
            ``(1) In general.--The Secretary, acting through the 
        Service, may provide intermediate behavioral health services, 
        which may incorporate Systems of Care, to Indian children and 
        adolescents, including--
                    ``(A) pretreatment assistance;
                    ``(B) inpatient, outpatient, and aftercare 
                services;
                    ``(C) emergency care;
                    ``(D) suicide prevention and crisis intervention; 
                and
                    ``(E) prevention and treatment of mental illness 
                and dysfunctional and self-destructive behavior, 
                including child abuse and family violence.
            ``(2) Use of funds.--Funds provided under this subsection 
        may be used--
                    ``(A) to construct or renovate an existing health 
                facility to provide intermediate behavioral health 
                services;
                    ``(B) to hire behavioral health professionals;
                    ``(C) to staff, operate, and maintain an 
                intermediate mental health facility, group home, sober 
                housing, transitional housing or similar facilities, or 
                youth shelter where intermediate behavioral health 
                services are being provided;
                    ``(D) to make renovations and hire appropriate 
                staff to convert existing hospital beds into adolescent 
                psychiatric units; and
                    ``(E) for intensive home- and community-based 
                services.
            ``(3) Criteria.--The Secretary, acting through the Service, 
        shall, in consultation with Indian tribes and tribal 
        organizations, establish criteria for the review and approval 
        of applications or proposals for funding made available 
        pursuant to this subsection.
    ``(d) Federally Owned Structures.--
            ``(1) In general.--The Secretary, in consultation with 
        Indian tribes and tribal organizations, shall--
                    ``(A) identify and use, where appropriate, 
                federally owned structures suitable for local 
                residential or regional behavioral health treatment for 
                Indian youths; and
                    ``(B) establish guidelines for determining the 
                suitability of any such federally owned structure to be 
                used for local residential or regional behavioral 
                health treatment for Indian youths.
            ``(2) Terms and conditions for use of structure.--Any 
        structure described in paragraph (1) may be used under such 
        terms and conditions as may be agreed upon by the Secretary and 
        the agency having responsibility for the structure and any 
        Indian tribe or tribal organization operating the program.
    ``(e) Rehabilitation and Aftercare Services.--
            ``(1) In general.--The Secretary, Indian tribes, or tribal 
        organizations, in cooperation with the Secretary of the 
        Interior, shall develop and implement within each Service unit, 
        community-based rehabilitation and follow-up services for 
        Indian youths who are having significant behavioral health 
        problems, and require long-term treatment, community 
        reintegration, and monitoring to support the Indian youths 
        after their return to their home community.
            ``(2) Administration.--Services under paragraph (1) shall 
        be provided by trained staff within the community who can 
        assist the Indian youths in their continuing development of 
        self-image, positive problem-solving skills, and nonalcohol or 
        substance abusing behaviors. Such staff may include alcohol and 
        substance abuse counselors, mental health professionals, and 
        other health professionals and paraprofessionals, including 
        community health representatives.
    ``(f) Inclusion of Family in Youth Treatment Program.--In providing 
the treatment and other services to Indian youths authorized by this 
section, the Secretary, acting through the Service, shall provide for 
the inclusion of family members of such youths in the treatment 
programs or other services as may be appropriate. Not less than 10 
percent of the funds appropriated for the purposes of carrying out 
subsection (e) shall be used for outpatient care of adult family 
members related to the treatment of an Indian youth under that 
subsection.
    ``(g) Multidrug Abuse Program.--The Secretary, acting through the 
Service, shall provide, consistent with section 702, programs and 
services to prevent and treat the abuse of multiple forms of 
substances, including alcohol, drugs, inhalants, and tobacco, among 
Indian youths residing in Indian communities, on or near reservations, 
and in urban areas and provide appropriate mental health services to 
address the incidence of mental illness among such youths.
    ``(h) Indian Youth Mental Health.--The Secretary, acting through 
the Service, shall collect data for the report under section 801 with 
respect to--
            ``(1) the number of Indian youth who are being provided 
        mental health services through the Service and tribal health 
        programs;
            ``(2) a description of, and costs associated with, the 
        mental health services provided for Indian youth through the 
        Service and tribal health programs;
            ``(3) the number of youth referred to the Service or tribal 
        health programs for mental health services;
            ``(4) the number of Indian youth provided residential 
        treatment for mental health and behavioral problems through the 
        Service and tribal health programs, reported separately for on- 
        and off-reservation facilities; and
            ``(5) the costs of the services described in paragraph (4).

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

    ``Not later than 1 year after the date of enactment of the Indian 
Health Care Improvement Reauthorization and Extension Act of 2009, the 
Secretary, acting through the Service, may provide, in each area of the 
Service, not less than 1 inpatient mental health care facility, or the 
equivalent, for Indians with behavioral health problems. For the 
purposes of this subsection, California shall be considered to be 2 
area offices, 1 office whose location shall be considered to encompass 
the northern area of the State of California and 1 office whose 
jurisdiction shall be considered to encompass the remainder of the 
State of California. The Secretary shall consider the possible 
conversion of existing, underused Service hospital beds into 
psychiatric units to meet such need.

``SEC. 710. TRAINING AND COMMUNITY EDUCATION.

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

``SEC. 711. BEHAVIORAL HEALTH PROGRAM.

    ``(a) Innovative Programs.--The Secretary, acting through the 
Service, consistent with section 702, may plan, develop, implement, and 
carry out programs to deliver innovative community-based behavioral 
health services to Indians.
    ``(b) Awards; Criteria.--The Secretary may award a grant for a 
project under subsection (a) to an Indian tribe or tribal organization 
and may consider the following criteria:
            ``(1) The project will address significant unmet behavioral 
        health needs among Indians.
            ``(2) The project will serve a significant number of 
        Indians.
            ``(3) The project has the potential to deliver services in 
        an efficient and effective manner.
            ``(4) The Indian tribe or tribal organization has the 
        administrative and financial capability to administer the 
        project.
            ``(5) The project may deliver services in a manner 
        consistent with traditional health care practices.
            ``(6) The project is coordinated with, and avoids 
        duplication of, existing services.
    ``(c) Equitable Treatment.--For purposes of this subsection, the 
Secretary shall, in evaluating project applications or proposals, use 
the same criteria that the Secretary uses in evaluating any other 
application or proposal for such funding.

``SEC. 712. FETAL ALCOHOL SPECTRUM DISORDERS PROGRAMS.

    ``(a) Programs.--
            ``(1) Establishment.--The Secretary, consistent with 
        section 701, acting through the Service, Indian Tribes, and 
        Tribal Organizations, is authorized to establish and operate 
        fetal alcohol spectrum disorders programs as provided in this 
        section for the purposes of meeting the health status 
        objectives specified in section 3.
            ``(2) Use of funds.--
                    ``(A) In general.--Funding provided pursuant to 
                this section shall be used for the following:
                            ``(i) To develop and provide for Indians 
                        community and in-school training, education, 
                        and prevention programs relating to fetal 
                        alcohol spectrum disorders.
                            ``(ii) To identify and provide behavioral 
                        health treatment to high-risk Indian women and 
                        high-risk women pregnant with an Indian's 
                        child.
                            ``(iii) To identify and provide appropriate 
                        psychological services, educational and 
                        vocational support, counseling, advocacy, and 
                        information to fetal alcohol spectrum 
                        disorders-affected Indians and their families 
                        or caretakers.
                            ``(iv) To develop and implement counseling 
                        and support programs in schools for fetal 
                        alcohol spectrum disorders-affected Indian 
                        children.
                            ``(v) To develop prevention and 
                        intervention models which incorporate 
                        practitioners of traditional health care 
                        practices, cultural values, and community 
                        involvement.
                            ``(vi) To develop, print, and disseminate 
                        education and prevention materials on fetal 
                        alcohol spectrum disorders.
                            ``(vii) To develop and implement, in 
                        consultation with Indian Tribes and Tribal 
                        Organizations, and in conference with urban 
                        Indian Organizations, culturally sensitive 
                        assessment and diagnostic tools including 
                        dysmorphology clinics and multidisciplinary 
                        fetal alcohol spectrum disorders clinics for 
                        use in Indian communities and urban Centers.
                            ``(viii) To develop and provide training on 
                        fetal alcohol spectrum disorders to 
                        professionals providing services to Indians, 
                        including medical and allied health 
                        practitioners, social service providers, 
                        educators, and law enforcement, court officials 
                        and corrections personnel in the juvenile and 
                        criminal justice systems.
                    ``(B) Additional uses.--In addition to any purpose 
                under subparagraph (A), funding provided pursuant to 
                this section may be used for 1 or more of the 
                following:
                            ``(i) Early childhood intervention projects 
                        from birth on to mitigate the effects of fetal 
                        alcohol spectrum disorders among Indians.
                            ``(ii) Community-based support services for 
                        Indians and women pregnant with Indian 
                        children.
                            ``(iii) Community-based housing for adult 
                        Indians with fetal alcohol spectrum disorders.
            ``(3) Criteria for applications.--The Secretary shall 
        establish criteria for the review and approval of applications 
        for funding under this section.
    ``(b) Services.--The Secretary, acting through the Service, Indian 
Tribes, and Tribal Organizations, shall--
            ``(1) develop and provide services for the prevention, 
        intervention, treatment, and aftercare for those affected by 
        fetal alcohol spectrum disorders in Indian communities; and
            ``(2) provide supportive services, including services to 
        meet the special educational, vocational, school-to-work 
        transition, and independent living needs of adolescent and 
        adult Indians with fetal alcohol spectrum disorders.
    ``(c) Applied Research Projects.--The Secretary, acting through the 
Substance Abuse and Mental Health Services Administration, shall make 
grants to Indian Tribes, Tribal Organizations, and urban Indian 
Organizations for applied research projects which propose to elevate 
the understanding of methods to prevent, intervene, treat, or provide 
rehabilitation and behavioral health aftercare for Indians and urban 
Indians affected by fetal alcohol spectrum disorders.
    ``(d) Funding for Urban Indian Organizations.--Ten percent of the 
funds appropriated pursuant to this section shall be used to make 
grants to urban Indian Organizations funded under title V.

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

    ``(a) Establishment.--The Secretary, acting through the Service, 
shall establish, consistent with section 702, in every Service area, 
programs involving treatment for--
            ``(1) victims of sexual abuse who are Indian children or 
        children in an Indian household; and
            ``(2) perpetrators of child sexual abuse who are Indian or 
        members of an Indian household.
    ``(b) Use of Funds.--Funding provided pursuant to this section 
shall be used for the following:
            ``(1) To develop and provide community education and 
        prevention programs related to sexual abuse of Indian children 
        or children in an Indian household.
            ``(2) To identify and provide behavioral health treatment 
        to victims of sexual abuse who are Indian children or children 
        in an Indian household, and to their family members who are 
        affected by sexual abuse.
            ``(3) To develop prevention and intervention models which 
        incorporate traditional health care practices, cultural values, 
        and community involvement.
            ``(4) To develop and implement culturally sensitive 
        assessment and diagnostic tools for use in Indian communities 
        and urban centers.
            ``(5) To identify and provide behavioral health treatment 
        to Indian perpetrators and perpetrators who are members of an 
        Indian household--
                    ``(A) making efforts to begin offender and 
                behavioral health treatment while the perpetrator is 
                incarcerated or at the earliest possible date if the 
                perpetrator is not incarcerated; and
                    ``(B) providing treatment after the perpetrator is 
                released, until it is determined that the perpetrator 
                is not a threat to children.
    ``(c) Coordination.--The programs established under subsection (a) 
shall be carried out in coordination with programs and services 
authorized under the Indian Child Protection and Family Violence 
Prevention Act (25 U.S.C. 3201 et seq.).

``SEC. 714. DOMESTIC AND SEXUAL VIOLENCE PREVENTION AND TREATMENT.

    ``(a) In General.--The Secretary, in accordance with section 702, 
is authorized to establish in each Service area programs involving the 
prevention and treatment of--
            ``(1) Indian victims of domestic violence or sexual abuse; 
        and
            ``(2) perpetrators of domestic violence or sexual abuse who 
        are Indian or members of an Indian household.
    ``(b) Use of Funds.--Funds made available to carry out this section 
shall be used--
            ``(1) to develop and implement prevention programs and 
        community education programs relating to domestic violence and 
        sexual abuse;
            ``(2) to provide behavioral health services, including 
        victim support services, and medical treatment (including 
        examinations performed by sexual assault nurse examiners) to 
        Indian victims of domestic violence or sexual abuse;
            ``(3) to purchase rape kits;
            ``(4) to develop prevention and intervention models, which 
        may incorporate traditional health care practices; and
            ``(5) to identify and provide behavioral health treatment 
        to perpetrators who are Indian or members of an Indian 
        household.
    ``(c) Training and Certification.--
            ``(1) In general.--Not later than 1 year after the date of 
        enactment of the Indian Health Care Improvement Reauthorization 
        and Extension Act of 2009, the Secretary shall establish 
        appropriate protocols, policies, procedures, standards of 
        practice, and, if not available elsewhere, training curricula 
        and training and certification requirements for services for 
        victims of domestic violence and sexual abuse.
            ``(2) Report.--Not later than 18 months after the date of 
        enactment of the Indian Health Care Improvement Reauthorization 
        and Extension Act of 2009, the Secretary shall submit to the 
        Committee on Indian Affairs of the Senate and the Committee on 
        Natural Resources of the House of Representatives a report that 
        describes the means and extent to which the Secretary has 
        carried out paragraph (1).
    ``(d) Coordination.--
            ``(1) In general.--The Secretary, in coordination with the 
        Attorney General, Federal and tribal law enforcement agencies, 
        Indian health programs, and domestic violence or sexual assault 
        victim organizations, shall develop appropriate victim services 
        and victim advocate training programs--
                    ``(A) to improve domestic violence or sexual abuse 
                responses;
                    ``(B) to improve forensic examinations and 
                collection;
                    ``(C) to identify problems or obstacles in the 
                prosecution of domestic violence or sexual abuse; and
                    ``(D) to meet other needs or carry out other 
                activities required to prevent, treat, and improve 
                prosecutions of domestic violence and sexual abuse.
            ``(2) Report.--Not later than 2 years after the date of 
        enactment of the Indian Health Care Improvement Reauthorization 
        and Extension Act of 2009, the Secretary shall submit to the 
        Committee on Indian Affairs of the Senate and the Committee on 
        Natural Resources of the House of Representatives a report that 
        describes, with respect to the matters described in paragraph 
        (1), the improvements made and needed, problems or obstacles 
        identified, and costs necessary to address the problems or 
        obstacles, and any other recommendations that the Secretary 
        determines to be appropriate.

``SEC. 715. BEHAVIORAL HEALTH RESEARCH.

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

             ``Subtitle B--Indian Youth Suicide Prevention

``SEC. 721. FINDINGS AND PURPOSE.

    ``(a) Findings.--Congress finds that--
            ``(1)(A) the rate of suicide of American Indians and Alaska 
        Natives is 1.9 times higher than the national average rate; and
            ``(B) the rate of suicide of Indian and Alaska Native youth 
        aged 15 through 24 is--
                    ``(i) 3.5 times the national average rate; and
                    ``(ii) the highest rate of any population group in 
                the United States;
            ``(2) many risk behaviors and contributing factors for 
        suicide are more prevalent in Indian country than in other 
        areas, including--
                    ``(A) history of previous suicide attempts;
                    ``(B) family history of suicide;
                    ``(C) history of depression or other mental 
                illness;
                    ``(D) alcohol or drug abuse;
                    ``(E) health disparities;
                    ``(F) stressful life events and losses;
                    ``(G) easy access to lethal methods;
                    ``(H) exposure to the suicidal behavior of others;
                    ``(I) isolation; and
                    ``(J) incarceration;
            ``(3) according to national data for 2005, suicide was the 
        second-leading cause of death for Indians and Alaska Natives of 
        both sexes aged 10 through 34;
            ``(4)(A) the suicide rates of Indian and Alaska Native 
        males aged 15 through 24 are--
                    ``(i) as compared to suicide rates of males of any 
                other racial group, up to 4 times greater; and
                    ``(ii) as compared to suicide rates of females of 
                any other racial group, up to 11 times greater; and
            ``(B) data demonstrates that, over their lifetimes, females 
        attempt suicide 2 to 3 times more often than males;
            ``(5)(A) Indian tribes, especially Indian tribes located in 
        the Great Plains, have experienced epidemic levels of suicide, 
        up to 10 times the national average; and
            ``(B) suicide clustering in Indian country affects entire 
        tribal communities;
            ``(6) death rates for Indians and Alaska Natives are 
        statistically underestimated because many areas of Indian 
        country lack the proper resources to identify and monitor the 
        presence of disease;
            ``(7)(A) the Indian Health Service experiences health 
        professional shortages, with physician vacancy rates of 
        approximately 17 percent, and nursing vacancy rates of 
        approximately 18 percent, in 2007;
            ``(B) 90 percent of all teens who die by suicide suffer 
        from a diagnosable mental illness at time of death;
            ``(C) more than \1/2\ of teens who die by suicide have 
        never been seen by a mental health provider; and
            ``(D) \1/3\ of health needs in Indian country relate to 
        mental health;
            ``(8) often, the lack of resources of Indian tribes and the 
        remote nature of Indian reservations make it difficult to meet 
        the requirements necessary to access Federal assistance, 
        including grants;
            ``(9) the Substance Abuse and Mental Health Services 
        Administration and the Service have established specific 
        initiatives to combat youth suicide in Indian country and among 
        Indians and Alaska Natives throughout the United States, 
        including the National Suicide Prevention Initiative of the 
        Service, which has worked with Service, tribal, and urban 
        Indian health programs since 2003;
            ``(10) the National Strategy for Suicide Prevention was 
        established in 2001 through a Department of Health and Human 
        Services collaboration among--
                    ``(A) the Substance Abuse and Mental Health 
                Services Administration;
                    ``(B) the Service;
                    ``(C) the Centers for Disease Control and 
                Prevention;
                    ``(D) the National Institutes of Health; and
                    ``(E) the Health Resources and Services 
                Administration; and
            ``(11) the Service and other agencies of the Department of 
        Health and Human Services use information technology and other 
        programs to address the suicide prevention and mental health 
        needs of Indians and Alaska Natives.
    ``(b) Purposes.--The purposes of this subtitle are--
            ``(1) to authorize the Secretary to carry out a 
        demonstration project to test the use of telemental health 
        services in suicide prevention, intervention, and treatment of 
        Indian youth, including through--
                    ``(A) the use of psychotherapy, psychiatric 
                assessments, diagnostic interviews, therapies for 
                mental health conditions predisposing to suicide, and 
                alcohol and substance abuse treatment;
                    ``(B) the provision of clinical expertise to, 
                consultation services with, and medical advice and 
                training for frontline health care providers working 
                with Indian youth;
                    ``(C) training and related support for community 
                leaders, family members, and health and education 
                workers who work with Indian youth;
                    ``(D) the development of culturally relevant 
                educational materials on suicide; and
                    ``(E) data collection and reporting;
            ``(2) to encourage Indian tribes, tribal organizations, and 
        other mental health care providers serving residents of Indian 
        country to obtain the services of predoctoral psychology and 
        psychiatry interns; and
            ``(3) to enhance the provision of mental health care 
        services to Indian youth through existing grant programs of the 
        Substance Abuse and Mental Health Services Administration.

``SEC. 722. DEFINITIONS.

    ``In this subtitle:
            ``(1) Administration.--The term `Administration' means the 
        Substance Abuse and Mental Health Services Administration.
            ``(2) Demonstration project.--The term `demonstration 
        project' means the Indian youth telemental health demonstration 
        project authorized under section 723(a).
            ``(3) Indian country.--The term `Indian country' has the 
        meaning given the term in section 1151 of title 18, United 
        States Code.
            ``(4) Telemental health.--The term `telemental health' 
        means the use of electronic information and telecommunications 
        technologies to support long-distance mental health care, 
        patient and professional-related education, public health, and 
        health administration.

``SEC. 723. INDIAN YOUTH TELEMENTAL HEALTH DEMONSTRATION PROJECT.

    ``(a) Authorization.--
            ``(1) In general.--The Secretary, acting through the 
        Service, is authorized to carry out a demonstration project to 
        award grants for the provision of telemental health services to 
        Indian youth who--
                    ``(A) have expressed suicidal ideas;
                    ``(B) have attempted suicide; or
                    ``(C) have mental health conditions that increase 
                or could increase the risk of suicide.
            ``(2) Eligibility for grants.--Grants under paragraph (1) 
        shall be awarded to Indian tribes and tribal organizations that 
        operate 1 or more facilities--
                    ``(A) located in an area with documented 
                disproportionately high rates of suicide;
                    ``(B) reporting active clinical telehealth 
                capabilities; or
                    ``(C) offering school-based telemental health 
                services to Indian youth.
            ``(3) Grant period.--The Secretary shall award grants under 
        this section for a period of up to 4 years.
            ``(4) Maximum number of grants.--Not more than 5 grants 
        shall be provided under paragraph (1), with priority 
        consideration given to Indian tribes and tribal organizations 
        that--
                    ``(A) serve a particular community or geographic 
                area in which there is a demonstrated need to address 
                Indian youth suicide;
                    ``(B) enter into collaborative partnerships with 
                Service or other tribal health programs or facilities 
                to provide services under this demonstration project;
                    ``(C) serve an isolated community or geographic 
                area that has limited or no access to behavioral health 
                services; or
                    ``(D) operate a detention facility at which Indian 
                youth are detained.
            ``(5) Consultation with administration.--In developing and 
        carrying out the demonstration project under this subsection, 
        the Secretary shall consult with the Administration as the 
        Federal agency focused on mental health issues, including 
        suicide.
    ``(b) Use of Funds.--
            ``(1) In general.--An Indian tribe or tribal organization 
        shall use a grant received under subsection (a) for the 
        following purposes:
                    ``(A) To provide telemental health services to 
                Indian youth, including the provision of--
                            ``(i) psychotherapy;
                            ``(ii) psychiatric assessments and 
                        diagnostic interviews, therapies for mental 
                        health conditions predisposing to suicide, and 
                        treatment; and
                            ``(iii) alcohol and substance abuse 
                        treatment.
                    ``(B) To provide clinician-interactive medical 
                advice, guidance and training, assistance in diagnosis 
                and interpretation, crisis counseling and intervention, 
                and related assistance to Service or tribal clinicians 
                and health services providers working with youth being 
                served under the demonstration project.
                    ``(C) To assist, educate, and train community 
                leaders, health education professionals and 
                paraprofessionals, tribal outreach workers, and family 
                members who work with the youth receiving telemental 
                health services under the demonstration project, 
                including with identification of suicidal tendencies, 
                crisis intervention and suicide prevention, emergency 
                skill development, and building and expanding networks 
                among those individuals and with State and local health 
                services providers.
                    ``(D) To develop and distribute culturally 
                appropriate community educational materials regarding--
                            ``(i) suicide prevention;
                            ``(ii) suicide education;
                            ``(iii) suicide screening;
                            ``(iv) suicide intervention; and
                            ``(v) ways to mobilize communities with 
                        respect to the identification of risk factors 
                        for suicide.
                    ``(E) To conduct data collection and reporting 
                relating to Indian youth suicide prevention efforts.
            ``(2) Traditional health care practices.--In carrying out 
        the purposes described in paragraph (1), an Indian tribe or 
        tribal organization may use and promote the traditional health 
        care practices of the Indian tribes of the youth to be served.
    ``(c) Applications.--
            ``(1) In general.--Subject to paragraph (2), to be eligible 
        to receive a grant under subsection (a), an Indian tribe or 
        tribal organization shall prepare and submit to the Secretary 
        an application, at such time, in such manner, and containing 
        such information as the Secretary may require, including--
                    ``(A) a description of the project that the Indian 
                tribe or tribal organization will carry out using the 
                funds provided under the grant;
                    ``(B) a description of the manner in which the 
                project funded under the grant would--
                            ``(i) meet the telemental health care needs 
                        of the Indian youth population to be served by 
                        the project; or
                            ``(ii) improve the access of the Indian 
                        youth population to be served to suicide 
                        prevention and treatment services;
                    ``(C) evidence of support for the project from the 
                local community to be served by the project;
                    ``(D) a description of how the families and 
                leadership of the communities or populations to be 
                served by the project would be involved in the 
                development and ongoing operations of the project;
                    ``(E) a plan to involve the tribal community of the 
                youth who are provided services by the project in 
                planning and evaluating the mental health care and 
                suicide prevention efforts provided, in order to ensure 
                the integration of community, clinical, environmental, 
                and cultural components of the treatment; and
                    ``(F) a plan for sustaining the project after 
                Federal assistance for the demonstration project has 
                terminated.
            ``(2) Efficiency of grant application process.--The 
        Secretary shall carry out such measures as the Secretary 
        determines to be necessary to maximize the time and workload 
        efficiency of the process by which Indian tribes and tribal 
        organizations apply for grants under paragraph (1).
    ``(d) Collaboration.--The Secretary, acting through the Service, 
shall encourage Indian tribes and tribal organizations receiving grants 
under this section to collaborate to enable comparisons regarding best 
practices across projects.
    ``(e) Annual Report.--Each grant recipient shall submit to the 
Secretary an annual report that--
            ``(1) describes the number of telemental health services 
        provided; and
            ``(2) includes any other information that the Secretary may 
        require.
    ``(f) Reports to Congress.--
            ``(1) Initial report.--
                    ``(A) In general.--Not later than 2 years after the 
                date on which the first grant is awarded under this 
                section, the Secretary shall submit to the Committee on 
                Indian Affairs of the Senate and the Committee on 
                Natural Resources and the Committee on Energy and 
                Commerce of the House of Representatives a report 
                that--
                            ``(i) describes each project funded by a 
                        grant under this section during the preceding 
                        2-year period, including a description of the 
                        level of success achieved by the project; and
                            ``(ii) evaluates whether the demonstration 
                        project should be continued during the period 
                        beginning on the date of termination of funding 
                        for the demonstration project under subsection 
                        (g) and ending on the date on which the final 
                        report is submitted under paragraph (2).
                    ``(B) Continuation of demonstration project.--On a 
                determination by the Secretary under clause (ii) of 
                subparagraph (A) that the demonstration project should 
                be continued, the Secretary may carry out the 
                demonstration project during the period described in 
                that clause using such sums otherwise made available to 
                the Secretary as the Secretary determines to be 
                appropriate.
            ``(2) Final report.--Not later than 270 days after the date 
        of termination of funding for the demonstration project under 
        subsection (g), the Secretary shall submit to the Committee on 
        Indian Affairs of the Senate and the Committee on Natural 
        Resources and the Committee on Energy and Commerce of the House 
        of Representatives a final report that--
                    ``(A) describes the results of the projects funded 
                by grants awarded under this section, including any 
                data available that indicate the number of attempted 
                suicides;
                    ``(B) evaluates the impact of the telemental health 
                services funded by the grants in reducing the number of 
                completed suicides among Indian youth;
                    ``(C) evaluates whether the demonstration project 
                should be--
                            ``(i) expanded to provide more than 5 
                        grants; and
                            ``(ii) designated as a permanent program; 
                        and
                    ``(D) evaluates the benefits of expanding the 
                demonstration project to include urban Indian 
                organizations.
    ``(g) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section $1,500,000 for each of fiscal 
years 2010 through 2013.

``SEC. 724. SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION 
              GRANTS.

    ``(a) Grant Applications.--
            ``(1) Efficiency of grant application process.--The 
        Secretary, acting through the Administration, shall carry out 
        such measures as the Secretary determines to be necessary to 
        maximize the time and workload efficiency of the process by 
        which Indian tribes and tribal organizations apply for grants 
        under any program administered by the Administration, including 
        by providing methods other than electronic methods of 
        submitting applications for those grants, if necessary.
            ``(2) Priority for certain grants.--
                    ``(A) In general.--To fulfill the trust 
                responsibility of the United States to Indian tribes, 
                in awarding relevant grants pursuant to a program 
                described in subparagraph (B), the Secretary shall take 
                into consideration the needs of Indian tribes or tribal 
                organizations, as applicable, that serve populations 
                with documented high suicide rates, regardless of 
                whether those Indian tribes or tribal organizations 
                possess adequate personnel or infrastructure to fulfill 
                all applicable requirements of the relevant program.
                    ``(B) Description of grant programs.--A grant 
                program referred to in subparagraph (A) is a grant 
                program--
                            ``(i) administered by the Administration to 
                        fund activities relating to mental health, 
                        suicide prevention, or suicide-related risk 
                        factors; and
                            ``(ii) under which an Indian tribe or 
                        tribal organization is an eligible recipient.
            ``(3) Clarification regarding indian tribes and tribal 
        organizations.--Notwithstanding any other provision of law, in 
        applying for a grant under any program administered by the 
        Administration, no Indian tribe or tribal organization shall be 
        required to apply through a State or State agency.
            ``(4) Requirements for affected states.--
                    ``(A) Definitions.--In this paragraph:
                            ``(i) Affected state.--The term `affected 
                        State' means a State--
                                    ``(I) the boundaries of which 
                                include 1 or more Indian tribes; and
                                    ``(II) the application for a grant 
                                under any program administered by the 
                                Administration of which includes 
                                statewide data.
                            ``(ii) Indian population.--The term `Indian 
                        population' means the total number of residents 
                        of an affected State who are members of 1 or 
                        more Indian tribes or tribal communities 
                        located within the affected State.
                    ``(B) Requirements.--As a condition of receipt of a 
                grant under any program administered by the 
                Administration, each affected State shall--
                            ``(i) describe in the grant application--
                                    ``(I) the Indian population of the 
                                affected State; and
                                    ``(II) the contribution of that 
                                Indian population to the statewide data 
                                used by the affected State in the 
                                application; and
                            ``(ii) demonstrate to the satisfaction of 
                        the Secretary that--
                                    ``(I) of the total amount of the 
                                grant, the affected State will allocate 
                                for use for the Indian population of 
                                the affected State an amount equal to 
                                the proportion that--
                                            ``(aa) the Indian 
                                        population of the affected 
                                        State; bears to
                                            ``(bb) the total population 
                                        of the affected State; and
                                    ``(II) the affected State will 
                                offer to enter into a partnership with 
                                each Indian tribe or tribal 
                                organization, as applicable, located 
                                within the affected State to carry out 
                                youth suicide prevention and treatment 
                                measures for members of the Indian 
                                tribe.
                    ``(C) Report.--Not later than 1 year after the date 
                of receipt of a grant described in subparagraph (B), an 
                affected State shall submit to the Secretary a report 
                describing the measures carried out by the affected 
                State to ensure compliance with the requirements of 
                subparagraph (B)(ii).
    ``(b) No Non-Federal Share Requirement.--Notwithstanding any other 
provision of law, no Indian tribe or tribal organization shall be 
required to provide a non-Federal share of the cost of any project or 
activity carried out using a grant provided under any program 
administered by the Administration.
    ``(c) Outreach for Rural and Isolated Indian Tribes.--Due to the 
rural, isolated nature of most Indian reservations and communities 
(especially those reservations and communities in the Great Plains 
region), the Secretary shall conduct outreach activities, with a 
particular emphasis on the provision of telemental health services, to 
achieve the purposes of this subtitle with respect to Indian tribes 
located in rural, isolated areas.
    ``(d) Provision of Other Assistance.--
            ``(1) In general.--The Secretary, acting through the 
        Administration, shall carry out such measures (including 
        monitoring and the provision of required assistance) as the 
        Secretary determines to be necessary to ensure the provision of 
        adequate suicide prevention and mental health services to 
        Indian tribes described in paragraph (2), regardless of whether 
        those Indian tribes possess adequate personnel or 
        infrastructure--
                    ``(A) to submit an application for a grant under 
                any program administered by the Administration, 
                including due to problems relating to access to the 
                Internet or other electronic means that may have 
                resulted in previous obstacles to submission of a grant 
                application; or
                    ``(B) to fulfill all applicable requirements of the 
                relevant program.
            ``(2) Description of indian tribes.--An Indian tribe 
        referred to in paragraph (1) is an Indian tribe--
                    ``(A) the members of which experience--
                            ``(i) a high rate of youth suicide;
                            ``(ii) low socioeconomic status; and
                            ``(iii) extreme health disparity;
                    ``(B) that is located in a remote and isolated 
                area; and
                    ``(C) that lacks technology and communication 
                infrastructure.
            ``(3) Authorization of appropriations.--There are 
        authorized to be appropriated to the Secretary such sums as the 
        Secretary determines to be necessary to carry out this 
        subsection.
    ``(e) Early Intervention and Assessment Services.--
            ``(1) Definition of affected entity.--In this subsection, 
        the term `affected entity' means any entity--
                    ``(A) that receives a grant for suicide 
                intervention, prevention, or treatment under a program 
                administered by the Administration; and
                    ``(B) the population to be served by which includes 
                Indian youth.
            ``(2) Requirement.--The Secretary, acting through the 
        Administration, shall ensure that each affected entity carrying 
        out a youth suicide early intervention and prevention strategy 
        described in section 520E(c)(1) of the Public Health Service 
        Act (42 U.S.C. 290bb-36(c)(1)), or any other youth suicide-
        related early intervention and assessment activity, provides 
        training or education to individuals who interact frequently 
        with the Indian youth to be served by the affected entity 
        (including parents, teachers, coaches, and mentors) on 
        identifying warning signs of Indian youth who are at risk of 
        committing suicide.

``SEC. 725. USE OF PREDOCTORAL PSYCHOLOGY AND PSYCHIATRY INTERNS.

    ``The Secretary shall carry out such activities as the Secretary 
determines to be necessary to encourage Indian tribes, tribal 
organizations, and other mental health care providers serving residents 
of Indian country to obtain the services of predoctoral psychology and 
psychiatry interns--
            ``(1) to increase the quantity of patients served by the 
        Indian tribes, tribal organizations, and other mental health 
        care providers; and
            ``(2) for purposes of recruitment and retention.

``SEC. 726. INDIAN YOUTH LIFE SKILLS DEVELOPMENT DEMONSTRATION PROGRAM.

    ``(a) Purpose.--The purpose of this section is to authorize the 
Secretary, acting through the Administration, to carry out a 
demonstration program to test the effectiveness of a culturally 
compatible, school-based, life skills curriculum for the prevention of 
Indian and Alaska Native adolescent suicide, including through--
            ``(1) the establishment of tribal partnerships to develop 
        and implement such a curriculum, in cooperation with--
                    ``(A) mental health professionals, with a priority 
                for tribal partnerships cooperating with mental health 
                professionals employed by the Service;
                    ``(B) tribal or local school agencies; and
                    ``(C) parent and community groups;
            ``(2) the provision by the Administration or the Service 
        of--
                    ``(A) technical expertise; and
                    ``(B) clinicians, analysts, and educators, as 
                appropriate;
            ``(3) training for teachers, school administrators, and 
        community members to implement the curriculum;
            ``(4) the establishment of advisory councils composed of 
        parents, educators, community members, trained peers, and 
        others to provide advice regarding the curriculum and other 
        components of the demonstration program;
            ``(5) the development of culturally appropriate support 
        measures to supplement the effectiveness of the curriculum; and
            ``(6) projects modeled after evidence-based projects, such 
        as programs evaluated and published in relevant literature.
    ``(b) Demonstration Grant Program.--
            ``(1) Definitions.--In this subsection:
                    ``(A) Curriculum.--The term `curriculum' means the 
                culturally compatible, school-based, life skills 
                curriculum for the prevention of Indian and Alaska 
                Native adolescent suicide identified by the Secretary 
                under paragraph (2)(A).
                    ``(B) Eligible entity.--The term `eligible entity' 
                means--
                            ``(i) an Indian tribe;
                            ``(ii) a tribal organization;
                            ``(iii) any other tribally authorized 
                        entity; and
                            ``(iv) any partnership composed of 2 or 
                        more entities described in clause (i), (ii), or 
                        (iii).
            ``(2) Establishment.--The Secretary, acting through the 
        Administration, may establish and carry out a demonstration 
        program under which the Secretary shall--
                    ``(A) identify a culturally compatible, school-
                based, life skills curriculum for the prevention of 
                Indian and Alaska Native adolescent suicide;
                    ``(B) identify the Indian tribes that are at 
                greatest risk for adolescent suicide;
                    ``(C) invite those Indian tribes to participate in 
                the demonstration program by--
                            ``(i) responding to a comprehensive program 
                        requirement request of the Secretary; or
                            ``(ii) submitting, through an eligible 
                        entity, an application in accordance with 
                        paragraph (4); and
                    ``(D) provide grants to the Indian tribes 
                identified under subparagraph (B) and eligible entities 
                to implement the curriculum with respect to Indian and 
                Alaska Native youths who--
                            ``(i) are between the ages of 10 and 19; 
                        and
                            ``(ii) attend school in a region that is at 
                        risk of high youth suicide rates, as determined 
                        by the Administration.
            ``(3) Requirements.--
                    ``(A) Term.--The term of a grant provided under the 
                demonstration program under this section shall be not 
                less than 4 years.
                    ``(B) Maximum number.--The Secretary may provide 
                not more than 5 grants under the demonstration program 
                under this section.
                    ``(C) Amount.--The grants provided under this 
                section shall be of equal amounts.
                    ``(D) Certain schools.--In selecting eligible 
                entities to receive grants under this section, the 
                Secretary shall ensure that not less than 1 
                demonstration program shall be carried out at each of--
                            ``(i) a school operated by the Bureau of 
                        Indian Education;
                            ``(ii) a Tribal school; and
                            ``(iii) a school receiving payments under 
                        section 8002 or 8003 of the Elementary and 
                        Secondary Education Act of 1965 (20 U.S.C. 
                        7702, 7703).
            ``(4) Applications.--To be eligible to receive a grant 
        under the demonstration program, an eligible entity shall 
        submit to the Secretary an application, at such time, in such 
        manner, and containing such information as the Secretary may 
        require, including--
                    ``(A) an assurance that, in implementing the 
                curriculum, the eligible entity will collaborate with 1 
                or more local educational agencies, including 
                elementary schools, middle schools, and high schools;
                    ``(B) an assurance that the eligible entity will 
                collaborate, for the purpose of curriculum development, 
                implementation, and training and technical assistance, 
                with 1 or more--
                            ``(i) nonprofit entities with demonstrated 
                        expertise regarding the development of 
                        culturally sensitive, school-based, youth 
                        suicide prevention and intervention programs; 
                        or
                            ``(ii) institutions of higher education 
                        with demonstrated interest and knowledge 
                        regarding culturally sensitive, school-based, 
                        life skills youth suicide prevention and 
                        intervention programs;
                    ``(C) an assurance that the curriculum will be 
                carried out in an academic setting in conjunction with 
                at least 1 classroom teacher not less frequently than 
                twice each school week for the duration of the academic 
                year;
                    ``(D) a description of the methods by which 
                curriculum participants will be--
                            ``(i) screened for mental health at-risk 
                        indicators; and
                            ``(ii) if needed and on a case-by-case 
                        basis, referred to a mental health clinician 
                        for further assessment and treatment and with 
                        crisis response capability; and
                    ``(E) an assurance that supportive services will be 
                provided to curriculum participants identified as high-
                risk participants, including referral, counseling, and 
                follow-up services for--
                            ``(i) drug or alcohol abuse;
                            ``(ii) sexual or domestic abuse; and
                            ``(iii) depression and other relevant 
                        mental health concerns.
            ``(5) Use of funds.--An Indian tribe identified under 
        paragraph (2)(B) or an eligible entity may use a grant provided 
        under this subsection--
                    ``(A) to develop and implement the curriculum in a 
                school-based setting;
                    ``(B) to establish an advisory council--
                            ``(i) to advise the Indian tribe or 
                        eligible entity regarding curriculum 
                        development; and
                            ``(ii) to provide support services 
                        identified as necessary by the community being 
                        served by the Indian tribe or eligible entity;
                    ``(C) to appoint and train a school- and community-
                based cultural resource liaison, who will act as an 
                intermediary among the Indian tribe or eligible entity, 
                the applicable school administrators, and the advisory 
                council established by the Indian tribe or eligible 
                entity;
                    ``(D) to establish an on-site, school-based, MA- or 
                PhD-level mental health practitioner (employed by the 
                Service, if practicable) to work with tribal educators 
                and other personnel;
                    ``(E) to provide for the training of peer 
                counselors to assist in carrying out the curriculum;
                    ``(F) to procure technical and training support 
                from nonprofit or State entities or institutions of 
                higher education identified by the community being 
                served by the Indian tribe or eligible entity as the 
                best suited to develop and implement the curriculum;
                    ``(G) to train teachers and school administrators 
                to effectively carry out the curriculum;
                    ``(H) to establish an effective referral procedure 
                and network;
                    ``(I) to identify and develop culturally compatible 
                curriculum support measures;
                    ``(J) to obtain educational materials and other 
                resources from the Administration or other appropriate 
                entities to ensure the success of the demonstration 
                program; and
                    ``(K) to evaluate the effectiveness of the 
                curriculum in preventing Indian and Alaska Native 
                adolescent suicide.
    ``(c) Evaluations.--Using such amounts made available pursuant to 
subsection (e) as the Secretary determines to be appropriate, the 
Secretary shall conduct, directly or through a grant, contract, or 
cooperative agreement with an entity that has experience regarding the 
development and operation of successful culturally compatible, school-
based, life skills suicide prevention and intervention programs or 
evaluations, an annual evaluation of the demonstration program under 
this section, including an evaluation of--
            ``(1) the effectiveness of the curriculum in preventing 
        Indian and Alaska Native adolescent suicide;
            ``(2) areas for program improvement; and
            ``(3) additional development of the goals and objectives of 
        the demonstration program.
    ``(d) Report to Congress.--
            ``(1) In general.--Subject to paragraph (2), not later than 
        180 days after the date of termination of the demonstration 
        program, the Secretary shall submit to the Committee on Indian 
        Affairs and the Committee on Health, Education, Labor, and 
        Pensions of the Senate and the Committee on Natural Resources 
        and the Committee on Education and Labor of the House of 
        Representatives a final report that--
                    ``(A) describes the results of the program of each 
                Indian tribe or eligible entity under this section;
                    ``(B) evaluates the effectiveness of the curriculum 
                in preventing Indian and Alaska Native adolescent 
                suicide;
                    ``(C) makes recommendations regarding--
                            ``(i) the expansion of the demonstration 
                        program under this section to additional 
                        eligible entities;
                            ``(ii) designating the demonstration 
                        program as a permanent program; and
                            ``(iii) identifying and distributing the 
                        curriculum through the Suicide Prevention 
                        Resource Center of the Administration; and
                    ``(D) incorporates any public comments received 
                under paragraph (2).
            ``(2) Public comment.--The Secretary shall provide a notice 
        of the report under paragraph (1) and an opportunity for public 
        comment on the report for a period of not less than 90 days 
        before submitting the report to Congress.
    ``(e) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section $1,000,000 for each of fiscal 
years 2010 through 2014.''.

                       Subtitle H--Miscellaneous

SEC. 191. CONFIDENTIALITY OF MEDICAL QUALITY ASSURANCE RECORDS; 
              QUALIFIED IMMUNITY FOR PARTICIPANTS.

    Title VIII of the Indian Health Care Improvement Act (as amended by 
section 101(b)) is amended by inserting after section 804 (25 U.S.C. 
1674) the following:

``SEC. 805. CONFIDENTIALITY OF MEDICAL QUALITY ASSURANCE RECORDS; 
              QUALIFIED IMMUNITY FOR PARTICIPANTS.

    ``(a) Definitions.--In this section:
            ``(1) Health care provider.--The term `health care 
        provider' means any health care professional, including 
        community health aides and practitioners certified under 
        section 119, who is--
                    ``(A) granted clinical practice privileges or 
                employed to provide health care services at--
                            ``(i) an Indian health program; or
                            ``(ii) a health program of an urban Indian 
                        organization; and
                    ``(B) licensed or certified to perform health care 
                services by a governmental board or agency or 
                professional health care society or organization.
            ``(2) Medical quality assurance program.--The term `medical 
        quality assurance program' means any activity carried out 
        before, on, or after the date of enactment of the Indian Health 
        Care Improvement Reauthorization and Extension Act of 2009 by 
        or for any Indian health program or urban Indian organization 
        to assess the quality of medical care, including activities 
        conducted by or on behalf of individuals, Indian health program 
        or urban Indian organization medical or dental treatment review 
        committees, or other review bodies responsible for quality 
        assurance, credentials, infection control, patient safety, 
        patient care assessment (including treatment procedures, blood, 
        drugs, and therapeutics), medical records, health resources 
        management review, and identification and prevention of medical 
        or dental incidents and risks.
            ``(3) Medical quality assurance record.--The term `medical 
        quality assurance record' means the proceedings, records, 
        minutes, and reports that--
                    ``(A) emanate from quality assurance program 
                activities described in paragraph (2); and
                    ``(B) are produced or compiled by or for an Indian 
                health program or urban Indian organization as part of 
                a medical quality assurance program.
    ``(b) Confidentiality of Records.--Medical quality assurance 
records created by or for any Indian health program or a health program 
of an urban Indian organization as part of a medical quality assurance 
program are confidential and privileged. Such records may not be 
disclosed to any person or entity, except as provided in subsection 
(d).
    ``(c) Prohibition on Disclosure and Testimony.--
            ``(1) In general.--No part of any medical quality assurance 
        record described in subsection (b) may be subject to discovery 
        or admitted into evidence in any judicial or administrative 
        proceeding, except as provided in subsection (d).
            ``(2) Testimony.--An individual who reviews or creates 
        medical quality assurance records for any Indian health program 
        or urban Indian organization who participates in any proceeding 
        that reviews or creates such records may not be permitted or 
        required to testify in any judicial or administrative 
        proceeding with respect to such records or with respect to any 
        finding, recommendation, evaluation, opinion, or action taken 
        by such person or body in connection with such records except 
        as provided in this section.
    ``(d) Authorized Disclosure and Testimony.--
            ``(1) In general.--Subject to paragraph (2), a medical 
        quality assurance record described in subsection (b) may be 
        disclosed, and an individual referred to in subsection (c) may 
        give testimony in connection with such a record, only as 
        follows:
                    ``(A) To a Federal agency or private organization, 
                if such medical quality assurance record or testimony 
                is needed by such agency or organization to perform 
                licensing or accreditation functions related to any 
                Indian health program or to a health program of an 
                urban Indian organization to perform monitoring, 
                required by law, of such program or organization.
                    ``(B) To an administrative or judicial proceeding 
                commenced by a present or former Indian health program 
                or urban Indian organization provider concerning the 
                termination, suspension, or limitation of clinical 
                privileges of such health care provider.
                    ``(C) To a governmental board or agency or to a 
                professional health care society or organization, if 
                such medical quality assurance record or testimony is 
                needed by such board, agency, society, or organization 
                to perform licensing, credentialing, or the monitoring 
                of professional standards with respect to any health 
                care provider who is or was an employee of any Indian 
                health program or urban Indian organization.
                    ``(D) To a hospital, medical center, or other 
                institution that provides health care services, if such 
                medical quality assurance record or testimony is needed 
                by such institution to assess the professional 
                qualifications of any health care provider who is or 
                was an employee of any Indian health program or urban 
                Indian organization and who has applied for or been 
                granted authority or employment to provide health care 
                services in or on behalf of such program or 
                organization.
                    ``(E) To an officer, employee, or contractor of the 
                Indian health program or urban Indian organization that 
                created the records or for which the records were 
                created. If that officer, employee, or contractor has a 
                need for such record or testimony to perform official 
                duties.
                    ``(F) To a criminal or civil law enforcement agency 
                or instrumentality charged under applicable law with 
                the protection of the public health or safety, if a 
                qualified representative of such agency or 
                instrumentality makes a written request that such 
                record or testimony be provided for a purpose 
                authorized by law.
                    ``(G) In an administrative or judicial proceeding 
                commenced by a criminal or civil law enforcement agency 
                or instrumentality referred to in subparagraph (F), but 
                only with respect to the subject of such proceeding.
            ``(2) Identity of participants.--With the exception of the 
        subject of a quality assurance action, the identity of any 
        person receiving health care services from any Indian health 
        program or urban Indian organization or the identity of any 
        other person associated with such program or organization for 
        purposes of a medical quality assurance program that is 
        disclosed in a medical quality assurance record described in 
        subsection (b) shall be deleted from that record or document 
        before any disclosure of such record is made outside such 
        program or organization.
    ``(e) Disclosure for Certain Purposes.--
            ``(1) In general.--Nothing in this section shall be 
        construed as authorizing or requiring the withholding from any 
        person or entity aggregate statistical information regarding 
        the results of any Indian health program or urban Indian 
        organization's medical quality assurance programs.
            ``(2) Withholding from congress.--Nothing in this section 
        shall be construed as authority to withhold any medical quality 
        assurance record from a committee of either House of Congress, 
        any joint committee of Congress, or the Government 
        Accountability Office if such record pertains to any matter 
        within their respective jurisdictions.
    ``(f) Prohibition on Disclosure of Record or Testimony.--An 
individual or entity having possession of or access to a record or 
testimony described by this section may not disclose the contents of 
such record or testimony in any manner or for any purpose except as 
provided in this section.
    ``(g) Exemption From Freedom of Information Act.--Medical quality 
assurance records described in subsection (b) may not be made available 
to any person under section 552 of title 5, United States Code.
    ``(h) Limitation on Civil Liability.--An individual who 
participates in or provides information to a person or body that 
reviews or creates medical quality assurance records described in 
subsection (b) shall not be civilly liable for such participation or 
for providing such information if the participation or provision of 
information was in good faith based on prevailing professional 
standards at the time the medical quality assurance program activity 
took place.
    ``(i) Application to Information in Certain Other Records.--Nothing 
in this section shall be construed as limiting access to the 
information in a record created and maintained outside a medical 
quality assurance program, including a patient's medical records, on 
the grounds that the information was presented during meetings of a 
review body that are part of a medical quality assurance program.
    ``(j) Regulations.--The Secretary, acting through the Service, 
shall promulgate regulations pursuant to section 802.
    ``(k) Continued Protection.--Disclosure under subsection (d) does 
not permit redisclosure except to the extent such further disclosure is 
authorized under subsection (d) or is otherwise authorized to be 
disclosed under this section.
    ``(l) Inconsistencies.--To the extent that the protections under 
part C of title IX of the Public Health Service Act (42 U.S.C. 229b-21 
et seq.) (as amended by the Patient Safety and Quality Improvement Act 
of 2005 (Public Law 109-41; 119 Stat. 424)) and this section are 
inconsistent, the provisions of whichever is more protective shall 
control.
    ``(m) Relationship to Other Law.--This section shall continue in 
force and effect, except as otherwise specifically provided in any 
Federal law enacted after the date of enactment of the Indian Health 
Care Improvement Reauthorization and Extension Act of 2009.''.

SEC. 192. ARIZONA, NORTH DAKOTA, AND SOUTH DAKOTA AS CONTRACT HEALTH 
              SERVICE DELIVERY AREAS; ELIGIBILITY OF CALIFORNIA 
              INDIANS.

    Title VIII of the Indian Health Care Improvement Act is amended--
            (1) by striking section 808 (25 U.S.C. 1678) and inserting 
        the following:

``SEC. 808. ARIZONA AS CONTRACT HEALTH SERVICE DELIVERY AREA.

    ``(a) In General.--The State of Arizona shall be designated as a 
contract health service delivery area by the Service for the purpose of 
providing contract health care services to members of Indian tribes in 
the State of Arizona.
    ``(b) Maintenance of Services.--The Service shall not curtail any 
health care services provided to Indians residing on reservations in 
the State of Arizona if the curtailment is due to the provision of 
contract services in that State pursuant to the designation of the 
State as a contract health service delivery area by subsection (a).'';
            (2) by inserting after section 808 (25 U.S.C. 1678) the 
        following:

``SEC. 808A. NORTH DAKOTA AND SOUTH DAKOTA AS CONTRACT HEALTH SERVICE 
              DELIVERY AREA.

    ``(a) In General.--The States of North Dakota and South Dakota 
shall be designated as a contract health service delivery area by the 
Service for the purpose of providing contract health care services to 
members of Indian tribes in the States of North Dakota and South 
Dakota.
    ``(b) Maintenance of Services.--The Service shall not curtail any 
health care services provided to Indians residing on any reservation, 
or in any county that has a common boundary with any reservation, in 
the State of North Dakota or South Dakota if the curtailment is due to 
the provision of contract services in those States pursuant to the 
designation of the States as a contract health service delivery area by 
subsection (a).''; and
            (3) by striking section 809 (25 U.S.C. 1679) and inserting 
        the following:

``SEC. 809. ELIGIBILITY OF CALIFORNIA INDIANS.

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

SEC. 193. METHODS TO INCREASE ACCESS TO PROFESSIONALS OF CERTAIN CORPS.

    Section 812 of the Indian Health Care Improvement Act (25 U.S.C. 
1680b) is amended to read as follows:

``SEC. 812. NATIONAL HEALTH SERVICE CORPS.

    ``(a) No Reduction in Services.--The Secretary shall not remove a 
member of the National Health Service Corps from an Indian health 
program or urban Indian organization or withdraw funding used to 
support such a member, unless the Secretary, acting through the 
Service, has ensured that the Indians receiving services from the 
member will experience no reduction in services.
    ``(b) Treatment of Indian Health Programs.--At the request of an 
Indian health program, the services of a member of the National Health 
Service Corps assigned to the Indian health program may be limited to 
the individuals who are eligible for services from that Indian health 
program.''.

SEC. 194. HEALTH SERVICES FOR INELIGIBLE PERSONS.

    Section 813 of the Indian Health Care Improvement Act (25 U.S.C. 
1680c) is amended to read as follows:

``SEC. 813. HEALTH SERVICES FOR INELIGIBLE PERSONS.

    ``(a) Children.--Any individual who--
            ``(1) has not attained 19 years of age;
            ``(2) is the natural or adopted child, stepchild, foster 
        child, legal ward, or orphan of an eligible Indian; and
            ``(3) is not otherwise eligible for health services 
        provided by the Service,
shall be eligible for all health services provided by the Service on 
the same basis and subject to the same rules that apply to eligible 
Indians until such individual attains 19 years of age. The existing and 
potential health needs of all such individuals shall be taken into 
consideration by the Service in determining the need for, or the 
allocation of, the health resources of the Service. If such an 
individual has been determined to be legally incompetent prior to 
attaining 19 years of age, such individual shall remain eligible for 
such services until 1 year after the date of a determination of 
competency.
    ``(b) Spouses.--Any spouse of an eligible Indian who is not an 
Indian, or who is of Indian descent but is not otherwise eligible for 
the health services provided by the Service, shall be eligible for such 
health services if all such spouses or spouses who are married to 
members of each Indian tribe being served are made eligible, as a 
class, by an appropriate resolution of the governing body of the Indian 
tribe or tribal organization providing such services. The health needs 
of persons made eligible under this paragraph shall not be taken into 
consideration by the Service in determining the need for, or allocation 
of, its health resources.
    ``(c) Health Facilities Providing Health Services.--
            ``(1) In general.--The Secretary is authorized to provide 
        health services under this subsection through health facilities 
        operated directly by the Service to individuals who reside 
        within the Service unit and who are not otherwise eligible for 
        such health services if--
                    ``(A) the Indian tribes served by such Service unit 
                requests such provision of health services to such 
                individuals, and
                    ``(B) the Secretary and the served Indian tribes 
                have jointly determined that the provision of such 
                health services will not result in a denial or 
                diminution of health services to eligible Indians.
            ``(2) ISDEAA programs.--In the case of health facilities 
        operated under a contract or compact entered into under the 
        Indian Self-Determination and Education Assistance Act (25 
        U.S.C. 450 et seq.), the governing body of the Indian tribe or 
        tribal organization providing health services under such 
        contract or compact is authorized to determine whether health 
        services should be provided under such contract or compact to 
        individuals who are not eligible for such health services under 
        any other subsection of this section or under any other 
        provision of law. In making such determinations, the governing 
        body of the Indian tribe or tribal organization shall take into 
        account the consideration described in paragraph (1)(B). Any 
        services provided by the Indian tribe or tribal organization 
        pursuant to a determination made under this subparagraph shall 
        be deemed to be provided under the agreement entered into by 
        the Indian tribe or tribal organization under the Indian Self-
        Determination and Education Assistance Act. The provisions of 
        section 314 of Public Law 101-512 (104 Stat. 1959), as amended 
        by section 308 of Public Law 103-138 (107 Stat. 1416), shall 
        apply to any services provided by the Indian tribe or tribal 
        organization pursuant to a determination made under this 
        subparagraph.
            ``(3) Payment for services.--
                    ``(A) In general.--Persons receiving health 
                services provided by the Service under this subsection 
                shall be liable for payment of such health services 
                under a schedule of charges prescribed by the Secretary 
                which, in the judgment of the Secretary, results in 
                reimbursement in an amount not less than the actual 
                cost of providing the health services. Notwithstanding 
                section 207 of this Act or any other provision of law, 
                amounts collected under this subsection, including 
                Medicare, Medicaid, or children's health insurance 
                program reimbursements under titles XVIII, XIX, and XXI 
                of the Social Security Act (42 U.S.C. 1395 et seq.), 
                shall be credited to the account of the program 
                providing the service and shall be used for the 
                purposes listed in section 401(d)(2) and amounts 
                collected under this subsection shall be available for 
                expenditure within such program.
                    ``(B) Indigent people.--Health services may be 
                provided by the Secretary through the Service under 
                this subsection to an indigent individual who would not 
                be otherwise eligible for such health services but for 
                the provisions of paragraph (1) only if an agreement 
                has been entered into with a State or local government 
                under which the State or local government agrees to 
                reimburse the Service for the expenses incurred by the 
                Service in providing such health services to such 
                indigent individual.
            ``(4) Revocation of consent for services.--
                    ``(A) Single tribe service area.--In the case of a 
                Service Area which serves only 1 Indian tribe, the 
                authority of the Secretary to provide health services 
                under paragraph (1) shall terminate at the end of the 
                fiscal year succeeding the fiscal year in which the 
                governing body of the Indian tribe revokes its 
                concurrence to the provision of such health services.
                    ``(B) Multitribal service area.--In the case of a 
                multitribal Service Area, the authority of the 
                Secretary to provide health services under paragraph 
                (1) shall terminate at the end of the fiscal year 
                succeeding the fiscal year in which at least 51 percent 
                of the number of Indian tribes in the Service Area 
                revoke their concurrence to the provisions of such 
                health services.
    ``(d) Other Services.--The Service may provide health services 
under this subsection to individuals who are not eligible for health 
services provided by the Service under any other provision of law in 
order to--
            ``(1) achieve stability in a medical emergency;
            ``(2) prevent the spread of a communicable disease or 
        otherwise deal with a public health hazard;
            ``(3) provide care to non-Indian women pregnant with an 
        eligible Indian's child for the duration of the pregnancy 
        through postpartum; or
            ``(4) provide care to immediate family members of an 
        eligible individual if such care is directly related to the 
        treatment of the eligible individual.
    ``(e) Hospital Privileges for Practitioners.--
            ``(1) In general.--Hospital privileges in health facilities 
        operated and maintained by the Service or operated under a 
        contract or compact pursuant to the Indian Self-Determination 
        and Education Assistance Act (25 U.S.C. 450 et seq.) may be 
        extended to non-Service health care practitioners who provide 
        services to individuals described in subsection (a), (b), (c), 
        or (d). Such non-Service health care practitioners may, as part 
        of the privileging process, be designated as employees of the 
        Federal Government for purposes of section 1346(b) and chapter 
        171 of title 28, United States Code (relating to Federal tort 
        claims) only with respect to acts or omissions which occur in 
        the course of providing services to eligible individuals as a 
        part of the conditions under which such hospital privileges are 
        extended.
            ``(2) Definition.--For purposes of this subsection, the 
        term `non-Service health care practitioner' means a 
        practitioner who is not--
                    ``(A) an employee of the Service; or
                    ``(B) an employee of an Indian tribe or tribal 
                organization operating a contract or compact under the 
                Indian Self-Determination and Education Assistance Act 
                (25 U.S.C. 450 et seq.) or an individual who provides 
                health care services pursuant to a personal services 
                contract with such Indian tribe or tribal organization.
    ``(f) Eligible Indian.--For purposes of this section, the term 
`eligible Indian' means any Indian who is eligible for health services 
provided by the Service without regard to the provisions of this 
section.''.

SEC. 195. ANNUAL BUDGET SUBMISSION.

    Title VIII of the Indian Health Care Improvement Act (25 U.S.C. 
1671 et seq.) is amended by adding at the end the following:

``SEC. 826. ANNUAL BUDGET SUBMISSION.

    ``Effective beginning with the submission of the annual budget 
request to Congress for fiscal year 2011, the President shall include, 
in the amount requested and the budget justification, amounts that 
reflect any changes in--
            ``(1) the cost of health care services, as indexed for 
        United States dollar inflation (as measured by the Consumer 
        Price Index); and
            ``(2) the size of the population served by the Service.''.

                   TITLE II--AMENDMENTS TO OTHER ACTS

SEC. 201. SOLICITATION OF PROPOSALS FOR SAFE HARBORS UNDER THE SOCIAL 
              SECURITY ACT FOR FACILITIES OF INDIAN HEALTH PROGRAMS AND 
              URBAN INDIAN ORGANIZATIONS.

    The Secretary of Health and Human Services, acting through the 
Office of the Inspector General of the Department of Health and Human 
Services, shall publish a notice, described in section 1128D(a)(1)(A) 
of the Social Security Act (42 U.S.C. 1320a-7d(a)(1)(A)), soliciting a 
proposal, not later than July 1, 2010, on the development of safe 
harbors described in such section relating to health care items and 
services provided by facilities of Indian health programs or an urban 
Indian organization (as such terms are defined in section 4 of the 
Indian Health Care Improvement Act). Such a safe harbor may relate to 
areas such as transportation, housing, or cost-sharing, assistance 
provided through such facilities or contract health services for 
Indians.

SEC. 202. ANNUAL REPORT REGARDING INDIANS SERVED BY HEALTH BENEFITS 
              PROGRAMS UNDER SOCIAL SECURITY ACT.

    Section 1139 of the Social Security Act (42 U.S.C. 1320b-9) is 
amended--
            (1) by redesignating subsection (c) as subsection (d); and
            (2) by inserting after subsection (b) the following:
    ``(c) Annual Reports on Indians Served by Health Benefit 
Programs.--
            ``(1) In general.--Beginning on January 1, 2011, and 
        annually thereafter, the Secretary, acting through the 
        Administration of the Centers for Medicare & Medicaid Services 
        and the Assistant Secretary for Indian Health, shall submit to 
        Congress a report regarding the enrollment and health status of 
        Indians receiving items or services under health benefit 
        programs funded under this Act during the preceding year.
            ``(2) Inclusions.--Each report under paragraph (1) shall 
        include the following:
                    ``(A) The total number of Indians enrolled in, or 
                receiving items or services under, such programs, 
                disaggregated with respect to each such program.
                    ``(B) The number of Indians described in paragraph 
                (1) that also received health benefits under programs 
                funded by the Indian Health Service.
                    ``(C) General information regarding the health 
                status of the Indians described in paragraph (1), 
                disaggregated with respect to specific diseases or 
                conditions and presented in a manner that is consistent 
                with protections for privacy of individually 
                identifiable health information under section 264(c) of 
                the Health Insurance Portability and Accountability Act 
                of 1996 (42 U.S.C. 1320d-2 note).
                    ``(D) A detailed statement of the status of 
                facilities of the Indian Health Service or an Indian 
                tribe, tribal organization or urban Indian organization 
                with respect to the compliance by such facilities with 
                the applicable conditions and requirements of titles 
                XVIII, XIX, and XXI, and, in the case of title XIX or 
                XXI, under a State plan under such title or under 
                waiver authority, and of the progress being made by 
                such facilities under plans submitted under section 
                1880(b) or 1911(b) or otherwise toward the achievement 
                and maintenance of such compliance.
                    ``(E) Such other information as the Secretary 
                determines is appropriate.''.

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.

    (a) In General.--Section 1860D-2(b)(4)(C) of the Social Security 
Act (42 U.S.C. 1395w-102(b)(4)(C)) is amended--
            (1) in clause (i), by striking ``and'' at the end;
            (2) in clause (ii)--
                    (A) by striking ``such costs shall be treated as 
                incurred only if'' and inserting ``subject to clause 
                (iii), such costs shall be treated as incurred if'';
                    (B) by striking ``, under section 1860D-14, or 
                under a State Pharmaceutical Assistance Program'';
                    (C) by striking ``(other than under such section or 
                such a Program)''; and
                    (D) by striking the period at the end and inserting 
                ``; and''; and
            (3) by inserting after clause (ii) the following new 
        clause:
                            ``(iii) such costs shall be treated as 
                        incurred and shall not be considered to be 
                        reimbursed under clause (ii) if such costs are 
                        borne or paid--
                                    ``(I) under section 1860D-14;
                                    ``(II) under a State Pharmaceutical 
                                Assistance Program;
                                    ``(III) by the Indian Health 
                                Service, an Indian tribe or tribal 
                                organization, or an urban Indian 
                                organization (as defined in section 4 
                                of the Indian Health Care Improvement 
                                Act);
                                    ``(IV) by a Federally qualified 
                                health center (as defined in section 
                                1861(aa)(4));
                                    ``(V) under an AIDS Drug Assistance 
                                Program under part B of title XXVI of 
                                the Public Health Service Act;
                                    ``(VI) by a subsection (d) hospital 
                                (as defined in section 1886(d)(1)(B)) 
                                that meets the requirements of clauses 
                                (i) and (ii) of section 340B(a)(4)(L) 
                                of the Public Health Service Act; or
                                    ``(VII) by a pharmaceutical 
                                manufacturer patient assistance 
                                program, either directly or through the 
                                distribution or donation of covered 
                                part D drugs, which shall be valued at 
                                the negotiated price of such covered 
                                part D drug under the enrollee's 
                                prescription drug plan or MA-PD plan as 
                                of the date that the drug was 
                                distributed or donated.''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
apply to costs incurred on or after January 1, 2010.

SEC. 204. MEDICARE AMENDMENTS.

    (a) In General.--Section 1880 of the Social Security Act (42 U.S.C. 
1395qq) is amended--
            (1) by redesignating subsection (f) as subsection (g); and
            (2) by inserting after subsection (e) the following:
    ``(f) Prohibition.--Payments made pursuant to this section shall 
not be reduced as a result of any beneficiary deductible, coinsurance, 
or other charge under section 1813.''.
    (b) Payment of Benefits.--Section 1833(a)(1)(B) of the Social 
Security Act (42 U.S.C. 1395l(a)(1)(B)) is amended by inserting ``or 
1880(e)'' after ``section 1861(s)(10)(A)''.

SEC. 205. EXPANSION OF PAYMENTS UNDER MEDICARE, MEDICAID, AND CHIP FOR 
              ALL COVERED SERVICES FURNISHED BY INDIAN HEALTH PROGRAMS.

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

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

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

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

                and
                    (B) by amending subsection (a) to read as follows:
    ``(a) Eligibility for Payments.--Subject to subsection (e), the 
Indian Health Service and an Indian tribe, tribal organization, or an 
urban Indian organization shall be eligible for payments under this 
title with respect to items and services furnished by the Indian Health 
Service, Indian tribe, tribal organization, or urban Indian 
organization if the furnishing of such services meets all the 
conditions and requirements which are applicable generally to the 
furnishing of items and services under this title.''.
            (2) Compliance with conditions and requirements.--
        Subsection (b) of such section is amended to read as follows:
    ``(b) Compliance With Conditions and Requirements.--Subject to 
subsection (e), a facility of the Indian Health Service or an Indian 
tribe, tribal organization, or an urban Indian organization which is 
eligible for payment under subsection (a) with respect to the 
furnishing of items and services, but which does not meet all of the 
conditions and requirements of this title which are applicable 
generally to such facility, shall make such improvements as are 
necessary to achieve or maintain compliance with such conditions and 
requirements in accordance with a plan submitted to and accepted by the 
Secretary for achieving or maintaining compliance with such conditions 
and requirements, and shall be deemed to meet such conditions and 
requirements (and to be eligible for payment under this title), without 
regard to the extent of its actual compliance with such conditions and 
requirements, during the first 12 months after the month in which such 
plan is submitted.''.
            (3) Cross-references to special fund for improvement of ihs 
        facilities; direct billing option; definitions.--
                    (A) In general.--Such section is further amended by 
                striking subsections (c) and (d) and inserting the 
                following new subsections:
    ``(c) Special Fund for Improvement of IHS Facilities.--For 
provisions relating to the authority of the Secretary to place payments 
to which a facility of the Indian Health Service is eligible for 
payment under this title into a special fund established under section 
401(c)(1) of the Indian Health Care Improvement Act, and the 
requirement to use amounts paid from such fund for making improvements 
in accordance with subsection (b), see subparagraphs (A) and (B) of 
section 401(c)(1) of such Act.
    ``(d) Direct Billing Option.--For provisions relating to the 
authority of a tribal health program or an urban Indian organization to 
elect to directly bill for, and receive payment for, health care items 
and services provided by such program or organization for which payment 
is made under this title, see section 401(d) of the Indian Health Care 
Improvement Act.''.
                    (B) Conforming amendment.--Paragraph (3) of section 
                1880(e) of such Act (42 U.S.C. 1395qq(e)) is amended by 
                inserting ``and section 401(c)(1) of the Indian Health 
                Care Improvement Act'' after ``Subsection (c)''.
            (4) Definitions.--Such section is further amended by 
        amending subsection (g) (as redesignated by section 204(a)(1) 
        of this Act) to read as follows:
    ``(g) Definitions.--In this section, the terms `Indian health 
program', `Indian tribe', `Service Unit', `tribal health program', 
`tribal organization', and `urban Indian organization' have the 
meanings given those terms in section 4 of the Indian Health Care 
Improvement Act.''.
    (c) Application to CHIP.--Section 2107(e)(1) of the Social Security 
Act (42 U.S.C. 1397gg(e)(1)) is amended--
            (1) by redesignating subparagraph (D) as subparagraph (E); 
        and
            (2) by inserting after subparagraph (C), the following new 
        subparagraph:
                    ``(D) Section 1911 (relating to Indian health 
                programs, other than subsection (d) of such 
                section).''.

SEC. 206. REAUTHORIZATION OF NATIVE HAWAIIAN HEALTH CARE PROGRAMS.

    (a) Reauthorization.--The Native Hawaiian Health Care Act of 1988 
(42 U.S.C. 11701 et seq.) is amended by striking ``2001'' each place it 
appears in sections 6(h)(1), 7(b), and 10(c) (42 U.S.C. 11705(h)(1), 
11706(b), 11709(c)) and inserting ``2019''.
    (b) Health and Education.--
            (1) In general.--Section 6(c) of the Native Hawaiian Health 
        Care Act of 1988 (42 U.S.C. 11705) is amended by adding at the 
        end the following:
            ``(4) Health and education.--In order to enable privately 
        funded organizations to continue to supplement public efforts 
        to provide educational programs designed to improve the health, 
        capability, and well-being of Native Hawaiians and to continue 
        to provide health services to Native Hawaiians, notwithstanding 
        any other provision of Federal or State law, it shall be lawful 
        for the private educational organization identified in section 
        7202(16) of the Elementary and Secondary Education Act of 1965 
        (20 U.S.C. 7512(16)) to continue to offer its educational 
        programs and services to Native Hawaiians (as defined in 
        section 7207 of that Act (20 U.S.C. 7517)) first and to others 
        only after the need for such programs and services by Native 
        Hawaiians has been met.''.
            (2) Effective date.--The amendment made by paragraph (1) 
        takes effect on December 5, 2006.
    (c) Definition of Health Promotion.--Section 12(2) of the Native 
Hawaiian Health Care Act of 1988 (42 U.S.C. 11711(2)) is amended--
            (1) in subparagraph (F), by striking ``and'' at the end;
            (2) in subparagraph (G), by striking the period at the end 
        and inserting ``, and''; and
            (3) by adding at the end the following:
                    ``(H) educational programs with the mission of 
                improving the health, capability, and well-being of 
                Native Hawaiians.''.
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