II 

Calendar No. 233 

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, Ms. KLOBUCHAR, Mr. BENNET, Mr. 

CRAPO, Mrs. MURRAY, Ms. CANTWELL, Mr. MERKLEY, and Mr. DODD) 

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

Committee on Indian Affairs 

DECEMBER 16, 2009 

Reported by Mr. DORGAN, with amendments 

[Omit the part struck through and insert the part printed in italic] 

A BILL 

To amend the Indian Health Care Improvement Act to revise 

and extend that Act, and for other purposes. 

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


jbell on DSKDVH8Z91PROD with BILLS
2 

•S 1790 RS

1 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

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

3 ‘‘Indian Health Care Improvement Reauthorization and 

4 Extension Act of 2009’’. 

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

6 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. Indian Health Care Improvement Fund. 

Sec. 122. Catastrophic Health Emergency Fund. 

Sec. 123. Diabetes prevention, treatment, and control. 

Sec. 121124. Other authority for provision of services; shared services for longterm care. 

Sec. 122125. Reimbursement from certain third parties of costs of health services. 

Sec. 123126. Crediting of reimbursements. 

Sec. 124127. Behavioral health training and community education programs. 

Sec. 125. Mammography and other cancer screening. 

Sec. 128. Cancer screenings. 

Sec. 126129. Patient travel costs. 

Sec. 127130. Epidemiology centers. 

Sec. 131. Indian youth grant program. 

Sec. 132. American Indians Into Psychology Program. 

Sec. 128133. Prevention, control, and elimination of communicable and infectious diseases. 

Sec. 129134. Methods to increase clinician recruitment and retention issues. 

Sec. 135. Liability for payment. 

Sec. 130136. Offices of Indian Men’s Health and Indian Women’s Health. 

Sec. 131. Contract health service disbursement formula. 

Sec. 137. Contract health service administration and disbursement formula. 

Subtitle C—Health Facilities 

Sec. 141. Health care facility priority system. 


jbell on DSKDVH8Z91PROD with BILLS
3 

•S 1790 RS

Sec. 142. Priority of certain projects protected. 

Sec. 141. Indian health care delivery demonstration projects. 

Sec. 143. Indian health care delivery demonstration projects. 

Sec. 142144. Tribal management of federally owned quarters. 

Sec. 143145. Other funding, equipment, and supplies for facilities. 

Sec. 144146. Indian country modular component facilities demonstration program. 

Sec. 145147. 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. 

Sec. 159. Navajo Nation Medicaid Agency feasibility study. 

Subtitle E—Health Services for Urban Indians 

Sec. 161. Facilities renovation. 

Sec. 162. Treatment of certain demonstration projects. 

Sec. 161163. Requirement to confer with urban Indian organizations. 

Sec. 162164. Expanded program authority for urban Indian organizations. 

Sec. 163165. Community health representatives. 

Sec. 166. Use of Federal Government facilities and sources of supply; health information technology. 

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. 


jbell on DSKDVH8Z91PROD with BILLS
4 

•S 1790 RS

‘‘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. 713. Child sexual abuse prevention and 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. 

Sec. 196. Prescription drug monitoring. 

Sec. 197. Tribal health program option for cost sharing. 

Sec. 198. Disease and injury prevention report. 

Sec. 199. Other GAO reports. 

Sec. 199A. Traditional health care practices. 

Sec. 199B. Director of HIV/AIDS Prevention and Treatment. 

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. 204201. Medicare amendments. 

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

covered services furnished by Indian health programs. 

Sec. 206202. Reauthorization of Native Hawaiian health care programs. 


jbell on DSKDVH8Z91PROD with BILLS
5 

•S 1790 RS

1 TITLE I—INDIAN HEALTH CARE 

2 IMPROVEMENT ACT REAU3 THORIZATION AND AMEND4 MENTS 

5 SEC. 101. REAUTHORIZATION. 

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

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

8 read as follows: 

9 ‘‘SEC. 825. AUTHORIZATION OF APPROPRIATIONS. 

10 ‘‘There are authorized to be appropriated such sums 

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

12 and each fiscal year thereafter, to remain available until 

13 expended.’’. 

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

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

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

18 1621h(m)). 

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

20 1621j). 

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

22 1621o). 

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

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

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


jbell on DSKDVH8Z91PROD with BILLS
6 

•S 1790 RS

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

2 1660b). 

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

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

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

6 (c) CONFORMING AMENDMENTS.— 

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

8 Improvement Act (25 U.S.C. 1621c(c)(1)) is amend9 ed by striking ‘‘through fiscal year 2000’’. 

10 (2) Section 213 of the Indian Health Care Im11 provement Act (25 U.S.C. 1621l) is amended by 

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

13 Secretary’’. 

14 (3) Section 310 of the Indian Health Care Im15 provement Act (25 U.S.C. 1638b) is amended by 

16 striking ‘‘funds provided pursuant to the authoriza17 tion contained in section 309’’ each place it appears 

18 and inserting ‘‘funds made available to carry out 

19 this title’’. 

20 SEC. 102. FINDINGS. 

21 Section 2 of the Indian Health Care Improvement 

22 Act (25 U.S.C. 1601) is amended— 

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

24 and (d) as paragraphs (1), (3), (4), and (5), respecVerDate Nov 24 2008 23:56 Dec 16, 2009 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S1790.RS S1790

jbell on DSKDVH8Z91PROD with BILLS
7 

•S 1790 RS

1 tively, and indenting the paragraphs appropriately; 

2 and 

3 (2) by inserting after paragraph (1) (as so re4 designated) the following: 

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

6 is to provide the resources, processes, and structure 

7 that will enable Indian tribes and tribal members to 

8 obtain the quantity and quality of health care serv9 ices and opportunities that will eradicate the health 

10 disparities between Indians and the general popu11 lation of the United States.’’. 

12 SEC. 103. DECLARATION OF NATIONAL INDIAN HEALTH 

13 POLICY. 

14 Section 3 of the Indian Health Care Improvement 

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

16 ‘‘SEC. 3. DECLARATION OF NATIONAL INDIAN HEALTH POL17 ICY. 

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

19 in fulfillment of its special trust responsibilities and legal 

20 obligations to Indians— 

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

22 for Indians and urban Indians and to provide all re23 sources necessary to effect that policy; 

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

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


jbell on DSKDVH8Z91PROD with BILLS
8 

•S 1790 RS

1 goals contained within the Healthy People 2010 ini2 tiative or successor objectives; 

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

4 the direction of health care services so as to render 

5 the persons administering such services and the 

6 services themselves more responsive to the needs and 

7 desires of Indian communities; 

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

9 the health professions and allied and associated 

10 health professions awarded to Indians so that the 

11 proportion of Indian health professionals in each 

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

13 the general population; 

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

15 shall be carried out with active and meaningful con16 sultation with Indian tribes and tribal organizations, 

17 and conference with urban Indian organizations, to 

18 implement this Act and the national policy of Indian 

19 self-determination; 

20 ‘‘(6) to ensure that the United States and In21 dian tribes work in a government-to-government re22 lationship to ensure quality health care for all tribal 

23 members; and 

24 ‘‘(7) to provide funding for programs and facili25 ties operated by Indian tribes and tribal organizaVerDate Nov 24 2008 23:56 Dec 16, 2009 Jkt 089200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S1790.RS S1790

jbell on DSKDVH8Z91PROD with BILLS
9 

•S 1790 RS

1 tions in amounts that are not less than the amounts 

2 provided to programs and facilities operated directly 

3 by the Service.’’. 

4 SEC. 104. DEFINITIONS. 

5 Section 4 of the Indian Health Care Improvement 

6 Act (25 U.S.C. 1603) is amended— 

7 (1) by striking the matter preceding subsection 

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

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

10 by redesignating the paragraphs contained in the 

11 subsections as subparagraphs and indenting the sub12 paragraphs appropriately; 

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

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

15 (27), (29), (1), (20), (11), (7), (19), (10), (21), (8), 

16 and (9), respectively, indenting the paragraphs ap17 propriately, and moving the paragraphs so as to ap18 pear in numerical order; 

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

20 inserting a heading the text of which is comprised of 

21 the term defined in the paragraph; 

22 (5) by inserting ‘‘The term’’ after each para23 graph heading; 

24 (6) by inserting after paragraph (1) (as redesig25 nated by paragraph (3)) the following: 


jbell on DSKDVH8Z91PROD with BILLS
10 

•S 1790 RS

1 ‘‘(2) BEHAVIORAL HEALTH.— 

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

3 health’ means the blending of substance (alco4 hol, drugs, inhalants, and tobacco) abuse and 

5 mental health disorders prevention and treat6 ment for the purpose of providing comprehen7 sive services. 

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

9 health’ includes the joint development of sub10 stance abuse and mental health treatment plan11 ning and coordinated case management using a 

12 multidisciplinary approach. 

13 ‘‘(3) CALIFORNIA INDIAN.—The term ‘Cali14 fornia Indian’ means any Indian who is eligible for 

15 health services provided by the Service pursuant to 

16 section 809. 

17 ‘‘(4) COMMUNITY COLLEGE.—The term ‘com18 munity college’ means— 

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

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

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

22 ‘contract health service’ means any health service 

23 that is— 

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

25 the expense of, an Indian health program; and 


jbell on DSKDVH8Z91PROD with BILLS
11 

•S 1790 RS

1 ‘‘(B) provided by a public or private med2 ical provider or hospital that is not a provider 

3 or hospital of the Indian health program. 

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

5 unless otherwise designated, means the Department 

6 of Health and Human Services.’’; 

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

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

9 ‘‘(7) DISEASE PREVENTION.— 

10 ‘‘(A) IN GENERAL.—The term ‘disease pre11 vention’ means any activity for— 

12 ‘‘(i) the reduction, limitation, and pre13 vention of— 

14 ‘‘(I) disease; and 

15 ‘‘(II) complications of disease; 

16 and 

17 ‘‘(ii) the reduction of consequences of 

18 disease. 

19 ‘‘(B) INCLUSIONS.—The term ‘disease pre20 vention’ includes an activity for— 

21 ‘‘(i) controlling— 

22 ‘‘(I) the development of diabetes; 

23 ‘‘(II) high blood pressure; 

24 ‘‘(III) infectious agents; 

25 ‘‘(IV) injuries; 


jbell on DSKDVH8Z91PROD with BILLS
12 

•S 1790 RS

1 ‘‘(V) occupational hazards and 

2 disabilities; 

3 ‘‘(VI) sexually transmittable dis4 eases; or 

5 ‘‘(VII) toxic agents; or 

6 ‘‘(ii) providing— 

7 ‘‘(I) fluoridation of water; or 

8 ‘‘(II) immunizations.’’; 

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

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

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

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

13 of maternal alcohol consumption during pregnancy, 

14 the following criteria are met: 

15 ‘‘(A) Central nervous system involvement 

16 such as mental retardation, developmental 

17 delay, intellectual deficit, microencephaly, or 

18 neurologic abnormalities. 

19 ‘‘(B) Craniofacial abnormalities with at 

20 least 2 of the following: microophthalmia, short 

21 palpebral fissures, poorly developed philtrum, 

22 thin upper lip, flat nasal bridge, and short 

23 upturned nose. 

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


jbell on DSKDVH8Z91PROD with BILLS
13 

•S 1790 RS

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

2 redesignated by paragraph (3)) and inserting the 

3 following: 

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

5 promotion’ means any activity for— 

6 ‘‘(A) fostering social, economic, environ7 mental, and personal factors conducive to 

8 health, including raising public awareness re9 garding health matters and enabling individuals 

10 to cope with health problems by increasing 

11 knowledge and providing valid information; 

12 ‘‘(B) encouraging adequate and appro13 priate diet, exercise, and sleep; 

14 ‘‘(C) promoting education and work in ac15 cordance with physical and mental capacity; 

16 ‘‘(D) making available safe water and sani17 tary facilities; 

18 ‘‘(E) improving the physical, economic, cul19 tural, psychological, and social environment; 

20 ‘‘(F) promoting culturally competent care; 

21 and 

22 ‘‘(G) providing adequate and appropriate 

23 programs, including programs for— 

24 ‘‘(i) abuse prevention (mental and 

25 physical); 


jbell on DSKDVH8Z91PROD with BILLS
14 

•S 1790 RS

1 ‘‘(ii) community health; 

2 ‘‘(iii) community safety; 

3 ‘‘(iv) consumer health education; 

4 ‘‘(v) diet and nutrition; 

5 ‘‘(vi) immunization and other methods 

6 of prevention of communicable diseases, in7 cluding HIV/AIDS; 

8 ‘‘(vii) environmental health; 

9 ‘‘(viii) exercise and physical fitness; 

10 ‘‘(ix) avoidance of fetal alcohol spec11 trum disorders; 

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

13 ‘‘(xi) human growth and development; 

14 ‘‘(xii) injury prevention and personal 

15 safety; 

16 ‘‘(xiii) behavioral health; 

17 ‘‘(xiv) monitoring of disease indicators 

18 between health care provider visits through 

19 appropriate means, including Internet20 based health care management systems; 

21 ‘‘(xv) personal health and wellness 

22 practices; 

23 ‘‘(xvi) personal capacity building; 

24 ‘‘(xvii) prenatal, pregnancy, and in25 fant care; 


jbell on DSKDVH8Z91PROD with BILLS
15 

•S 1790 RS

1 ‘‘(xviii) psychological well-being; 

2 ‘‘(xix) reproductive health and family 

3 planning; 

4 ‘‘(xx) safe and adequate water; 

5 ‘‘(xxi) healthy work environments; 

6 ‘‘(xxii) elimination, reduction, and 

7 prevention of contaminants that create 

8 unhealthy household conditions (including 

9 mold and other allergens); 

10 ‘‘(xxiii) stress control; 

11 ‘‘(xxiv) substance abuse; 

12 ‘‘(xxv) sanitary facilities; 

13 ‘‘(xxvi) sudden infant death syndrome 

14 prevention; 

15 ‘‘(xxvii) tobacco use cessation and re16 duction; 

17 ‘‘(xxviii) violence prevention; and 

18 ‘‘(xxix) such other activities identified 

19 by the Service, a tribal health program, or 

20 an urban Indian organization to promote 

21 achievement of any of the objectives re22 ferred to in section 3(2). 

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

24 ‘Indian health program’ means— 


jbell on DSKDVH8Z91PROD with BILLS
16 

•S 1790 RS

1 ‘‘(A) any health program administered di2 rectly by the Service; 

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

4 ‘‘(C) any Indian tribe or tribal organiza5 tion to which the Secretary provides funding 

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

7 1910 (25 U.S.C. 47) (commonly known as the 

8 ‘Buy Indian Act’).’’; 

9 (10) by inserting after paragraph (14) (as re10 designated by paragraph (3)) the following: 

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

12 term ‘junior or community college’ has the meaning 

13 given the term in section 312(e) of the Higher Edu14 cation Act of 1965 (20 U.S.C. 1058(e)). 

15 ‘‘(16) RESERVATION.— 

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

17 means a reservation, Pueblo, or colony of any 

18 Indian tribe. 

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

20 includes— 

21 ‘‘(i) former reservations in Oklahoma; 

22 ‘‘(ii) Indian allotments; and 

23 ‘‘(iii) Alaska Native Regions estab24 lished pursuant to the Alaska Native 


jbell on DSKDVH8Z91PROD with BILLS
17 

•S 1790 RS

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

2 seq.).’’; 

3 (11) by striking paragraph (20) (as redesig4 nated by paragraph (3)) and inserting the following: 

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

6 means an administrative entity of the Service or a 

7 tribal health program through which services are 

8 provided, directly or by contract, to eligible Indians 

9 within a defined geographic area.’’; 

10 (12) by inserting after paragraph (21) (as re11 designated by paragraph (3)) the following: 

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

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

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

15 16(a)). 

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

17 means a telecommunications link to an end user 

18 through the use of eligible equipment that electroni19 cally links health professionals or patients and 

20 health professionals at separate sites in order to ex21 change health care information in audio, video, 

22 graphic, or other format for the purpose of providing 

23 improved health care services. 

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

25 term ‘tribal college or university’ has the meaning 


jbell on DSKDVH8Z91PROD with BILLS
18 

•S 1790 RS

1 given the term in section 316(b) of the Higher Edu2 cation Act of 1965 (20 U.S.C. 1059c(b)). 

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

4 ‘tribal health program’ means an Indian tribe or 

5 tribal organization that operates any health pro6 gram, service, function, activity, or facility funded, 

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

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

9 the Indian Self-Determination and Education Assist10 ance Act (25 U.S.C. 450 et seq.).’’; and 

11 (13) by striking paragraph (26) (as redesig12 nated by paragraph (3)) and inserting the following: 

13 ‘‘(26) TRIBAL ORGANIZATION.—The term ‘trib14 al organization’ has the meaning given the term in 

15 section 4 of the Indian Self-Determination and Edu16 cation Assistance Act (25 U.S.C. 450b).’’. 

17 Subtitle A—Indian Health 

18 Manpower 

19 SEC. 111. COMMUNITY HEALTH AIDE PROGRAM. 

20 Section 119 of the Indian Health Care Improvement 

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

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

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

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

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


jbell on DSKDVH8Z91PROD with BILLS
19 

•S 1790 RS

1 the Service, shall develop and operate a Community 

2 Health Aide Program in the State of Alaska under which 

3 the Service— 

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

5 as health aides or community health practitioners; 

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

7 provision of health care, health promotion, and dis8 ease prevention services to Alaska Natives living in 

9 villages in rural Alaska; and 

10 ‘‘(3) provides for the establishment of tele11 conferencing capacity in health clinics located in or 

12 near those villages for use by community health 

13 aides or community health practitioners. 

14 ‘‘(b) SPECIFIC PROGRAM REQUIREMENTS.—The Sec15 retary, acting through the Community Health Aide Pro16 gram of the Service, shall— 

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

18 provide a high standard of training to community 

19 health aides and community health practitioners to 

20 ensure that those aides and practitioners provide 

21 quality health care, health promotion, and disease 

22 prevention services to the villages served by the Pro23 gram; 

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

25 a curriculum that— 


jbell on DSKDVH8Z91PROD with BILLS
20 

•S 1790 RS

1 ‘‘(A) combines education regarding the 

2 theory of health care with supervised practical 

3 experience in the provision of health care; 

4 ‘‘(B) provides instruction and practical ex5 perience in the provision of acute care, emer6 gency care, health promotion, disease preven7 tion, and the efficient and effective manage8 ment of clinic pharmacies, supplies, equipment, 

9 and facilities; and 

10 ‘‘(C) promotes the achievement of the 

11 health status objectives specified in section 

12 3(2); 

13 ‘‘(3) establish and maintain a Community 

14 Health Aide Certification Board to certify as com15 munity health aides or community health practi16 tioners individuals who have successfully completed 

17 the training described in paragraph (1) or can dem18 onstrate equivalent experience; 

19 ‘‘(4) develop and maintain a system that identi20 fies the needs of community health aides and com21 munity health practitioners for continuing education 

22 in the provision of health care, including the areas 

23 described in paragraph (2)(B), and develop pro24 grams that meet the needs for such continuing edu25 cation; 


jbell on DSKDVH8Z91PROD with BILLS
21 

•S 1790 RS

1 ‘‘(5) develop and maintain a system that pro2 vides close supervision of community health aides 

3 and community health practitioners; 

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

5 community health aides and community health prac6 titioners is reviewed and evaluated to ensure the pro7 vision of quality health care, health promotion, and 

8 disease prevention services; and 

9 ‘‘(7) ensure that— 

10 ‘‘(A) pulpal therapy (not including 

11 pulpotomies on deciduous teeth) or extraction of 

12 adult teeth can be performed by a dental health 

13 aide therapist only after consultation with a li14 censed dentist who determines that the proce15 dure is a medical emergency that cannot be re16 solved with palliative treatment; and 

17 ‘‘(B) dental health aide therapists are 

18 strictly prohibited from performing all other 

19 oral or jaw surgeries, subject to the condition 

20 that uncomplicated extractions shall not be con21 sidered oral surgery under this section. 

22 ‘‘(c) PROGRAM REVIEW.— 

23 ‘‘(1) NEUTRAL PANEL.— 

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

25 acting through the Service, shall establish a 


jbell on DSKDVH8Z91PROD with BILLS
22 

•S 1790 RS

1 neutral panel to carry out the study under 

2 paragraph (2). 

3 ‘‘(B) MEMBERSHIP.—Members of the neu4 tral panel shall be appointed by the Secretary 

5 from among clinicians, economists, community 

6 practitioners, oral epidemiologists, and Alaska 

7 Natives. 

8 ‘‘(2) STUDY.— 

9 ‘‘(A) IN GENERAL.—The neutral panel es10 tablished under paragraph (1) shall conduct a 

11 study of the dental health aide therapist serv12 ices provided by the Community Health Aide 

13 Program under this section to ensure that the 

14 quality of care provided through those services 

15 is adequate and appropriate. 

16 ‘‘(B) PARAMETERS OF STUDY.—The Sec17 retary, in consultation with interested parties, 

18 including professional dental organizations, 

19 shall develop the parameters of the study. 

20 ‘‘(C) INCLUSIONS.—The study shall in21 clude a determination by the neutral panel with 

22 respect to— 

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

24 aide therapist services under this section to 


jbell on DSKDVH8Z91PROD with BILLS
23 

•S 1790 RS

1 address the dental care needs of Alaska 

2 Natives; 

3 ‘‘(ii) the quality of care provided 

4 through those services, including any train5 ing, improvement, or additional oversight 

6 required to improve the quality of care; 

7 and 

8 ‘‘(iii) whether safer and less costly al9 ternatives to the dental health aide thera10 pist services exist. 

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

12 study under this paragraph, the neutral panel 

13 shall consult with Alaska tribal organizations 

14 with respect to the adequacy and accuracy of 

15 the study. 

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

17 to the Secretary, the Committee on Indian Affairs of 

18 the Senate, and the Committee on Natural Re19 sources of the House of Representatives a report de20 scribing the results of the study under paragraph 

21 (2), including a description of— 

22 ‘‘(A) any determination of the neutral 

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

24 ‘‘(B) any comments received from Alaska 

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


jbell on DSKDVH8Z91PROD with BILLS
24 

•S 1790 RS

1 ‘‘(d) NATIONALIZATION OF PROGRAM.— 

2 ‘‘(1) IN GENERAL.—Except as provided in para3 graph (2), the Secretary, acting through the Service, 

4 may establish a national Community Health Aide 

5 Program in accordance with the program under this 

6 section, as the Secretary determines to be appro7 priate. 

8 ‘‘(2) REQUIREMENT; EXCLUSION.—In estab9 lishing a national program under paragraph (1), the 

10 Secretary— 

11 ‘‘(A) shall not reduce the amounts provided 

12 for the Community Health Aide Program de13 scribed in subsections (a) and (b); and 

14 ‘‘(B) shall exclude dental health aide thera15 pist services from services covered under the pro16 gram.’’. 

17 SEC. 112. HEALTH PROFESSIONAL CHRONIC SHORTAGE 

18 DEMONSTRATION PROGRAMS. 

19 Title I of the Indian Health Care Improvement Act 

20 (25 U.S.C. 1611 et seq.) (as amended by section 101(b)) 

21 is amended by adding at the end the following: 

22 ‘‘SEC. 123. HEALTH PROFESSIONAL CHRONIC SHORTAGE 

23 DEMONSTRATION PROGRAMS. 

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

25 acting through the Service, may fund demonstration proVerDate Nov 24 2008 23:56 Dec 16, 2009 Jkt 089200 PO 00000 Frm 00024 Fmt 6652 Sfmt 6201 E:\BILLS\S1790.RS S1790

jbell on DSKDVH8Z91PROD with BILLS
25 

•S 1790 RS

1 grams for Indian health programs to address the chronic 

2 shortages of health professionals. 

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

4 demonstration programs under subsection (a) shall be— 

5 ‘‘(1) to provide direct clinical and practical ex6 perience within an Indian health program to health 

7 profession students and residents from medical 

8 schools; 

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

10 Indians by ensuring access to qualified health pro11 fessionals; 

12 ‘‘(3) to provide academic and scholarly opportu13 nities for health professionals serving Indians by 

14 identifying all academic and scholarly resources of 

15 the region; and 

16 ‘‘(4) to provide training and support for alter17 native provider types, such as community health rep18 resentatives, and community health aides. 

19 ‘‘(c) ADVISORY BOARD.—The demonstration pro20 grams established pursuant to subsection (a) shall incor21 porate a program advisory board, which may be composed 

22 of representatives of tribal governments, Indian health 

23 programs, and Indian communities in the areas to be 

24 served by the demonstration programs.’’. 


jbell on DSKDVH8Z91PROD with BILLS
26 

•S 1790 RS

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

2 Title I of the Indian Health Care Improvement Act 

3 (25 U.S.C. 1611 et seq.) (as amended by section 112) is 

4 amended by adding at the end the following: 

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

6 ‘‘Employees of a tribal health program or urban In7 dian organization shall be exempt from payment of licens8 ing, registration, and any other fees imposed by a Federal 

9 agency to the same extent that officers of the commis10 sioned corps of the Public Health Service and other em11 ployees of the Service are exempt from those fees.’’. 

12 Subtitle B—Health Services 

13 SEC. 121. INDIAN HEALTH CARE IMPROVEMENT FUND. 

14 Section 201 of the Indian Health Care Improvement 

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

16 ‘‘SEC. 201. INDIAN HEALTH CARE IMPROVEMENT FUND. 

17 ‘‘(a) USE OF FUNDS.—The Secretary, acting through 

18 the Service, is authorized to expend funds, directly or under 

19 the authority of the Indian Self-Determination and Edu20 cation Assistance Act (25 U.S.C. 450 et seq.), which are 

21 appropriated under the authority of this section, for the 

22 purposes of— 

23 ‘‘(1) eliminating the deficiencies in health status 

24 and health resources of all Indian tribes; 

25 ‘‘(2) eliminating backlogs in the provision of 

26 health care services to Indians; 


jbell on DSKDVH8Z91PROD with BILLS
27 

•S 1790 RS

1 ‘‘(3) meeting the health needs of Indians in an 

2 efficient and equitable manner, including the use of 

3 telehealth and telemedicine when appropriate; 

4 ‘‘(4) eliminating inequities in funding for both 

5 direct care and contract health service programs; and 

6 ‘‘(5) augmenting the ability of the Service to 

7 meet the following health service responsibilities with 

8 respect to those Indian tribes with the highest levels 

9 of health status deficiencies and resource deficiencies: 

10 ‘‘(A) Clinical care, including inpatient 

11 care, outpatient care (including audiology, clin12 ical eye, and vision care), primary care, sec13 ondary and tertiary care, and long-term care. 

14 ‘‘(B) Preventive health, including mammog15 raphy and other cancer screening. 

16 ‘‘(C) Dental care. 

17 ‘‘(D) Mental health, including community 

18 mental health services, inpatient mental health 

19 services, dormitory mental health services, thera20 peutic and residential treatment centers, and 

21 training of traditional health care practitioners. 

22 ‘‘(E) Emergency medical services. 

23 ‘‘(F) Treatment and control of, and reha24 bilitative care related to, alcoholism and drug 


jbell on DSKDVH8Z91PROD with BILLS
28 

•S 1790 RS

1 abuse (including fetal alcohol syndrome) among 

2 Indians. 

3 ‘‘(G) Injury prevention programs, including 

4 data collection and evaluation, demonstration 

5 projects, training, and capacity building. 

6 ‘‘(H) Home health care. 

7 ‘‘(I) Community health representatives. 

8 ‘‘(J) Maintenance and improvement. 

9 ‘‘(b) NO OFFSET OR LIMITATION.—Any funds appro10 priated under the authority of this section shall not be used 

11 to offset or limit any other appropriations made to the 

12 Service under this Act or the Act of November 2, 1921 (25 

13 U.S.C. 13) (commonly known as the ‘Snyder Act’), or any 

14 other provision of law. 

15 ‘‘(c) ALLOCATION; USE.— 

16 ‘‘(1) IN GENERAL.—Funds appropriated under 

17 the authority of this section shall be allocated to Serv18 ice units, Indian tribes, or tribal organizations. The 

19 funds allocated to each Indian tribe, tribal organiza20 tion, or Service unit under this paragraph shall be 

21 used by the Indian tribe, tribal organization, or Serv22 ice unit under this paragraph to improve the health 

23 status and reduce the resource deficiency of each In24 dian tribe served by such Service unit, Indian tribe, 

25 or tribal organization. 


jbell on DSKDVH8Z91PROD with BILLS
29 

•S 1790 RS

1 ‘‘(2) APPORTIONMENT OF ALLOCATED FUNDS.— 

2 The apportionment of funds allocated to a Service 

3 unit, Indian tribe, or tribal organization under para4 graph (1) among the health service responsibilities de5 scribed in subsection (a)(5) shall be determined by the 

6 Service in consultation with, and with the active par7 ticipation of, the affected Indian tribes and tribal or8 ganizations. 

9 ‘‘(d) PROVISIONS RELATING TO HEALTH STATUS AND

10 RESOURCE DEFICIENCIES.—For the purposes of this sec11 tion, the following definitions apply: 

12 ‘‘(1) DEFINITION.—The term ‘health status and 

13 resource deficiency’ means the extent to which— 

14 ‘‘(A) the health status objectives set forth in 

15 sections 3(1) and 3(2) are not being achieved; 

16 and 

17 ‘‘(B) the Indian tribe or tribal organization 

18 does not have available to it the health resources 

19 it needs, taking into account the actual cost of 

20 providing health care services given local geo21 graphic, climatic, rural, or other circumstances. 

22 ‘‘(2) AVAILABLE RESOURCES.—The health re23 sources available to an Indian tribe or tribal organi24 zation include health resources provided by the Serv25 ice as well as health resources used by the Indian 


jbell on DSKDVH8Z91PROD with BILLS
30 

•S 1790 RS

1 tribe or tribal organization, including services and fi2 nancing systems provided by any Federal programs, 

3 private insurance, and programs of State or local 

4 governments. 

5 ‘‘(3) PROCESS FOR REVIEW OF DETERMINA6 TIONS.—The Secretary shall establish procedures 

7 which allow any Indian tribe or tribal organization 

8 to petition the Secretary for a review of any deter9 mination of the extent of the health status and re10 source deficiency of such Indian tribe or tribal orga11 nization. 

12 ‘‘(e) ELIGIBILITY FOR FUNDS.—Tribal health pro13 grams shall be eligible for funds appropriated under the au14 thority of this section on an equal basis with programs that 

15 are administered directly by the Service. 

16 ‘‘(f) REPORT.—By no later than the date that is 3 

17 years after the date of enactment of the Indian Health Care 

18 Improvement Reauthorization and Extension Act of 2009, 

19 the Secretary shall submit to Congress the current health 

20 status and resource deficiency report of the Service for each 

21 Service unit, including newly recognized or acknowledged 

22 Indian tribes. Such report shall set out— 

23 ‘‘(1) the methodology then in use by the Service 

24 for determining tribal health status and resource defiVerDate Nov 24 2008 23:56 Dec 16, 2009 Jkt 089200 PO 00000 Frm 00030 Fmt 6652 Sfmt 6203 E:\BILLS\S1790.RS S1790

jbell on DSKDVH8Z91PROD with BILLS
31 

•S 1790 RS

1 ciencies, as well as the most recent application of that 

2 methodology; 

3 ‘‘(2) the extent of the health status and resource 

4 deficiency of each Indian tribe served by the Service 

5 or a tribal health program; 

6 ‘‘(3) the amount of funds necessary to eliminate 

7 the health status and resource deficiencies of all In8 dian tribes served by the Service or a tribal health 

9 program; and 

10 ‘‘(4) an estimate of— 

11 ‘‘(A) the amount of health service funds ap12 propriated under the authority of this Act, or 

13 any other Act, including the amount of any 

14 funds transferred to the Service for the preceding 

15 fiscal year which is allocated to each Service 

16 unit, Indian tribe, or tribal organization; 

17 ‘‘(B) the number of Indians eligible for 

18 health services in each Service unit or Indian 

19 tribe or tribal organization; and 

20 ‘‘(C) the number of Indians using the Serv21 ice resources made available to each Service unit, 

22 Indian tribe or tribal organization, and, to the 

23 extent available, information on the waiting lists 

24 and number of Indians turned away for services 

25 due to lack of resources. 


jbell on DSKDVH8Z91PROD with BILLS
32 

•S 1790 RS

1 ‘‘(g) INCLUSION IN BASE BUDGET.—Funds appro2 priated under this section for any fiscal year shall be in3 cluded in the base budget of the Service for the purpose of 

4 determining appropriations under this section in subse5 quent fiscal years. 

6 ‘‘(h) CLARIFICATION.—Nothing in this section is in7 tended to diminish the primary responsibility of the Service 

8 to eliminate existing backlogs in unmet health care needs, 

9 nor are the provisions of this section intended to discourage 

10 the Service from undertaking additional efforts to achieve 

11 equity among Indian tribes and tribal organizations. 

12 ‘‘(i) FUNDING DESIGNATION.—Any funds appro13 priated under the authority of this section shall be des14 ignated as the ‘Indian Health Care Improvement Fund’.’’. 

15 SEC. 122. CATASTROPHIC HEALTH EMERGENCY FUND. 

16 Section 202 of the Indian Health Care Improvement 

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

18 ‘‘SEC. 202. CATASTROPHIC HEALTH EMERGENCY FUND. 

19 ‘‘(a) ESTABLISHMENT.—There is established an In20 dian Catastrophic Health Emergency Fund (hereafter in 

21 this section referred to as the ‘CHEF’) consisting of— 

22 ‘‘(1) the amounts deposited under subsection (f); 

23 and 

24 ‘‘(2) the amounts appropriated to CHEF under 

25 this section. 


jbell on DSKDVH8Z91PROD with BILLS
33 

•S 1790 RS

1 ‘‘(b) ADMINISTRATION.—CHEF shall be administered 

2 by the Secretary, acting through the headquarters of the 

3 Service, solely for the purpose of meeting the extraordinary 

4 medical costs associated with the treatment of victims of 

5 disasters or catastrophic illnesses who are within the re6 sponsibility of the Service. 

7 ‘‘(c) CONDITIONS ON USE OF FUND.—No part of 

8 CHEF or its administration shall be subject to contract or 

9 grant under any law, including the Indian Self-Determina10 tion and Education Assistance Act (25 U.S.C. 450 et seq.), 

11 nor shall CHEF funds be allocated, apportioned, or dele12 gated on an Area Office, Service Unit, or other similar 

13 basis. 

14 ‘‘(d) REGULATIONS.—The Secretary shall promulgate 

15 regulations consistent with the provisions of this section 

16 to— 

17 ‘‘(1) establish a definition of disasters and cata18 strophic illnesses for which the cost of the treatment 

19 provided under contract would qualify for payment 

20 from CHEF; 

21 ‘‘(2) provide that a Service Unit shall not be eli22 gible for reimbursement for the cost of treatment from 

23 CHEF until its cost of treating any victim of such 

24 catastrophic illness or disaster has reached a certain 

25 threshold cost which the Secretary shall establish at— 


jbell on DSKDVH8Z91PROD with BILLS
34 

•S 1790 RS

1 ‘‘(A) the 2000 level of $19,000; and 

2 ‘‘(B) for any subsequent year, not less than 

3 the threshold cost of the previous year increased 

4 by the percentage increase in the medical care 

5 expenditure category of the consumer price index 

6 for all urban consumers (United States city av7 erage) for the 12-month period ending with De8 cember of the previous year; 

9 ‘‘(3) establish a procedure for the reimbursement 

10 of the portion of the costs that exceeds such threshold 

11 cost incurred by— 

12 ‘‘(A) Service Units; or 

13 ‘‘(B) whenever otherwise authorized by the 

14 Service, non-Service facilities or providers; 

15 ‘‘(4) establish a procedure for payment from 

16 CHEF in cases in which the exigencies of the medical 

17 circumstances warrant treatment prior to the author18 ization of such treatment by the Service; and 

19 ‘‘(5) establish a procedure that will ensure that 

20 no payment shall be made from CHEF to any pro21 vider of treatment to the extent that such provider is 

22 eligible to receive payment for the treatment from any 

23 other Federal, State, local, or private source of reim24 bursement for which the patient is eligible. 


jbell on DSKDVH8Z91PROD with BILLS
35 

•S 1790 RS

1 ‘‘(e) NO OFFSET OR LIMITATION.—Amounts appro2 priated to CHEF under this section shall not be used to 

3 offset or limit appropriations made to the Service under 

4 the authority of the Act of November 2, 1921 (25 U.S.C. 

5 13) (commonly known as the ‘Snyder Act’), or any other 

6 law. 

7 ‘‘(f) DEPOSIT OF REIMBURSEMENT FUNDS.—There 

8 shall be deposited into CHEF all reimbursements to which 

9 the Service is entitled from any Federal, State, local, or 

10 private source (including third party insurance) by reason 

11 of treatment rendered to any victim of a disaster or cata12 strophic illness the cost of which was paid from CHEF.’’. 

13 SEC. 123. DIABETES PREVENTION, TREATMENT, AND CON14 TROL. 

15 Section 204 of the Indian Health Care Improvement 

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

17 ‘‘SEC. 204. DIABETES PREVENTION, TREATMENT, AND CON18 TROL. 

19 ‘‘(a) DETERMINATIONS REGARDING DIABETES.—The 

20 Secretary, acting through the Service, and in consultation 

21 with Indian tribes and tribal organizations, shall deter22 mine— 

23 ‘‘(1) by Indian tribe and by Service unit, the in24 cidence of, and the types of complications resulting 

25 from, diabetes among Indians; and 


jbell on DSKDVH8Z91PROD with BILLS
36 

•S 1790 RS

1 ‘‘(2) based on the determinations made pursuant 

2 to paragraph (1), the measures (including patient 

3 education and effective ongoing monitoring of disease 

4 indicators) each Service unit should take to reduce the 

5 incidence of, and prevent, treat, and control the com6 plications resulting from, diabetes among Indian 

7 tribes within that Service unit. 

8 ‘‘(b) DIABETES SCREENING.—To the extent medically 

9 indicated and with informed consent, the Secretary shall 

10 screen each Indian who receives services from the Service 

11 for diabetes and for conditions which indicate a high risk 

12 that the individual will become diabetic and establish a 

13 cost-effective approach to ensure ongoing monitoring of dis14 ease indicators. Such screening and monitoring may be con15 ducted by a tribal health program and may be conducted 

16 through appropriate Internet-based health care manage17 ment programs. 

18 ‘‘(c) DIABETES PROJECTS.—The Secretary shall con19 tinue to maintain each model diabetes project in existence 

20 on the date of enactment of the Indian Health Care Im21 provement Reauthorization and Extension Act of 2009, any 

22 such other diabetes programs operated by the Service or 

23 tribal health programs, and any additional diabetes 

24 projects, such as the Medical Vanguard program provided 

25 for in title IV of Public Law 108–87, as implemented to 


jbell on DSKDVH8Z91PROD with BILLS
37 

•S 1790 RS

1 serve Indian tribes. tribal health programs shall receive re2 curring funding for the diabetes projects that they operate 

3 pursuant to this section, both at the date of enactment of 

4 the Indian Health Care Improvement Reauthorization and 

5 Extension Act of 2009 and for projects which are added and 

6 funded thereafter. 

7 ‘‘(d) DIALYSIS PROGRAMS.—The Secretary is author8 ized to provide, through the Service, Indian tribes, and trib9 al organizations, dialysis programs, including the purchase 

10 of dialysis equipment and the provision of necessary staff11 ing. 

12 ‘‘(e) OTHER DUTIES OF THE SECRETARY.— 

13 ‘‘(1) IN GENERAL.—The Secretary shall, to the 

14 extent funding is available— 

15 ‘‘(A) in each area office, consult with In16 dian tribes and tribal organizations regarding 

17 programs for the prevention, treatment, and con18 trol of diabetes; 

19 ‘‘(B) establish in each area office a registry 

20 of patients with diabetes to track the incidence 

21 of diabetes and the complications from diabetes 

22 in that area; and 

23 ‘‘(C) ensure that data collected in each area 

24 office regarding diabetes and related complica25 tions among Indians are disseminated to all 


jbell on DSKDVH8Z91PROD with BILLS
38 

•S 1790 RS

1 other area offices, subject to applicable patient 

2 privacy laws. 

3 ‘‘(2) DIABETES CONTROL OFFICERS.— 

4 ‘‘(A) IN GENERAL.—The Secretary may es5 tablish and maintain in each area office a posi6 tion of diabetes control officer to coordinate and 

7 manage any activity of that area office relating 

8 to the prevention, treatment, or control of diabe9 tes to assist the Secretary in carrying out a pro10 gram under this section or section 330C of the 

11 Public Health Service Act (42 U.S.C. 254c–3). 

12 ‘‘(B) CERTAIN ACTIVITIES.—Any activity 

13 carried out by a diabetes control officer under 

14 subparagraph (A) that is the subject of a con15 tract or compact under the Indian Self-Deter16 mination and Education Assistance Act (25 

17 U.S.C. 450 et seq.), and any funds made avail18 able to carry out such an activity, shall not be 

19 divisible for purposes of that Act.’’. 

20 SEC. 121124. OTHER AUTHORITY FOR PROVISION OF SERV21 ICES; SHARED SERVICES FOR LONG-TERM 

22 CARE. 

23 (a) OTHER AUTHORITY FOR PROVISION OF SERV24 ICES.— 


jbell on DSKDVH8Z91PROD with BILLS
39 

•S 1790 RS

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

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

3 amended to read as follows: 

4 ‘‘SEC. 205. OTHER AUTHORITY FOR PROVISION OF SERV5 ICES. 

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

7 ‘‘(1) ASSISTED LIVING SERVICE.—The term ‘as8 sisted living service’ means any service provided by 

9 an assisted living facility (as defined in section 

10 232(b) of the National Housing Act (12 U.S.C. 

11 1715w(b))), except that such an assisted living facil12 ity— 

13 ‘‘(A) shall not be required to obtain a li14 cense; but 

15 ‘‘(B) shall meet all applicable standards 

16 for licensure. 

17 ‘‘(2) HOME- AND COMMUNITY-BASED SERV18 ICE.—The term ‘home- and community-based serv19 ice’ means 1 or more of the services specified in 

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

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

22 provided by the Service or by an Indian tribe or trib23 al organization pursuant to the Indian Self-Deter24 mination and Education Assistance Act (25 U.S.C. 


jbell on DSKDVH8Z91PROD with BILLS
40 

•S 1790 RS

1 450 et seq.)) that are or will be provided in accord2 ance with applicable standards. 

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

4 means— 

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

6 subparagraphs (A) through (H) of section 

7 1861(dd)(1) of the Social Security Act (42 

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

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

10 or tribal organization determines are necessary 

11 and appropriate to provide in furtherance of 

12 that care. 

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

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

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

16 7702B(c) of the Internal Revenue Code of 1986. 

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

18 through the Service, Indian tribes, and tribal organiza19 tions, may provide funding under this Act to meet the ob20 jectives set forth in section 3 through health care-related 

21 services and programs not otherwise described in this Act 

22 for the following services: 

23 ‘‘(1) Hospice care. 

24 ‘‘(2) Assisted living services. 

25 ‘‘(3) Long-term care services. 


jbell on DSKDVH8Z91PROD with BILLS
41 

•S 1790 RS

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

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

3 eligible to receive long-term care services under this sec4 tion: 

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

6 certain number of activities of daily living without 

7 assistance. 

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

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

10 disabling mental illness, who may be able to perform 

11 activities of daily living under supervision. 

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

13 tribal health program determines to be appropriate. 

14 ‘‘(d) AUTHORIZATION OF CONVENIENT CARE SERV15 ICES.—The Secretary, acting through the Service, Indian 

16 tribes, and tribal organizations, may also provide funding 

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

18 3 for convenient care services programs pursuant to sec19 tion 307(c)(2)(A).’’. 

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

21 Care Improvement Act (25 U.S.C. 1680k) is re22 pealed. 

23 (b) SHARED SERVICES FOR LONG-TERM CARE.—Sec24 tion 822 of the Indian Health Care Improvement Act (25 

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


jbell on DSKDVH8Z91PROD with BILLS
42 

•S 1790 RS

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

2 ‘‘(a) LONG-TERM CARE.— 

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

4 provision of law, the Secretary, acting through the 

5 Service, is authorized to provide directly, or enter 

6 into contracts or compacts under the Indian Self-De7 termination and Education Assistance Act (25 

8 U.S.C. 450 et seq.) with Indian tribes or tribal orga9 nizations for, the delivery of long-term care (includ10 ing health care services associated with long-term 

11 care) provided in a facility to Indians. 

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

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

14 or other services between the Service or a tribal 

15 health program and a long-term care or related facil16 ity owned and operated (directly or through a con17 tract or compact under the Indian Self-Determina18 tion and Education Assistance Act (25 U.S.C. 450 

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

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

21 entered into pursuant to subsection (a)— 

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

23 tribal organization, delegate to the Indian tribe or 

24 tribal organization such powers of supervision and 

25 control over Service employees as the Secretary deVerDate Nov 24 2008 23:56 Dec 16, 2009 Jkt 089200 PO 00000 Frm 00042 Fmt 6652 Sfmt 6201 E:\BILLS\S1790.RS S1790

jbell on DSKDVH8Z91PROD with BILLS
43 

•S 1790 RS

1 termines to be necessary to carry out the purposes 

2 of this section; 

3 ‘‘(2) shall provide that expenses (including sala4 ries) relating to services that are shared between the 

5 Service and the tribal health program be allocated 

6 proportionately between the Service and the Indian 

7 tribe or tribal organization; and 

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

9 organization to construct, renovate, or expand a 

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

11 construction of a facility attached to a Service facil12 ity). 

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

14 provided for under this section shall meet the require15 ments for nursing facilities under section 1919 of the So16 cial Security Act (42 U.S.C. 1396r). 

17 ‘‘(d) OTHER ASSISTANCE.—The Secretary shall pro18 vide such technical and other assistance as may be nec19 essary to enable applicants to comply with this section. 

20 ‘‘(e) USE OF EXISTING OR UNDERUSED FACILI21 TIES.—The Secretary shall encourage the use of existing 

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

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


jbell on DSKDVH8Z91PROD with BILLS
44 

•S 1790 RS

1 SEC. 122125. REIMBURSEMENT FROM CERTAIN THIRD PAR2 TIES OF COSTS OF HEALTH SERVICES. 

3 Section 206 of the Indian Health Care Improvement 

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

5 ‘‘SEC. 206. REIMBURSEMENT FROM CERTAIN THIRD PAR6 TIES OF COSTS OF HEALTH SERVICES. 

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

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

9 organization shall have the right to recover from an insur10 ance company, health maintenance organization, employee 

11 benefit plan, third-party tortfeasor, or any other respon12 sible or liable third party (including a political subdivision 

13 or local governmental entity of a State) the reasonable 

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

15 organization in providing health services through the Serv16 ice, an Indian tribe, or tribal organization, or, if higher, 

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

18 services furnished by providers other than governmental 

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

20 individual, or any nongovernmental provider of such serv21 ices, would be eligible to receive damages, reimbursement, 

22 or indemnification for such charges or expenses if— 

23 ‘‘(1) such services had been provided by a non24 governmental provider; and 


jbell on DSKDVH8Z91PROD with BILLS
45 

•S 1790 RS

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

2 such charges or expenses and did pay such charges 

3 or expenses. 

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

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

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

7 health services were provided is covered under— 

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

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

10 plan or program. 

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

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

13 no provision of any contract, insurance or health mainte14 nance organization policy, employee benefit plan, self-in15 surance plan, managed care plan, or other health care plan 

16 or program entered into or renewed after the date of en17 actment of the Indian Health Care Amendments of 1988, 

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

19 States, an Indian tribe, or tribal organization under sub20 section (a). 

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

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

23 or tribal organization to enforce the right of recovery pro24 vided under this section shall operate to deny to the inVerDate Nov 24 2008 23:56 Dec 16, 2009 Jkt 089200 PO 00000 Frm 00045 Fmt 6652 Sfmt 6201 E:\BILLS\S1790.RS S1790

jbell on DSKDVH8Z91PROD with BILLS
46 

•S 1790 RS

1 jured person the recovery for that portion of the person’s 

2 damage not covered hereunder. 

3 ‘‘(e) ENFORCEMENT.— 

4 ‘‘(1) IN GENERAL.—The United States, an In5 dian tribe, or tribal organization may enforce the 

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

7 ‘‘(A) intervening or joining in any civil ac8 tion or proceeding brought— 

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

10 services were provided by the Secretary, an 

11 Indian tribe, or tribal organization; or 

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

13 such individual, or 

14 ‘‘(B) instituting a separate civil action, in15 cluding a civil action for injunctive relief and 

16 other relief and including, with respect to a po17 litical subdivision or local governmental entity 

18 of a State, such an action against an official 

19 thereof. 

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

21 made to provide notice of action instituted under 

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

23 services were provided, either before or during the 

24 pendency of such action. 

25 ‘‘(3) RECOVERY FROM TORTFEASORS.— 


jbell on DSKDVH8Z91PROD with BILLS
47 

•S 1790 RS

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

2 an Indian tribe or tribal organization that is 

3 authorized or required under a compact or con4 tract issued pursuant to the Indian Self-Deter5 mination and Education Assistance Act (25 

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

7 services to a person who is injured or suffers a 

8 disease on or after the date of enactment of the 

9 Indian Health Care Improvement Reauthoriza10 tion and Extension Act of 2009 under cir11 cumstances that establish grounds for a claim 

12 of liability against the tortfeasor with respect to 

13 the injury or disease, the Indian tribe or tribal 

14 organization shall have a right to recover from 

15 the tortfeasor (or an insurer of the tortfeasor) 

16 the reasonable value of the health services so 

17 furnished, paid for, or to be paid for, in accord18 ance with the Federal Medical Care Recovery 

19 Act (42 U.S.C. 2651 et seq.), to the same ex20 tent and under the same circumstances as the 

21 United States may recover under that Act. 

22 ‘‘(B) TREATMENT.—The right of an In23 dian tribe or tribal organization to recover 

24 under subparagraph (A) shall be independent of 

25 the rights of the injured or diseased person 


jbell on DSKDVH8Z91PROD with BILLS
48 

•S 1790 RS

1 served by the Indian tribe or tribal organiza2 tion. 

3 ‘‘(f) LIMITATION.—Absent specific written authoriza4 tion by the governing body of an Indian tribe for the pe5 riod of such authorization (which may not be for a period 

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

7 time upon written notice by the governing body to the 

8 Service), the United States shall not have a right of recov9 ery under this section if the injury, illness, or disability 

10 for which health services were provided is covered under 

11 a self-insurance plan funded by an Indian tribe, tribal or12 ganization, or urban Indian organization. Where such au13 thorization is provided, the Service may receive and ex14 pend such amounts for the provision of additional health 

15 services consistent with such authorization. 

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

17 brought to enforce the provisions of this section, a pre18 vailing plaintiff shall be awarded its reasonable attorney’s 

19 fees and costs of litigation. 

20 ‘‘(h) NONAPPLICABILITY OF CLAIMS FILING RE21 QUIREMENTS.—An insurance company, health mainte22 nance organization, self-insurance plan, managed care 

23 plan, or other health care plan or program (under the So24 cial Security Act or otherwise) may not deny a claim for 

25 benefits submitted by the Service or by an Indian tribe 


jbell on DSKDVH8Z91PROD with BILLS
49 

•S 1790 RS

1 or tribal organization based on the format in which the 

2 claim is submitted if such format complies with the format 

3 required for submission of claims under title XVIII of the 

4 Social Security Act or recognized under section 1175 of 

5 such Act. 

6 ‘‘(i) APPLICATION TO URBAN INDIAN ORGANIZA7 TIONS.—The previous provisions of this section shall apply 

8 to urban Indian organizations with respect to populations 

9 served by such Organizations in the same manner they 

10 apply to Indian tribes and tribal organizations with re11 spect to populations served by such Indian tribes and trib12 al organizations. 

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

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

15 to all actions commenced under this section, and the ref16 erences therein to the United States are deemed to include 

17 Indian tribes, tribal organizations, and urban Indian orga18 nizations. 

19 ‘‘(k) SAVINGS.—Nothing in this section shall be con20 strued to limit any right of recovery available to the 

21 United States, an Indian tribe, or tribal organization 

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

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


jbell on DSKDVH8Z91PROD with BILLS
50 

•S 1790 RS

1 SEC. 123126. CREDITING OF REIMBURSEMENTS. 

2 Section 207 of the Indian Health Care Improvement 

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

4 ‘‘SEC. 207. CREDITING OF REIMBURSEMENTS. 

5 ‘‘(a) USE OF AMOUNTS.— 

6 ‘‘(1) RETENTION BY PROGRAM.—Except as pro7 vided in sections 202(a)(2) and 813, all reimburse8 ments received or recovered under any of the pro9 grams described in paragraph (2), including under 

10 section 813, by reason of the provision of health 

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

12 organization, or by an urban Indian organization, 

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

14 tribal organization, or such urban Indian organiza15 tion, respectively, and may be used as provided in 

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

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

18 credited to such unit and used for such purposes. 

19 ‘‘(2) PROGRAMS COVERED.—The programs re20 ferred to in paragraph (1) are the following: 

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

22 Social Security Act. 

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

24 ‘‘(C) Public Law 87–693. 

25 ‘‘(D) Any other provision of law. 


jbell on DSKDVH8Z91PROD with BILLS
51 

•S 1790 RS

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

2 not offset or limit any amount obligated to any Service 

3 Unit or entity receiving funding from the Service because 

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

5 SEC. 124127. BEHAVIORAL HEALTH TRAINING AND COMMU6 NITY EDUCATION PROGRAMS. 

7 Section 209 of the Indian Health Care Improvement 

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

9 (d) and inserting the following: 

10 ‘‘(d) BEHAVIORAL HEALTH TRAINING AND COMMU11 NITY EDUCATION PROGRAMS.— 

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

13 through the Service, and the Secretary of the Inte14 rior, in consultation with Indian tribes and tribal or15 ganizations, shall conduct a study and compile a list 

16 of the types of staff positions specified in paragraph 

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

18 training in the identification, prevention, education, 

19 referral, or treatment of mental illness, or dysfunc20 tional and self destructive behavior. 

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

22 paragraph (1) are— 

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

24 Indian Affairs, including existing positions, in 

25 the fields of— 


jbell on DSKDVH8Z91PROD with BILLS
52 

•S 1790 RS

1 ‘‘(i) elementary and secondary edu2 cation; 

3 ‘‘(ii) social services and family and 

4 child welfare; 

5 ‘‘(iii) law enforcement and judicial 

6 services; and 

7 ‘‘(iv) alcohol and substance abuse; 

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

9 ‘‘(C) staff positions similar to those identi10 fied in subparagraphs (A) and (B) established 

11 and maintained by Indian tribes and tribal or12 ganizations (without regard to the funding 

13 source). 

14 ‘‘(3) TRAINING CRITERIA.— 

15 ‘‘(A) IN GENERAL.—The appropriate Sec16 retary shall provide training criteria appropriate 

17 to each type of position identified in paragraphs 

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

19 training has been, or shall be provided to any 

20 individual in any such position. With respect to 

21 any such individual in a position identified pur22 suant to paragraph (2)(C), the respective Secre23 taries shall provide appropriate training to, or 

24 provide funds to, an Indian tribe or tribal orga25 nization for training of appropriate individuals. 


jbell on DSKDVH8Z91PROD with BILLS
53 

•S 1790 RS

1 In the case of positions funded under a contract 

2 or compact under the Indian Self-Determina3 tion and Education Assistance Act (25 U.S.C. 

4 450 et seq.), the appropriate Secretary shall en5 sure that such training costs are included in the 

6 contract or compact, as the Secretary deter7 mines necessary. 

8 ‘‘(B) POSITION SPECIFIC TRAINING CRI9 TERIA.—Position specific training criteria shall 

10 be culturally relevant to Indians and Indian 

11 tribes and shall ensure that appropriate infor12 mation regarding traditional health care prac13 tices is provided. 

14 ‘‘(4) COMMUNITY EDUCATION ON MENTAL ILL15 NESS.—The Service shall develop and implement, on 

16 request of an Indian tribe, tribal organization, or 

17 urban Indian organization, or assist the Indian tribe, 

18 tribal organization, or urban Indian organization to 

19 develop and implement, a program of community 

20 education on mental illness. In carrying out this 

21 paragraph, the Service shall, upon request of an In22 dian tribe, tribal organization, or urban Indian orga23 nization, provide technical assistance to the Indian 

24 tribe, tribal organization, or urban Indian organiza25 tion to obtain and develop community educational 


jbell on DSKDVH8Z91PROD with BILLS
54 

•S 1790 RS

1 materials on the identification, prevention, referral, 

2 and treatment of mental illness and dysfunctional 

3 and self-destructive behavior. 

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

5 date of enactment of the Indian Health Care Im6 provement Reauthorization and Extension Act of 

7 2009, the Secretary shall develop a plan under which 

8 the Service will increase the health care staff pro9 viding behavioral health services by at least 500 po10 sitions within 5 years after the date of enactment of 

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

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

13 developed under this paragraph shall be imple14 mented under the Act of November 2, 1921 (25 

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

16 SEC. 125. MAMMOGRAPHY AND OTHER CANCER SCREEN17 ING. 

18 Section 212 of the Indian Health Care Improvement 

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

20 ‘‘SEC. 212. MAMMOGRAPHY AND OTHER CANCER SCREEN21 ING. 

22 ‘‘The Secretary, acting through the Service, shall pro23 vide for screening as follows: 

24 ‘‘(1) SCREENING MAMMOGRAPHY.—Screening 

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


jbell on DSKDVH8Z91PROD with BILLS
55 

•S 1790 RS

1 Social Security Act (42 U.S.C. 1395x(jj))) for In2 dian women at a frequency appropriate to those 

3 women under accepted and appropriate national 

4 standards, and under such terms and conditions as 

5 are consistent with standards established by the Sec6 retary to ensure the safety and accuracy of screen7 ing mammography under part B of title XVIII of 

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

9 ‘‘(2) OTHER CANCER SCREENING.— 

10 ‘‘(A) IN GENERAL.—Other cancer screen11 ing that receives an A or B rating as rec12 ommended by the United States Preventive 

13 Services Task Force established under section 

14 915(a)(1) of the Public Health Service Act (42 

15 U.S.C. 299b–4(a)(1)). 

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

17 ensure that screening provided for under this 

18 paragraph complies with the recommendations 

19 of the Task Force referred to in subparagraph 

20 (A) with respect to— 

21 ‘‘(i) frequency; 

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

23 ‘‘(iii) the procedure or technology to 

24 be used; 

25 ‘‘(iv) evidence of effectiveness; and 


jbell on DSKDVH8Z91PROD with BILLS
56 

•S 1790 RS

1 ‘‘(v) other matters that the Secretary 

2 determines to be appropriate.’’. 

3 SEC. 128. CANCER SCREENINGS. 

4 Section 212 of the Indian Health Care Improvement 

5 Act (25 U.S.C. 1621k) is amended by inserting ‘‘and other 

6 cancer screenings’’ before the period at the end. 

7 SEC. 126129. PATIENT TRAVEL COSTS. 

8 Section 213 of the Indian Health Care Improvement 

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

10 ‘‘SEC. 213. PATIENT TRAVEL COSTS. 

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

12 section, the term ‘qualified escort’ means— 

13 ‘‘(1) an adult escort (including a parent, guard14 ian, or other family member) who is required be15 cause of the physical or mental condition, or age, of 

16 the applicable patient; 

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

18 providing necessary medical care during travel by 

19 the applicable patient; or 

20 ‘‘(3) other escorts, as the Secretary or applica21 ble Indian Health Program determines to be appro22 priate. 

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

24 through the Service and Tribal Health Programs, is au25 thorized to provide funds for the following patient travel 


jbell on DSKDVH8Z91PROD with BILLS
57 

•S 1790 RS

1 costs, including qualified escorts, associated with receiving 

2 health care services provided (either through direct or con3 tract care or through a contract or compact under the In4 dian Self-Determination and Education Assistance Act 

5 (25 U.S.C. 450 et seq.)) under this Act— 

6 ‘‘(1) emergency air transportation and non7 emergency air transportation where ground trans8 portation is infeasible; 

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

10 other means of transportation is available), specially 

11 equipped vehicle, and ambulance; and 

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

13 may be available and required when air or motor ve14 hicle transportation is not available.’’. 

15 SEC. 127130. EPIDEMIOLOGY CENTERS. 

16 Section 214 of the Indian Health Care Improvement 

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

18 ‘‘SEC. 214. EPIDEMIOLOGY CENTERS. 

19 ‘‘(a) ESTABLISHMENT OF CENTERS.— 

20 ‘‘(1) IN GENERAL.—The Secretary shall estab21 lish an epidemiology center in each Service area to 

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

23 ‘‘(2) NEW CENTERS.— 

24 ‘‘(A) IN GENERAL.—Subject to subpara25 graph (B), any new center established after the 


jbell on DSKDVH8Z91PROD with BILLS
58 

•S 1790 RS

1 date of enactment of the Indian Health Care 

2 Improvement Reauthorization and Extension 

3 Act of 2009 may be operated under a grant au4 thorized by subsection (d). 

5 ‘‘(B) REQUIREMENT.—Funding provided 

6 in a grant described in subparagraph (A) shall 

7 not be divisible. 

8 ‘‘(3) FUNDS NOT DIVISIBLE.—An epidemiology 

9 center established under this subsection shall be sub10 ject to the Indian Self-Determination and Education 

11 Assistance Act (25 U.S.C. 450 et seq.), but the funds 

12 for the center shall not be divisible. 

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

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

15 and urban Indian organizations, each Service area epide16 miology center established under this section shall, with 

17 respect to the applicable Service area— 

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

19 progress made toward meeting, each of the health 

20 status objectives of the Service, the Indian tribes, 

21 tribal organizations, and urban Indian organizations 

22 in the Service area; 

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

24 systems, and other systems that impact the improve25 ment of Indian health; 


jbell on DSKDVH8Z91PROD with BILLS
59 

•S 1790 RS

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

2 and urban Indian organizations in identifying high3 est-priority health status objectives and the services 

4 needed to achieve those objectives, based on epide5 miological data; 

6 ‘‘(4) make recommendations for the targeting 

7 of services needed by the populations served; 

8 ‘‘(5) make recommendations to improve health 

9 care delivery systems for Indians and urban Indians; 

10 ‘‘(6) provide requested technical assistance to 

11 Indian tribes, tribal organizations, and urban Indian 

12 organizations in the development of local health 

13 service priorities and incidence and prevalence rates 

14 of disease and other illness in the community; and 

15 ‘‘(7) provide disease surveillance and assist In16 dian tribes, tribal organizations, and urban Indian 

17 communities to promote public health. 

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

19 Centers for Disease Control and Prevention shall provide 

20 technical assistance to the centers in carrying out this sec21 tion. 

22 ‘‘(d) GRANTS FOR STUDIES.— 

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

24 grants to Indian tribes, tribal organizations, Indian 

25 organizations, and eligible intertribal consortia to 


jbell on DSKDVH8Z91PROD with BILLS
60 

•S 1790 RS

1 conduct epidemiological studies of Indian commu2 nities. 

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

4 intertribal consortium or Indian organization shall 

5 be eligible to receive a grant under this subsection 

6 if the intertribal consortium is— 

7 ‘‘(A) incorporated for the primary purpose 

8 of improving Indian health; and 

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

10 urban Indian communities residing in the area 

11 in which the intertribal consortium is located. 

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

13 grant under this subsection shall be submitted in 

14 such manner and at such time as the Secretary shall 

15 prescribe. 

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

17 grant under this subsection shall— 

18 ‘‘(A) demonstrate the technical, adminis19 trative, and financial expertise necessary to 

20 carry out the functions described in paragraph 

21 (5); 

22 ‘‘(B) consult and cooperate with providers 

23 of related health and social services in order to 

24 avoid duplication of existing services; and 


jbell on DSKDVH8Z91PROD with BILLS
61 

•S 1790 RS

1 ‘‘(C) demonstrate cooperation from Indian 

2 tribes or urban Indian organizations in the area 

3 to be served. 

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

5 paragraph (1) may be used— 

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

7 in subsection (b); 

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

9 with, tribal leaders, urban Indian community 

10 leaders, and related health staff regarding 

11 health care and health service management 

12 issues; and 

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

14 tribal organizations, and urban Indian organi15 zations, to provide to the Service information 

16 regarding ways to improve the health status of 

17 Indians. 

18 ‘‘(e) ACCESS TO INFORMATION.— 

19 ‘‘(1) IN GENERAL.—An epidemiology center op20 erated by a grantee pursuant to a grant awarded 

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

22 health authority (as defined in section 164.501 of 

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

24 regulation)) for purposes of the Health Insurance 


jbell on DSKDVH8Z91PROD with BILLS
62 

•S 1790 RS

1 Portability and Accountability Act of 1996 (Public 

2 Law 104–191; 110 Stat. 1936). 

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

4 shall grant to each epidemiology center described in 

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

6 monitoring systems, delivery systems, and other pro7 tected health information in the possession of the 

8 Secretary. 

9 ‘‘(3) REQUIREMENT.—The activities of an epi10 demiology center described in paragraph (1) shall be 

11 for the purposes of research and for preventing and 

12 controlling disease, injury, or disability (as those ac13 tivities are described in section 164.512 of title 45, 

14 Code of Federal Regulations (or a successor regula15 tion)), for purposes of the Health Insurance Port16 ability and Accountability Act of 1996 (Public Law 

17 104–191; 110 Stat. 1936).104–191; 110 Stat. 

18 1936).’’. 

19 ‘‘(f) FUNDS NOT DIVISIBLE.—An epidemiology cen20 ter established under this section shall be subject to the 

21 Indian Self-Determination and Education Assistance Act 

22 (25 U.S.C. 450 et seq.), but the funds for the center shall 

23 not be divisible.’’. 


jbell on DSKDVH8Z91PROD with BILLS
63 

•S 1790 RS

1 SEC. 131. INDIAN YOUTH GRANT PROGRAM. 

2 Section 216(b)(2) of the Indian Health Care Improve3 ment Act (25 U.S.C. 1621o(b)(2)) is amended by striking 

4 ‘‘section 209(m)’’ and inserting ‘‘section 708(c)’’. 

5 SEC. 132. AMERICAN INDIANS INTO PSYCHOLOGY PRO6 GRAM. 

7 Section 217 of the Indian Health Care Improvement 

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

9 ‘‘SEC. 217. AMERICAN INDIANS INTO PSYCHOLOGY PRO10 GRAM. 

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

12 through the Service, shall make grants of not more than 

13 $300,000 to each of 9 colleges and universities for the pur14 pose of developing and maintaining Indian psychology ca15 reer recruitment programs as a means of encouraging Indi16 ans to enter the behavioral health field. These programs 

17 shall be located at various locations throughout the country 

18 to maximize their availability to Indian students and new 

19 programs shall be established in different locations from 

20 time to time. 

21 ‘‘(b) QUENTIN N. BURDICK PROGRAM GRANT.—The 

22 Secretary shall provide a grant authorized under subsection 

23 (a) to develop and maintain a program at the University 

24 of North Dakota to be known as the ‘Quentin N. Burdick 

25 American Indians Into Psychology Program’. Such pro26 gram shall, to the maximum extent feasible, coordinate with 


jbell on DSKDVH8Z91PROD with BILLS
64 

•S 1790 RS

1 the Quentin N. Burdick Indian health programs authorized 

2 under section 117(b), the Quentin N. Burdick American In3 dians Into Nursing Program authorized under section 

4 115(e), and existing university research and communica5 tions networks. 

6 ‘‘(c) REGULATIONS.—The Secretary shall issue regula7 tions pursuant to this Act for the competitive awarding of 

8 grants provided under this section. 

9 ‘‘(d) CONDITIONS OF GRANT.—Applicants under this 

10 section shall agree to provide a program which, at a min11 imum— 

12 ‘‘(1) provides outreach and recruitment for 

13 health professions to Indian communities including 

14 elementary, secondary, and accredited and accessible 

15 community colleges that will be served by the pro16 gram; 

17 ‘‘(2) incorporates a program advisory board 

18 comprised of representatives from the tribes and com19 munities that will be served by the program; 

20 ‘‘(3) provides summer enrichment programs to 

21 expose Indian students to the various fields of psy22 chology through research, clinical, and experimental 

23 activities; 

24 ‘‘(4) provides stipends to undergraduate and 

25 graduate students to pursue a career in psychology; 


jbell on DSKDVH8Z91PROD with BILLS
65 

•S 1790 RS

1 ‘‘(5) develops affiliation agreements with tribal 

2 colleges and universities, the Service, university affili3 ated programs, and other appropriate accredited and 

4 accessible entities to enhance the education of Indian 

5 students; 

6 ‘‘(6) to the maximum extent feasible, uses exist7 ing university tutoring, counseling, and student sup8 port services; and 

9 ‘‘(7) to the maximum extent feasible, employs 

10 qualified Indians in the program. 

11 ‘‘(e) ACTIVE DUTY SERVICE REQUIREMENT.—The ac12 tive duty service obligation prescribed under section 338C 

13 of the Public Health Service Act (42 U.S.C. 254m) shall 

14 be met by each graduate who receives a stipend described 

15 in subsection (d)(4) that is funded under this section. Such 

16 obligation shall be met by service— 

17 ‘‘(1) in an Indian health program; 

18 ‘‘(2) in a program assisted under title V; or 

19 ‘‘(3) in the private practice of psychology if, as 

20 determined by the Secretary, in accordance with 

21 guidelines promulgated by the Secretary, such prac22 tice is situated in a physician or other health profes23 sional shortage area and addresses the health care 

24 needs of a substantial number of Indians. 


jbell on DSKDVH8Z91PROD with BILLS
66 

•S 1790 RS

1 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There is 

2 authorized to be appropriated to carry out this section 

3 $2,700,000 for fiscal year 2010 and each fiscal year there4 after.’’. 

5 SEC. 128133. PREVENTION, CONTROL, AND ELIMINATION OF 

6 COMMUNICABLE AND INFECTIOUS DISEASES. 

7 Section 218 of the Indian Health Care Improvement 

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

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

10 COMMUNICABLE AND INFECTIOUS DISEASES. 

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

12 through the Service, and after consultation with the Cen13 ters for Disease Control and Prevention, may make grants 

14 available to Indian tribes and tribal organizations for the 

15 following: 

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

17 elimination of communicable and infectious diseases, 

18 including tuberculosis, hepatitis, HIV, respiratory 

19 syncytial virus, hanta virus, sexually transmitted dis20 eases, and H. pylori. 

21 ‘‘(2) Public information and education pro22 grams for the prevention, control, and elimination of 

23 communicable and infectious diseases. 

24 ‘‘(3) Education, training, and clinical skills im25 provement activities in the prevention, control, and 


jbell on DSKDVH8Z91PROD with BILLS
67 

•S 1790 RS

1 elimination of communicable and infectious diseases 

2 for health professionals, including allied health pro3 fessionals. 

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

5 treatment, and prevention of hepatitis C virus 

6 (HCV). 

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

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

9 or proposal for funding is submitted to the Secretary. 

10 ‘‘(c) COORDINATION WITH HEALTH AGENCIES.—In11 dian tribes and tribal organizations receiving funding 

12 under this section are encouraged to coordinate their ac13 tivities with the Centers for Disease Control and Preven14 tion and State and local health agencies. 

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

16 out this section, the Secretary— 

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

18 tribal organization, provide technical assistance; and 

19 ‘‘(2) shall prepare and submit a report to Con20 gress biennially on the use of funds under this sec21 tion and on the progress made toward the preven22 tion, control, and elimination of communicable and 

23 infectious diseases among Indians and urban Indi24 ans.’’. 


jbell on DSKDVH8Z91PROD with BILLS
68 

•S 1790 RS

1 SEC. 129134. METHODS TO INCREASE CLINICIAN RECRUIT2 MENT AND RETENTION ISSUES. 

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

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

5 read as follows: 

6 ‘‘SEC. 221. LICENSING. 

7 ‘‘Licensed health professionals employed by a tribal 

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

9 from the licensing requirements of the State in which the 

10 tribal health program performs the services described in 

11 the contract or compact of the tribal health program under 

12 the Indian Self-Determination and Education Assistance 

13 Act (25 U.S.C. 450 et seq.).’’. 

14 (b) TREATMENT OF SCHOLARSHIPS FOR CERTAIN

15 PURPOSES.—Title I of the Indian Health Care Improve16 ment Act (25 U.S.C. 1611 et seq.) (as amended by section 

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

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

19 PURPOSES. 

20 ‘‘A scholarship provided to an individual pursuant to 

21 this title shall be considered to be a qualified scholarship 

22 for purposes of section 117 of the Internal Revenue Code 

23 of 1986.’’. 

24 (c) CONTINUING EDUCATION ALLOWANCES.—Section 

25 106 of the Indian Health Care Improvement Act (25 U.S.C. 

26 1615) is amended to read as follows: 


jbell on DSKDVH8Z91PROD with BILLS
69 

•S 1790 RS

1 ‘‘SEC. 106. CONTINUING EDUCATION ALLOWANCES. 

2 ‘‘In order to encourage scholarship and stipend recipi3 ents under sections 104, 105, and 115 and health profes4 sionals, including community health representatives and 

5 emergency medical technicians, to join or continue in an 

6 Indian health program and to provide services in the rural 

7 and remote areas in which a significant portion of Indians 

8 reside, the Secretary, acting through the Service, may— 

9 ‘‘(1) provide programs or allowances to transi10 tion into an Indian health program, including licens11 ing, board or certification examination assistance, 

12 and technical assistance in fulfilling service obliga13 tions under sections 104, 105, and 115; and 

14 ‘‘(2) provide programs or allowances to health 

15 professionals employed in an Indian health program 

16 to enable those professionals, for a period of time each 

17 year prescribed by regulation of the Secretary, to take 

18 leave of the duty stations of the professionals for pro19 fessional consultation, management, leadership, and 

20 refresher training courses.’’. 

21 SEC. 135. LIABILITY FOR PAYMENT. 

22 Section 222 of the Indian Health Care Improvement 

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

24 ‘‘SEC. 222. LIABILITY FOR PAYMENT. 

25 ‘‘(a) NO PATIENT LIABILITY.—A patient who receives 

26 contract health care services that are authorized by the 


jbell on DSKDVH8Z91PROD with BILLS
70 

•S 1790 RS

1 Service shall not be liable for the payment of any charges 

2 or costs associated with the provision of such services. 

3 ‘‘(b) NOTIFICATION.—The Secretary shall notify a con4 tract care provider and any patient who receives contract 

5 health care services authorized by the Service that such pa6 tient is not liable for the payment of any charges or costs 

7 associated with the provision of such services not later than 

8 5 business days after receipt of a notification of a claim 

9 by a provider of contract care services. 

10 ‘‘(c) NO RECOURSE.—Following receipt of the notice 

11 provided under subsection (b), or, if a claim has been 

12 deemed accepted under section 220(b), the provider shall 

13 have no further recourse against the patient who received 

14 the services.’’. 

15 SEC. 130136. OFFICES OF INDIAN MEN’S HEALTH AND IN16 DIAN WOMEN’S HEALTH. 

17 Section 223 of the Indian Health Care Improvement 

18 Act (25 U.S.C. 1621v) is amended— 

19 (1) by striking the section designation and 

20 heading and all that follows through ‘‘oversee efforts 

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

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

23 WOMEN’S HEALTH. 

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


jbell on DSKDVH8Z91PROD with BILLS
71 

•S 1790 RS

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

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

4 ‘‘(2) DIRECTOR.— 

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

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

7 be appointed by the Secretary. 

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

10 men in the United States. 

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

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

14 2009, the Secretary, acting through the Service, 

15 shall submit to Congress a report describing— 

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

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

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

22 Secretary, acting through the Service, shall establish an 

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

24 Health’, to’’; and 


jbell on DSKDVH8Z91PROD with BILLS
72 

•S 1790 RS

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

3 ‘‘of all ages’’. 

4 SEC. 131. CONTRACT HEALTH SERVICE DISBURSEMENT 

5 FORMULA. 

6 Title II of the Indian Health Care Improvement Act 

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

8 the following: 

9 ‘‘SEC. 226. CONTRACT HEALTH SERVICE DISBURSEMENT 

10 FORMULA. 

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

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

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

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

17 health service funds. 

18 ‘‘(b) REGULATIONS.— 

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

21 in the Federal Register by the Secretary no later 

22 than 24 months after the date of enactment of this 

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


jbell on DSKDVH8Z91PROD with BILLS
73 

•S 1790 RS

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

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

5 ‘‘(c) PROCEDURES.— 

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

7 committee established pursuant to section 565 of 

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

9 shall have as its members only representatives of the 

10 Federal Government and representatives of Indian 

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

13 tribal organizations from each Service area. 

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

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

17 tribal organizations, and individual tribal members. 

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

21 the government-to-government relationship between 

22 the United States and Indian tribes.’’. 


jbell on DSKDVH8Z91PROD with BILLS
74 

•S 1790 RS

1 SEC. 137. CONTRACT HEALTH SERVICE ADMINISTRATION 

2 AND DISBURSEMENT FORMULA. 

3 Title II of the Indian Health Care Improvement Act 

4 (25 U.S.C. 1621 et seq.) is amended by adding at the end 

5 the following: 

6 ‘‘SEC. 226. CONTRACT HEALTH SERVICE ADMINISTRATION 

7 AND DISBURSEMENT FORMULA. 

8 ‘‘(a) SUBMISSION OF REPORT.—As soon as practicable 

9 after the date of enactment of the Indian Health Care Im10 provement Reauthorization and Extension Act of 2009, the 

11 Comptroller General of the United States shall submit to 

12 the Secretary, the Committee on Indian Affairs of the Sen13 ate, and the Committee on Natural Resources of the House 

14 of Representatives, and make available to each Indian tribe, 

15 a report describing the results of the study of the Comp16 troller General regarding the funding of the contract health 

17 service program (including historic funding levels and a 

18 recommendation of the funding level needed for the pro19 gram) and the administration of the contract health service 

20 program (including the distribution of funds pursuant to 

21 the program), as requested by Congress in March 2009, or 

22 pursuant to section 830. 

23 ‘‘(b) CONSULTATION WITH TRIBES.—On receipt of the 

24 report under subsection (a), the Secretary shall consult with 

25 Indian tribes regarding the contract health service program, 


jbell on DSKDVH8Z91PROD with BILLS
75 

•S 1790 RS

1 including the distribution of funds pursuant to the pro2 gram— 

3 ‘‘(1) to determine whether the current distribu4 tion formula would require modification if the con5 tract health service program were funded at the level 

6 recommended by the Comptroller General; 

7 ‘‘(2) to identify any inequities in the current 

8 distribution formula under the current funding level 

9 or inequitable results for any Indian tribe under the 

10 funding level recommended by the Comptroller Gen11 eral; 

12 ‘‘(3) to identify any areas of program adminis13 tration that may result in the inefficient or ineffective 

14 management of the program; and 

15 ‘‘(4) to identify any other issues and rec16 ommendations to improve the administration of the 

17 contract health services program and correct any un18 fair results or funding disparities identified under 

19 paragraph (2). 

20 ‘‘(c) SUBSEQUENT ACTION BY SECRETARY.—If, after 

21 consultation with Indian tribes under subsection (b), the 

22 Secretary determines that any issue described in subsection 

23 (b)(2) exists, the Secretary may initiate procedures under 

24 subchapter III of chapter 5 of title 5, United States Code, 

25 to negotiate or promulgate regulations to establish a disVerDate Nov 24 2008 23:56 Dec 16, 2009 Jkt 089200 PO 00000 Frm 00075 Fmt 6652 Sfmt 6203 E:\BILLS\S1790.RS S1790

jbell on DSKDVH8Z91PROD with BILLS
76 

•S 1790 RS

1 bursement formula for the contract health service program 

2 funding.’’. 

3 Subtitle C—Health Facilities 

4 SEC. 141. HEALTH CARE FACILITY PRIORITY SYSTEM. 

5 Section 301 of the Indian Health Care Improvement 

6 Act (25 U.S.C. 1631) is amended— 

7 (1) by redesignating subsection (d) as subsection 

8 (h); and 

9 (2) by striking subsection (c) and inserting the 

10 following: 

11 ‘‘(c) HEALTH CARE FACILITY PRIORITY SYSTEM.— 

12 ‘‘(1) IN GENERAL.— 

13 ‘‘(A) PRIORITY SYSTEM.—The Secretary, 

14 acting through the Service, shall maintain a 

15 health care facility priority system, which— 

16 ‘‘(i) shall be developed in consultation 

17 with Indian tribes and tribal organizations; 

18 ‘‘(ii) shall give Indian tribes’ needs the 

19 highest priority; 

20 ‘‘(iii)(I) may include the lists required 

21 in paragraph (2)(B)(ii); and 

22 ‘‘(II) shall include the methodology re23 quired in paragraph (2)(B)(v); and 

24 ‘‘(III) may include such health care fa25 cilities, and such renovation or expansion 


jbell on DSKDVH8Z91PROD with BILLS
77 

•S 1790 RS

1 needs of any health care facility, as the 

2 Service may identify; and 

3 ‘‘(iv) shall provide an opportunity for 

4 the nomination of planning, design, and 

5 construction projects by the Service, Indian 

6 tribes, and tribal organizations for consider7 ation under the priority system at least 

8 once every 3 years, or more frequently as 

9 the Secretary determines to be appropriate. 

10 ‘‘(B) NEEDS OF FACILITIES UNDER ISDEAA

11 AGREEMENTS.—The Secretary shall ensure that 

12 the planning, design, construction, renovation, 

13 and expansion needs of Service and non-Service 

14 facilities operated under contracts or compacts 

15 in accordance with the Indian Self-Determina16 tion and Education Assistance Act (25 U.S.C. 

17 450 et seq.) are fully and equitably integrated 

18 into the health care facility priority system. 

19 ‘‘(C) CRITERIA FOR EVALUATING NEEDS.— 

20 For purposes of this subsection, the Secretary, in 

21 evaluating the needs of facilities operated under 

22 a contract or compact under the Indian Self-De23 termination and Education Assistance Act (25 

24 U.S.C. 450 et seq.), shall use the criteria used by 


jbell on DSKDVH8Z91PROD with BILLS
78 

•S 1790 RS

1 the Secretary in evaluating the needs of facilities 

2 operated directly by the Service. 

3 ‘‘(D) PRIORITY OF CERTAIN PROJECTS PRO4 TECTED.—The priority of any project established 

5 under the construction priority system in effect 

6 on the date of enactment of the Indian Health 

7 Care Improvement Reauthorization and Exten8 sion Act of 2009 shall not be affected by any 

9 change in the construction priority system tak10 ing place after that date if the project— 

11 ‘‘(i) was identified in the fiscal year 

12 2008 Service budget justification as— 

13 ‘‘(I) 1 of the 10 top-priority inpa14 tient projects; 

15 ‘‘(II) 1 of the 10 top-priority out16 patient projects; 

17 ‘‘(III) 1 of the 10 top-priority 

18 staff quarters developments; or 

19 ‘‘(IV) 1 of the 10 top-priority 

20 Youth Regional Treatment Centers; 

21 ‘‘(ii) had completed both Phase I and 

22 Phase II of the construction priority system 

23 in effect on the date of enactment of such 

24 Act; or 


jbell on DSKDVH8Z91PROD with BILLS
79 

•S 1790 RS

1 ‘‘(iii) is not included in clause (i) or 

2 (ii) and is selected, as determined by the 

3 Secretary— 

4 ‘‘(I) on the initiative of the Sec5 retary; or 

6 ‘‘(II) pursuant to a request of an 

7 Indian tribe or tribal organization. 

8 ‘‘(2) REPORT; CONTENTS.— 

9 ‘‘(A) INITIAL COMPREHENSIVE REPORT.— 

10 ‘‘(i) DEFINITIONS.—In this subpara11 graph: 

12 ‘‘(I) FACILITIES APPROPRIATION

13 ADVISORY BOARD.—The term ‘Facili14 ties Appropriation Advisory Board’ 

15 means the advisory board, comprised of 

16 12 members representing Indian tribes 

17 and 2 members representing the Serv18 ice, established at the discretion of the 

19 Director— 

20 ‘‘(aa) to provide advice and 

21 recommendations for policies and 

22 procedures of the programs funded 

23 pursuant to facilities appropria24 tions; and 


jbell on DSKDVH8Z91PROD with BILLS
80 

•S 1790 RS

1 ‘‘(bb) to address other facili2 ties issues. 

3 ‘‘(II) FACILITIES NEEDS ASSESS4 MENT WORKGROUP.—The term ‘Facili5 ties Needs Assessment Workgroup’ 

6 means the workgroup established at the 

7 discretion of the Director— 

8 ‘‘(aa) to review the health 

9 care facilities construction pri10 ority system; and 

11 ‘‘(bb) to make recommenda12 tions to the Facilities Appropria13 tion Advisory Board for revising 

14 the priority system. 

15 ‘‘(ii) INITIAL REPORT.— 

16 ‘‘(I) IN GENERAL.—Not later than 

17 1 year after the date of enactment of 

18 the Indian Health Care Improvement 

19 Reauthorization and Extension Act of 

20 2009, the Secretary shall submit to the 

21 Committee on Indian Affairs of the 

22 Senate and the Committee on Natural 

23 Resources of the House of Representa24 tives a report that describes the com25 prehensive, national, ranked list of all 


jbell on DSKDVH8Z91PROD with BILLS
81 

•S 1790 RS

1 health care facilities needs for the Serv2 ice, Indian tribes, and tribal organiza3 tions (including inpatient health care 

4 facilities, outpatient health care facili5 ties, specialized health care facilities 

6 (such as for long-term care and alcohol 

7 and drug abuse treatment), wellness 

8 centers, and staff quarters, and the 

9 renovation and expansion needs, if 

10 any, of such facilities) developed by the 

11 Service, Indian tribes, and tribal orga12 nizations for the Facilities Needs As13 sessment Workgroup and the Facilities 

14 Appropriation Advisory Board. 

15 ‘‘(II) INCLUSIONS.—The initial 

16 report shall include— 

17 ‘‘(aa) the methodology and 

18 criteria used by the Service in de19 termining the needs and estab20 lishing the ranking of the facili21 ties needs; and 

22 ‘‘(bb) such other information 

23 as the Secretary determines to be 

24 appropriate. 


jbell on DSKDVH8Z91PROD with BILLS
82 

•S 1790 RS

1 ‘‘(iii) UPDATES OF REPORT.—Begin2 ning in calendar year 2011, the Secretary 

3 shall— 

4 ‘‘(I) update the report under 

5 clause (ii) not less frequently that once 

6 every 5 years; and 

7 ‘‘(II) include the updated report 

8 in the appropriate annual report 

9 under subparagraph (B) for submis10 sion to Congress under section 801. 

11 ‘‘(B) ANNUAL REPORTS.—The Secretary 

12 shall submit to the President, for inclusion in the 

13 report required to be transmitted to Congress 

14 under section 801, a report which sets forth the 

15 following: 

16 ‘‘(i) A description of the health care fa17 cility priority system of the Service estab18 lished under paragraph (1). 

19 ‘‘(ii) Health care facilities lists, which 

20 may include— 

21 ‘‘(I) the 10 top-priority inpatient 

22 health care facilities; 

23 ‘‘(II) the 10 top-priority out24 patient health care facilities; 


jbell on DSKDVH8Z91PROD with BILLS
83 

•S 1790 RS

1 ‘‘(III) the 10 top-priority special2 ized health care facilities (such as long3 term care and alcohol and drug abuse 

4 treatment); and 

5 ‘‘(IV) the 10 top-priority staff 

6 quarters developments associated with 

7 health care facilities. 

8 ‘‘(iii) The justification for such order 

9 of priority. 

10 ‘‘(iv) The projected cost of such 

11 projects. 

12 ‘‘(v) The methodology adopted by the 

13 Service in establishing priorities under its 

14 health care facility priority system. 

15 ‘‘(3) REQUIREMENTS FOR PREPARATION OF RE16 PORTS.—In preparing the report required under 

17 paragraph (2), the Secretary shall— 

18 ‘‘(A) consult with and obtain information 

19 on all health care facilities needs from Indian 

20 tribes and tribal organizations; and 

21 ‘‘(B) review the total unmet needs of all In22 dian tribes and tribal organizations for health 

23 care facilities (including staff quarters), includ24 ing needs for renovation and expansion of exist25 ing facilities. 


jbell on DSKDVH8Z91PROD with BILLS
84 

•S 1790 RS

1 ‘‘(d) REVIEW OF METHODOLOGY USED FOR HEALTH

2 FACILITIES CONSTRUCTION PRIORITY SYSTEM.— 

3 ‘‘(1) IN GENERAL.—Not later than 1 year after 

4 the establishment of the priority system under sub5 section (c)(1)(A), the Comptroller General of the 

6 United States shall prepare and finalize a report re7 viewing the methodologies applied, and the processes 

8 followed, by the Service in making each assessment of 

9 needs for the list under subsection (c)(2)(A)(ii) and 

10 developing the priority system under subsection 

11 (c)(1), including a review of— 

12 ‘‘(A) the recommendations of the Facilities 

13 Appropriation Advisory Board and the Facili14 ties Needs Assessment Workgroup (as those terms 

15 are defined in subsection (c)(2)(A)(i)); and 

16 ‘‘(B) the relevant criteria used in ranking 

17 or prioritizing facilities other than hospitals or 

18 clinics. 

19 ‘‘(2) SUBMISSION TO CONGRESS.—The Comp20 troller General of the United States shall submit the 

21 report under paragraph (1) to— 

22 ‘‘(A) the Committees on Indian Affairs and 

23 Appropriations of the Senate; 


jbell on DSKDVH8Z91PROD with BILLS
85 

•S 1790 RS

1 ‘‘(B) the Committees on Natural Resources 

2 and Appropriations of the House of Representa3 tives; and 

4 ‘‘(C) the Secretary. 

5 ‘‘(e) FUNDING CONDITION.—All funds appropriated 

6 under the Act of November 2, 1921 (25 U.S.C. 13) (com7 monly known as the ‘Snyder Act’), for the planning, design, 

8 construction, or renovation of health facilities for the benefit 

9 of 1 or more Indian Tribes shall be subject to the provisions 

10 of section 102 of the Indian Self-Determination and Edu11 cation Assistance Act (25 U.S.C. 450f) or sections 504 and 

12 505 of that Act (25 U.S.C. 458aaa–3, 458aaa–4). 

13 ‘‘(f) DEVELOPMENT OF INNOVATIVE APPROACHES.— 

14 The Secretary shall consult and cooperate with Indian 

15 tribes and tribal organizations, and confer with urban In16 dian organizations, in developing innovative approaches to 

17 address all or part of the total unmet need for construction 

18 of health facilities, that may include— 

19 ‘‘(1) the establishment of an area distribution 

20 fund in which a portion of health facility construc21 tion funding could be devoted to all Service areas; 

22 ‘‘(2) approaches provided for in other provisions 

23 of this title; and 

24 ‘‘(3) other approaches, as the Secretary deter25 mines to be appropriate.’’. 


jbell on DSKDVH8Z91PROD with BILLS
86 

•S 1790 RS

1 SEC. 142. PRIORITY OF CERTAIN PROJECTS PROTECTED. 

2 Section 301 of the Indian Health Care Improvement 

3 Act (25 U.S.C. 1631) (as amended by section 141) is 

4 amended by adding at the end the following: 

5 ‘‘(g) PRIORITY OF CERTAIN PROJECTS PROTECTED.— 

6 The priority of any project established under the construc7 tion priority system in effect on the date of enactment of 

8 this Indian Health Care Improvement Reauthorization and 

9 Extension Act of 2009 shall not be affected by any change 

10 in the construction priority system taking place after that 

11 date if the project— 

12 ‘‘(1) was identified in the fiscal year 2008 Serv13 ice budget justification as— 

14 ‘‘(A) 1 of the 10 top-priority inpatient 

15 projects; 

16 ‘‘(B) 1 of the 10 top-priority outpatient 

17 projects; 

18 ‘‘(C) 1 of the 10 top-priority staff quarters 

19 developments; or 

20 ‘‘(D) 1 of the 10 top-priority Youth Re21 gional Treatment Centers; 

22 ‘‘(2) had completed both Phase I and Phase II 

23 of the construction priority system in effect on the 

24 date of enactment of such Act; or 

25 ‘‘(3) is not included in clause (i) or (ii) and is 

26 selected, as determined by the Secretary— 


jbell on DSKDVH8Z91PROD with BILLS
87 

•S 1790 RS

1 ‘‘(A) on the initiative of the Secretary; or 

2 ‘‘(B) pursuant to a request of an Indian 

3 tribe or tribal organization.’’. 

4 SEC. 141. INDIAN HEALTH CARE DELIVERY DEMONSTRA5 TION PROJECTS. 

6 Section 307 of the Indian Health Care Improvement 

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

8 ‘‘SEC. 307. INDIAN HEALTH CARE DELIVERY DEMONSTRA9 TION PROJECTS. 

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

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

12 contracts under the Indian Self-Determination and Edu13 cation Assistance Act (25 U.S.C. 450 et seq.) with Indian 

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

15 delivery demonstration project to test alternative means 

16 of delivering health care and services to Indians through 

17 facilities. 

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

19 projects pursuant to this section— 

20 ‘‘(1) may authorize such contracts for the con21 struction and renovation of hospitals, health centers, 

22 health stations, and other facilities to deliver health 

23 care services; and 

24 ‘‘(2) is authorized— 

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


jbell on DSKDVH8Z91PROD with BILLS
88 

•S 1790 RS

1 ‘‘(B) to permit carryover of funds appro2 priated for the provision of health care services; 

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

4 funds; 

5 ‘‘(D) to permit the use of funds or prop6 erty donated from any source for project pur7 poses; 

8 ‘‘(E) to provide for the reversion of do9 nated real or personal property to the donor; 

10 and 

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

12 match other funds, including Federal funds. 

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

14 ‘‘(1) DEFINITION OF CONVENIENT CARE SERV15 ICE.—In this subsection, the term ‘convenient care 

16 service’ means any primary health care service, such 

17 as urgent care services, nonemergent care services, 

18 prevention services and screenings, and any service 

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

20 at an alternative setting. 

21 ‘‘(2) GENERAL PROJECTS.— 

22 ‘‘(A) CRITERIA.—The Secretary may ap23 prove under this section demonstration projects 

24 that meet the following criteria: 


jbell on DSKDVH8Z91PROD with BILLS
89 

•S 1790 RS

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

2 or program, such as a program for conven3 ient care services, or the reorientation of 

4 an existing facility or program. 

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

6 including Indians with low health status, 

7 will be served by the project. 

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

9 deliver services in an efficient and effective 

10 manner. 

11 ‘‘(iv) The project is economically via12 ble. 

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

14 Indian tribe or tribal organization, the In15 dian tribe or tribal organization has the 

16 administrative and financial capability to 

17 administer the project. 

18 ‘‘(vi) The project is integrated with 

19 providers of related health and social serv20 ices and is coordinated with, and avoids 

21 duplication of, existing services in order to 

22 expand the availability of services. 

23 ‘‘(B) PRIORITY.—In approving demonstra24 tion projects under this paragraph, the Sec25 retary shall give priority to demonstration 


jbell on DSKDVH8Z91PROD with BILLS
90 

•S 1790 RS

1 projects, to the extent the projects meet the cri2 teria described in subparagraph (A), located in 

3 any of the following Service units: 

4 ‘‘(i) Cass Lake, Minnesota. 

5 ‘‘(ii) Mescalero, New Mexico. 

6 ‘‘(iii) Owyhee and Elko, Nevada. 

7 ‘‘(iv) Schurz, Nevada. 

8 ‘‘(v) Ft. Yuma, California. 

9 ‘‘(3) INNOVATIVE HEALTH SERVICES DELIVERY

10 DEMONSTRATION PROJECT.— 

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

12 at innovative ways to deliver health care serv13 ices, such as medical, dental, alternative medi14 cine, pharmaceutical, nursing, and clinical lab15 oratory services, in American Indian and Alas16 ka Native communities, including convenient 

17 care service, community health centers, and 

18 other health care models which improve access 

19 to quality health promotion and disease preven20 tion services. 

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

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

23 the Secretary is authorized to approve not more 

24 than 10 applications for health care delivery 

25 demonstration projects that— 


jbell on DSKDVH8Z91PROD with BILLS
91 

•S 1790 RS

1 ‘‘(i) include a convenient care service 

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

4 ‘‘(ii) meet the criteria described in 

5 subparagraph (C). 

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

8 projects that meet all of the following criteria: 

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

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

12 health care services at existing health care 

13 facilities, which may be due to limited 

14 hours of operation at those facilities or 

15 other factors. 

16 ‘‘(iii) The project— 

17 ‘‘(I) expands the availability of 

18 services; or 

19 ‘‘(II) reduces— 

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

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

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

25 provide for the establishment of peer review panels, as necVerDate Nov 24 2008 23:56 Dec 16, 2009 Jkt 089200 PO 00000 Frm 00091 Fmt 6652 Sfmt 6401 E:\BILLS\S1790.RS S1790

jbell on DSKDVH8Z91PROD with BILLS
92 

•S 1790 RS

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

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

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

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

8 section 813, the authority to provide services to persons 

9 otherwise ineligible for the health care benefits of the 

10 Service, and the authority to extend hospital privileges in 

11 Service facilities to non-Service health practitioners as 

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

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

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

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

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

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

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

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

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


jbell on DSKDVH8Z91PROD with BILLS
93 

•S 1790 RS

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

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

5 projects under this section.’’. 

6 SEC. 143. INDIAN HEALTH CARE DELIVERY DEMONSTRA7 TION PROJECTS. 

8 Section 307 of the Indian Health Care Improvement 

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

10 ‘‘SEC. 307. INDIAN HEALTH CARE DELIVERY DEMONSTRA11 TION PROJECTS. 

12 ‘‘(a) PURPOSE AND GENERAL AUTHORITY.— 

13 ‘‘(1) PURPOSE.—The purpose of this section is to 

14 encourage the establishment of demonstration projects 

15 that meet the applicable criteria of this section to be 

16 carried out by the Secretary, acting through the Serv17 ice, or Indian tribes or tribal organizations acting 

18 pursuant to contracts or compacts under the Indian 

19 Self Determination and Education Assistance Act (25 

20 U.S.C. 450 et seq.)— 

21 ‘‘(A) to test alternative means of delivering 

22 health care and services to Indians through fa23 cilities; or 

24 ‘‘(B) to use alternative or innovative meth25 ods or models of delivering health care services to 


jbell on DSKDVH8Z91PROD with BILLS
94 

•S 1790 RS

1 Indians (including primary care services, con2 tract health services, or any other program or 

3 service authorized by this Act) through conven4 ient care services (as defined in subsection (c)), 

5 community health centers, or cooperative agree6 ments or arrangements with other health care 

7 providers that share or coordinate the use of fa8 cilities, funding, or other resources, or otherwise 

9 coordinate or improve the coordination of activi10 ties of the Service, Indian tribes, or tribal orga11 nizations, with those of the other health care pro12 viders. 

13 ‘‘(2) AUTHORITY.—The Secretary, acting through 

14 the Service, is authorized to carry out, or to enter 

15 into contracts or compacts under the Indian Self-De16 termination and Education Assistance Act (25 U.S.C. 

17 450 et seq.) with Indian tribes or tribal organizations 

18 to carry out, health care delivery demonstration 

19 projects that— 

20 ‘‘(A) test alternative means of delivering 

21 health care and services to Indians through fa22 cilities; or 

23 ‘‘(B) otherwise carry out the purposes of 

24 this section. 


jbell on DSKDVH8Z91PROD with BILLS
95 

•S 1790 RS

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

2 projects pursuant to this section— 

3 ‘‘(1) may authorize such contracts for the con4 struction and renovation of hospitals, health centers, 

5 health stations, and other facilities to deliver health 

6 care services; and 

7 ‘‘(2) is authorized— 

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

9 ‘‘(B) to permit use and carryover of funds 

10 appropriated for the provision of health care 

11 services under this Act (including for the pur12 chase of health benefits coverage, as authorized 

13 by section 402(a)); 

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

15 funds, including other Federal funds, funds from 

16 third-party collections in accordance with sec17 tions 206, 207, and 401, and non-Federal funds 

18 contributed by State or local governmental agen19 cies or facilities or private health care providers 

20 pursuant to cooperative or other agreements with 

21 the Service, 1 or more Indian tribes, or tribal or22 ganizations; 

23 ‘‘(D) to permit the use of funds or property 

24 donated or otherwise provided from any source 

25 for project purposes; 


jbell on DSKDVH8Z91PROD with BILLS
96 

•S 1790 RS

1 ‘‘(E) to provide for the reversion of donated 

2 real or personal property to the donor; and 

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

4 match other funds, including Federal funds. 

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

6 ‘‘(1) DEFINITION OF CONVENIENT CARE SERV7 ICE.—In this subsection, the term ‘convenient care 

8 service’ means any primary health care service, such 

9 as urgent care services, nonemergent care services, 

10 prevention services and screenings, and any service 

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

12 ‘‘(A) at an alternative setting; or 

13 ‘‘(B) during hours other than regular work14 ing hours. 

15 ‘‘(2) GENERAL PROJECTS.— 

16 ‘‘(A) CRITERIA.—The Secretary may ap17 prove under this section demonstration projects 

18 that meet the following criteria: 

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

20 or program, such as a program for conven21 ient care services, or an improvement in, 

22 increased efficiency at, or reorientation of 

23 an existing facility or program. 


jbell on DSKDVH8Z91PROD with BILLS
97 

•S 1790 RS

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

2 including Indians with low health status, 

3 will be served by the project. 

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

5 deliver services in an efficient and effective 

6 manner. 

7 ‘‘(iv) The project is economically via8 ble. 

9 ‘‘(v) For projects carried out by an In10 dian tribe or tribal organization, the In11 dian tribe or tribal organization has the ad12 ministrative and financial capability to ad13 minister the project. 

14 ‘‘(vi) The project is integrated with 

15 providers of related health or social services 

16 (including State and local health care agen17 cies or other health care providers) and is 

18 coordinated with, and avoids duplication of, 

19 existing services in order to expand the 

20 availability of services. 

21 ‘‘(B) PRIORITY.—In approving demonstra22 tion projects under this paragraph, the Secretary 

23 shall give priority to demonstration projects, to 

24 the extent the projects meet the criteria described 


jbell on DSKDVH8Z91PROD with BILLS
98 

•S 1790 RS

1 in subparagraph (A), located in any of the fol2 lowing Service units: 

3 ‘‘(i) Cass Lake, Minnesota. 

4 ‘‘(ii) Mescalero, New Mexico. 

5 ‘‘(iii) Owyhee and Elko, Nevada. 

6 ‘‘(iv) Schurz, Nevada. 

7 ‘‘(v) Ft. Yuma, California. 

8 ‘‘(3) INNOVATIVE HEALTH SERVICES DELIVERY

9 DEMONSTRATION PROJECT.— 

10 ‘‘(A) APPLICATION OR REQUEST.—On re11 ceipt of an application or request from an In12 dian tribe, a consortium of Indian tribes, or a 

13 tribal organization within a Service area, the 

14 Secretary shall take into consideration alter15 native or innovated methods to deliver health 

16 care services within the Service area (or a por17 tion of, or facility within, the Service area) as 

18 described in the application or request, including 

19 medical, dental, pharmaceutical, nursing, clin20 ical laboratory, contract health services, conven21 ient care services, community health centers, or 

22 any other health care services delivery models de23 signed to improve access to, or efficiency or qual24 ity of, the health care, health promotion, or disVerDate Nov 24 2008 23:56 Dec 16, 2009 Jkt 089200 PO 00000 Frm 00098 Fmt 6652 Sfmt 6203 E:\BILLS\S1790.RS S1790

jbell on DSKDVH8Z91PROD with BILLS
99 

•S 1790 RS

1 ease prevention services and programs under this 

2 Act. 

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

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

5 the Secretary is authorized under this paragraph 

6 to approve not more than 10 applications for 

7 health care delivery demonstration projects that 

8 meet the criteria described in subparagraph (C). 

9 ‘‘(C) CRITERIA.—The Secretary shall ap10 prove under subparagraph (B) demonstration 

11 projects that meet all of the following criteria: 

12 ‘‘(i) The criteria set forth in paragraph 

13 (2)(A). 

14 ‘‘(ii) There is a lack of access to health 

15 care services at existing health care facili16 ties, which may be due to limited hours of 

17 operation at those facilities or other factors. 

18 ‘‘(iii) The project— 

19 ‘‘(I) expands the availability of 

20 services; or 

21 ‘‘(II) reduces— 

22 ‘‘(aa) the burden on Contract 

23 Health Services; or 

24 ‘‘(bb) the need for emergency 

25 room visits. 


jbell on DSKDVH8Z91PROD with BILLS
100 

•S 1790 RS

1 ‘‘(d) TECHNICAL ASSISTANCE.—On receipt of an ap2 plication or request from an Indian tribe, a consortium of 

3 Indian tribes, or a tribal organization, the Secretary shall 

4 provide such technical and other assistance as may be nec5 essary to enable applicants to comply with this section, in6 cluding information regarding the Service unit budget and 

7 available funding for carrying out the proposed demonstra8 tion project. 

9 ‘‘(e) SERVICE TO INELIGIBLE PERSONS.—Subject to 

10 section 813, the authority to provide services to persons oth11 erwise ineligible for the health care benefits of the Service, 

12 and the authority to extend hospital privileges in Service 

13 facilities to non-Service health practitioners as provided in 

14 section 813, may be included, subject to the terms of that 

15 section, in any demonstration project approved pursuant 

16 to this section. 

17 ‘‘(f) EQUITABLE TREATMENT.—For purposes of sub18 section (c), the Secretary, in evaluating facilities operated 

19 under any contract or compact under the Indian Self-Deter20 mination and Education Assistance Act (25 U.S.C. 450 et 

21 seq.), shall use the same criteria that the Secretary uses in 

22 evaluating facilities operated directly by the Service. 

23 ‘‘(g) EQUITABLE INTEGRATION OF FACILITIES.—The 

24 Secretary shall ensure that the planning, design, construc25 tion, renovation, and expansion needs of Service and nonVerDate Nov 24 2008 23:56 Dec 16, 2009 Jkt 089200 PO 00000 Frm 00100 Fmt 6652 Sfmt 6203 E:\BILLS\S1790.RS S1790

jbell on DSKDVH8Z91PROD with BILLS
101 

•S 1790 RS

1 Service facilities that are the subject of a contract or com2 pact under the Indian Self-Determination and Education 

3 Assistance Act (25 U.S.C. 450 et seq.) for health services 

4 are fully and equitably integrated into the implementation 

5 of the health care delivery demonstration projects under this 

6 section.’’. 

7 SEC. 142144. TRIBAL MANAGEMENT OF FEDERALLY OWNED 

8 QUARTERS. 

9 Title III of the Indian Health Care Improvement Act 

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

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

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

13 QUARTERS. 

14 ‘‘(a) RENTAL RATES.— 

15 ‘‘(1) ESTABLISHMENT.—Notwithstanding any 

16 other provision of law, a tribal health program that 

17 operates a hospital or other health facility and the 

18 federally owned quarters associated with such a fa19 cility pursuant to a contract or compact under the 

20 Indian Self-Determination and Education Assistance 

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

22 rates charged to the occupants of those quarters, on 

23 providing notice to the Secretary. 


jbell on DSKDVH8Z91PROD with BILLS
102 

•S 1790 RS

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

2 under this subsection, a tribal health program shall 

3 attempt— 

4 ‘‘(A) to base the rental rates on the rea5 sonable value of the quarters to the occupants 

6 of the quarters; and 

7 ‘‘(B) to generate sufficient funds to pru8 dently provide for the operation and mainte9 nance of the quarters, and at the discretion of 

10 the tribal health program, to supply reserve 

11 funds for capital repairs and replacement of the 

12 quarters. 

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

14 quarters the rental rates for which are established 

15 by a tribal health program under this subsection 

16 shall remain eligible to receive improvement and re17 pair funds to the same extent that all federally 

18 owned quarters used to house personnel in programs 

19 of the Service are eligible to receive those funds. 

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

21 health program that establishes a rental rate under 

22 this subsection shall provide occupants of the feder23 ally owned quarters a notice of any change in the 

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

25 notice before the effective date of the change. 


jbell on DSKDVH8Z91PROD with BILLS
103 

•S 1790 RS

1 ‘‘(5) RATES IN ALASKA.—A rental rate estab2 lished by a tribal health program under this section 

3 for a federally owned quarters in the State of Alaska 

4 may be based on the cost of comparable private 

5 rental housing in the nearest established community 

6 with a year-round population of 1,500 or more indi7 viduals. 

8 ‘‘(b) DIRECT COLLECTION OF RENT.— 

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

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

11 tribal health program may collect rent directly from 

12 Federal employees who occupy federally owned quar13 ters if the tribal health program submits to the Sec14 retary and the employees a notice of the election of 

15 the tribal health program to collect rents directly 

16 from the employees. 

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

18 notice described in paragraph (1)— 

19 ‘‘(A) the affected Federal employees shall 

20 pay rent for occupancy of a federally owned 

21 quarters directly to the applicable tribal health 

22 program; and 

23 ‘‘(B) the Secretary shall not have the au24 thority to collect rent from the employees 

25 through payroll deduction or otherwise. 


jbell on DSKDVH8Z91PROD with BILLS
104 

•S 1790 RS

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

2 under this subsection— 

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

4 tribal health program in a separate account, 

5 which shall be used by the tribal health pro6 gram for the maintenance (including capital re7 pairs and replacement) and operation of the 

8 quarters, as the tribal health program deter9 mines to be appropriate; and 

10 ‘‘(B) shall not be made payable to, or oth11 erwise be deposited with, the United States. 

12 ‘‘(4) RETROCESSION OF AUTHORITY.—If a trib13 al health program that elected to collect rent directly 

14 under paragraph (1) requests retrocession of the au15 thority of the tribal health program to collect that 

16 rent, the retrocession shall take effect on the earlier 

17 of— 

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

19 not less than 180 days after the tribal health 

20 program submits the request; and 

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

22 agreed on by the Secretary and the tribal health 

23 program.’’. 


jbell on DSKDVH8Z91PROD with BILLS
105 

•S 1790 RS

1 SEC. 143145. OTHER FUNDING, EQUIPMENT, AND SUPPLIES 

2 FOR FACILITIES. 

3 Title III of the Indian Health Care Improvement Act 

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

5 the following: 

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

7 FOR FACILITIES. 

8 ‘‘(a) AUTHORIZATION.— 

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

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

12 construction or operation of a health care facility 

13 may transfer the funds, equipment, or supplies to 

14 the Secretary for the construction or operation of a 

15 health care facility to achieve— 

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

17 head of any Federal agency to which funds, equip18 ment, or other supplies are made available for the 

19 planning, design, construction, or operation of a 

20 health care or sanitation facility may transfer the 

21 funds, equipment, or supplies to the Secretary for the 

22 planning, design, construction, or operation of a 

23 health care or sanitation facility to achieve— 

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


jbell on DSKDVH8Z91PROD with BILLS
106 

•S 1790 RS

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

2 equipment, or supplies were made available to 

3 the Federal agency. 

4 ‘‘(2) AUTHORITY TO ACCEPT FUNDS.—The Sec5 retary may— 

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

7 Federal and State agencies, funds, equipment, 

8 or supplies that are available for the construc9 tion or operation of health care or sanitation fa10 cilities; and 

11 ‘‘(B) use those funds, equipment, and sup12 plies to plan, design, and construct health care 

13 facilities, construct, and operate health care or 

14 sanitation facilities for Indians, including pur15 suant to a contract or compact under the In16 dian Self-Determination and Education Assist17 ance Act (25 U.S.C. 450 et seq.). 

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

19 by the Secretary under this subsection shall not af20 fect any priority established under section 301. 

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

22 may enter into interagency agreements with Federal or 

23 State agencies and other entities, and accept funds, equip24 ment, or other supplies from those entities, to provide for 

25 the planning, design, and construction of health care faVerDate Nov 24 2008 23:56 Dec 16, 2009 Jkt 089200 PO 00000 Frm 00106 Fmt 6652 Sfmt 6201 E:\BILLS\S1790.RS S1790

jbell on DSKDVH8Z91PROD with BILLS
107 

•S 1790 RS

1 cilities construction, and operation of health care or sanita2 tion facilities to be administered by Indian health pro3 grams to achieve— 

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

5 ‘‘(2) the purposes for which the funds were ap6 propriated or otherwise provided. 

7 ‘‘(c) ESTABLISHMENT OF STANDARDS.—The Sec8 retary, acting through the Service, shall establish, by regu9 lation, standards for the planning, design, and construc10 tion of health care facilities serving Indians under this 

11 Act.’’. 

12 ‘‘(c) ESTABLISHMENT OF STANDARDS.— 

13 ‘‘(1) IN GENERAL.—The Secretary, acting 

14 through the Service, shall establish, by regulation, 

15 standards for the planning, design, construction, and 

16 operation of health care or sanitation facilities serv17 ing Indians under this Act. 

18 ‘‘(2) OTHER REGULATIONS.—Notwithstanding 

19 any other provision of law, any other applicable regu20 lations of the Department shall apply in carrying out 

21 projects using funds transferred under this section. 

22 ‘‘(d) DEFINITION OF SANITATION FACILITY.—In this 

23 section, the term ‘sanitation facility’ means a safe and ade24 quate water supply system, sanitary sewage disposal sysVerDate Nov 24 2008 23:56 Dec 16, 2009 Jkt 089200 PO 00000 Frm 00107 Fmt 6652 Sfmt 6203 E:\BILLS\S1790.RS S1790

jbell on DSKDVH8Z91PROD with BILLS
108 

•S 1790 RS

1 tem, or sanitary solid waste system (including all related 

2 equipment and support infrastructure).’’. 

3 SEC. 144146. INDIAN COUNTRY MODULAR COMPONENT FA4 CILITIES DEMONSTRATION PROGRAM. 

5 Title III of the Indian Health Care Improvement Act 

6 (25 U.S.C. 1631 et seq.) (as amended by section 143145) 

7 is amended by adding at the end the following: 

8 ‘‘SEC. 312. INDIAN COUNTRY MODULAR COMPONENT FA9 CILITIES DEMONSTRATION PROGRAM. 

10 ‘‘(a) DEFINITION OF MODULAR COMPONENT

11 HEALTH CARE FACILITY.—In this section, the term ‘mod12 ular component health care facility’ means a health care 

13 facility that is constructed— 

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

15 units for subsequent transport to the destination lo16 cation; and 

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

18 provision of health care facility than a traditionally 

19 constructed health care building. 

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

21 through the Service, shall establish a demonstration pro22 gram under which the Secretary shall award no less than 

23 3 grants for purchase, installation and maintenance of 

24 modular component health care facilities in Indian com25 munities for provision of health care services. 


jbell on DSKDVH8Z91PROD with BILLS
109 

•S 1790 RS

1 ‘‘(c) SELECTION OF LOCATIONS.— 

2 ‘‘(1) PETITIONS.— 

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

4 solicit from Indian tribes petitions for location 

5 of the modular component health care facilities 

6 in the Service areas of the petitioning Indian 

7 tribes. 

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

9 a grant under this section, an Indian tribe or 

10 tribal organization must submit to the Sec11 retary a petition to construct a modular compo12 nent health care facility in the Indian commu13 nity of the Indian tribe, at such time, in such 

14 manner, and containing such information as the 

15 Secretary may require. 

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

17 each modular component health care facility to be 

18 provided under the demonstration program, the Sec19 retary shall give priority to projects already on the 

20 Indian Health Service facilities construction priority 

21 list and petitions which demonstrate that erection of 

22 a modular component health facility— 

23 ‘‘(A) is more economical than construction 

24 of a traditionally constructed health care facil25 ity; 


jbell on DSKDVH8Z91PROD with BILLS
110 

•S 1790 RS

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

2 selected location in less time than traditional 

3 construction; and 

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

5 services needed by the Indian population to be 

6 served. 

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

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

12 2011 Planned Construction Budget’ and dated May 

13 7, 2009 (or any successor list). 

14 ‘‘(d) ELIGIBILITY.— 

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

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

20 et seq.). 

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

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

24 provided for the project shall be subject to the proviVerDate Nov 24 2008 23:56 Dec 16, 2009 Jkt 089200 PO 00000 Frm 00110 Fmt 6652 Sfmt 6201 E:\BILLS\S1790.RS S1790

jbell on DSKDVH8Z91PROD with BILLS
111 

•S 1790 RS

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

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

4 on which funds are made available for the demonstration 

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

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

9 success of the activity; and 

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

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

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

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

15 out the demonstration program under this section for the 

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

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

18 SEC. 145147. MOBILE HEALTH STATIONS DEMONSTRATION 

19 PROGRAM. 

20 Title III of the Indian Health Care Improvement Act 

21 (25 U.S.C. 1631 et seq.) (as amended by section 144146) 

22 is amended by adding at the end the following: 

23 ‘‘SEC. 313. MOBILE HEALTH STATIONS DEMONSTRATION 

24 PROGRAM. 

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


jbell on DSKDVH8Z91PROD with BILLS
112 

•S 1790 RS

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

2 term ‘eligible tribal consortium’ means a consortium 

3 composed of 2 or more Service units between which 

4 a mobile health station can be transported by road 

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

6 Service or by an Indian tribe or tribal organization 

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

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

10 ‘mobile health station’ means a health care unit 

11 that— 

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

14 truck or similar vehicle; 

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

16 more specialty health care services; and 

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

18 stationary health care facility when appropriate. 

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

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

21 health care service’ means a health care service 

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


jbell on DSKDVH8Z91PROD with BILLS
113 

•S 1790 RS

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

2 health care service’ includes any service relating 

3 to— 

4 ‘‘(i) dialysis; 

5 ‘‘(ii) surgery; 

6 ‘‘(iii) mammography; 

7 ‘‘(iv) dentistry; or 

8 ‘‘(v) any other specialty health care 

9 service. 

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

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

13 mobile health station projects. 

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

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

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

19 be served; 

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

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

24 to be served; and 


jbell on DSKDVH8Z91PROD with BILLS
114 

•S 1790 RS

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

2 may require. 

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

4 amounts made available to carry out the demonstration 

5 program under this section— 

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

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

12 necessary for the Indian population served; 

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

14 (regardless of whether the mobile health station is 

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

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

19 equipment for a mobile health station, including the 

20 establishment or maintenance of such equipment at 

21 a modular component health care facility (as defined 

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

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

24 on which the demonstration program is established under 

25 subsection (b) and annually thereafter, the Secretary, actVerDate Nov 24 2008 23:56 Dec 16, 2009 Jkt 089200 PO 00000 Frm 00114 Fmt 6652 Sfmt 6201 E:\BILLS\S1790.RS S1790

jbell on DSKDVH8Z91PROD with BILLS
115 

•S 1790 RS

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

2 describing— 

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

5 success of the activity; and 

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

7 mobile health stations to provide specialty health 

8 care services for Indian communities. 

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

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

11 carry out the demonstration program under this section 

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

14 Subtitle D—Access to Health 

15 Services 

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

18 Section 401 of the Indian Health Care Improvement 

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

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

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

23 CHIP PAYMENTS IN DETERMINING APPROPRIATIONS.— 

24 Any payments received by an Indian health program or 

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


jbell on DSKDVH8Z91PROD with BILLS
116 

•S 1790 RS

1 or XXI of the Social Security Act for services provided 

2 to Indians eligible for benefits under such respective titles 

3 shall not be considered in determining appropriations for 

4 the provision of health care and services to Indians. 

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

6 this Act authorizes the Secretary to provide services to an 

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

8 Social Security Act in preference to an Indian without 

9 such coverage. 

10 ‘‘(c) USE OF FUNDS.— 

11 ‘‘(1) SPECIAL FUND.— 

12 ‘‘(A) 100 PERCENT PASS-THROUGH OF

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

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

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

19 held by the Secretary. In making payments 

20 from such fund, the Secretary shall ensure that 

21 each Service unit of the Service receives 100 

22 percent of the amount to which the facilities of 

23 the Service, for which such Service unit makes 

24 collections, are entitled by reason of a provision 

25 of either such title. 


jbell on DSKDVH8Z91PROD with BILLS
117 

•S 1790 RS

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

2 by a facility of the Service under subparagraph 

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

4 XIX of the Social Security Act shall first be 

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

6 provided in appropriation Acts) for the purpose 

7 of making any improvements in the programs 

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

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

12 Any amounts so received that are in excess of 

13 the amount necessary to achieve or maintain 

14 such conditions and requirements shall, subject 

15 to consultation with the Indian tribes being 

16 served by the Service unit, be used for reducing 

17 the health resource deficiencies (as determined 

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

20 205. 

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

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

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

24 receive payments directly. No payment may be made 

25 out of the special fund described in such paragraph 


jbell on DSKDVH8Z91PROD with BILLS
118 

•S 1790 RS

1 with respect to reimbursement made for services 

2 provided by such program during the period of such 

3 election. 

4 ‘‘(d) DIRECT BILLING.— 

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

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

7 program may elect to directly bill for, and receive 

8 payment for, health care items and services provided 

9 by such program for which payment is made under 

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

11 or from any other third party payor. 

12 ‘‘(2) DIRECT REIMBURSEMENT.— 

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

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

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

18 services furnished without regard to subsection 

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

20 shall be used by the tribal health program for 

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

23 necessary to achieve or maintain compliance 

24 with the conditions and requirements applicable 

25 generally to such items and services under the 


jbell on DSKDVH8Z91PROD with BILLS
119 

•S 1790 RS

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

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

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

8 that would otherwise be provided as a contract 

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

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

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

16 requirements applicable to the program under 

17 such title, as well as all auditing requirements 

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

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

22 amounts paid under title XVIII, XIX, or XXI 

23 of the Social Security Act. 

24 ‘‘(C) IDENTIFICATION OF SOURCE OF PAY25 MENTS.—Any tribal health program that reVerDate Nov 24 2008 23:56 Dec 16, 2009 Jkt 089200 PO 00000 Frm 00119 Fmt 6652 Sfmt 6201 E:\BILLS\S1790.RS S1790

jbell on DSKDVH8Z91PROD with BILLS
120 

•S 1790 RS

1 ceives reimbursements or payments under title 

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

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

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

7 ‘‘(3) EXAMINATION AND IMPLEMENTATION OF

8 CHANGES.— 

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

10 through the Service and with the assistance of 

11 the Administrator of the Centers for Medicare 

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

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

18 necessary to provide for direct billing under a 

19 program under title XIX or XXI of the Social 

20 Security Act. 

21 ‘‘(B) COORDINATION OF INFORMATION.— 

22 The Service shall provide the Administrator of 

23 the Centers for Medicare & Medicaid Services 

24 with copies of the lists submitted to the Service 

25 under paragraph (2)(C), enrollment data reVerDate Nov 24 2008 23:56 Dec 16, 2009 Jkt 089200 PO 00000 Frm 00120 Fmt 6652 Sfmt 6201 E:\BILLS\S1790.RS S1790

jbell on DSKDVH8Z91PROD with BILLS
121 

•S 1790 RS

1 garding patients served by the Service (and by 

2 tribal health programs, to the extent such data 

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

5 purposes of administering title XVIII, XIX, or 

6 XXI of the Social Security Act. 

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

8 health program that bills directly under the program 

9 established under this subsection may withdraw 

10 from participation in the same manner and under 

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

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

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

16 authority under the program established under this 

17 subsection shall be returned to the Secretary upon 

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

20 ‘‘(5) TERMINATION FOR FAILURE TO COMPLY

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

23 in the direct billing program established under this 

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


jbell on DSKDVH8Z91PROD with BILLS
122 

•S 1790 RS

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

2 health program with notice of a determination that 

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

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

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

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

11 the Social Security Act.’’. 

12 SEC. 152. PURCHASING HEALTH CARE COVERAGE. 

13 Section 402 of the Indian Health Care Improvement 

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

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

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

17 available under law (including a provision of the Social 

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

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

21 organizations, and urban Indian organizations for health 

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

24 amounts to purchase health benefits coverage (including 

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


jbell on DSKDVH8Z91PROD with BILLS
123 

•S 1790 RS

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

2 service delivery area that would otherwise be provided as 

3 a contract health service) for such beneficiaries in any 

4 manner, including through— 

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

6 plan; 

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

8 health care plan; 

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

10 care organization; 

11 ‘‘(4) a self-insured plan; or 

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

13 plan. 

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

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

17 financial needs of such beneficiaries (as determined by the 

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

19 of income levels developed or implemented by such 1 ore 

20 more Indian tribes). 

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

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

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

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


jbell on DSKDVH8Z91PROD with BILLS
124 

•S 1790 RS

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

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

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

5 INDIAN TRIBES, TRIBAL ORGANIZATIONS, 

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

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

10 OTHER HEALTH BENEFITS PROGRAMS. 

11 Section 404 of the Indian Health Care Improvement 

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

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

16 TO FACILITATE OUTREACH, ENROLLMENT, 

17 AND COVERAGE OF INDIANS UNDER SOCIAL 

18 SECURITY ACT HEALTH BENEFIT PROGRAMS 

19 AND OTHER HEALTH BENEFITS PROGRAMS. 

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

22 make grants to or enter into contracts with Indian tribes 

23 and tribal organizations to assist such tribes and tribal 

24 organizations in establishing and administering programs 

25 on or near reservations and trust lands, including proVerDate Nov 24 2008 23:56 Dec 16, 2009 Jkt 089200 PO 00000 Frm 00124 Fmt 6652 Sfmt 6201 E:\BILLS\S1790.RS S1790

jbell on DSKDVH8Z91PROD with BILLS
125 

•S 1790 RS

1 grams to provide outreach and enrollment through video, 

2 electronic delivery methods, or telecommunication devices 

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

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

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

11 the charging of premiums and cost sharing is not 

12 prohibited under such programs, to pay premiums or 

13 cost sharing for coverage for such benefits, which 

14 may be based on financial need (as determined by 

15 the Indian tribe or tribes or tribal organizations 

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

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

20 the Service, shall place conditions as deemed necessary to 

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

22 which the Secretary makes with any Indian tribe or tribal 

23 organization pursuant to this section. Such conditions 

24 shall include requirements that the Indian tribe or tribal 

25 organization successfully undertake— 


jbell on DSKDVH8Z91PROD with BILLS
126 

•S 1790 RS

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

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

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

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

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

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

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

17 the same manner they apply to grants and contracts 

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

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

22 under paragraph (1) requirements that are— 

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


jbell on DSKDVH8Z91PROD with BILLS
127 

•S 1790 RS

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

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

4 this section. 

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

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

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

11 provision of health care items and services to Indians 

12 under the programs established under title XVIII, XIX, 

13 or XXI of the Social Security Act. 

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

16 HEALTH BENEFITS PROGRAMS.—For provisions relating 

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

20 and children’s health insurance programs established 

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

22 benefits under the Medicare program established under 

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


jbell on DSKDVH8Z91PROD with BILLS
128 

•S 1790 RS

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

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

4 any enrollment fee or similar charge. 

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

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

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

10 Section 405 of the Indian Health Care Improvement 

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

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

14 ‘‘(a) AUTHORITY.— 

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

16 into (or expand) arrangements for the sharing of 

17 medical facilities and services between the Service, 

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

20 Defense. 

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

24 described in paragraph (1) without first consulting 


jbell on DSKDVH8Z91PROD with BILLS
129 

•S 1790 RS

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

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

4 any action under this section or under subchapter IV of 

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

6 impair— 

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

8 care services provided through the Service and the 

9 eligibility of any Indian to receive health services 

10 through the Service; 

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

12 to any Indian through the Service; 

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

14 care services provided by the Department of Vet15 erans Affairs; 

16 ‘‘(4) the quality of health care services provided 

17 by the Department of Veterans Affairs or the De18 partment of Defense; or 

19 ‘‘(5) the eligibility of any Indian who is a vet20 eran to receive health services through the Depart21 ment of Veterans Affairs. 

22 ‘‘(c) REIMBURSEMENT.—The Service, Indian tribe, 

23 or tribal organization shall be reimbursed by the Depart24 ment of Veterans Affairs or the Department of Defense 

25 (as the case may be) where services are provided through 


jbell on DSKDVH8Z91PROD with BILLS
130 

•S 1790 RS

1 the Service, an Indian tribe, or a tribal organization to 

2 beneficiaries eligible for services from either such Depart3 ment, notwithstanding any other provision of law. 

4 ‘‘(d) CONSTRUCTION.—Nothing in this section may 

5 be construed as creating any right of a non-Indian veteran 

6 to obtain health services from the Service.’’. 

7 SEC. 155. ELIGIBLE INDIAN VETERAN SERVICES. 

8 Title IV of the Indian Health Care Improvement Act 

9 (25 U.S.C. 1641 et seq.) (as amended by section 101(b)) 

10 is amended by adding at the end the following: 

11 ‘‘SEC. 407. ELIGIBLE INDIAN VETERAN SERVICES. 

12 ‘‘(a) FINDINGS; PURPOSE.— 

13 ‘‘(1) FINDINGS.—Congress finds that— 

14 ‘‘(A) collaborations between the Secretary 

15 and the Secretary of Veterans Affairs regarding 

16 the treatment of Indian veterans at facilities of 

17 the Service should be encouraged to the max18 imum extent practicable; and 

19 ‘‘(B) increased enrollment for services of 

20 the Department of Veterans Affairs by veterans 

21 who are members of Indian tribes should be en22 couraged to the maximum extent practicable. 

23 ‘‘(2) PURPOSE.—The purpose of this section is 

24 to reaffirm the goals stated in the document entitled 

25 ‘Memorandum of Understanding Between the VA/ 


jbell on DSKDVH8Z91PROD with BILLS
131 

•S 1790 RS

1 Veterans Health Administration And HHS/Indian 

2 Health Service’ and dated February 25, 2003 (relat3 ing to cooperation and resource sharing between the 

4 Veterans Health Administration and Service). 

5 ‘‘(b) DEFINITIONS.—In this section: 

6 ‘‘(1) ELIGIBLE INDIAN VETERAN.—The term 

7 ‘eligible Indian veteran’ means an Indian or Alaska 

8 Native veteran who receives any medical service that 

9 is— 

10 ‘‘(A) authorized under the laws adminis11 tered by the Secretary of Veterans Affairs; and 

12 ‘‘(B) administered at a facility of the Serv13 ice (including a facility operated by an Indian 

14 tribe or tribal organization through a contract 

15 or compact with the Service under the Indian 

16 Self-Determination and Education Assistance 

17 Act (25 U.S.C. 450 et seq.)) pursuant to a local 

18 memorandum of understanding. 

19 ‘‘(2) LOCAL MEMORANDUM OF UNDER20 STANDING.—The term ‘local memorandum of under21 standing’ means a memorandum of understanding 

22 between the Secretary (or a designee, including the 

23 director of any area office of the Service) and the 

24 Secretary of Veterans Affairs (or a designee) to im25 plement the document entitled ‘Memorandum of UnVerDate Nov 24 2008 23:56 Dec 16, 2009 Jkt 089200 PO 00000 Frm 00131 Fmt 6652 Sfmt 6201 E:\BILLS\S1790.RS S1790

jbell on DSKDVH8Z91PROD with BILLS
132 

•S 1790 RS

1 derstanding Between the VA/Veterans Health Ad2 ministration And HHS/Indian Health Service’ and 

3 dated February 25, 2003 (relating to cooperation 

4 and resource sharing between the Veterans Health 

5 Administration and Indian Health Service). 

6 ‘‘(c) ELIGIBLE INDIAN VETERANS EXPENSES.— 

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

8 provision of law, the Secretary shall provide for vet9 eran-related expenses incurred by eligible Indian vet10 erans as described in subsection (b)(1)(B). 

11 ‘‘(2) METHOD OF PAYMENT.—The Secretary 

12 shall establish such guidelines as the Secretary de13 termines to be appropriate regarding the method of 

14 payments to the Secretary of Veterans Affairs under 

15 paragraph (1). 

16 ‘‘(d) TRIBAL APPROVAL OF MEMORANDA.—In nego17 tiating a local memorandum of understanding with the 

18 Secretary of Veterans Affairs regarding the provision of 

19 services to eligible Indian veterans, the Secretary shall 

20 consult with each Indian tribe that would be affected by 

21 the local memorandum of understanding. 

22 ‘‘(e) FUNDING.— 

23 ‘‘(1) TREATMENT.—Expenses incurred by the 

24 Secretary in carrying out subsection (c)(1) shall not 


jbell on DSKDVH8Z91PROD with BILLS
133 

•S 1790 RS

1 be considered to be Contract Health Service ex2 penses. 

3 ‘‘(2) USE OF FUNDS.—Of funds made available 

4 to the Secretary in appropriations Acts for the Serv5 ice (excluding funds made available for facilities, 

6 Contract Health Services, or contract support costs), 

7 the Secretary shall use such sums as are necessary 

8 to carry out this section.’’. 

9 SEC. 156. NONDISCRIMINATION UNDER FEDERAL HEALTH 

10 CARE PROGRAMS IN QUALIFICATIONS FOR 

11 REIMBURSEMENT FOR SERVICES. 

12 Title IV of the Indian Health Care Improvement Act 

13 (25 U.S.C. 1641 et seq.) (as amended by section 155) is 

14 amended by adding at the end the following: 

15 ‘‘SEC. 408. NONDISCRIMINATION UNDER FEDERAL HEALTH 

16 CARE PROGRAMS IN QUALIFICATIONS FOR 

17 REIMBURSEMENT FOR SERVICES. 

18 ‘‘(a) REQUIREMENT TO SATISFY GENERALLY APPLI19 CABLE PARTICIPATION REQUIREMENTS.— 

20 ‘‘(1) IN GENERAL.—A Federal health care pro21 gram must accept an entity that is operated by the 

22 Service, an Indian tribe, tribal organization, or 

23 urban Indian organization as a provider eligible to 

24 receive payment under the program for health care 

25 services furnished to an Indian on the same basis as 


jbell on DSKDVH8Z91PROD with BILLS
134 

•S 1790 RS

1 any other provider qualified to participate as a pro2 vider of health care services under the program if 

3 the entity meets generally applicable State or other 

4 requirements for participation as a provider of 

5 health care services under the program. 

6 ‘‘(2) SATISFACTION OF STATE OR LOCAL LICEN7 SURE OR RECOGNITION REQUIREMENTS.—Any re8 quirement for participation as a provider of health 

9 care services under a Federal health care program 

10 that an entity be licensed or recognized under the 

11 State or local law where the entity is located to fur12 nish health care services shall be deemed to have 

13 been met in the case of an entity operated by the 

14 Service, an Indian tribe, tribal organization, or 

15 urban Indian organization if the entity meets all the 

16 applicable standards for such licensure or recogni17 tion, regardless of whether the entity obtains a li18 cense or other documentation under such State or 

19 local law. In accordance with section 221, the ab20 sence of the licensure of a health professional em21 ployed by such an entity under the State or local law 

22 where the entity is located shall not be taken into 

23 account for purposes of determining whether the en24 tity meets such standards, if the professional is li25 censed in another State. 


jbell on DSKDVH8Z91PROD with BILLS
135 

•S 1790 RS

1 ‘‘(b) APPLICATION OF EXCLUSION FROM PARTICIPA2 TION IN FEDERAL HEALTH CARE PROGRAMS.— 

3 ‘‘(1) EXCLUDED ENTITIES.—No entity operated 

4 by the Service, an Indian tribe, tribal organization, 

5 or urban Indian organization that has been excluded 

6 from participation in any Federal health care pro7 gram or for which a license is under suspension or 

8 has been revoked by the State where the entity is lo9 cated shall be eligible to receive payment or reim10 bursement under any such program for health care 

11 services furnished to an Indian. 

12 ‘‘(2) EXCLUDED INDIVIDUALS.—No individual 

13 who has been excluded from participation in any 

14 Federal health care program or whose State license 

15 is under suspension shall be eligible to receive pay16 ment or reimbursement under any such program for 

17 health care services furnished by that individual, di18 rectly or through an entity that is otherwise eligible 

19 to receive payment for health care services, to an In20 dian. 

21 ‘‘(3) FEDERAL HEALTH CARE PROGRAM DE22 FINED.—In this subsection, the term, ‘Federal 

23 health care program’ has the meaning given that 

24 term in section 1128B(f) of the Social Security Act 

25 (42 U.S.C. 1320a–7b(f)), except that, for purposes 


jbell on DSKDVH8Z91PROD with BILLS
136 

•S 1790 RS

1 of this subsection, such term shall include the health 

2 insurance program under chapter 89 of title 5, 

3 United States Code. 

4 ‘‘(c) RELATED PROVISIONS.—For provisions related 

5 to nondiscrimination against providers operated by the 

6 Service, an Indian tribe, tribal organization, or urban In7 dian organization, see section 1139(c) of the Social Secu8 rity Act (42 U.S.C. 1320b–9(c)).’’. 

9 SEC. 157. ACCESS TO FEDERAL INSURANCE. 

10 Title IV of the Indian Health Care Improvement Act 

11 (25 U.S.C. 1641 et seq.) (as amended by section 156) is 

12 amended by adding at the end the following: 

13 ‘‘SEC. 409. ACCESS TO FEDERAL INSURANCE. 

14 ‘‘Notwithstanding the provisions of title 5, United 

15 States Code, Executive order, or administrative regula16 tion, an Indian tribe or tribal organization carrying out 

17 programs under the Indian Self-Determination and Edu18 cation Assistance Act (25 U.S.C. 450 et seq.) or an urban 

19 Indian organization carrying out programs under title V 

20 of this Act shall be entitled to purchase coverage, rights, 

21 and benefits for the employees of such Indian tribe or trib22 al organization, or urban Indian organization, under chap23 ter 89 of title 5, United States Code, and chapter 87 of 

24 such title if necessary employee deductions and agency 

25 contributions in payment for the coverage, rights, and benVerDate Nov 24 2008 23:56 Dec 16, 2009 Jkt 089200 PO 00000 Frm 00136 Fmt 6652 Sfmt 6201 E:\BILLS\S1790.RS S1790

jbell on DSKDVH8Z91PROD with BILLS
137 

•S 1790 RS

1 efits for the period of employment with such Indian tribe 

2 or tribal organization, or urban Indian organization, are 

3 currently deposited in the applicable Employee’s Fund 

4 under such title.’’. 

5 SEC. 158. GENERAL EXCEPTIONS. 

6 Title IV of the Indian Health Care Improvement Act 

7 (25 U.S.C. 1641 et seq.) (as amended by section 157) is 

8 amended by adding at the end the following: 

9 ‘‘SEC. 410. GENERAL EXCEPTIONS. 

10 ‘‘The requirements of this title shall not apply to any 

11 excepted benefits described in paragraph (1)(A) or (3) of 

12 section 2791(c) of the Public Health Service Act (42 

13 U.S.C. 300gg–91).’’. 

14 SEC. 159. NAVAJO NATION MEDICAID AGENCY FEASIBILITY 

15 STUDY. 

16 Title IV of the Indian Health Care Improvement Act 

17 (25 U.S.C. 1641 et seq.) (as amended by section 158) is 

18 amended by adding at the end the following: 

19 ‘‘SEC. 411. NAVAJO NATION MEDICAID AGENCY FEASIBILITY 

20 STUDY. 

21 ‘‘(a) STUDY.—The Secretary shall conduct a study to 

22 determine the feasibility of treating the Navajo Nation as 

23 a State for the purposes of title XIX of the Social Security 

24 Act, to provide services to Indians living within the bound25 aries of the Navajo Nation through an entity established 


jbell on DSKDVH8Z91PROD with BILLS
138 

•S 1790 RS

1 having the same authority and performing the same func2 tions as single-State medicaid agencies responsible for the 

3 administration of the State plan under title XIX of the So4 cial Security Act. 

5 ‘‘(b) CONSIDERATIONS.—In conducting the study, the 

6 Secretary shall consider the feasibility of— 

7 ‘‘(1) assigning and paying all expenditures for 

8 the provision of services and related administration 

9 funds, under title XIX of the Social Security Act, to 

10 Indians living within the boundaries of the Navajo 

11 Nation that are currently paid to or would otherwise 

12 be paid to the State of Arizona, New Mexico, or Utah; 

13 ‘‘(2) providing assistance to the Navajo Nation 

14 in the development and implementation of such entity 

15 for the administration, eligibility, payment, and de16 livery of medical assistance under title XIX of the So17 cial Security Act; 

18 ‘‘(3) providing an appropriate level of matching 

19 funds for Federal medical assistance with respect to 

20 amounts such entity expends for medical assistance 

21 for services and related administrative costs; and 

22 ‘‘(4) authorizing the Secretary, at the option of 

23 the Navajo Nation, to treat the Navajo Nation as a 

24 State for the purposes of title XIX of the Social Secu25 rity Act (relating to the State children’s health insurVerDate Nov 24 2008 23:56 Dec 16, 2009 Jkt 089200 PO 00000 Frm 00138 Fmt 6652 Sfmt 6203 E:\BILLS\S1790.RS S1790

jbell on DSKDVH8Z91PROD with BILLS
139 

•S 1790 RS

1 ance program) under terms equivalent to those de2 scribed in paragraphs (2) through (4). 

3 ‘‘(c) REPORT.—Not later then 3 years after the date 

4 of enactment of the Indian Health Care Improvement Reau5 thorization and Extension Act of 2009, the Secretary shall 

6 submit to the Committee on Indian Affairs and Committee 

7 on Finance of the Senate and the Committee on Natural 

8 Resources and Committee on Energy and Commerce of the 

9 House of Representatives a report that includes— 

10 ‘‘(1) the results of the study under this section; 

11 ‘‘(2) a summary of any consultation that oc12 curred between the Secretary and the Navajo Nation, 

13 other Indian Tribes, the States of Arizona, New Mex14 ico, and Utah, counties which include Navajo Lands, 

15 and other interested parties, in conducting this study; 

16 ‘‘(3) projected costs or savings associated with es17 tablishment of such entity, and any estimated impact 

18 on services provided as described in this section in re19 lation to probable costs or savings; and 

20 ‘‘(4) legislative actions that would be required to 

21 authorize the establishment of such entity if such enti22 ty is determined by the Secretary to be feasible.’’. 


jbell on DSKDVH8Z91PROD with BILLS
140 

•S 1790 RS

1 Subtitle E—Health Services for 

2 Urban Indians 

3 SEC. 161. FACILITIES RENOVATION. 

4 Section 509 of the Indian Health Care Improvement 

5 Act (25 U.S.C. 1659) is amended by inserting ‘‘or construc6 tion or expansion of facilities’’ after ‘‘renovations to facili7 ties’’. 

8 SEC. 162. TREATMENT OF CERTAIN DEMONSTRATION 

9 PROJECTS. 

10 Section 512 of the Indian Health Care Improvement 

11 Act (25 U.S.C. 1660b) is amended to read as follows: 

12 ‘‘SEC. 512. TREATMENT OF CERTAIN DEMONSTRATION 

13 PROJECTS. 

14 ‘‘Notwithstanding any other provision of law, the 

15 Tulsa Clinic and Oklahoma City Clinic demonstration 

16 projects shall— 

17 ‘‘(1) be permanent programs within the Service’s 

18 direct care program; 

19 ‘‘(2) continue to be treated as Service units and 

20 operating units in the allocation of resources and co21 ordination of care; and 

22 ‘‘(3) continue to meet the requirements and defi23 nitions of an urban Indian organization in this Act, 

24 and shall not be subject to the provisions of the InVerDate Nov 24 2008 23:56 Dec 16, 2009 Jkt 089200 PO 00000 Frm 00140 Fmt 6652 Sfmt 6203 E:\BILLS\S1790.RS S1790

jbell on DSKDVH8Z91PROD with BILLS
141 

•S 1790 RS

1 dian Self-Determination and Education Assistance 

2 Act (25 U.S.C. 450 et seq.).’’. 

3 SEC. 161163. REQUIREMENT TO CONFER WITH URBAN IN4 DIAN ORGANIZATIONS. 

5 (a) CONFERRING WITH URBAN INDIAN ORGANIZA6 TIONS.—Title V of the Indian Health Care Improvement 

7 Act (25 U.S.C. 1651 et seq.) (as amended by section 

8 101(b)) is amended by adding at the end the following: 

9 ‘‘SEC. 514. CONFERRING WITH URBAN INDIAN ORGANIZA10 TIONS. 

11 ‘‘(a) DEFINITION OF CONFER.—In this section, the 

12 term ‘confer’ means to engage in an open and free ex13 change of information and opinions that— 

14 ‘‘(1) leads to mutual understanding and com15 prehension; and 

16 ‘‘(2) emphasizes trust, respect, and shared re17 sponsibility. 

18 ‘‘(b) REQUIREMENT.—The Secretary shall ensure 

19 that the Service confers, to the maximum extent prac20 ticable, with urban Indian organizations in carrying out 

21 this Act.’’. 

22 (b) CONTRACTS WITH, AND GRANTS TO, URBAN IN23 DIAN ORGANIZATIONS.—Section 502 of the Indian Health 

24 Care Improvement Act (25 U.S.C. 1652) is amended to 

25 read as follows: 


jbell on DSKDVH8Z91PROD with BILLS
142 

•S 1790 RS

1 ‘‘SEC. 502. CONTRACTS WITH, AND GRANTS TO, URBAN IN2 DIAN ORGANIZATIONS. 

3 ‘‘(a) IN GENERAL.—Pursuant to the Act of Novem4 ber 2, 1921 (25 U.S.C. 13) (commonly known as the ‘Sny5 der Act’), the Secretary, acting through the Service, shall 

6 enter into contracts with, or make grants to, urban Indian 

7 organizations to assist the urban Indian organizations in 

8 the establishment and administration, within urban cen9 ters, of programs that meet the requirements of this title. 

10 ‘‘(b) CONDITIONS.—Subject to section 506, the Sec11 retary, acting through the Service, shall include such con12 ditions as the Secretary considers necessary to effect the 

13 purpose of this title in any contract into which the Sec14 retary enters with, or in any grant the Secretary makes 

15 to, any urban Indian organization pursuant to this title.’’. 

16 SEC. 162164. EXPANDED PROGRAM AUTHORITY FOR URBAN 

17 INDIAN ORGANIZATIONS. 

18 Title V of the Indian Health Care Improvement Act 

19 (25 U.S.C. 1651 et seq.) (as amended by section 163(a)) 

20 is amended by adding at the end the following: 

21 ‘‘SEC. 515. EXPANDED PROGRAM AUTHORITY FOR URBAN 

22 INDIAN ORGANIZATIONS. 

23 ‘‘Notwithstanding any other provision of this Act, the 

24 Secretary, acting through the Service, is authorized to es25 tablish programs, including programs for awarding grants, 

26 for urban Indian organizations that are identical to any 


jbell on DSKDVH8Z91PROD with BILLS
143 

•S 1790 RS

1 programs established pursuant to sections 218, 702, and 

2 708(g).’’. 

3 SEC. 163165. COMMUNITY HEALTH REPRESENTATIVES. 

4 Title V of the Indian Health Care Improvement Act 

5 (25 U.S.C. 1651 et seq.) (as amended by section 164) is 

6 amended by adding at the end the following: 

7 ‘‘SEC. 516. COMMUNITY HEALTH REPRESENTATIVES. 

8 ‘‘The Secretary, acting through the Service, may 

9 enter into contracts with, and make grants to, urban In10 dian organizations for the employment of Indians trained 

11 as health service providers through the Community Health 

12 Representative Program under section 107 in the provi13 sion of health care, health promotion, and disease preven14 tion services to urban Indians.’’. 

15 SEC. 166. USE OF FEDERAL GOVERNMENT FACILITIES AND 

16 SOURCES OF SUPPLY; HEALTH INFORMATION 

17 TECHNOLOGY. 

18 Title V of the Indian Health Care Improvement Act 

19 (25 U.S.C. 1651 et seq.) (as amended by section 165) is 

20 amended by adding at the end the following: 

21 ‘‘SEC. 517. USE OF FEDERAL GOVERNMENT FACILITIES AND 

22 SOURCES OF SUPPLY. 

23 ‘‘(a) IN GENERAL.—The Secretary may permit an 

24 urban Indian organization that has entered into a contract 

25 or received a grant pursuant to this title, in carrying out 


jbell on DSKDVH8Z91PROD with BILLS
144 

•S 1790 RS

1 the contract or grant, to use, in accordance with such terms 

2 and conditions for use and maintenance as are agreed on 

3 by the Secretary and the urban Indian organizations— 

4 ‘‘(1) any existing facility under the jurisdiction 

5 of the Secretary; 

6 ‘‘(2) all equipment contained in or pertaining to 

7 such an existing facility; and 

8 ‘‘(3) any other personal property of the Federal 

9 Government under the jurisdiction of the Secretary. 

10 ‘‘(b) DONATIONS.—Subject to subsection (d), the Sec11 retary may donate to an urban Indian organization that 

12 has entered into a contract or received a grant pursuant 

13 to this title any personal or real property determined to 

14 be excess to the needs of the Service or the General Services 

15 Administration for the purposes of carrying out the con16 tract or grant. 

17 ‘‘(c) ACQUISITION OF PROPERTY.—The Secretary may 

18 acquire excess or surplus personal or real property of the 

19 Federal Government for donation, subject to subsection (d), 

20 to an urban Indian organization that has entered into a 

21 contract or received a grant pursuant to this title if the 

22 Secretary determines that the property is appropriate for 

23 use by the urban Indian organization for purposes of the 

24 contract or grant. 


jbell on DSKDVH8Z91PROD with BILLS
145 

•S 1790 RS

1 ‘‘(d) PRIORITY.—If the Secretary receives from an 

2 urban Indian organization or an Indian tribe or tribal or3 ganization a request for a specific item of personal or real 

4 property described in subsection (b) or (c), the Secretary 

5 shall give priority to the request for donation to the Indian 

6 tribe or tribal organization, if the Secretary receives the re7 quest from the Indian tribe or tribal organization before 

8 the earlier of— 

9 ‘‘(1) the date on which the Secretary transfers 

10 title to the property to the urban Indian organiza11 tion; and 

12 ‘‘(2) the date on which the Secretary transfers 

13 the property physically to the urban Indian organiza14 tion. 

15 ‘‘(e) EXECUTIVE AGENCY STATUS.—For purposes of 

16 section 501(a) of title 40, United States Code, an urban 

17 Indian organization that has entered into a contract or re18 ceived a grant pursuant to this title may be considered to 

19 be an Executive agency in carrying out the contract or 

20 grant. 

21 ‘‘SEC. 518. HEALTH INFORMATION TECHNOLOGY. 

22 ‘‘The Secretary, acting through the Service, may make 

23 grants to urban Indian organizations under this title for 

24 the development, adoption, and implementation of health 

25 information technology (as defined in section 3000 of the 


jbell on DSKDVH8Z91PROD with BILLS
146 

•S 1790 RS

1 Public Health Service Act (42 U.S.C. 300jj)), telemedicine 

2 services development, and related infrastructure.’’. 

3 Subtitle F—Organizational 

4 Improvements 

5 SEC. 171. ESTABLISHMENT OF THE INDIAN HEALTH SERV6 ICE AS AN AGENCY OF THE PUBLIC HEALTH 

7 SERVICE. 

8 Section 601 of the Indian Health Care Improvement 

9 Act (25 U.S.C. 1661) is amended to read as follows: 

10 ‘‘SEC. 601. ESTABLISHMENT OF THE INDIAN HEALTH SERV11 ICE AS AN AGENCY OF THE PUBLIC HEALTH 

12 SERVICE. 

13 ‘‘(a) ESTABLISHMENT.— 

14 ‘‘(1) IN GENERAL.—In order to more effectively 

15 and efficiently carry out the responsibilities, authori16 ties, and functions of the United States to provide 

17 health care services to Indians and Indian tribes, as 

18 are or may be hereafter provided by Federal statute 

19 or treaties, there is established within the Public 

20 Health Service of the Department the Indian Health 

21 Service. 

22 ‘‘(2) DIRECTOR.—The Service shall be adminis23 tered by a Director, who shall be appointed by the 

24 President, by and with the advice and consent of the 

25 Senate. The Director shall report to the Secretary. 


jbell on DSKDVH8Z91PROD with BILLS
147 

•S 1790 RS

1 Effective with respect to an individual appointed by 

2 the President, by and with the advice and consent 

3 of the Senate, after January 1, 2008, the term of 

4 service of the Director shall be 4 years. A Director 

5 may serve more than 1 term. 

6 ‘‘(3) INCUMBENT.—The individual serving in 

7 the position of Director of the Service on the day be8 fore the date of enactment of the Indian Health 

9 Care Improvement Reauthorization and Extension 

10 Act of 2009 shall serve as Director. 

11 ‘‘(4) ADVOCACY AND CONSULTATION.—The po12 sition of Director is established to, in a manner con13 sistent with the government-to-government relation14 ship between the United States and Indian Tribes— 

15 ‘‘(A) facilitate advocacy for the develop16 ment of appropriate Indian health policy; and 

17 ‘‘(B) promote consultation on matters re18 lating to Indian health. 

19 ‘‘(b) AGENCY.—The Service shall be an agency within 

20 the Public Health Service of the Department, and shall 

21 not be an office, component, or unit of any other agency 

22 of the Department. 

23 ‘‘(c) DUTIES.—The Director shall— 

24 ‘‘(1) perform all functions that were, on the day 

25 before the date of enactment of the Indian Health 


jbell on DSKDVH8Z91PROD with BILLS
148 

•S 1790 RS

1 Care Improvement Reauthorization and Extension 

2 Act of 2009, carried out by or under the direction 

3 of the individual serving as Director of the Service 

4 on that day; 

5 ‘‘(2) perform all functions of the Secretary re6 lating to the maintenance and operation of hospital 

7 and health facilities for Indians and the planning 

8 for, and provision and utilization of, health services 

9 for Indians, including by ensuring that all agency di10 rectors, managers, and chief executive officers have 

11 appropriate and adequate training, experience, skill 

12 levels, knowledge, abilities, and education (including 

13 continuing training requirements) to competently ful14 fill the duties of the positions and the mission of the 

15 Service; 

16 ‘‘(3) administer all health programs under 

17 which health care is provided to Indians based upon 

18 their status as Indians which are administered by 

19 the Secretary, including programs under— 

20 ‘‘(A) this Act; 

21 ‘‘(B) the Act of November 2, 1921 (25 

22 U.S.C. 13); 

23 ‘‘(C) the Act of August 5, 1954 (42 U.S.C. 

24 2001 et seq.); 


jbell on DSKDVH8Z91PROD with BILLS
149 

•S 1790 RS

1 ‘‘(D) the Act of August 16, 1957 (42 

2 U.S.C. 2005 et seq.); and 

3 ‘‘(E) the Indian Self-Determination and 

4 Education Assistance Act (25 U.S.C. 450 et 

5 seq.); 

6 ‘‘(4) administer all scholarship and loan func7 tions carried out under title I; 

8 ‘‘(5) directly advise the Secretary concerning 

9 the development of all policy- and budget-related 

10 matters affecting Indian health; 

11 ‘‘(6) collaborate with the Assistant Secretary 

12 for Health concerning appropriate matters of Indian 

13 health that affect the agencies of the Public Health 

14 Service; 

15 ‘‘(7) advise each Assistant Secretary of the De16 partment concerning matters of Indian health with 

17 respect to which that Assistant Secretary has au18 thority and responsibility; 

19 ‘‘(8) advise the heads of other agencies and pro20 grams of the Department concerning matters of In21 dian health with respect to which those heads have 

22 authority and responsibility; 

23 ‘‘(9) coordinate the activities of the Department 

24 concerning matters of Indian health; and 


jbell on DSKDVH8Z91PROD with BILLS
150 

•S 1790 RS

1 ‘‘(10) perform such other functions as the Sec2 retary may designate. 

3 ‘‘(d) AUTHORITY.— 

4 ‘‘(1) IN GENERAL.—The Secretary, acting 

5 through the Director, shall have the authority— 

6 ‘‘(A) except to the extent provided for in 

7 paragraph (2), to appoint and compensate em8 ployees for the Service in accordance with title 

9 5, United States Code; 

10 ‘‘(B) to enter into contracts for the pro11 curement of goods and services to carry out the 

12 functions of the Service; and 

13 ‘‘(C) to manage, expend, and obligate all 

14 funds appropriated for the Service. 

15 ‘‘(2) PERSONNEL ACTIONS.—Notwithstanding 

16 any other provision of law, the provisions of section 

17 12 of the Act of June 18, 1934 (48 Stat. 986; 25 

18 U.S.C. 472), shall apply to all personnel actions 

19 taken with respect to new positions created within 

20 the Service as a result of its establishment under 

21 subsection (a).’’. 

22 SEC. 172. OFFICE OF DIRECT SERVICE TRIBES. 

23 Title VI of the Indian Health Care Improvement Act 

24 (25 U.S.C. 1661 et seq.) (as amended by section 101(b)) 

25 is amended by adding at the end the following: 


jbell on DSKDVH8Z91PROD with BILLS
151 

•S 1790 RS

1 ‘‘SEC. 603. OFFICE OF DIRECT SERVICE TRIBES. 

2 ‘‘(a) ESTABLISHMENT.—There is established within 

3 the Service an office, to be known as the ‘Office of Direct 

4 Service Tribes’. 

5 ‘‘(b) TREATMENT.—The Office of Direct Service 

6 Tribes shall be located in the Office of the Director. 

7 ‘‘(c) DUTIES.—The Office of Direct Service Tribes 

8 shall be responsible for— 

9 ‘‘(1) providing Service-wide leadership, guidance 

10 and support for direct service tribes to include stra11 tegic planning and program evaluation; 

12 ‘‘(2) ensuring maximum flexibility to tribal 

13 health and related support systems for Indian bene14 ficiaries; 

15 ‘‘(3) serving as the focal point for consultation 

16 and participation between direct service tribes and 

17 organizations and the Service in the development of 

18 Service policy; 

19 ‘‘(4) holding no less than biannual consultations 

20 with direct service tribes in appropriate locations to 

21 gather information and aid in the development of 

22 health policy; and 

23 ‘‘(5) directing a national program and providing 

24 leadership and advocacy in the development of 

25 health policy, program management, budget formuVerDate Nov 24 2008 23:56 Dec 16, 2009 Jkt 089200 PO 00000 Frm 00151 Fmt 6652 Sfmt 6201 E:\BILLS\S1790.RS S1790

jbell on DSKDVH8Z91PROD with BILLS
152 

•S 1790 RS

1 lation, resource allocation, and delegation support 

2 for direct service tribes.’’. 

3 SEC. 173. NEVADA AREA OFFICE. 

4 Title VI of the Indian Health Care Improvement Act 

5 (25 U.S.C. 1661 et seq.) (as amended by section 172) is 

6 amended by adding at the end the following: 

7 ‘‘SEC. 604. NEVADA AREA OFFICE. 

8 ‘‘(a) IN GENERAL.—Not later than 1 year after the 

9 date of enactment of this section, the Secretary of Health 

10 and Human Services, in consultation with Indian tribes, 

11 tribal organizations, and urban Indian organizations in 

12 the State of Nevada, shall submit to Congress a plan ex13 plaining the manner and schedule by which a Nevada area 

14 office, separate and distinct from the Phoenix area office, 

15 can be established in Nevada. 

16 ‘‘(b) FAILURE TO SUBMIT A PLAN.—If the Secretary 

17 fails to submit a plan in accordance with this section, the 

18 Secretary shall withhold such operations funds reserved 

19 for the Phoenix Area Office of the Indian Health Service. 

20 Funds withheld pursuant to this subsection may, at the 

21 discretion of the Secretary, be restored to the Phoenix 

22 Area Office upon compliance with this section.’’. 

23 ‘‘SEC. 604. NEVADA AREA OFFICE. 

24 ‘‘(a) IN GENERAL.—Not later than 1 year after the 

25 date of enactment of this section, in a manner consistent 


jbell on DSKDVH8Z91PROD with BILLS
153 

•S 1790 RS

1 with the tribal consultation policy of the Service, the Sec2 retary shall submit to Congress a plan describing the man3 ner and schedule by which an area office, separate and dis4 tinct from the Phoenix Area Office of the Service, can be 

5 established in the State of Nevada. 

6 ‘‘(b) FAILURE TO SUBMIT PLAN.— 

7 ‘‘(1) DEFINITION OF OPERATIONS FUNDS.—In 

8 this subsection, the term ‘operations funds’ means 

9 only the funds used for— 

10 ‘‘(A) the administration of services, includ11 ing functional expenses such as overtime, per12 sonnel salaries, and associated benefits; or 

13 ‘‘(B) related tasks that directly affect the 

14 operations described in subparagraph (A). 

15 ‘‘(2) WITHHOLDING OF FUNDS.—If the Secretary 

16 fails to submit a plan in accordance with subsection 

17 (a), the Secretary shall withhold the operations funds 

18 reserved for the Office of the Director, subject to the 

19 condition that the withholding shall not adversely im20 pact the capacity of the Service to deliver health care 

21 services. 

22 ‘‘(3) RESTORATION.—The operations funds with23 held pursuant to paragraph (2) may be restored, at 

24 the discretion of the Secretary, to the Office of the DiVerDate Nov 24 2008 23:56 Dec 16, 2009 Jkt 089200 PO 00000 Frm 00153 Fmt 6652 Sfmt 6203 E:\BILLS\S1790.RS S1790

jbell on DSKDVH8Z91PROD with BILLS
154 

•S 1790 RS

1 rector on achievement by that Office of compliance 

2 with this section.’’. 

3 Subtitle G—Behavioral Health 

4 Programs 

5 SEC. 181. BEHAVIORAL HEALTH PROGRAMS. 

6 Title VII of the Indian Health Care Improvement Act 

7 (25 U.S.C. 1665 et seq.) is amended to read as follows: 

8 ‘‘TITLE VII—BEHAVIORAL 

9 HEALTH PROGRAMS 

10 ‘‘Subtitle A—General Programs 

11 ‘‘SEC. 701. DEFINITIONS. 

12 ‘‘In this subtitle: 

13 ‘‘(1) ALCOHOL-RELATED

14 NEURODEVELOPMENTAL DISORDERS; ARND.—The 

15 term ‘alcohol-related neurodevelopmental disorders’ 

16 or ‘ARND’ means, with a history of maternal alco17 hol consumption during pregnancy, central nervous 

18 system abnormalities, which may range from minor 

19 intellectual deficits and developmental delays to 

20 mental retardation. ARND children may have behav21 ioral problems, learning disabilities, problems with 

22 executive functioning, and attention disorders. The 

23 neurological defects of ARND may be as severe as 

24 FAS, but facial anomalies and other physical charVerDate Nov 24 2008 23:56 Dec 16, 2009 Jkt 089200 PO 00000 Frm 00154 Fmt 6652 Sfmt 6201 E:\BILLS\S1790.RS S1790

jbell on DSKDVH8Z91PROD with BILLS
155 

•S 1790 RS

1 acteristics are not present in ARND, thus making 

2 diagnosis difficult. 

3 ‘‘(2) ASSESSMENT.—The term ‘assessment’ 

4 means the systematic collection, analysis, and dis5 semination of information on health status, health 

6 needs, and health problems. 

7 ‘‘(3) BEHAVIORAL HEALTH AFTERCARE.—The 

8 term ‘behavioral health aftercare’ includes those ac9 tivities and resources used to support recovery fol10 lowing inpatient, residential, intensive substance 

11 abuse, or mental health outpatient or outpatient 

12 treatment. The purpose is to help prevent or deal 

13 with relapse by ensuring that by the time a client or 

14 patient is discharged from a level of care, such as 

15 outpatient treatment, an aftercare plan has been de16 veloped with the client. An aftercare plan may use 

17 such resources as a community-based therapeutic 

18 group, transitional living facilities, a 12-step spon19 sor, a local 12-step or other related support group, 

20 and other community-based providers. 

21 ‘‘(4) DUAL DIAGNOSIS.—The term ‘dual diag22 nosis’ means coexisting substance abuse and mental 

23 illness conditions or diagnosis. Such clients are 

24 sometimes referred to as mentally ill chemical abus25 ers (MICAs). 


jbell on DSKDVH8Z91PROD with BILLS
156 

•S 1790 RS

1 ‘‘(5) FETAL ALCOHOL SPECTRUM DIS2 ORDERS.— 

3 ‘‘(A) IN GENERAL.—The term ‘fetal alco4 hol spectrum disorders’ includes a range of ef5 fects that can occur in an individual whose 

6 mother drank alcohol during pregnancy, includ7 ing physical, mental, behavioral, and/or learning 

8 disabilities with possible lifelong implications. 

9 ‘‘(B) INCLUSIONS.—The term ‘fetal alcohol 

10 spectrum disorders’ may include— 

11 ‘‘(i) fetal alcohol syndrome (FAS); 

12 ‘‘(ii) partial fetal alcohol syndrome 

13 (partial FAS); 

14 ‘‘(iii) alcohol-related birth defects 

15 (ARBD); and 

16 ‘‘(iv) alcohol-related 

17 neurodevelopmental disorders (ARND). 

18 ‘‘(6) FAS OR FETAL ALCOHOL SYNDROME.— 

19 The term ‘FAS’ or ‘fetal alcohol syndrome’ means a 

20 syndrome in which, with a history of maternal alco21 hol consumption during pregnancy, the following cri22 teria are met: 

23 ‘‘(A) Central nervous system involvement, 

24 such as mental retardation, developmental 


jbell on DSKDVH8Z91PROD with BILLS
157 

•S 1790 RS

1 delay, intellectual deficit, microencephaly, or 

2 neurological abnormalities. 

3 ‘‘(B) Craniofacial abnormalities with at 

4 least 2 of the following: 

5 ‘‘(i) Microophthalmia. 

6 ‘‘(ii) Short palpebral fissures. 

7 ‘‘(iii) Poorly developed philtrum. 

8 ‘‘(iv) Thin upper lip. 

9 ‘‘(v) Flat nasal bridge. 

10 ‘‘(vi) Short upturned nose. 

11 ‘‘(C) Prenatal or postnatal growth delay. 

12 ‘‘(7) REHABILITATION.—The term ‘rehabilita13 tion’ means medical and health care services that— 

14 ‘‘(A) are recommended by a physician or 

15 licensed practitioner of the healing arts within 

16 the scope of their practice under applicable law; 

17 ‘‘(B) are furnished in a facility, home, or 

18 other setting in accordance with applicable 

19 standards; and 

20 ‘‘(C) have as their purpose any of the fol21 lowing: 

22 ‘‘(i) The maximum attainment of 

23 physical, mental, and developmental func24 tioning. 


jbell on DSKDVH8Z91PROD with BILLS
158 

•S 1790 RS

1 ‘‘(ii) Averting deterioration in physical 

2 or mental functional status. 

3 ‘‘(iii) The maintenance of physical or 

4 mental health functional status. 

5 ‘‘(8) SUBSTANCE ABUSE.—The term ‘substance 

6 abuse’ includes inhalant abuse. 

7 ‘‘(9) SYSTEMS OF CARE.—The term ‘Systems of 

8 Care’ means a system for delivering services to chil9 dren and their families that is child-centered, family10 focused and family-driven, community-based, and 

11 culturally competent and responsive to the needs of 

12 the children and families being served. The systems 

13 of care approach values prevention and early identi14 fication, smooth transitions for children and fami15 lies, child and family participation and advocacy, 

16 comprehensive array of services, individualized serv17 ice planning, services in the least restrictive environ18 ment, and integrated services with coordinated plan19 ning across the child-serving systems. 

20 ‘‘SEC. 702. BEHAVIORAL HEALTH PREVENTION AND TREAT21 MENT SERVICES. 

22 ‘‘(a) PURPOSES.—The purposes of this section are as 

23 follows: 

24 ‘‘(1) To authorize and direct the Secretary, act25 ing through the Service, Indian tribes, and tribal orVerDate Nov 24 2008 23:56 Dec 16, 2009 Jkt 089200 PO 00000 Frm 00158 Fmt 6652 Sfmt 6201 E:\BILLS\S1790.RS S1790

jbell on DSKDVH8Z91PROD with BILLS
159 

•S 1790 RS

1 ganizations, to develop a comprehensive behavioral 

2 health prevention and treatment program which em3 phasizes collaboration among alcohol and substance 

4 abuse, social services, and mental health programs. 

5 ‘‘(2) To provide information, direction, and 

6 guidance relating to mental illness and dysfunction 

7 and self-destructive behavior, including child abuse 

8 and family violence, to those Federal, tribal, State, 

9 and local agencies responsible for programs in In10 dian communities in areas of health care, education, 

11 social services, child and family welfare, alcohol and 

12 substance abuse, law enforcement, and judicial serv13 ices. 

14 ‘‘(3) To assist Indian tribes to identify services 

15 and resources available to address mental illness and 

16 dysfunctional and self-destructive behavior. 

17 ‘‘(4) To provide authority and opportunities for 

18 Indian tribes and tribal organizations to develop, im19 plement, and coordinate with community-based pro20 grams which include identification, prevention, edu21 cation, referral, and treatment services, including 

22 through multidisciplinary resource teams. 

23 ‘‘(5) To ensure that Indians, as citizens of the 

24 United States and of the States in which they reVerDate Nov 24 2008 23:56 Dec 16, 2009 Jkt 089200 PO 00000 Frm 00159 Fmt 6652 Sfmt 6201 E:\BILLS\S1790.RS S1790

jbell on DSKDVH8Z91PROD with BILLS
160 

•S 1790 RS

1 side, have the same access to behavioral health serv2 ices to which all citizens have access. 

3 ‘‘(6) To modify or supplement existing pro4 grams and authorities in the areas identified in 

5 paragraph (2). 

6 ‘‘(b) PLANS.— 

7 ‘‘(1) DEVELOPMENT.—The Secretary, acting 

8 through the Service, Indian tribes, and tribal organi9 zations, shall encourage Indian tribes and tribal or10 ganizations to develop tribal plans, and urban Indian 

11 organizations to develop local plans, and for all such 

12 groups to participate in developing areawide plans 

13 for Indian Behavioral Health Services. The plans 

14 shall include, to the extent feasible, the following 

15 components: 

16 ‘‘(A) An assessment of the scope of alcohol 

17 or other substance abuse, mental illness, and 

18 dysfunctional and self-destructive behavior, in19 cluding suicide, child abuse, and family vio20 lence, among Indians, including— 

21 ‘‘(i) the number of Indians served who 

22 are directly or indirectly affected by such 

23 illness or behavior; or 


jbell on DSKDVH8Z91PROD with BILLS
161 

•S 1790 RS

1 ‘‘(ii) an estimate of the financial and 

2 human cost attributable to such illness or 

3 behavior. 

4 ‘‘(B) An assessment of the existing and 

5 additional resources necessary for the preven6 tion and treatment of such illness and behavior, 

7 including an assessment of the progress toward 

8 achieving the availability of the full continuum 

9 of care described in subsection (c). 

10 ‘‘(C) An estimate of the additional funding 

11 needed by the Service, Indian tribes, tribal or12 ganizations, and urban Indian organizations to 

13 meet their responsibilities under the plans. 

14 ‘‘(2) NATIONAL CLEARINGHOUSE.—The Sec15 retary, acting through the Service, shall coordinate 

16 with existing national clearinghouses and informa17 tion centers to include at the clearinghouses and 

18 centers plans and reports on the outcomes of such 

19 plans developed by Indian tribes, tribal organiza20 tions, urban Indian organizations, and Service areas 

21 relating to behavioral health. The Secretary shall en22 sure access to these plans and outcomes by any In23 dian tribe, tribal organization, urban Indian organi24 zation, or the Service. 


jbell on DSKDVH8Z91PROD with BILLS
162 

•S 1790 RS

1 ‘‘(3) TECHNICAL ASSISTANCE.—The Secretary 

2 shall provide technical assistance to Indian tribes, 

3 tribal organizations, and urban Indian organizations 

4 in preparation of plans under this section and in de5 veloping standards of care that may be used and 

6 adopted locally. 

7 ‘‘(c) PROGRAMS.—The Secretary, acting through the 

8 Service, shall provide, to the extent feasible and if funding 

9 is available, programs including the following: 

10 ‘‘(1) COMPREHENSIVE CARE.—A comprehensive 

11 continuum of behavioral health care which pro12 vides— 

13 ‘‘(A) community-based prevention, inter14 vention, outpatient, and behavioral health 

15 aftercare; 

16 ‘‘(B) detoxification (social and medical); 

17 ‘‘(C) acute hospitalization; 

18 ‘‘(D) intensive outpatient/day treatment; 

19 ‘‘(E) residential treatment; 

20 ‘‘(F) transitional living for those needing a 

21 temporary, stable living environment that is 

22 supportive of treatment and recovery goals; 

23 ‘‘(G) emergency shelter; 

24 ‘‘(H) intensive case management; 

25 ‘‘(I) diagnostic services; and 


jbell on DSKDVH8Z91PROD with BILLS
163 

•S 1790 RS

1 ‘‘(J) promotion of healthy approaches to 

2 risk and safety issues, including injury preven3 tion. 

4 ‘‘(2) CHILD CARE.—Behavioral health services 

5 for Indians from birth through age 17, including— 

6 ‘‘(A) preschool and school age fetal alcohol 

7 spectrum disorder services, including assess8 ment and behavioral intervention; 

9 ‘‘(B) mental health and substance abuse 

10 services (emotional, organic, alcohol, drug, in11 halant, and tobacco); 

12 ‘‘(C) identification and treatment of co-oc13 curring disorders and comorbidity; 

14 ‘‘(D) prevention of alcohol, drug, inhalant, 

15 and tobacco use; 

16 ‘‘(E) early intervention, treatment, and 

17 aftercare; 

18 ‘‘(F) promotion of healthy approaches to 

19 risk and safety issues; and 

20 ‘‘(G) identification and treatment of ne21 glect and physical, mental, and sexual abuse. 

22 ‘‘(3) ADULT CARE.—Behavioral health services 

23 for Indians from age 18 through 55, including— 

24 ‘‘(A) early intervention, treatment, and 

25 aftercare; 


jbell on DSKDVH8Z91PROD with BILLS
164 

•S 1790 RS

1 ‘‘(B) mental health and substance abuse 

2 services (emotional, alcohol, drug, inhalant, and 

3 tobacco), including sex specific services; 

4 ‘‘(C) identification and treatment of co-oc5 curring disorders (dual diagnosis) and comor6 bidity; 

7 ‘‘(D) promotion of healthy approaches for 

8 risk-related behavior; 

9 ‘‘(E) treatment services for women at risk 

10 of giving birth to a child with a fetal alcohol 

11 spectrum disorder; and 

12 ‘‘(F) sex specific treatment for sexual as13 sault and domestic violence. 

14 ‘‘(4) FAMILY CARE.—Behavioral health services 

15 for families, including— 

16 ‘‘(A) early intervention, treatment, and 

17 aftercare for affected families; 

18 ‘‘(B) treatment for sexual assault and do19 mestic violence; and 

20 ‘‘(C) promotion of healthy approaches re21 lating to parenting, domestic violence, and other 

22 abuse issues. 

23 ‘‘(5) ELDER CARE.—Behavioral health services 

24 for Indians 56 years of age and older, including— 


jbell on DSKDVH8Z91PROD with BILLS
165 

•S 1790 RS

1 ‘‘(A) early intervention, treatment, and 

2 aftercare; 

3 ‘‘(B) mental health and substance abuse 

4 services (emotional, alcohol, drug, inhalant, and 

5 tobacco), including sex specific services; 

6 ‘‘(C) identification and treatment of co-oc7 curring disorders (dual diagnosis) and comor8 bidity; 

9 ‘‘(D) promotion of healthy approaches to 

10 managing conditions related to aging; 

11 ‘‘(E) sex specific treatment for sexual as12 sault, domestic violence, neglect, physical and 

13 mental abuse and exploitation; and 

14 ‘‘(F) identification and treatment of de15 mentias regardless of cause. 

16 ‘‘(d) COMMUNITY BEHAVIORAL HEALTH PLAN.— 

17 ‘‘(1) ESTABLISHMENT.—The governing body of 

18 any Indian tribe, tribal organization, or urban In19 dian organization may adopt a resolution for the es20 tablishment of a community behavioral health plan 

21 providing for the identification and coordination of 

22 available resources and programs to identify, pre23 vent, or treat substance abuse, mental illness, or 

24 dysfunctional and self-destructive behavior, including 

25 child abuse and family violence, among its members 


jbell on DSKDVH8Z91PROD with BILLS
166 

•S 1790 RS

1 or its service population. This plan should include 

2 behavioral health services, social services, intensive 

3 outpatient services, and continuing aftercare. 

4 ‘‘(2) TECHNICAL ASSISTANCE.—At the request 

5 of an Indian tribe, tribal organization, or urban In6 dian organization, the Bureau of Indian Affairs and 

7 the Service shall cooperate with and provide tech8 nical assistance to the Indian tribe, tribal organiza9 tion, or urban Indian organization in the develop10 ment and implementation of such plan. 

11 ‘‘(3) FUNDING.—The Secretary, acting through 

12 the Service, Indian tribes, and tribal organizations, 

13 may make funding available to Indian tribes and 

14 tribal organizations which adopt a resolution pursu15 ant to paragraph (1) to obtain technical assistance 

16 for the development of a community behavioral 

17 health plan and to provide administrative support in 

18 the implementation of such plan. 

19 ‘‘(e) COORDINATION FOR AVAILABILITY OF SERV20 ICES.—The Secretary, acting through the Service, shall 

21 coordinate behavioral health planning, to the extent fea22 sible, with other Federal agencies and with State agencies, 

23 to encourage comprehensive behavioral health services for 

24 Indians regardless of their place of residence. 


jbell on DSKDVH8Z91PROD with BILLS
167 

•S 1790 RS

1 ‘‘(f) MENTAL HEALTH CARE NEED ASSESSMENT.— 

2 Not later than 1 year after the date of enactment of the 

3 Indian Health Care Improvement Reauthorization and 

4 Extension Act of 2009, the Secretary, acting through the 

5 Service, shall make an assessment of the need for inpa6 tient mental health care among Indians and the avail7 ability and cost of inpatient mental health facilities which 

8 can meet such need. In making such assessment, the Sec9 retary shall consider the possible conversion of existing, 

10 underused Service hospital beds into psychiatric units to 

11 meet such need. 

12 ‘‘SEC. 703. MEMORANDA OF AGREEMENT WITH THE DE13 PARTMENT OF INTERIOR. 

14 ‘‘(a) CONTENTS.—Not later than 1 year after the 

15 date of enactment of the Indian Health Care Improvement 

16 Reauthorization and Extension Act of 2009, the Sec17 retary, acting through the Service, and the Secretary of 

18 the Interior shall develop and enter into a memoranda of 

19 agreement, or review and update any existing memoranda 

20 of agreement, as required by section 4205 of the Indian 

21 Alcohol and Substance Abuse Prevention and Treatment 

22 Act of 1986 (25 U.S.C. 2411) under which the Secretaries 

23 address the following: 


jbell on DSKDVH8Z91PROD with BILLS
168 

•S 1790 RS

1 ‘‘(1) The scope and nature of mental illness and 

2 dysfunctional and self-destructive behavior, including 

3 child abuse and family violence, among Indians. 

4 ‘‘(2) The existing Federal, tribal, State, local, 

5 and private services, resources, and programs avail6 able to provide behavioral health services for Indi7 ans. 

8 ‘‘(3) The unmet need for additional services, re9 sources, and programs necessary to meet the needs 

10 identified pursuant to paragraph (1). 

11 ‘‘(4)(A) The right of Indians, as citizens of the 

12 United States and of the States in which they re13 side, to have access to behavioral health services to 

14 which all citizens have access. 

15 ‘‘(B) The right of Indians to participate in, and 

16 receive the benefit of, such services. 

17 ‘‘(C) The actions necessary to protect the exer18 cise of such right. 

19 ‘‘(5) The responsibilities of the Bureau of In20 dian Affairs and the Service, including mental illness 

21 identification, prevention, education, referral, and 

22 treatment services (including services through multi23 disciplinary resource teams), at the central, area, 

24 and agency and Service unit, Service area, and headVerDate Nov 24 2008 23:56 Dec 16, 2009 Jkt 089200 PO 00000 Frm 00168 Fmt 6652 Sfmt 6201 E:\BILLS\S1790.RS S1790

jbell on DSKDVH8Z91PROD with BILLS
169 

•S 1790 RS

1 quarters levels to address the problems identified in 

2 paragraph (1). 

3 ‘‘(6) A strategy for the comprehensive coordina4 tion of the behavioral health services provided by the 

5 Bureau of Indian Affairs and the Service to meet 

6 the problems identified pursuant to paragraph (1), 

7 including— 

8 ‘‘(A) the coordination of alcohol and sub9 stance abuse programs of the Service, the Bu10 reau of Indian Affairs, and Indian tribes and 

11 tribal organizations (developed under the Indian 

12 Alcohol and Substance Abuse Prevention and 

13 Treatment Act of 1986 (25 U.S.C. 2401 et 

14 seq.)) with behavioral health initiatives pursu15 ant to this Act, particularly with respect to the 

16 referral and treatment of dually diagnosed indi17 viduals requiring behavioral health and sub18 stance abuse treatment; and 

19 ‘‘(B) ensuring that the Bureau of Indian 

20 Affairs and Service programs and services (in21 cluding multidisciplinary resource teams) ad22 dressing child abuse and family violence are co23 ordinated with such non-Federal programs and 

24 services. 


jbell on DSKDVH8Z91PROD with BILLS
170 

•S 1790 RS

1 ‘‘(7) Directing appropriate officials of the Bu2 reau of Indian Affairs and the Service, particularly 

3 at the agency and Service unit levels, to cooperate 

4 fully with tribal requests made pursuant to commu5 nity behavioral health plans adopted under section 

6 702(c) and section 4206 of the Indian Alcohol and 

7 Substance Abuse Prevention and Treatment Act of 

8 1986 (25 U.S.C. 2412). 

9 ‘‘(8) Providing for an annual review of such 

10 agreement by the Secretaries which shall be provided 

11 to Congress and Indian tribes and tribal organiza12 tions. 

13 ‘‘(b) SPECIFIC PROVISIONS REQUIRED.—The memo14 randa of agreement updated or entered into pursuant to 

15 subsection (a) shall include specific provisions pursuant to 

16 which the Service shall assume responsibility for— 

17 ‘‘(1) the determination of the scope of the prob18 lem of alcohol and substance abuse among Indians, 

19 including the number of Indians within the jurisdic20 tion of the Service who are directly or indirectly af21 fected by alcohol and substance abuse and the finan22 cial and human cost; 

23 ‘‘(2) an assessment of the existing and needed 

24 resources necessary for the prevention of alcohol and 


jbell on DSKDVH8Z91PROD with BILLS
171 

•S 1790 RS

1 substance abuse and the treatment of Indians af2 fected by alcohol and substance abuse; and 

3 ‘‘(3) an estimate of the funding necessary to 

4 adequately support a program of prevention of alco5 hol and substance abuse and treatment of Indians 

6 affected by alcohol and substance abuse. 

7 ‘‘(c) PUBLICATION.—Each memorandum of agree8 ment entered into or renewed (and amendments or modi9 fications thereto) under subsection (a) shall be published 

10 in the Federal Register. At the same time as publication 

11 in the Federal Register, the Secretary shall provide a copy 

12 of such memoranda, amendment, or modification to each 

13 Indian tribe, tribal organization, and urban Indian organi14 zation. 

15 ‘‘SEC. 704. COMPREHENSIVE BEHAVIORAL HEALTH PRE16 VENTION AND TREATMENT PROGRAM. 

17 ‘‘(a) ESTABLISHMENT.— 

18 ‘‘(1) IN GENERAL.—The Secretary, acting 

19 through the Service, shall provide a program of com20 prehensive behavioral health, prevention, treatment, 

21 and aftercare, including Systems of Care, which, 

22 which may include, if feasible and appropriate, sys23 tems of care, and shall include— 

24 ‘‘(A) prevention, through educational inter25 vention, in Indian communities; 


jbell on DSKDVH8Z91PROD with BILLS
172 

•S 1790 RS

1 ‘‘(B) acute detoxification, psychiatric hos2 pitalization, residential, and intensive outpatient 

3 treatment; 

4 ‘‘(C) community-based rehabilitation and 

5 aftercare; 

6 ‘‘(D) community education and involve7 ment, including extensive training of health 

8 care, educational, and community-based per9 sonnel; 

10 ‘‘(E) specialized residential treatment pro11 grams for high-risk populations, including preg12 nant and postpartum women and their children; 

13 and 

14 ‘‘(F) diagnostic services. 

15 ‘‘(2) TARGET POPULATIONS.—The target popu16 lation of such programs shall be members of Indian 

17 tribes. Efforts to train and educate key members of 

18 the Indian community shall also target employees of 

19 health, education, judicial, law enforcement, legal, 

20 and social service programs. 

21 ‘‘(b) CONTRACT HEALTH SERVICES.— 

22 ‘‘(1) IN GENERAL.—The Secretary, acting 

23 through the Service, may enter into contracts with 

24 public or private providers of behavioral health treatVerDate Nov 24 2008 23:56 Dec 16, 2009 Jkt 089200 PO 00000 Frm 00172 Fmt 6652 Sfmt 6201 E:\BILLS\S1790.RS S1790

jbell on DSKDVH8Z91PROD with BILLS
173 

•S 1790 RS

1 ment services for the purpose of carrying out the 

2 program required under subsection (a). 

3 ‘‘(2) PROVISION OF ASSISTANCE.—In carrying 

4 out this subsection, the Secretary shall provide as5 sistance to Indian tribes and tribal organizations to 

6 develop criteria for the certification of behavioral 

7 health service providers and accreditation of service 

8 facilities which meet minimum standards for such 

9 services and facilities. 

10 ‘‘SEC. 705. MENTAL HEALTH TECHNICIAN PROGRAM. 

11 ‘‘(a) IN GENERAL.—Pursuant to the Act of Novem12 ber 2, 1921 (25 U.S.C. 13) (commonly known as the ‘Sny13 der Act’), the Secretary shall establish and maintain a 

14 mental health technician program within the Service 

15 which— 

16 ‘‘(1) provides for the training of Indians as 

17 mental health technicians; and 

18 ‘‘(2) employs such technicians in the provision 

19 of community-based mental health care that includes 

20 identification, prevention, education, referral, and 

21 treatment services. 

22 ‘‘(b) PARAPROFESSIONAL TRAINING.—In carrying 

23 out subsection (a), the Secretary, acting through the Serv24 ice, shall provide high-standard paraprofessional training 

25 in mental health care necessary to provide quality care to 


jbell on DSKDVH8Z91PROD with BILLS
174 

•S 1790 RS

1 the Indian communities to be served. Such training shall 

2 be based upon a curriculum developed or approved by the 

3 Secretary which combines education in the theory of men4 tal health care with supervised practical experience in the 

5 provision of such care. 

6 ‘‘(c) SUPERVISION AND EVALUATION OF TECHNI7 CIANS.—The Secretary, acting through the Service, shall 

8 supervise and evaluate the mental health technicians in 

9 the training program. 

10 ‘‘(d) TRADITIONAL HEALTH CARE PRACTICES.—The 

11 Secretary, acting through the Service, shall ensure that 

12 the program established pursuant to this subsectionsection 

13 involves the use and promotion of the traditional health 

14 care practices of the Indian tribes to be served. 

15 ‘‘SEC. 706. LICENSING REQUIREMENT FOR MENTAL 

16 HEALTH CARE WORKERS. 

17 ‘‘(a) IN GENERAL.—Subject to section 221, and ex18 cept as provided in subsection (b), any individual employed 

19 as a psychologist, social worker, or marriage and family 

20 therapist for the purpose of providing mental health care 

21 services to Indians in a clinical setting under this Act is 

22 required to be licensed as a psychologist, social worker, 

23 or marriage and family therapist, respectively. 

24 ‘‘(b) TRAINEES.—An individual may be employed as 

25 a trainee in psychology, social work, or marriage and famVerDate Nov 24 2008 23:56 Dec 16, 2009 Jkt 089200 PO 00000 Frm 00174 Fmt 6652 Sfmt 6201 E:\BILLS\S1790.RS S1790

jbell on DSKDVH8Z91PROD with BILLS
175 

•S 1790 RS

1 ily therapy to provide mental health care services de2 scribed in subsection (a) if such individual— 

3 ‘‘(1) works under the direct supervision of a li4 censed psychologist, social worker, or marriage and 

5 family therapist, respectively; 

6 ‘‘(2) is enrolled in or has completed at least 2 

7 years of course work at a post-secondary, accredited 

8 education program for psychology, social work, mar9 riage and family therapy, or counseling; and 

10 ‘‘(3) meets such other training, supervision, and 

11 quality review requirements as the Secretary may es12 tablish. 

13 ‘‘SEC. 707. INDIAN WOMEN TREATMENT PROGRAMS. 

14 ‘‘(a) GRANTS.—The Secretary, consistent with sec15 tion 702, may make grants to Indian tribes, tribal organi16 zations, and urban Indian organizations to develop and 

17 implement a comprehensive behavioral health program of 

18 prevention, intervention, treatment, and relapse preven19 tion services that specifically addresses the cultural, his20 torical, social, and child care needs of Indian women, re21 gardless of age. 

22 ‘‘(b) USE OF GRANT FUNDS.—A grant made pursu23 ant to this section may be used— 

24 ‘‘(1) to develop and provide community train25 ing, education, and prevention programs for Indian 


jbell on DSKDVH8Z91PROD with BILLS
176 

•S 1790 RS

1 women relating to behavioral health issues, including 

2 fetal alcohol spectrum disorders; 

3 ‘‘(2) to identify and provide psychological serv4 ices, counseling, advocacy, support, and relapse pre5 vention to Indian women and their families; and 

6 ‘‘(3) to develop prevention and intervention 

7 models for Indian women which incorporate tradi8 tional health care practices, cultural values, and 

9 community and family involvement. 

10 ‘‘(c) CRITERIA.—The Secretary, in consultation with 

11 Indian tribes and tribal organizations, shall establish cri12 teria for the review and approval of applications and pro13 posals for funding under this section. 

14 ‘‘(d) ALLOCATION OF FUNDS FOR URBAN INDIAN

15 ORGANIZATIONS.—20 percent of the funds appropriated 

16 pursuant to this section shall be used to make grants to 

17 urban Indian organizations. 

18 ‘‘SEC. 708. INDIAN YOUTH PROGRAM. 

19 ‘‘(a) DETOXIFICATION AND REHABILITATION.—The 

20 Secretary, acting through the Service, consistent with sec21 tion 702, shall develop and implement a program for acute 

22 detoxification and treatment for Indian youths, including 

23 behavioral health services. The program shall include re24 gional treatment centers designed to include detoxification 

25 and rehabilitation for both sexes on a referral basis and 


jbell on DSKDVH8Z91PROD with BILLS
177 

•S 1790 RS

1 programs developed and implemented by Indian tribes or 

2 tribal organizations at the local level under the Indian 

3 Self-Determination and Education Assistance Act (25 

4 U.S.C. 450 et seq.). Regional centers shall be integrated 

5 with the intake and rehabilitation programs based in the 

6 referring Indian community. 

7 ‘‘(b) ALCOHOL AND SUBSTANCE ABUSE TREATMENT

8 CENTERS OR FACILITIES.— 

9 ‘‘(1) ESTABLISHMENT.— 

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

11 through the Service, shall construct, renovate, 

12 or, as necessary, purchase, and appropriately 

13 staff and operate, at least 1 youth regional 

14 treatment center or treatment network in each 

15 area under the jurisdiction of an area office. 

16 ‘‘(B) AREA OFFICE IN CALIFORNIA.—For 

17 the purposes of this subsection, the area office 

18 in California shall be considered to be 2 area 

19 offices, 1 office whose jurisdiction shall be con20 sidered to encompass the northern area of the 

21 State of California, and 1 office whose jurisdic22 tion shall be considered to encompass the re23 mainder of the State of California for the pur24 pose of implementing California treatment net25 works. 


jbell on DSKDVH8Z91PROD with BILLS
178 

•S 1790 RS

1 ‘‘(2) FUNDING.—For the purpose of staffing 

2 and operating such centers or facilities, funding 

3 shall be pursuant to the Act of November 2, 1921 

4 (25 U.S.C. 13). 

5 ‘‘(3) LOCATION.—A youth treatment center 

6 constructed or purchased under this subsection shall 

7 be constructed or purchased at a location within the 

8 area described in paragraph (1) agreed upon (by ap9 propriate tribal resolution) by a majority of the In10 dian tribes to be served by such center. 

11 ‘‘(4) SPECIFIC PROVISION OF FUNDS.— 

12 ‘‘(A) IN GENERAL.—Notwithstanding any 

13 other provision of this title, the Secretary may, 

14 from amounts authorized to be appropriated for 

15 the purposes of carrying out this section, make 

16 funds available to— 

17 ‘‘(i) the Tanana Chiefs Conference, 

18 Incorporated, for the purpose of leasing, 

19 constructing, renovating, operating, and 

20 maintaining a residential youth treatment 

21 facility in Fairbanks, Alaska; and 

22 ‘‘(ii) the Southeast Alaska Regional 

23 Health Corporation to staff and operate a 

24 residential youth treatment facility without 

25 regard to the proviso set forth in section 


jbell on DSKDVH8Z91PROD with BILLS
179 

•S 1790 RS

1 4(l) of the Indian Self-Determination and 

2 Education Assistance Act (25 U.S.C. 

3 450b(l)). 

4 ‘‘(B) PROVISION OF SERVICES TO ELIGI5 BLE YOUTHS.—Until additional residential 

6 youth treatment facilities are established in 

7 Alaska pursuant to this section, the facilities 

8 specified in subparagraph (A) shall make every 

9 effort to provide services to all eligible Indian 

10 youths residing in Alaska. 

11 ‘‘(c) INTERMEDIATE ADOLESCENT BEHAVIORAL

12 HEALTH SERVICES.— 

13 ‘‘(1) IN GENERAL.—The Secretary, acting 

14 through the Service, may provide intermediate be15 havioral health services, which may incorporate Sys16 tems of Care, if feasible and appropriate, incorporate 

17 systems of care, to Indian children and adolescents, 

18 including— 

19 ‘‘(A) pretreatment assistance; 

20 ‘‘(B) inpatient, outpatient, and aftercare 

21 services; 

22 ‘‘(C) emergency care; 

23 ‘‘(D) suicide prevention and crisis interven24 tion; and 


jbell on DSKDVH8Z91PROD with BILLS
180 

•S 1790 RS

1 ‘‘(E) prevention and treatment of mental 

2 illness and dysfunctional and self-destructive 

3 behavior, including child abuse and family vio4 lence. 

5 ‘‘(2) USE OF FUNDS.—Funds provided under 

6 this subsection may be used— 

7 ‘‘(A) to construct or renovate an existing 

8 health facility to provide intermediate behav9 ioral health services; 

10 ‘‘(B) to hire behavioral health profes11 sionals; 

12 ‘‘(C) to staff, operate, and maintain an in13 termediate mental health facility, group home, 

14 sober housing, transitional housing or similar 

15 facilities, or youth shelter where intermediate 

16 behavioral health services are being provided; 

17 ‘‘(D) to make renovations and hire appro18 priate staff to convert existing hospital beds 

19 into adolescent psychiatric units; and 

20 ‘‘(E) for intensive home- and community21 based services. 

22 ‘‘(3) CRITERIA.—The Secretary, acting through 

23 the Service, shall, in consultation with Indian tribes 

24 and tribal organizations, establish criteria for the reVerDate Nov 24 2008 23:56 Dec 16, 2009 Jkt 089200 PO 00000 Frm 00180 Fmt 6652 Sfmt 6201 E:\BILLS\S1790.RS S1790

jbell on DSKDVH8Z91PROD with BILLS
181 

•S 1790 RS

1 view and approval of applications or proposals for 

2 funding made available pursuant to this subsection. 

3 ‘‘(d) FEDERALLY OWNED STRUCTURES.— 

4 ‘‘(1) IN GENERAL.—The Secretary, in consulta5 tion with Indian tribes and tribal organizations, 

6 shall— 

7 ‘‘(A) identify and use, where appropriate, 

8 federally owned structures suitable for local res9 idential or regional behavioral health treatment 

10 for Indian youths; and 

11 ‘‘(B) establish guidelines for determining 

12 the suitability of any such federally owned 

13 structure to be used for local residential or re14 gional behavioral health treatment for Indian 

15 youths. 

16 ‘‘(2) TERMS AND CONDITIONS FOR USE OF

17 STRUCTURE.—Any structure described in paragraph 

18 (1) may be used under such terms and conditions as 

19 may be agreed upon by the Secretary and the agency 

20 having responsibility for the structure and any In21 dian tribe or tribal organization operating the pro22 gram. 

23 ‘‘(e) REHABILITATION AND AFTERCARE SERVICES.— 

24 ‘‘(1) IN GENERAL.—The Secretary, Indian 

25 tribes, or tribal organizations, in cooperation with 


jbell on DSKDVH8Z91PROD with BILLS
182 

•S 1790 RS

1 the Secretary of the Interior, shall develop and im2 plement within each Service unit, community-based 

3 rehabilitation and follow-up services for Indian 

4 youths who are having significant behavioral health 

5 problems, and require long-term treatment, commu6 nity reintegration, and monitoring to support the In7 dian youths after their return to their home commu8 nity. 

9 ‘‘(2) ADMINISTRATION.—Services under para10 graph (1) shall be provided by trained staff within 

11 the community who can assist the Indian youths in 

12 their continuing development of self-image, positive 

13 problem-solving skills, and nonalcohol or substance 

14 abusing behaviors. Such staff may include alcohol 

15 and substance abuse counselors, mental health pro16 fessionals, and other health professionals and para17 professionals, including community health represent18 atives. 

19 ‘‘(f) INCLUSION OF FAMILY IN YOUTH TREATMENT

20 PROGRAM.—In providing the treatment and other services 

21 to Indian youths authorized by this section, the Secretary, 

22 acting through the Service, shall provide for the inclusion 

23 of family members of such youths in the treatment pro24 grams or other services as may be appropriate. Not less 

25 than 10 percent of the funds appropriated for the purVerDate Nov 24 2008 23:56 Dec 16, 2009 Jkt 089200 PO 00000 Frm 00182 Fmt 6652 Sfmt 6201 E:\BILLS\S1790.RS S1790

jbell on DSKDVH8Z91PROD with BILLS
183 

•S 1790 RS

1 poses of carrying out subsection (e) shall be used for out2 patient care of adult family members related to the treat3 ment of an Indian youth under that subsection. 

4 ‘‘(g) MULTIDRUG ABUSE PROGRAM.—The Secretary, 

5 acting through the Service, shall provide, consistent with 

6 section 702, programs and services to prevent and treat 

7 the abuse of multiple forms of substances, including alco8 hol, drugs, inhalants, and tobacco, among Indian youths 

9 residing in Indian communities, on or near reservations, 

10 and in urban areas and provide appropriate mental health 

11 services to address the incidence of mental illness among 

12 such youths. 

13 ‘‘(h) INDIAN YOUTH MENTAL HEALTH.—The Sec14 retary, acting through the Service, shall collect data for 

15 the report under section 801 with respect to— 

16 ‘‘(1) the number of Indian youth who are being 

17 provided mental health services through the Service 

18 and tribal health programs; 

19 ‘‘(2) a description of, and costs associated with, 

20 the mental health services provided for Indian youth 

21 through the Service and tribal health programs; 

22 ‘‘(3) the number of youth referred to the Serv23 ice or tribal health programs for mental health serv24 ices; 


jbell on DSKDVH8Z91PROD with BILLS
184 

•S 1790 RS

1 ‘‘(4) the number of Indian youth provided resi2 dential treatment for mental health and behavioral 

3 problems through the Service and tribal health pro4 grams, reported separately for on- and off-reserva5 tion facilities; and 

6 ‘‘(5) the costs of the services described in para7 graph (4). 

8 ‘‘SEC. 709. INPATIENT AND COMMUNITY-BASED MENTAL 

9 HEALTH FACILITIES DESIGN, CONSTRUC10 TION, AND STAFFING. 

11 ‘‘Not later than 1 year after the date of enactment 

12 of the Indian Health Care Improvement Reauthorization 

13 and Extension Act of 2009, the Secretary, acting through 

14 the Service, may provide, in each area of the Service, not 

15 less than 1 inpatient mental health care facility, or the 

16 equivalent, for Indians with behavioral health problems. 

17 For the purposes of this subsection, California shall be 

18 considered to be 2 area offices, 1 office whose location 

19 shall be considered to encompass the northern area of the 

20 State of California and 1 office whose jurisdiction shall 

21 be considered to encompass the remainder of the State 

22 of California. The Secretary shall consider the possible 

23 conversion of existing, underused Service hospital beds 

24 into psychiatric units to meet such need. 


jbell on DSKDVH8Z91PROD with BILLS
185 

•S 1790 RS

1 ‘‘SEC. 710. TRAINING AND COMMUNITY EDUCATION. 

2 ‘‘(a) PROGRAM.—The Secretary, in cooperation with 

3 the Secretary of the Interior, shall develop and implement 

4 or assist Indian tribes and tribal organizations to develop 

5 and implement, within each Service unit or tribal program, 

6 a program of community education and involvement which 

7 shall be designed to provide concise and timely information 

8 to the community leadership of each tribal community. 

9 Such program shall include education about behavioral 

10 health issues to political leaders, tribal judges, law en11 forcement personnel, members of tribal health and edu12 cation boards, health care providers including traditional 

13 practitioners, and other critical members of each tribal 

14 community. Such program may also include community15 based training to develop local capacity and tribal commu16 nity provider training for prevention, intervention, treat17 ment, and aftercare. 

18 ‘‘(b) INSTRUCTION.—The Secretary, acting through 

19 the Service, shall provide instruction in the area of behav20 ioral health issues, including instruction in crisis interven21 tion and family relations in the context of alcohol and sub22 stance abuse, child sexual abuse, youth alcohol and sub23 stance abuse, and the causes and effects of fetal alcohol 

24 spectrum disorders to appropriate employees of the Bu25 reau of Indian Affairs and the Service, and to personnel 

26 in schools or programs operated under any contract with 


jbell on DSKDVH8Z91PROD with BILLS
186 

•S 1790 RS

1 the Bureau of Indian Affairs or the Service, including su2 pervisors of emergency shelters and halfway houses de3 scribed in section 4213 of the Indian Alcohol and Sub4 stance Abuse Prevention and Treatment Act of 1986 (25 

5 U.S.C. 2433). 

6 ‘‘(c) TRAINING MODELS.—In carrying out the edu7 cation and training programs required by this section, the 

8 Secretary, in consultation with Indian tribes, tribal organi9 zations, Indian behavioral health experts, and Indian alco10 hol and substance abuse prevention experts, shall develop 

11 and provide community-based training models. Such mod12 els shall address— 

13 ‘‘(1) the elevated risk of alcohol andalcohol 

14 abuse and other behavioral health problems faced by 

15 children of alcoholics; 

16 ‘‘(2) the cultural, spiritual, and 

17 multigenerational aspects of behavioral health prob18 lem prevention and recovery; and 

19 ‘‘(3) community-based and multidisciplinary 

20 strategies, including Systems of Care,for preventing 

21 and treating behavioral health problems. 

22 ‘‘SEC. 711. BEHAVIORAL HEALTH PROGRAM. 

23 ‘‘(a) INNOVATIVE PROGRAMS.—The Secretary, acting 

24 through the Service, consistent with section 702, may 

25 plan, develop, implement, and carry out programs to deVerDate Nov 24 2008 23:56 Dec 16, 2009 Jkt 089200 PO 00000 Frm 00186 Fmt 6652 Sfmt 6201 E:\BILLS\S1790.RS S1790

jbell on DSKDVH8Z91PROD with BILLS
187 

•S 1790 RS

1 liver innovative community-based behavioral health serv2 ices to Indians. 

3 ‘‘(b) AWARDS; CRITERIA.—The Secretary may award 

4 a grant for a project under subsection (a) to an Indian 

5 tribe or tribal organization and may consider the following 

6 criteria: 

7 ‘‘(1) The project will address significant unmet 

8 behavioral health needs among Indians. 

9 ‘‘(2) The project will serve a significant number 

10 of Indians. 

11 ‘‘(3) The project has the potential to deliver 

12 services in an efficient and effective manner. 

13 ‘‘(4) The Indian tribe or tribal organization has 

14 the administrative and financial capability to admin15 ister the project. 

16 ‘‘(5) The project may deliver services in a man17 ner consistent with traditional health care practices. 

18 ‘‘(6) The project is coordinated with, and avoids 

19 duplication of, existing services. 

20 ‘‘(c) EQUITABLE TREATMENT.—For purposes of this 

21 subsection, the Secretary shall, in evaluating project appli22 cations or proposals, use the same criteria that the Sec23 retary uses in evaluating any other application or proposal 

24 for such funding. 


jbell on DSKDVH8Z91PROD with BILLS
188 

•S 1790 RS

1 ‘‘SEC. 712. FETAL ALCOHOL SPECTRUM DISORDERS PRO2 GRAMS. 

3 ‘‘(a) PROGRAMS.— 

4 ‘‘(1) ESTABLISHMENT.—The Secretary, con5 sistent with section 701section 702, acting through 

6 the Service, Indian Tribes, and Tribal Organiza7 tions, is authorized to establish and operate fetal al8 cohol spectrum disorders programs as provided in 

9 this section for the purposes of meeting the health 

10 status objectives specified in section 3. 

11 ‘‘(2) USE OF FUNDS.— 

12 ‘‘(A) IN GENERAL.—Funding provided 

13 pursuant to this section shall be used for the 

14 following: 

15 ‘‘(i) To develop and provide for Indi16 ans community and in-school training, edu17 cation, and prevention programs relating 

18 to fetal alcohol spectrum disorders. 

19 ‘‘(ii) To identify and provide behav20 ioral health treatment to high-risk Indian 

21 women and high-risk women pregnant with 

22 an Indian’s child. 

23 ‘‘(iii) To identify and provide appro24 priate psychological services, educational 

25 and vocational support, counseling, advo26 cacy, and information to fetal alcohol specVerDate Nov 24 2008 23:56 Dec 16, 2009 Jkt 089200 PO 00000 Frm 00188 Fmt 6652 Sfmt 6201 E:\BILLS\S1790.RS S1790

jbell on DSKDVH8Z91PROD with BILLS
189 

•S 1790 RS

1 trum disorders-affected Indians and their 

2 families or caretakers. 

3 ‘‘(iv) To develop and implement coun4 seling and support programs in schools for 

5 fetal alcohol spectrum disorders-affected 

6 Indian children. 

7 ‘‘(v) To develop prevention and inter8 vention models which incorporate practi9 tioners of traditional health care practices, 

10 cultural values, and community involve11 ment. 

12 ‘‘(vi) To develop, print, and dissemi13 nate education and prevention materials on 

14 fetal alcohol spectrum disorders. 

15 ‘‘(vii) To develop and implement, in 

16 consultation with Indian Tribes and Tribal 

17 Organizations, and in conference with 

18 urban Indian Organizations, culturally sen19 sitive assessment and diagnostic tools in20 cluding dysmorphology clinics and multi21 disciplinary fetal alcohol spectrum dis22 orders clinics for use in Indian commu23 nities and urban Centers. 

24 ‘‘(viii) To develop and provide training 

25 on fetal alcohol spectrum disorders to proVerDate Nov 24 2008 23:56 Dec 16, 2009 Jkt 089200 PO 00000 Frm 00189 Fmt 6652 Sfmt 6201 E:\BILLS\S1790.RS S1790

jbell on DSKDVH8Z91PROD with BILLS
190 

•S 1790 RS

1 fessionals providing services to Indians, in2 cluding medical and allied health practi3 tioners, social service providers, educators, 

4 and law enforcement, court officials and 

5 corrections personnel in the juvenile and 

6 criminal justice systems. 

7 ‘‘(B) ADDITIONAL USES.—In addition to 

8 any purpose under subparagraph (A), funding 

9 provided pursuant to this section may be used 

10 for 1 or more of the following: 

11 ‘‘(i) Early childhood intervention 

12 projects from birth on to mitigate the ef13 fects of fetal alcohol spectrum disorders 

14 among Indians. 

15 ‘‘(ii) Community-based support serv16 ices for Indians and women pregnant with 

17 Indian children. 

18 ‘‘(iii) Community-based housing for 

19 adult Indians with fetal alcohol spectrum 

20 disorders. 

21 ‘‘(3) CRITERIA FOR APPLICATIONS.—The Sec22 retary shall establish criteria for the review and ap23 proval of applications for funding under this section. 

24 ‘‘(b) SERVICES.—The Secretary, acting through the 

25 Service, Indian Tribes, and Tribal Organizations, shall— 


jbell on DSKDVH8Z91PROD with BILLS
191 

•S 1790 RS

1 ‘‘(1) develop and provide services for the pre2 vention, intervention, treatment, and aftercare for 

3 those affected by fetal alcohol spectrum disorders in 

4 Indian communities; and 

5 ‘‘(2) provide supportive services, including serv6 ices to meet the special educational, vocational, 

7 school-to-work transition, and independent living 

8 needs of adolescent and adult Indians with fetal al9 cohol spectrum disorders. 

10 ‘‘(c) APPLIED RESEARCH PROJECTS.—The Sec11 retary, acting through the Substance Abuse and Mental 

12 Health Services Administration, shall make grants to In13 dian Tribes, Tribal Organizations, and urban Indian Or14 ganizations for applied research projects which propose to 

15 elevate the understanding of methods to prevent, inter16 vene, treat, or provide rehabilitation and behavioral health 

17 aftercare for Indians and urban Indians affected by fetal 

18 alcohol spectrum disorders. 

19 ‘‘(d) FUNDING FOR URBAN INDIAN ORGANIZA20 TIONS.—Ten percent of the funds appropriated pursuant 

21 to this section shall be used to make grants to urban In22 dian Organizations funded under title V. 


jbell on DSKDVH8Z91PROD with BILLS
192 

•S 1790 RS

1 ‘‘SEC. 713. CHILD SEXUAL ABUSE AND PREVENTION TREAT2 MENT PROGRAMS. 

3 ‘‘SEC. 713. CHILD SEXUAL ABUSE PREVENTION AND TREAT4 MENT PROGRAMS. 

5 ‘‘(a) ESTABLISHMENT.—The Secretary, acting 

6 through the Service, shall establish, consistent with section 

7 702, in every Service area, programs involving treatment 

8 for— 

9 ‘‘(1) victims of sexual abuse who are Indian 

10 children or children in an Indian household; and 

11 ‘‘(2) perpetrators of child sexual abuse who are 

12 Indian or members of an Indian household. 

13 ‘‘(2) other members of the household or family of 

14 the victims described in paragraph (1). 

15 ‘‘(b) USE OF FUNDS.—Funding provided pursuant to 

16 this section shall be used for the following: 

17 ‘‘(1) To develop and provide community edu18 cation and prevention programs related to sexual 

19 abuse of Indian children or children in an Indian 

20 household. 

21 ‘‘(2) To identify and provide behavioral health 

22 treatment to victims of sexual abuse who are Indian 

23 children or children in an Indian household, and to 

24 their family members who are affected by sexual 

25 abuse. 


jbell on DSKDVH8Z91PROD with BILLS
193 

•S 1790 RS

1 ‘‘(3) To develop prevention and intervention 

2 models which incorporate traditional health care 

3 practices, cultural values, and community involve4 ment. 

5 ‘‘(4) To develop and implement culturally sen6 sitive assessment and diagnostic tools for use in In7 dian communities and urban centers. 

8 ‘‘(5) To identify and provide behavioral health 

9 treatment to Indian perpetrators and perpetrators 

10 who are members of an Indian household— 

11 ‘‘(A) making efforts to begin offender and 

12 behavioral health treatment while the perpe13 trator is incarcerated or at the earliest possible 

14 date if the perpetrator is not incarcerated; and 

15 ‘‘(B) providing treatment after the perpe16 trator is released, until it is determined that the 

17 perpetrator is not a threat to children. 

18 ‘‘(c) COORDINATION.—The programs established 

19 under subsection (a) shall be carried out in coordination 

20 with programs and services authorized under the Indian 

21 Child Protection and Family Violence Prevention Act (25 

22 U.S.C. 3201 et seq.). 


jbell on DSKDVH8Z91PROD with BILLS
194 

•S 1790 RS

1 ‘‘SEC. 714. DOMESTIC AND SEXUAL VIOLENCE PREVENTION 

2 AND TREATMENT. 

3 ‘‘(a) IN GENERAL.—The Secretary, in accordance 

4 with section 702, is authorized to establish in each Service 

5 area programs involving the prevention and treatment 

6 of— 

7 ‘‘(1) Indian victims of domestic violence or sex8 ual abuse; and 

9 ‘‘(2) perpetrators of domestic violence or sexual 

10 abuse who are Indian or members of an Indian 

11 household. 

12 ‘‘(2) other members of the household or family of 

13 the victims described in paragraph (1). 

14 ‘‘(b) USE OF FUNDS.—Funds made available to carry 

15 out this section shall be used— 

16 ‘‘(1) to develop and implement prevention pro17 grams and community education programs relating 

18 to domestic violence and sexual abuse; 

19 ‘‘(2) to provide behavioral health services, in20 cluding victim support services, and medical treat21 ment (including examinations performed by sexual 

22 assault nurse examiners) to Indian victims of domes23 tic violence or sexual abuse; 

24 ‘‘(3) to purchase rape kits; 


jbell on DSKDVH8Z91PROD with BILLS
195 

•S 1790 RS

1 ‘‘(4) to develop prevention and intervention 

2 models, which may incorporate traditional health 

3 care practices; and 

4 ‘‘(5) to identify and provide behavioral health 

5 treatment to perpetrators who are Indian or mem6 bers of an Indian household. 

7 ‘‘(3) to purchase rape kits; and 

8 ‘‘(4) to develop prevention and intervention mod9 els, which may incorporate traditional health care 

10 practices. 

11 ‘‘(c) TRAINING AND CERTIFICATION.— 

12 ‘‘(1) IN GENERAL.—Not later than 1 year after 

13 the date of enactment of the Indian Health Care Im14 provement Reauthorization and Extension Act of 

15 2009, the Secretary shall establish appropriate pro16 tocols, policies, procedures, standards of practice, 

17 and, if not available elsewhere, training curricula 

18 and training and certification requirements for serv19 ices for victims of domestic violence and sexual 

20 abuse. 

21 ‘‘(2) REPORT.—Not later than 18 months after 

22 the date of enactment of the Indian Health Care Im23 provement Reauthorization and Extension Act of 

24 2009, the Secretary shall submit to the Committee 

25 on Indian Affairs of the Senate and the Committee 


jbell on DSKDVH8Z91PROD with BILLS
196 

•S 1790 RS

1 on Natural Resources of the House of Representa2 tives a report that describes the means and extent 

3 to which the Secretary has carried out paragraph 

4 (1). 

5 ‘‘(d) COORDINATION.— 

6 ‘‘(1) IN GENERAL.—The Secretary, in coordina7 tion with the Attorney General, Federal and tribal 

8 law enforcement agencies, Indian health programs, 

9 and domestic violence or sexual assault victim orga10 nizations, shall develop appropriate victim services 

11 and victim advocate training programs— 

12 ‘‘(A) to improve domestic violence or sex13 ual abuse responses; 

14 ‘‘(B) to improve forensic examinations and 

15 collection; 

16 ‘‘(C) to identify problems or obstacles in 

17 the prosecution of domestic violence or sexual 

18 abuse; and 

19 ‘‘(D) to meet other needs or carry out 

20 other activities required to prevent, treat, and 

21 improve prosecutions of domestic violence and 

22 sexual abuse. 

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

24 date of enactment of the Indian Health Care Im25 provement Reauthorization and Extension Act of 


jbell on DSKDVH8Z91PROD with BILLS
197 

•S 1790 RS

1 2009, the Secretary shall submit to the Committee 

2 on Indian Affairs of the Senate and the Committee 

3 on Natural Resources of the House of Representa4 tives a report that describes, with respect to the 

5 matters described in paragraph (1), the improve6 ments made and needed, problems or obstacles iden7 tified, and costs necessary to address the problems 

8 or obstacles, and any other recommendations that 

9 the Secretary determines to be appropriate. 

10 ‘‘SEC. 715. BEHAVIORAL HEALTH RESEARCH. 

11 ‘‘(a) IN GENERAL.—The Secretary, in consultation 

12 with appropriate Federal agencies, shall make grants to, 

13 or enter into contracts with, Indian tribes, tribal organiza14 tions, and urban Indian organizations or enter into con15 tracts with, or make grants to appropriate institutions for, 

16 the conduct of research on the incidence and prevalence 

17 of behavioral health problems among Indians served by the 

18 Service, Indian tribes, or tribal organizations and among 

19 Indians in urban areas. Research priorities under this sec20 tion shall include— 

21 ‘‘(1) the multifactorial causes of Indian youth 

22 suicide, including— 

23 ‘‘(A) protective and risk factors and sci24 entific data that identifies those factors; and 


jbell on DSKDVH8Z91PROD with BILLS
198 

•S 1790 RS

1 ‘‘(B) the effects of loss of cultural identity 

2 and the development of scientific data on those 

3 effects; 

4 ‘‘(2) the interrelationship and interdependence 

5 of behavioral health problems with alcoholism and 

6 other substance abuse, suicide, homicides, other in7 juries, and the incidence of family violence; and 

8 ‘‘(3) the development of models of prevention 

9 techniques. 

10 ‘‘(b) EMPHASIS.—The effect of the interrelationships 

11 and interdependencies referred to in subsection (a)(2) on 

12 children, and the development of prevention techniques 

13 under subsection (a)(3) applicable to children, shall be em14 phasized. 

15 ‘‘Subtitle B—Indian Youth Suicide 

16 Prevention 

17 ‘‘SEC. 721. FINDINGS AND PURPOSE. 

18 ‘‘(a) FINDINGS.—Congress finds that— 

19 ‘‘(1)(A) the rate of suicide of American Indians 

20 and Alaska Natives is 1.9 times higher than the na21 tional average rate; and 

22 ‘‘(B) the rate of suicide of Indian and Alaska 

23 Native youth aged 15 through 24 is— 

24 ‘‘(i) 3.5 times the national average rate; 

25 and 


jbell on DSKDVH8Z91PROD with BILLS
199 

•S 1790 RS

1 ‘‘(ii) the highest rate of any population 

2 group in the United States; 

3 ‘‘(2) many risk behaviors and contributing fac4 tors for suicide are more prevalent in Indian country 

5 than in other areas, including— 

6 ‘‘(A) history of previous suicide attempts; 

7 ‘‘(B) family history of suicide; 

8 ‘‘(C) history of depression or other mental 

9 illness; 

10 ‘‘(D) alcohol or drug abuse; 

11 ‘‘(E) health disparities; 

12 ‘‘(F) stressful life events and losses; 

13 ‘‘(G) easy access to lethal methods; 

14 ‘‘(H) exposure to the suicidal behavior of 

15 others; 

16 ‘‘(I) isolation; and 

17 ‘‘(J) incarceration; 

18 ‘‘(3) according to national data for 2005, sui19 cide was the second-leading cause of death for Indi20 ans and Alaska Natives of both sexes aged 10 

21 through 34; 

22 ‘‘(4)(A) the suicide rates of Indian and Alaska 

23 Native males aged 15 through 24 are— 


jbell on DSKDVH8Z91PROD with BILLS
200 

•S 1790 RS

1 ‘‘(i) as compared to suicide rates of males 

2 of any other racial group, up to 4 times greater; 

3 and 

4 ‘‘(ii) as compared to suicide rates of fe5 males of any other racial group, up to 11 times 

6 greater; and 

7 ‘‘(B) data demonstrates that, over their life8 times, females attempt suicide 2 to 3 times more 

9 often than males; 

10 ‘‘(5)(A) Indian tribes, especially Indian tribes 

11 located in the Great Plains, have experienced epi12 demic levels of suicide, up to 10 times the national 

13 average; and 

14 ‘‘(B) suicide clustering in Indian country affects 

15 entire tribal communities; 

16 ‘‘(6) death rates for Indians and Alaska Natives 

17 are statistically underestimated because many areas 

18 of Indian country lack the proper resources to iden19 tify and monitor the presence of disease; 

20 ‘‘(7)(A) the Indian Health Service experiences 

21 health professional shortages, with physician vacancy 

22 rates of approximately 17 percent, and nursing va23 cancy rates of approximately 18 percent, in 2007; 


jbell on DSKDVH8Z91PROD with BILLS
201 

•S 1790 RS

1 ‘‘(B) 90 percent of all teens who die by suicide 

2 suffer from a diagnosable mental illness at time of 

3 death; 

‘‘(C) more than 1 4 ⁄2 of teens who die by suicide 

5 have never been seen by a mental health provider; 

6 and 

‘‘(D) 1 7 ⁄3 of health needs in Indian country re8 late to mental health; 

9 ‘‘(8) often, the lack of resources of Indian 

10 tribes and the remote nature of Indian reservations 

11 make it difficult to meet the requirements necessary 

12 to access Federal assistance, including grants; 

13 ‘‘(9) the Substance Abuse and Mental Health 

14 Services Administration and the Service have estab15 lished specific initiatives to combat youth suicide in 

16 Indian country and among Indians and Alaska Na17 tives throughout the United States, including the 

18 National Suicide Prevention Initiative of the Service, 

19 which has worked with Service, tribal, and urban In20 dian health programs since 2003; 

21 ‘‘(10) the National Strategy for Suicide Preven22 tion was established in 2001 through a Department 

23 of Health and Human Services collaboration 

24 among— 


jbell on DSKDVH8Z91PROD with BILLS
202 

•S 1790 RS

1 ‘‘(A) the Substance Abuse and Mental 

2 Health Services Administration; 

3 ‘‘(B) the Service; 

4 ‘‘(C) the Centers for Disease Control and 

5 Prevention; 

6 ‘‘(D) the National Institutes of Health; 

7 and 

8 ‘‘(E) the Health Resources and Services 

9 Administration; and 

10 ‘‘(11) the Service and other agencies of the De11 partment of Health and Human Services use infor12 mation technology and other programs to address 

13 the suicide prevention and mental health needs of 

14 Indians and Alaska Natives. 

15 ‘‘(b) PURPOSES.—The purposes of this subtitle are— 

16 ‘‘(1) to authorize the Secretary to carry out a 

17 demonstration project to test the use of telemental 

18 health services in suicide prevention, intervention, 

19 and treatment of Indian youth, including through— 

20 ‘‘(A) the use of psychotherapy, psychiatric 

21 assessments, diagnostic interviews, therapies for 

22 mental health conditions predisposing to sui23 cide, and alcohol and substance abuse treat24 ment; 


jbell on DSKDVH8Z91PROD with BILLS
203 

•S 1790 RS

1 ‘‘(B) the provision of clinical expertise to, 

2 consultation services with, and medical advice 

3 and training for frontline health care providers 

4 working with Indian youth; 

5 ‘‘(C) training and related support for com6 munity leaders, family members, and health 

7 and education workers who work with Indian 

8 youth; 

9 ‘‘(D) the development of culturally relevant 

10 educational materials on suicide; and 

11 ‘‘(E) data collection and reporting; 

12 ‘‘(2) to encourage Indian tribes, tribal organiza13 tions, and other mental health care providers serving 

14 residents of Indian country to obtain the services of 

15 predoctoral psychology and psychiatry interns; and 

16 ‘‘(3) to enhance the provision of mental health 

17 care services to Indian youth through existing grant 

18 programs of the Substance Abuse and Mental 

19 Health Services Administration. 

20 ‘‘SEC. 722. DEFINITIONS. 

21 ‘‘In this subtitle: 

22 ‘‘(1) ADMINISTRATION.—The term ‘Administra23 tion’ means the Substance Abuse and Mental Health 

24 Services Administration. 


jbell on DSKDVH8Z91PROD with BILLS
204 

•S 1790 RS

1 ‘‘(2) DEMONSTRATION PROJECT.—The term 

2 ‘demonstration project’ means the Indian youth tele3 mental health demonstration project authorized 

4 under section 723(a). 

5 ‘‘(3) INDIAN COUNTRY.—The term ‘Indian 

6 country’ has the meaning given the term in section 

7 1151 of title 18, United States Code. 

8 ‘‘(4)(3) TELEMENTAL HEALTH.—The term 

9 ‘telemental health’ means the use of electronic infor10 mation and telecommunications technologies to sup11 port long-distance mental health care, patient and 

12 professional-related education, public health, and 

13 health administration. 

14 ‘‘SEC. 723. INDIAN YOUTH TELEMENTAL HEALTH DEM15 ONSTRATION PROJECT. 

16 ‘‘(a) AUTHORIZATION.— 

17 ‘‘(1) IN GENERAL.—The Secretary, acting 

18 through the Service, is authorized to carry out a 

19 demonstration project to award grants for the provi20 sion of telemental health services to Indian youth 

21 who— 

22 ‘‘(A) have expressed suicidal ideas; 

23 ‘‘(B) have attempted suicide; or 


jbell on DSKDVH8Z91PROD with BILLS
205 

•S 1790 RS

1 ‘‘(C) have mentalbehavioral health condi2 tions that increase or could increase the risk of 

3 suicide. 

4 ‘‘(2) ELIGIBILITY FOR GRANTS.—Grants under 

5 paragraph (1) shall be awarded to Indian tribes and 

6 tribal organizations that operate 1 or more facili7 ties— 

8 ‘‘(A) located in an area with documented 

9 disproportionately high rates of suicide; 

10 ‘‘(B) reporting active clinical telehealth ca11 pabilities; or 

12 ‘‘(C) offering school-based telemental 

13 health services to Indian youth. 

14 ‘‘(3) GRANT PERIOD.—The Secretary shall 

15 award grants under this section for a period of up 

16 to 4 years. 

17 ‘‘(4) MAXIMUM NUMBER OF GRANTS.—Not 

18 more than 5 grants shall be provided under para19 graph (1), with priority consideration given to In20 dian tribes and tribal organizations that— 

21 ‘‘(A) serve a particular community or geo22 graphic area in which there is a demonstrated 

23 need to address Indian youth suicide; 

24 ‘‘(B) enter into collaborative partnerships 

25 with Service or other tribal health programs or 


jbell on DSKDVH8Z91PROD with BILLS
206 

•S 1790 RS

1 facilities to provide services under this dem2 onstration project; 

3 ‘‘(C) serve an isolated community or geo4 graphic area that has limited or no access to 

5 behavioral health services; or 

6 ‘‘(D) operate a detention facility at which 

7 Indian youth are detained. 

8 ‘‘(5) CONSULTATION WITH ADMINISTRATION.— 

9 In developing and carrying out the demonstration 

10 project under this subsection, the Secretary shall 

11 consult with the Administration as the Federal agen12 cy focused on mental health issues, including suicide. 

13 ‘‘(b) USE OF FUNDS.— 

14 ‘‘(1) IN GENERAL.—An Indian tribe or tribal 

15 organization shall use a grant received under sub16 section (a) for the following purposes: 

17 ‘‘(A) To provide telemental health services 

18 to Indian youth, including the provision of— 

19 ‘‘(i) psychotherapy; 

20 ‘‘(ii) psychiatric assessments and di21 agnostic interviews, therapies for mental 

22 health conditions predisposing to suicide, 

23 and treatment; and 

24 ‘‘(iii) alcohol and substance abuse 

25 treatment. 


jbell on DSKDVH8Z91PROD with BILLS
207 

•S 1790 RS

1 ‘‘(B) To provide clinician-interactive med2 ical advice, guidance and training, assistance in 

3 diagnosis and interpretation, crisis counseling 

4 and intervention, and related assistance to 

5 Service or tribal clinicians and health services 

6 providers working with youth being served 

7 under the demonstration project. 

8 ‘‘(C) To assist, educate, and train commu9 nity leaders, health education professionals and 

10 paraprofessionals, tribal outreach workers, and 

11 family members who work with the youth re12 ceiving telemental health services under the 

13 demonstration project, including with identifica14 tion of suicidal tendencies, crisis intervention 

15 and suicide prevention, emergency skill develop16 ment, and building and expanding networks 

17 among those individuals and with State and 

18 local health services providers. 

19 ‘‘(D) To develop and distribute culturally 

20 appropriate community educational materials 

21 regarding— 

22 ‘‘(i) suicide prevention; 

23 ‘‘(ii) suicide education; 

24 ‘‘(iii) suicide screening; 

25 ‘‘(iv) suicide intervention; and 


jbell on DSKDVH8Z91PROD with BILLS
208 

•S 1790 RS

1 ‘‘(v) ways to mobilize communities 

2 with respect to the identification of risk 

3 factors for suicide. 

4 ‘‘(E) To conduct data collection and re5 porting relating to Indian youth suicide preven6 tion efforts. 

7 ‘‘(2) TRADITIONAL HEALTH CARE PRAC8 TICES.—In carrying out the purposes described in 

9 paragraph (1), an Indian tribe or tribal organization 

10 may use and promote the traditional health care 

11 practices of the Indian tribes of the youth to be 

12 served. 

13 ‘‘(c) APPLICATIONS.— 

14 ‘‘(1) IN GENERAL.—Subject to paragraph (2), 

15 to be eligible to receive a grant under subsection (a), 

16 an Indian tribe or tribal organization shall prepare 

17 and submit to the Secretary an application, at such 

18 time, in such manner, and containing such informa19 tion as the Secretary may require, including— 

20 ‘‘(A) a description of the project that the 

21 Indian tribe or tribal organization will carry out 

22 using the funds provided under the grant; 

23 ‘‘(B) a description of the manner in which 

24 the project funded under the grant would— 


jbell on DSKDVH8Z91PROD with BILLS
209 

•S 1790 RS

1 ‘‘(i) meet the telemental health care 

2 needs of the Indian youth population to be 

3 served by the project; or 

4 ‘‘(ii) improve the access of the Indian 

5 youth population to be served to suicide 

6 prevention and treatment services; 

7 ‘‘(C) evidence of support for the project 

8 from the local community to be served by the 

9 project; 

10 ‘‘(D) a description of how the families and 

11 leadership of the communities or populations to 

12 be served by the project would be involved in 

13 the development and ongoing operations of the 

14 project; 

15 ‘‘(E) a plan to involve the tribal commu16 nity of the youth who are provided services by 

17 the project in planning and evaluating the men18 talbehavioral health care and suicide prevention 

19 efforts provided, in order to ensure the integra20 tion of community, clinical, environmental, and 

21 cultural components of the treatment; and 

22 ‘‘(F) a plan for sustaining the project after 

23 Federal assistance for the demonstration 

24 project has terminated. 


jbell on DSKDVH8Z91PROD with BILLS
210 

•S 1790 RS

1 ‘‘(2) EFFICIENCY OF GRANT APPLICATION

2 PROCESS.—The Secretary shall carry out such meas3 ures as the Secretary determines to be necessary to 

4 maximize the time and workload efficiency of the 

5 process by which Indian tribes and tribal organiza6 tions apply for grants under paragraph (1). 

7 ‘‘(d) COLLABORATION.—The Secretary, acting 

8 through the Service, shall encourage Indian tribes and 

9 tribal organizations receiving grants under this section to 

10 collaborate to enable comparisons regarding best practices 

11 across projects. 

12 ‘‘(e) ANNUAL REPORT.—Each grant recipient shall 

13 submit to the Secretary an annual report that— 

14 ‘‘(1) describes the number of telemental health 

15 services provided; and 

16 ‘‘(2) includes any other information that the 

17 Secretary may require. 

18 ‘‘(f) REPORTS TO CONGRESS.— 

19 ‘‘(1) INITIAL REPORT.— 

20 ‘‘(A) IN GENERAL.—Not later than 2 years 

21 after the date on which the first grant is award22 ed under this section, the Secretary shall sub23 mit to the Committee on Indian Affairs of the 

24 Senate and the Committee on Natural Re25 sources and the Committee on Energy and 


jbell on DSKDVH8Z91PROD with BILLS
211 

•S 1790 RS

1 Commerce of the House of Representatives a 

2 report that— 

3 ‘‘(i) describes each project funded by 

4 a grant under this section during the pre5 ceding 2-year period, including a descrip6 tion of the level of success achieved by the 

7 project; and 

8 ‘‘(ii) evaluates whether the demonstra9 tion project should be continued during the 

10 period beginning on the date of termi11 nation of funding for the demonstration 

12 project under subsection (g) and ending on 

13 the date on which the final report is sub14 mitted under paragraph (2). 

15 ‘‘(B) CONTINUATION OF DEMONSTRATION

16 PROJECT.—On a determination by the Sec17 retary under clause (ii) of subparagraph (A) 

18 that the demonstration project should be con19 tinued, the Secretary may carry out the dem20 onstration project during the period described 

21 in that clause using such sums otherwise made 

22 available to the Secretary as the Secretary de23 termines to be appropriate. 

24 ‘‘(2) FINAL REPORT.—Not later than 270 days 

25 after the date of termination of funding for the demVerDate Nov 24 2008 23:56 Dec 16, 2009 Jkt 089200 PO 00000 Frm 00211 Fmt 6652 Sfmt 6201 E:\BILLS\S1790.RS S1790

jbell on DSKDVH8Z91PROD with BILLS
212 

•S 1790 RS

1 onstration project under subsection (g), the Sec2 retary shall submit to the Committee on Indian Af3 fairs of the Senate and the Committee on Natural 

4 Resources and the Committee on Energy and Com5 merce of the House of Representatives a final report 

6 that— 

7 ‘‘(A) describes the results of the projects 

8 funded by grants awarded under this section, 

9 including any data available that indicate the 

10 number of attempted suicides; 

11 ‘‘(B) evaluates the impact of the tele12 mental health services funded by the grants in 

13 reducing the number of completed suicides 

14 among Indian youth; 

15 ‘‘(C) evaluates whether the demonstration 

16 project should be— 

17 ‘‘(i) expanded to provide more than 5 

18 grants; and 

19 ‘‘(ii) designated as a permanent pro20 gram; and 

21 ‘‘(D) evaluates the benefits of expanding 

22 the demonstration project to include urban In23 dian organizations. 


jbell on DSKDVH8Z91PROD with BILLS
213 

•S 1790 RS

1 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There 

2 is authorized to be appropriated to carry out this section 

3 $1,500,000 for each of fiscal years 2010 through 2013. 

4 ‘‘SEC. 724. SUBSTANCE ABUSE AND MENTAL HEALTH SERV5 ICES ADMINISTRATION GRANTS. 

6 ‘‘(a) GRANT APPLICATIONS.— 

7 ‘‘(1) EFFICIENCY OF GRANT APPLICATION

8 PROCESS.—The Secretary, acting through the Ad9 ministration, shall carry out such measures as the 

10 Secretary determines to be necessary to maximize 

11 the time and workload efficiency of the process by 

12 which Indian tribes and tribal organizations apply 

13 for grants under any program administered by the 

14 Administration, including by providing methods 

15 other than electronic methods of submitting applica16 tions for those grants, if necessary. 

17 ‘‘(2) PRIORITY FOR CERTAIN GRANTS.— 

18 ‘‘(A) IN GENERAL.—To fulfill the trust re19 sponsibility of the United States to Indian 

20 tribes, in awarding relevant grants pursuant to 

21 a program described in subparagraph (B), the 

22 Secretary shall take into consideration the 

23 needs of Indian tribes or tribal organizations, 

24 as applicable, that serve populations with docu25 mented high suicide rates, regardless of whether 


jbell on DSKDVH8Z91PROD with BILLS
214 

•S 1790 RS

1 those Indian tribes or tribal organizations pos2 sess adequate personnel or infrastructure to ful3 fill all applicable requirements of the relevant 

4 program. 

5 ‘‘(B) DESCRIPTION OF GRANT PRO6 GRAMS.—A grant program referred to in sub7 paragraph (A) is a grant program— 

8 ‘‘(i) administered by the Administra9 tion to fund activities relating to mental 

10 health, suicide prevention, or suicide-re11 lated risk factors; and 

12 ‘‘(ii) under which an Indian tribe or 

13 tribal organization is an eligible recipient. 

14 ‘‘(3) CLARIFICATION REGARDING INDIAN

15 TRIBES AND TRIBAL ORGANIZATIONS.—Notwith16 standing any other provision of law, in applying for 

17 a grant under any program administered by the Ad18 ministration, no Indian tribe or tribal organization 

19 shall be required to apply through a State or State 

20 agency. 

21 ‘‘(4) REQUIREMENTS FOR AFFECTED

22 STATES.— 

23 ‘‘(A) DEFINITIONS.—In this paragraph: 

24 ‘‘(i) AFFECTED STATE.—The term 

25 ‘affected State’ means a State— 


jbell on DSKDVH8Z91PROD with BILLS
215 

•S 1790 RS

1 ‘‘(I) the boundaries of which in2 clude 1 or more Indian tribes; and 

3 ‘‘(II) the application for a grant 

4 under any program administered by 

5 the Administration of which includes 

6 statewide data. 

7 ‘‘(ii) INDIAN POPULATION.—The term 

8 ‘Indian population’ means the total num9 ber of residents of an affected State who 

10 are members of 1 or more Indian tribes or 

11 tribal communities located within the af12 fected State.are Indian. 

13 ‘‘(B) REQUIREMENTS.—As a condition of 

14 receipt of a grant under any program adminis15 tered by the Administration, each affected State 

16 shall— 

17 ‘‘(i) describe in the grant applica18 tion— 

19 ‘‘(I) the Indian population of the 

20 affected State; and 

21 ‘‘(II) the contribution of that In22 dian population to the statewide data 

23 used by the affected State in the ap24 plication; and 


jbell on DSKDVH8Z91PROD with BILLS
216 

•S 1790 RS

1 ‘‘(ii) demonstrate to the satisfaction 

2 of the Secretary that— 

3 ‘‘(I) of the total amount of the 

4 grant, the affected State will allocate 

5 for use for the Indian population of 

6 the affected State an amount equal to 

7 the proportion that— 

8 ‘‘(aa) the Indian population 

9 of the affected State; bears to 

10 ‘‘(bb) the total population of 

11 the affected State; and 

12 ‘‘(II) the affected State will offer 

13 to enter into a partnership with each 

14 Indian tribe or tribal organization, as 

15 applicable, located within the affected 

16 State to carry out youth suicide pre17 vention and treatment measures for 

18 members of the Indian tribe. 

19 ‘‘(II) the affected State will take 

20 reasonable efforts to collaborate with 

21 each Indian tribe located within the af22 fected State to carry out youth suicide 

23 prevention and treatment measures for 

24 members of the Indian tribe. 


jbell on DSKDVH8Z91PROD with BILLS
217 

•S 1790 RS

1 ‘‘(C) REPORT.—Not later than 1 year 

2 after the date of receipt of a grant described in 

3 subparagraph (B), an affected State shall sub4 mit to the Secretary a report describing the 

5 measures carried out by the affected State to 

6 ensure compliance with the requirements of 

7 subparagraph (B)(ii). 

8 ‘‘(b) NO NON-FEDERAL SHARE REQUIREMENT.— 

9 Notwithstanding any other provision of law, no Indian 

10 tribe or tribal organization shall be required to provide a 

11 non-Federal share of the cost of any project or activity 

12 carried out using a grant provided under any program ad13 ministered by the Administration. 

14 ‘‘(c) OUTREACH FOR RURAL AND ISOLATED INDIAN

15 TRIBES.—Due to the rural, isolated nature of most Indian 

16 reservations and communities (especially those reserva17 tions and communities in the Great Plains region), the 

18 Secretary shall conduct outreach activities, with a par19 ticular emphasis on the provision of telemental health 

20 services, to achieve the purposes of this subtitle with re21 spect to Indian tribes located in rural, isolated areas. 

22 ‘‘(d) PROVISION OF OTHER ASSISTANCE.— 

23 ‘‘(1) IN GENERAL.—The Secretary, acting 

24 through the Administration, shall carry out such 

25 measures (including monitoring and the provision of 


jbell on DSKDVH8Z91PROD with BILLS
218 

•S 1790 RS

1 required assistance) as the Secretary determines to 

2 be necessary to ensure the provision of adequate sui3 cide prevention and mental health services to Indian 

4 tribes described in paragraph (2), regardless of 

5 whether those Indian tribes possess adequate per6 sonnel or infrastructure— 

7 ‘‘(A) to submit an application for a grant 

8 under any program administered by the Admin9 istration, including due to problems relating to 

10 access to the Internet or other electronic means 

11 that may have resulted in previous obstacles to 

12 submission of a grant application; or 

13 ‘‘(B) to fulfill all applicable requirements 

14 of the relevant program. 

15 ‘‘(2) DESCRIPTION OF INDIAN TRIBES.—An In16 dian tribe referred to in paragraph (1) is an Indian 

17 tribe— 

18 ‘‘(A) the members of which experience— 

19 ‘‘(i) a high rate of youth suicide; 

20 ‘‘(ii) low socioeconomic status; and 

21 ‘‘(iii) extreme health disparity; 

22 ‘‘(B) that is located in a remote and iso23 lated area; and 

24 ‘‘(C) that lacks technology and commu25 nication infrastructure. 


jbell on DSKDVH8Z91PROD with BILLS
219 

•S 1790 RS

1 ‘‘(3) AUTHORIZATION OF APPROPRIATIONS.— 

2 There are authorized to be appropriated to the Sec3 retary such sums as the Secretary determines to be 

4 necessary to carry out this subsection. 

5 ‘‘(e) EARLY INTERVENTION AND ASSESSMENT SERV6 ICES.— 

7 ‘‘(1) DEFINITION OF AFFECTED ENTITY.—In 

8 this subsection, the term ‘affected entity’ means any 

9 entity— 

10 ‘‘(A) that receives a grant for suicide inter11 vention, prevention, or treatment under a pro12 gram administered by the Administration; and 

13 ‘‘(B) the population to be served by which 

14 includes Indian youth. 

15 ‘‘(2) REQUIREMENT.—The Secretary, acting 

16 through the Administration, shall ensure that each 

17 affected entity carrying out a youth suicide early 

18 intervention and prevention strategy described in 

19 section 520E(c)(1) of the Public Health Service Act 

20 (42 U.S.C. 290bb–36(c)(1)), or any other youth sui21 cide-related early intervention and assessment activ22 ity, provides training or education to individuals who 

23 interact frequently with the Indian youth to be 

24 served by the affected entity (including parents, 

25 teachers, coaches, and mentors) on identifying warnVerDate Nov 24 2008 23:56 Dec 16, 2009 Jkt 089200 PO 00000 Frm 00219 Fmt 6652 Sfmt 6201 E:\BILLS\S1790.RS S1790

jbell on DSKDVH8Z91PROD with BILLS
220 

•S 1790 RS

1 ing signs of Indian youth who are at risk of commit2 ting suicide. 

3 ‘‘SEC. 725. USE OF PREDOCTORAL PSYCHOLOGY AND PSY4 CHIATRY INTERNS. 

5 ‘‘The Secretary shall carry out such activities as the 

6 Secretary determines to be necessary to encourage Indian 

7 tribes, tribal organizations, and other mental health care 

8 providers serving residents of Indian country to obtain the 

9 services of predoctoral psychology and psychiatry in10 terns— 

11 ‘‘(1) to increase the quantity of patients served 

12 by the Indian tribes, tribal organizations, and other 

13 mental health care providers; and 

14 ‘‘(2) for purposes of recruitment and retention. 

15 ‘‘SEC. 726. INDIAN YOUTH LIFE SKILLS DEVELOPMENT 

16 DEMONSTRATION PROGRAM. 

17 ‘‘(a) PURPOSE.—The purpose of this section is to au18 thorize the Secretary, acting through the Administration, 

19 to carry out a demonstration program to test the effective20 ness of a culturally compatible, school-based, life skills 

21 curriculum for the prevention of Indian and Alaska Native 

22 adolescent suicide, including through— 

23 ‘‘(1) the establishment of tribal partnerships to 

24 develop and implement such a curriculum, in co25 operation with— 


jbell on DSKDVH8Z91PROD with BILLS
221 

•S 1790 RS

1 ‘‘(A) mentalbehavioral health professionals, 

2 with a priority for tribal partnerships cooper3 ating with mental health professionals employed 

4 by the Service; 

5 ‘‘(B) tribal or local school agencies; and 

6 ‘‘(C) parent and community groups; 

7 ‘‘(2) the provision by the Administration or the 

8 Service of— 

9 ‘‘(A) technical expertise; and 

10 ‘‘(B) clinicians, analysts, and educators, as 

11 appropriate; 

12 ‘‘(3) training for teachers, school administra13 tors, and community members to implement the cur14 riculum; 

15 ‘‘(4) the establishment of advisory councils com16 posed of parents, educators, community members, 

17 trained peers, and others to provide advice regarding 

18 the curriculum and other components of the dem19 onstration program; 

20 ‘‘(5) the development of culturally appropriate 

21 support measures to supplement the effectiveness of 

22 the curriculum; and 

23 ‘‘(6) projects modeled after evidence-based 

24 projects, such as programs evaluated and published 

25 in relevant literature. 


jbell on DSKDVH8Z91PROD with BILLS
222 

•S 1790 RS

1 ‘‘(b) DEMONSTRATION GRANT PROGRAM.— 

2 ‘‘(1) DEFINITIONS.—In this subsection: 

3 ‘‘(A) CURRICULUM.—The term ‘cur4 riculum’ means the culturally compatible, 

5 school-based, life skills curriculum for the pre6 vention of Indian and Alaska Native adolescent 

7 suicide identified by the Secretary under para8 graph (2)(A). 

9 ‘‘(B) ELIGIBLE ENTITY.—The term ‘eligi10 ble entity’ means— 

11 ‘‘(i) an Indian tribe; 

12 ‘‘(ii) a tribal organization; 

13 ‘‘(iii) any other tribally authorized en14 tity; and 

15 ‘‘(iv) any partnership composed of 2 

16 or more entities described in clause (i), (ii), 

17 or (iii). 

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

19 through the Administration, may establish and carry 

20 out a demonstration program under which the Sec21 retary shall— 

22 ‘‘(A) identify a culturally compatible, 

23 school-based, life skills curriculum for the pre24 vention of Indian and Alaska Native adolescent 

25 suicide; 


jbell on DSKDVH8Z91PROD with BILLS
223 

•S 1790 RS

1 ‘‘(B) identify the Indian tribes that are at 

2 greatest risk for adolescent suicide; 

3 ‘‘(C) invite those Indian tribes to partici4 pate in the demonstration program by— 

5 ‘‘(i) responding to a comprehensive 

6 program requirement request of the Sec7 retary; or 

8 ‘‘(ii) submitting, through an eligible 

9 entity, an application in accordance with 

10 paragraph (4); and 

11 ‘‘(D) provide grants to the Indian tribes 

12 identified under subparagraph (B) and eligible 

13 entities to implement the curriculum with re14 spect to Indian and Alaska Native youths 

15 who— 

16 ‘‘(i) are between the ages of 10 and 

17 19; and 

18 ‘‘(ii) attend school in a region that is 

19 at risk of high youth suicide rates, as de20 termined by the Administration. 

21 ‘‘(3) REQUIREMENTS.— 

22 ‘‘(A) TERM.—The term of a grant pro23 vided under the demonstration program under 

24 this section shall be not less than 4 years. 


jbell on DSKDVH8Z91PROD with BILLS
224 

•S 1790 RS

1 ‘‘(B) MAXIMUM NUMBER.—The Secretary 

2 may provide not more than 5 grants under the 

3 demonstration program under this section. 

4 ‘‘(C) AMOUNT.—The grants provided 

5 under this section shall be of equal amounts. 

6 ‘‘(D) CERTAIN SCHOOLS.—In selecting eli7 gible entities to receive grants under this sec8 tion, the Secretary shall ensure that not less 

9 than 1 demonstration program shall be carried 

10 out at each of— 

11 ‘‘(i) a school operated by the Bureau 

12 of Indian Education; 

13 ‘‘(ii) a Tribal school; and 

14 ‘‘(iii) a school receiving payments 

15 under section 8002 or 8003 of the Elemen16 tary and Secondary Education Act of 1965 

17 (20 U.S.C. 7702, 7703). 

18 ‘‘(4) APPLICATIONS.—To be eligible to receive a 

19 grant under the demonstration program, an eligible 

20 entity shall submit to the Secretary an application, 

21 at such time, in such manner, and containing such 

22 information as the Secretary may require, includ23 ing— 

24 ‘‘(A) an assurance that, in implementing 

25 the curriculum, the eligible entity will collaboVerDate Nov 24 2008 23:56 Dec 16, 2009 Jkt 089200 PO 00000 Frm 00224 Fmt 6652 Sfmt 6201 E:\BILLS\S1790.RS S1790

jbell on DSKDVH8Z91PROD with BILLS
225 

•S 1790 RS

1 rate with 1 or more local educational agencies, 

2 including elementary schools, middle schools, 

3 and high schools; 

4 ‘‘(B) an assurance that the eligible entity 

5 will collaborate, for the purpose of curriculum 

6 development, implementation, and training and 

7 technical assistance, with 1 or more— 

8 ‘‘(i) nonprofit entities with dem9 onstrated expertise regarding the develop10 ment of culturally sensitive, school-based, 

11 youth suicide prevention and intervention 

12 programs; or 

13 ‘‘(ii) institutions of higher education 

14 with demonstrated interest and knowledge 

15 regarding culturally sensitive, school-based, 

16 life skills youth suicide prevention and 

17 intervention programs; 

18 ‘‘(C) an assurance that the curriculum will 

19 be carried out in an academic setting in con20 junction with at least 1 classroom teacher not 

21 less frequently than twice each school week for 

22 the duration of the academic year; 

23 ‘‘(D) a description of the methods by 

24 which curriculum participants will be— 


jbell on DSKDVH8Z91PROD with BILLS
226 

•S 1790 RS

1 ‘‘(i) screened for mental health at-risk 

2 indicators; and 

3 ‘‘(ii) if needed and on a case-by-case 

4 basis, referred to a mental health clinician 

5 for further assessment and treatment and 

6 with crisis response capability; and 

7 ‘‘(E) an assurance that supportive services 

8 will be provided to curriculum participants iden9 tified as high-risk participants, including refer10 ral, counseling, and follow-up services for— 

11 ‘‘(i) drug or alcohol abuse; 

12 ‘‘(ii) sexual or domestic abuse; and 

13 ‘‘(iii) depression and other relevant 

14 mental health concerns. 

15 ‘‘(5) USE OF FUNDS.—An Indian tribe identi16 fied under paragraph (2)(B) or an eligible entity 

17 may use a grant provided under this subsection— 

18 ‘‘(A) to develop and implement the cur19 riculum in a school-based setting; 

20 ‘‘(B) to establish an advisory council— 

21 ‘‘(i) to advise the Indian tribe or eligi22 ble entity regarding curriculum develop23 ment; and 

24 ‘‘(ii) to provide support services iden25 tified as necessary by the community being 


jbell on DSKDVH8Z91PROD with BILLS
227 

•S 1790 RS

1 served by the Indian tribe or eligible enti2 ty; 

3 ‘‘(C) to appoint and train a school- and 

4 community-based cultural resource liaison, who 

5 will act as an intermediary among the Indian 

6 tribe or eligible entity, the applicable school ad7 ministrators, and the advisory council estab8 lished by the Indian tribe or eligible entity; 

9 ‘‘(D) to establish an on-site, school-based, 

10 MA- or PhD-level mental health practitioner 

11 (employed by the Service, if practicable) to 

12 work with tribal educators and other personnel; 

13 ‘‘(E) to provide for the training of peer 

14 counselors to assist in carrying out the cur15 riculum; 

16 ‘‘(F) to procure technical and training sup17 port from nonprofit or State entities or institu18 tions of higher education identified by the com19 munity being served by the Indian tribe or eligi20 ble entity as the best suited to develop and im21 plement the curriculum; 

22 ‘‘(G) to train teachers and school adminis23 trators to effectively carry out the curriculum; 

24 ‘‘(H) to establish an effective referral pro25 cedure and network; 


jbell on DSKDVH8Z91PROD with BILLS
228 

•S 1790 RS

1 ‘‘(I) to identify and develop culturally com2 patible curriculum support measures; 

3 ‘‘(J) to obtain educational materials and 

4 other resources from the Administration or 

5 other appropriate entities to ensure the success 

6 of the demonstration program; and 

7 ‘‘(K) to evaluate the effectiveness of the 

8 curriculum in preventing Indian and Alaska 

9 Native adolescent suicide. 

10 ‘‘(c) EVALUATIONS.—Using such amounts made 

11 available pursuant to subsection (e) as the Secretary de12 termines to be appropriate, the Secretary shall conduct, 

13 directly or through a grant, contract, or cooperative agree14 ment with an entity that has experience regarding the de15 velopment and operation of successful culturally compat16 ible, school-based, life skills suicide prevention and inter17 vention programs or evaluations, an annual evaluation of 

18 the demonstration program under this section, including 

19 an evaluation of— 

20 ‘‘(1) the effectiveness of the curriculum in pre21 venting Indian and Alaska Native adolescent suicide; 

22 ‘‘(2) areas for program improvement; and 

23 ‘‘(3) additional development of the goals and 

24 objectives of the demonstration program. 

25 ‘‘(d) REPORT TO CONGRESS.— 


jbell on DSKDVH8Z91PROD with BILLS
229 

•S 1790 RS

1 ‘‘(1) IN GENERAL.—Subject to paragraph (2), 

2 not later than 180 days after the date of termination 

3 of the demonstration program, the Secretary shall 

4 submit to the Committee on Indian Affairs and the 

5 Committee on Health, Education, Labor, and Pen6 sions of the Senate and the Committee on Natural 

7 Resources and the Committee on Education and 

8 Labor of the House of Representatives a final report 

9 that— 

10 ‘‘(A) describes the results of the program 

11 of each Indian tribe or eligible entity under this 

12 section; 

13 ‘‘(B) evaluates the effectiveness of the cur14 riculum in preventing Indian and Alaska Native 

15 adolescent suicide; 

16 ‘‘(C) makes recommendations regarding— 

17 ‘‘(i) the expansion of the demonstra18 tion program under this section to addi19 tional eligible entities; 

20 ‘‘(ii) designating the demonstration 

21 program as a permanent program; and 

22 ‘‘(iii) identifying and distributing the 

23 curriculum through the Suicide Prevention 

24 Resource Center of the Administration; 

25 and 


jbell on DSKDVH8Z91PROD with BILLS
230 

•S 1790 RS

1 ‘‘(D) incorporates any public comments re2 ceived under paragraph (2). 

3 ‘‘(2) PUBLIC COMMENT.—The Secretary shall 

4 provide a notice of the report under paragraph (1) 

5 and an opportunity for public comment on the re6 port for a period of not less than 90 days before 

7 submitting the report to Congress. 

8 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 

9 is authorized to be appropriated to carry out this section 

10 $1,000,000 for each of fiscal years 2010 through 2014.’’. 

11 Subtitle H—Miscellaneous 

12 SEC. 191. CONFIDENTIALITY OF MEDICAL QUALITY ASSUR13 ANCE RECORDS; QUALIFIED IMMUNITY FOR 

14 PARTICIPANTS. 

15 Title VIII of the Indian Health Care Improvement 

16 Act (as amended by section 101(b)) is amended by insert17 ing after section 804 (25 U.S.C. 1674) the following: 

18 ‘‘SEC. 805. CONFIDENTIALITY OF MEDICAL QUALITY ASSUR19 ANCE RECORDS; QUALIFIED IMMUNITY FOR 

20 PARTICIPANTS. 

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

22 ‘‘(1) HEALTH CARE PROVIDER.—The term 

23 ‘health care provider’ means any health care profes24 sional, including community health aides and practi25 tioners certified under section 119, who is— 


jbell on DSKDVH8Z91PROD with BILLS
231 

•S 1790 RS

1 ‘‘(A) granted clinical practice privileges or 

2 employed to provide health care services at— 

3 ‘‘(i) an Indian health program; or 

4 ‘‘(ii) a health program of an urban In5 dian organization; and 

6 ‘‘(B) licensed or certified to perform health 

7 care services by a governmental board or agen8 cy or professional health care society or organi9 zation. 

10 ‘‘(2) MEDICAL QUALITY ASSURANCE PRO11 GRAM.—The term ‘medical quality assurance pro12 gram’ means any activity carried out before, on, or 

13 after the date of enactment of the Indian Health 

14 Care Improvement Reauthorization and Extension 

15 Act of 2009 by or for any Indian health program or 

16 urban Indian organization to assess the quality of 

17 medical care, including activities conducted by or on 

18 behalf of individuals, Indian health program or 

19 urban Indian organization medical or dental treat20 ment review committees, or other review bodies re21 sponsible for quality assurance, credentials, infection 

22 control, patient safety, patient care assessment (in23 cluding treatment procedures, blood, drugs, and 

24 therapeutics), medical records, health resources 


jbell on DSKDVH8Z91PROD with BILLS
232 

•S 1790 RS

1 management review, and identification and preven2 tion of medical or dental incidents and risks. 

3 ‘‘(3) MEDICAL QUALITY ASSURANCE RECORD.— 

4 The term ‘medical quality assurance record’ means 

5 the proceedings, records, minutes, and reports 

6 that— 

7 ‘‘(A) emanate from quality assurance pro8 gram activities described in paragraph (2); and 

9 ‘‘(B) are produced or compiled by or for an 

10 Indian health program or urban Indian organi11 zation as part of a medical quality assurance 

12 program. 

13 ‘‘(b) CONFIDENTIALITY OF RECORDS.—Medical qual14 ity assurance records created by or for any Indian health 

15 program or a health program of an urban Indian organiza16 tion as part of a medical quality assurance program are 

17 confidential and privileged. Such records may not be dis18 closed to any person or entity, except as provided in sub19 section (d). 

20 ‘‘(c) PROHIBITION ON DISCLOSURE AND TESTI21 MONY.— 

22 ‘‘(1) IN GENERAL.—No part of any medical 

23 quality assurance record described in subsection (b) 

24 may be subject to discovery or admitted into eviVerDate Nov 24 2008 23:56 Dec 16, 2009 Jkt 089200 PO 00000 Frm 00232 Fmt 6652 Sfmt 6201 E:\BILLS\S1790.RS S1790

jbell on DSKDVH8Z91PROD with BILLS
233 

•S 1790 RS

1 dence in any judicial or administrative proceeding, 

2 except as provided in subsection (d). 

3 ‘‘(2) TESTIMONY.—An individual who reviews 

4 or creates medical quality assurance records for any 

5 Indian health program or urban Indian organization 

6 who participates in any proceeding that reviews or 

7 creates such records may not be permitted or re8 quired to testify in any judicial or administrative 

9 proceeding with respect to such records or with re10 spect to any finding, recommendation, evaluation, 

11 opinion, or action taken by such person or body in 

12 connection with such records except as provided in 

13 this section. 

14 ‘‘(d) AUTHORIZED DISCLOSURE AND TESTIMONY.— 

15 ‘‘(1) IN GENERAL.—Subject to paragraph (2), a 

16 medical quality assurance record described in sub17 section (b) may be disclosed, and an individual re18 ferred to in subsection (c) may give testimony in 

19 connection with such a record, only as follows: 

20 ‘‘(A) To a Federal agency or private orga21 nization, if such medical quality assurance 

22 record or testimony is needed by such agency or 

23 organization to perform licensing or accredita24 tion functions related to any Indian health pro25 gram or to a health program of an urban InVerDate Nov 24 2008 23:56 Dec 16, 2009 Jkt 089200 PO 00000 Frm 00233 Fmt 6652 Sfmt 6201 E:\BILLS\S1790.RS S1790

jbell on DSKDVH8Z91PROD with BILLS
234 

•S 1790 RS

1 dian organization to perform monitoring, re2 quired by law, of such program or organization. 

3 ‘‘(B) To an administrative or judicial pro4 ceeding commenced by a present or former In5 dian health program or urban Indian organiza6 tion provider concerning the termination, sus7 pension, or limitation of clinical privileges of 

8 such health care provider. 

9 ‘‘(C) To a governmental board or agency 

10 or to a professional health care society or orga11 nization, if such medical quality assurance 

12 record or testimony is needed by such board, 

13 agency, society, or organization to perform li14 censing, credentialing, or the monitoring of pro15 fessional standards with respect to any health 

16 care provider who is or was an employee of any 

17 Indian health program or urban Indian organi18 zation. 

19 ‘‘(D) To a hospital, medical center, or 

20 other institution that provides health care serv21 ices, if such medical quality assurance record or 

22 testimony is needed by such institution to as23 sess the professional qualifications of any health 

24 care provider who is or was an employee of any 

25 Indian health program or urban Indian organiVerDate Nov 24 2008 23:56 Dec 16, 2009 Jkt 089200 PO 00000 Frm 00234 Fmt 6652 Sfmt 6201 E:\BILLS\S1790.RS S1790

jbell on DSKDVH8Z91PROD with BILLS
235 

•S 1790 RS

1 zation and who has applied for or been granted 

2 authority or employment to provide health care 

3 services in or on behalf of such program or or4 ganization. 

5 ‘‘(E) To an officer, employee, or contractor 

6 of the Indian health program or urban Indian 

7 organization that created the records or for 

8 which the records were created. If that officer, 

9 employee, or contractor has a need for such 

10 record or testimony to perform official duties. 

11 ‘‘(F) To a criminal or civil law enforce12 ment agency or instrumentality charged under 

13 applicable law with the protection of the public 

14 health or safety, if a qualified representative of 

15 such agency or instrumentality makes a written 

16 request that such record or testimony be pro17 vided for a purpose authorized by law. 

18 ‘‘(G) In an administrative or judicial pro19 ceeding commenced by a criminal or civil law 

20 enforcement agency or instrumentality referred 

21 to in subparagraph (F), but only with respect 

22 to the subject of such proceeding. 

23 ‘‘(2) IDENTITY OF PARTICIPANTS.—With the 

24 exception of the subject of a quality assurance ac25 tion, the identity of any person receiving health care 


jbell on DSKDVH8Z91PROD with BILLS
236 

•S 1790 RS

1 services from any Indian health program or urban 

2 Indian organization or the identity of any other per3 son associated with such program or organization 

4 for purposes of a medical quality assurance program 

5 that is disclosed in a medical quality assurance 

6 record described in subsection (b) shall be deleted 

7 from that record or document before any disclosure 

8 of such record is made outside such program or or9 ganization. 

10 ‘‘(e) DISCLOSURE FOR CERTAIN PURPOSES.— 

11 ‘‘(1) IN GENERAL.—Nothing in this section 

12 shall be construed as authorizing or requiring the 

13 withholding from any person or entity aggregate sta14 tistical information regarding the results of any In15 dian health program or urban Indian organization’s 

16 medical quality assurance programs. 

17 ‘‘(2) WITHHOLDING FROM CONGRESS.—Noth18 ing in this section shall be construed as authority to 

19 withhold any medical quality assurance record from 

20 a committee of either House of Congress, any joint 

21 committee of Congress, or the Government Account22 ability Office if such record pertains to any matter 

23 within their respective jurisdictions. 

24 ‘‘(f) PROHIBITION ON DISCLOSURE OF RECORD OR

25 TESTIMONY.—An individual or entity having possession of 


jbell on DSKDVH8Z91PROD with BILLS
237 

•S 1790 RS

1 or access to a record or testimony described by this section 

2 may not disclose the contents of such record or testimony 

3 in any manner or for any purpose except as provided in 

4 this section. 

5 ‘‘(g) EXEMPTION FROM FREEDOM OF INFORMATION

6 ACT.—Medical quality assurance records described in sub7 section (b) may not be made available to any person under 

8 section 552 of title 5, United States Code. 

9 ‘‘(h) LIMITATION ON CIVIL LIABILITY.—An indi10 vidual who participates in or provides information to a 

11 person or body that reviews or creates medical quality as12 surance records described in subsection (b) shall not be 

13 civilly liable for such participation or for providing such 

14 information if the participation or provision of information 

15 was in good faith based on prevailing professional stand16 ards at the time the medical quality assurance program 

17 activity took place. 

18 ‘‘(i) APPLICATION TO INFORMATION IN CERTAIN

19 OTHER RECORDS.—Nothing in this section shall be con20 strued as limiting access to the information in a record 

21 created and maintained outside a medical quality assur22 ance program, including a patient’s medical records, on 

23 the grounds that the information was presented during 

24 meetings of a review body that are part of a medical qual25 ity assurance program. 


jbell on DSKDVH8Z91PROD with BILLS
238 

•S 1790 RS

1 ‘‘(j) REGULATIONS.—The Secretary, acting through 

2 the Service, shall promulgate regulations pursuant to sec3 tion 802. 

4 ‘‘(k) CONTINUED PROTECTION.—Disclosure under 

5 subsection (d) does not permit redisclosure except to the 

6 extent such further disclosure is authorized under sub7 section (d) or is otherwise authorized to be disclosed under 

8 this section. 

9 ‘‘(l) INCONSISTENCIES.—To the extent that the pro10 tections under part C of title IX of the Public Health Serv11 ice Act (42 U.S.C. 229b–21 et seq.) (as amended by the 

12 Patient Safety and Quality Improvement Act of 2005 

13 (Public Law 109–41; 119 Stat. 424)) and this section are 

14 inconsistent, the provisions of whichever is more protective 

15 shall control. 

16 ‘‘(m) RELATIONSHIP TO OTHER LAW.—This section 

17 shall continue in force and effect, except as otherwise spe18 cifically provided in any Federal law enacted after the date 

19 of enactment of the Indian Health Care Improvement Re20 authorization and Extension Act of 2009.’’. 


jbell on DSKDVH8Z91PROD with BILLS
239 

•S 1790 RS

1 SEC. 192. ARIZONA, NORTH DAKOTA, AND SOUTH DAKOTA 

2 AS CONTRACT HEALTH SERVICE DELIVERY 

3 AREAS; ELIGIBILITY OF CALIFORNIA INDI4 ANS. 

5 Title VIII of the Indian Health Care Improvement 

6 Act is amended— 

7 (1) by striking section 808 (25 U.S.C. 1678) 

8 and inserting the following: 

9 ‘‘SEC. 808. ARIZONA AS CONTRACT HEALTH SERVICE DELIV10 ERY AREA. 

11 ‘‘(a) IN GENERAL.—The State of Arizona shall be 

12 designated as a contract health service delivery area by 

13 the Service for the purpose of providing contract health 

14 care services to members of Indian tribes in the State of 

15 Arizona. 

16 ‘‘(b) MAINTENANCE OF SERVICES.—The Service 

17 shall not curtail any health care services provided to Indi18 ans residing on reservations in the State of Arizona if the 

19 curtailment is due to the provision of contract services in 

20 that State pursuant to the designation of the State as a 

21 contract health service delivery area by subsection (a).’’; 

22 (2) by inserting after section 808 (25 U.S.C. 

23 1678) the following: 


jbell on DSKDVH8Z91PROD with BILLS
240 

•S 1790 RS

1 ‘‘SEC. 808A. NORTH DAKOTA AND SOUTH DAKOTA AS CON2 TRACT HEALTH SERVICE DELIVERY AREA. 

3 ‘‘(a) IN GENERAL.—The States of North Dakota and 

4 South Dakota shall be designated as a contract health 

5 service delivery area by the Service for the purpose of pro6 viding contract health care services to members of Indian 

7 tribes in the States of North Dakota and South Dakota. 

8 ‘‘(b) MAINTENANCE OF SERVICES.—The Service 

9 shall not curtail any health care services provided to Indi10 ans residing on any reservation, or in any county that has 

11 a common boundary with any reservation, in the State of 

12 North Dakota or South Dakota if the curtailment is due 

13 to the provision of contract services in those States pursu14 ant to the designation of the States as a contract health 

15 service delivery area by subsection (a).’’; and 

16 (3) by striking section 809 (25 U.S.C. 1679) 

17 and inserting the following: 

18 ‘‘SEC. 809. ELIGIBILITY OF CALIFORNIA INDIANS. 

19 ‘‘(a) IN GENERAL.—The following California Indians 

20 shall be eligible for health services provided by the Service: 

21 ‘‘(1) Any member of a federally recognized In22 dian tribe. 

23 ‘‘(2) Any descendant of an Indian who was re24 siding in California on June 1, 1852, if such de25 scendant— 


jbell on DSKDVH8Z91PROD with BILLS
241 

•S 1790 RS

1 ‘‘(A) is a member of the Indian community 

2 served by a local program of the Service; and 

3 ‘‘(B) is regarded as an Indian by the com4 munity in which such descendant lives. 

5 ‘‘(3) Any Indian who holds trust interests in 

6 public domain, national forest, or reservation allot7 ments in California. 

8 ‘‘(4) Any Indian in Californiaof California who 

9 is listed on the plans for distribution of the assets 

10 of rancherias and reservations located within the 

11 State of California under the Act of August 18, 

12 1958 (72 Stat. 619), and any descendant of such an 

13 Indian. 

14 ‘‘(b) CLARIFICATION.—Nothing in this section may 

15 be construed as expanding the eligibility of California Indi16 ans for health services provided by the Service beyond the 

17 scope of eligibility for such health services that applied on 

18 May 1, 1986.’’. 

19 SEC. 193. METHODS TO INCREASE ACCESS TO PROFES20 SIONALS OF CERTAIN CORPS. 

21 Section 812 of the Indian Health Care Improvement 

22 Act (25 U.S.C. 1680b) is amended to read as follows: 

23 ‘‘SEC. 812. NATIONAL HEALTH SERVICE CORPS. 

24 ‘‘(a) NO REDUCTION IN SERVICES.—The Secretary 

25 shall not remove a member of the National Health Service 


jbell on DSKDVH8Z91PROD with BILLS
242 

•S 1790 RS

1 Corps from an Indian health program or urban Indian or2 ganization or withdraw funding used to support such a 

3 member, unless the Secretary, acting through the Service, 

4 has ensured that the Indians receiving services from the 

5 member will experience no reduction in services. 

6 ‘‘(b) TREATMENT OF INDIAN HEALTH PROGRAMS.— 

7 At the request of an Indian health program, the services 

8 of a member of the National Health Service Corps as9 signed to the Indian health program may be limited to 

10 the individuals who are eligible for services from that In11 dian health program.’’. 

12 SEC. 194. HEALTH SERVICES FOR INELIGIBLE PERSONS. 

13 Section 813 of the Indian Health Care Improvement 

14 Act (25 U.S.C. 1680c) is amended to read as follows: 

15 ‘‘SEC. 813. HEALTH SERVICES FOR INELIGIBLE PERSONS. 

16 ‘‘(a) CHILDREN.—Any individual who— 

17 ‘‘(1) has not attained 19 years of age; 

18 ‘‘(2) is the natural or adopted child, stepchild, 

19 foster child, legal ward, or orphan of an eligible In20 dian; and 

21 ‘‘(3) is not otherwise eligible for health services 

22 provided by the Service, 

23 shall be eligible for all health services provided by the 

24 Service on the same basis and subject to the same rules 

25 that apply to eligible Indians until such individual attains 


jbell on DSKDVH8Z91PROD with BILLS
243 

•S 1790 RS

1 19 years of age. The existing and potential health needs 

2 of all such individuals shall be taken into consideration 

3 by the Service in determining the need for, or the alloca4 tion of, the health resources of the Service. If such an indi5 vidual has been determined to be legally incompetent prior 

6 to attaining 19 years of age, such individual shall remain 

7 eligible for such services until 1 year after the date of a 

8 determination of competency. 

9 ‘‘(b) SPOUSES.—Any spouse of an eligible Indian who 

10 is not an Indian, or who is of Indian descent but is not 

11 otherwise eligible for the health services provided by the 

12 Service, shall be eligible for such health services if all such 

13 spouses or spouses who are married to members of each 

14 Indian tribe being served are made eligible, as a class, by 

15 an appropriate resolution of the governing body of the In16 dian tribe or tribal organization providing such services. 

17 The health needs of persons made eligible under this para18 graph shall not be taken into consideration by the Service 

19 in determining the need for, or allocation of, its health 

20 resources. 

21 ‘‘(c) HEALTH FACILITIES PROVIDING HEALTH

22 SERVICES.— 

23 ‘‘(1) IN GENERAL.—The Secretary is authorized 

24 to provide health services under this subsection 

25 through health facilities operated directly by the 


jbell on DSKDVH8Z91PROD with BILLS
244 

•S 1790 RS

1 Service to individuals who reside within the Service 

2 unit and who are not otherwise eligible for such 

3 health services if— 

4 ‘‘(A) the Indian tribes served by such Serv5 ice unit requests such provision of health serv6 ices to such individuals, and 

7 ‘‘(B) the Secretary and the served Indian 

8 tribes have jointly determined that the provision 

9 of such health services will not result in a de10 nial or diminution of health services to eligible 

11 Indians. 

12 ‘‘(2) ISDEAA PROGRAMS.—In the case of 

13 health facilities operated under a contract or com14 pact entered into under the Indian Self-Determina15 tion and Education Assistance Act (25 U.S.C. 450 

16 et seq.), the governing body of the Indian tribe or 

17 tribal organization providing health services under 

18 such contract or compact is authorized to determine 

19 whether health services should be provided under 

20 such contract or compact to individuals who are not 

21 eligible for such health services under any other sub22 section of this section or under any other provision 

23 of law. In making such determinations, the gov24 erning body of the Indian tribe or tribal organization 

25 shall take into account the consideration described in 


jbell on DSKDVH8Z91PROD with BILLS
245 

•S 1790 RS

1 paragraph (1)(B). Any services provided by the In2 dian tribe or tribal organization pursuant to a deter3 mination made under this subparagraph shall be 

4 deemed to be provided under the agreement entered 

5 into by the Indian tribe or tribal organization under 

6 the Indian Self-Determination and Education Assist7 ance Act. The provisions of section 314 of Public 

8 Law 101–512 (104 Stat. 1959), as amended by sec9 tion 308 of Public Law 103–138 (107 Stat. 1416), 

10 shall apply to any services provided by the Indian 

11 tribe or tribal organization pursuant to a determina12 tion made under this subparagraph. 

13 ‘‘(3) PAYMENT FOR SERVICES.— 

14 ‘‘(A) IN GENERAL.—Persons receiving 

15 health services provided by the Service under 

16 this subsection shall be liable for payment of 

17 such health services under a schedule of charges 

18 prescribed by the Secretary which, in the judg19 ment of the Secretary, results in reimbursement 

20 in an amount not less than the actual cost of 

21 providing the health services. Notwithstanding 

22 section 207 of this Act or any other provision 

23 of law, amounts collected under this subsection, 

24 including Medicare, Medicaid, or children’s 

25 health insurance program reimbursements 


jbell on DSKDVH8Z91PROD with BILLS
246 

•S 1790 RS

1 under titles XVIII, XIX, and XXI of the Social 

2 Security Act (42 U.S.C. 1395 et seq.), shall be 

3 credited to the account of the program pro4 viding the service and shall be used for the pur5 poses listed in section 401(d)(2) and amounts 

6 collected under this subsection shall be available 

7 for expenditure within such program. 

8 ‘‘(B) INDIGENT PEOPLE.—Health services 

9 may be provided by the Secretary through the 

10 Service under this subsection to an indigent in11 dividual who would not be otherwise eligible for 

12 such health services but for the provisions of 

13 paragraph (1) only if an agreement has been 

14 entered into with a State or local government 

15 under which the State or local government 

16 agrees to reimburse the Service for the expenses 

17 incurred by the Service in providing such health 

18 services to such indigent individual. 

19 ‘‘(4) REVOCATION OF CONSENT FOR SERV20 ICES.— 

21 ‘‘(A) SINGLE TRIBE SERVICE AREA.—In 

22 the case of a Service Area which serves only 1 

23 Indian tribe, the authority of the Secretary to 

24 provide health services under paragraph (1) 

25 shall terminate at the end of the fiscal year sucVerDate Nov 24 2008 23:56 Dec 16, 2009 Jkt 089200 PO 00000 Frm 00246 Fmt 6652 Sfmt 6201 E:\BILLS\S1790.RS S1790

jbell on DSKDVH8Z91PROD with BILLS
247 

•S 1790 RS

1 ceeding the fiscal year in which the governing 

2 body of the Indian tribe revokes its concurrence 

3 to the provision of such health services. 

4 ‘‘(B) MULTITRIBAL SERVICE AREA.—In 

5 the case of a multitribal Service Area, the au6 thority of the Secretary to provide health serv7 ices under paragraph (1) shall terminate at the 

8 end of the fiscal year succeeding the fiscal year 

9 in which at least 51 percent of the number of 

10 Indian tribes in the Service Area revoke their 

11 concurrence to the provisions of such health 

12 services. 

13 ‘‘(d) OTHER SERVICES.—The Service may provide 

14 health services under this subsection to individuals who 

15 are not eligible for health services provided by the Service 

16 under any other provision of law in order to— 

17 ‘‘(1) achieve stability in a medical emergency; 

18 ‘‘(2) prevent the spread of a communicable dis19 ease or otherwise deal with a public health hazard; 

20 ‘‘(3) provide care to non-Indian women preg21 nant with an eligible Indian’s child for the duration 

22 of the pregnancy through postpartum; or 

23 ‘‘(4) provide care to immediate family members 

24 of an eligible individual if such care is directly re25 lated to the treatment of the eligible individual. 


jbell on DSKDVH8Z91PROD with BILLS
248 

•S 1790 RS

1 ‘‘(e) HOSPITAL PRIVILEGES FOR PRACTITIONERS.— 

2 ‘‘(1) IN GENERAL.—Hospital privileges in 

3 health facilities operated and maintained by the 

4 Service or operated under a contract or compact 

5 pursuant to the Indian Self-Determination and Edu6 cation Assistance Act (25 U.S.C. 450 et seq.) may 

7 be extended to non-Service health care practitioners 

8 who provide services to individuals described in sub9 section (a), (b), (c), or (d). Such non-Service health 

10 care practitioners may, as part of the privileging 

11 process, be designated as employees of the Federal 

12 Government for purposes of section 1346(b) and 

13 chapter 171 of title 28, United States Code (relating 

14 to Federal tort claims) only with respect to acts or 

15 omissions which occur in the course of providing 

16 services to eligible individuals as a part of the condi17 tions under which such hospital privileges are ex18 tended. 

19 ‘‘(2) DEFINITION.—For purposes of this sub20 section, the term ‘non-Service health care practi21 tioner’ means a practitioner who is not— 

22 ‘‘(A) an employee of the Service; or 

23 ‘‘(B) an employee of an Indian tribe or 

24 tribal organization operating a contract or com25 pact under the Indian Self-Determination and 


jbell on DSKDVH8Z91PROD with BILLS
249 

•S 1790 RS

1 Education Assistance Act (25 U.S.C. 450 et 

2 seq.) or an individual who provides health care 

3 services pursuant to a personal services con4 tract with such Indian tribe or tribal organiza5 tion. 

6 ‘‘(f) ELIGIBLE INDIAN.—For purposes of this sec7 tion, the term ‘eligible Indian’ means any Indian who is 

8 eligible for health services provided by the Service without 

9 regard to the provisions of this section.’’. 

10 SEC. 195. ANNUAL BUDGET SUBMISSION. 

11 Title VIII of the Indian Health Care Improvement 

12 Act (25 U.S.C. 1671 et seq.) is amended by adding at 

13 the end the following: 

14 ‘‘SEC. 826. ANNUAL BUDGET SUBMISSION. 

15 ‘‘Effective beginning with the submission of the an16 nual budget request to Congress for fiscal year 2011, the 

17 President shall include, in the amount requested and the 

18 budget justification, amounts that reflect any changes 

19 in— 

20 ‘‘(1) the cost of health care services, as indexed 

21 for United States dollar inflation (as measured by 

22 the Consumer Price Index); and 

23 ‘‘(2) the size of the population served by the 

24 Service.’’. 


jbell on DSKDVH8Z91PROD with BILLS
250 

•S 1790 RS

1 SEC. 196. PRESCRIPTION DRUG MONITORING. 

2 Title VIII of the Indian Health Care Improvement Act 

3 (25 U.S.C. 1671 et seq.) (as amended by section 195) is 

4 amended by adding at the end the following: 

5 ‘‘SEC. 827. PRESCRIPTION DRUG MONITORING. 

6 ‘‘(a) MONITORING.— 

7 ‘‘(1) ESTABLISHMENT.—The Secretary, in co8 ordination with the Secretary of the Interior and the 

9 Attorney General, shall establish a prescription drug 

10 monitoring program, to be carried out at health care 

11 facilities of the Service, tribal health care facilities, 

12 and urban Indian health care facilities. 

13 ‘‘(2) REPORT.—Not later than 18 months after 

14 the date of enactment of the Indian Health Care Im15 provement Reauthorization and Extension Act of 

16 2009, the Secretary shall submit to the Committee on 

17 Indian Affairs of the Senate and the Committee on 

18 Natural Resources of the House of Representatives a 

19 report that describes— 

20 ‘‘(A) the needs of the Service, tribal health 

21 care facilities, and urban Indian health care fa22 cilities with respect to the prescription drug 

23 monitoring program under paragraph (1); 

24 ‘‘(B) the planned development of that pro25 gram, including any relevant statutory or ad26 ministrative limitations; and 


jbell on DSKDVH8Z91PROD with BILLS
251 

•S 1790 RS

1 ‘‘(C) the means by which the program could 

2 be carried out in coordination with any State 

3 prescription drug monitoring program. 

4 ‘‘(b) ABUSE.— 

5 ‘‘(1) IN GENERAL.—The Attorney General, in 

6 conjunction with the Secretary and the Secretary of 

7 the Interior, shall conduct— 

8 ‘‘(A) an assessment of the capacity of, and 

9 support required by, relevant Federal and tribal 

10 agencies— 

11 ‘‘(i) to carry out data collection and 

12 analysis regarding incidents of prescription 

13 drug abuse in Indian communities; and 

14 ‘‘(ii) to exchange among those agencies 

15 and Indian health programs information 

16 relating to prescription drug abuse in In17 dian communities, including statutory and 

18 administrative requirements and limita19 tions relating to that abuse; and 

20 ‘‘(B) training for Indian health care pro21 viders, tribal leaders, law enforcement officers, 

22 and school officials regarding awareness and 

23 prevention of prescription drug abuse and strate24 gies for improving agency responses to addressVerDate Nov 24 2008 23:56 Dec 16, 2009 Jkt 089200 PO 00000 Frm 00251 Fmt 6652 Sfmt 6203 E:\BILLS\S1790.RS S1790

jbell on DSKDVH8Z91PROD with BILLS
252 

•S 1790 RS

1 ing prescription drug abuse in Indian commu2 nities. 

3 ‘‘(2) REPORT.—Not later than 18 months after 

4 the date of enactment of the Indian Health Care Im5 provement Reauthorization and Extension Act of 

6 2009, the Attorney General shall submit to the Com7 mittee on Indian Affairs of the Senate and the Com8 mittee on Natural Resources of the House of Rep9 resentatives a report that describes— 

10 ‘‘(A) the capacity of Federal and tribal 

11 agencies to carry out data collection and anal12 ysis and information exchanges as described in 

13 paragraph (1)(A); 

14 ‘‘(B) the training conducted pursuant to 

15 paragraph (1)(B); 

16 ‘‘(C) infrastructure enhancements required 

17 to carry out the activities described in para18 graph (1), if any; and 

19 ‘‘(D) any statutory or administrative bar20 riers to carrying out those activities.’’. 

21 SEC. 197. TRIBAL HEALTH PROGRAM OPTION FOR COST 

22 SHARING. 

23 Title VIII of the Indian Health Care Improvement Act 

24 (25 U.S.C. 1671 et seq.) (as amended by section 196) is 

25 amended by adding at the end the following: 


jbell on DSKDVH8Z91PROD with BILLS
253 

•S 1790 RS

1 ‘‘SEC. 828. TRIBAL HEALTH PROGRAM OPTION FOR COST 

2 SHARING. 

3 ‘‘(a) IN GENERAL.—Nothing in this Act limits the 

4 ability of a tribal health program operating any health pro5 gram, service, function, activity, or facility funded, in 

6 whole or part, by the Service through, or provided for in, 

7 a compact with the Service pursuant to title V of the Indian 

8 Self-Determination and Education Assistance Act (25 

9 U.S.C. 458aaa et seq.) to charge an Indian for services pro10 vided by the tribal health program. 

11 ‘‘(b) SERVICE.—Nothing in this Act authorizes the 

12 Service— 

13 ‘‘(1) to charge an Indian for services; or 

14 ‘‘(2) to require any tribal health program to 

15 charge an Indian for services.’’. 

16 SEC. 198. DISEASE AND INJURY PREVENTION REPORT. 

17 Title VIII of the Indian Health Care Improvement Act 

18 (25 U.S.C. 1671 et seq.) (as amended by section 197) is 

19 amended by adding at the end the following: 

20 ‘‘SEC. 829. DISEASE AND INJURY PREVENTION REPORT. 

21 ‘‘Not later than 18 months after the date of enactment 

22 of the Indian Health Care Improvement Reauthorization 

23 and Extension Act of 2009, the Secretary shall submit to 

24 the Committee on Indian Affairs of the Senate and the 

25 Committees on Natural Resources and Energy and Com26 merce of the House of Representatives describing— 


jbell on DSKDVH8Z91PROD with BILLS
254 

•S 1790 RS

1 ‘‘(1) all disease and injury prevention activities 

2 conducted by the Service, independently or in con3 junction with other Federal departments and agencies 

4 and Indian tribes; and 

5 ‘‘(2) the effectiveness of those activities, including 

6 the reductions of injury or disease conditions achieved 

7 by the activities.’’. 

8 SEC. 199. OTHER GAO REPORTS. 

9 Title VIII of the Indian Health Care Improvement Act 

10 (25 U.S.C. 1671 et seq.) (as amended by section 198) is 

11 amended by adding at the end the following: 

12 ‘‘SEC. 830. OTHER GAO REPORTS. 

13 ‘‘(a) COORDINATION OF SERVICES.— 

14 ‘‘(1) STUDY AND EVALUATION.—The Comptroller 

15 General of the United States shall conduct a study, 

16 and evaluate the effectiveness, of coordination of 

17 health care services provided to Indians— 

18 ‘‘(A) through Medicare, Medicaid, or 

19 SCHIP; 

20 ‘‘(B) by the Service; or 

21 ‘‘(C) using funds provided by— 

22 ‘‘(i) State or local governments; or 

23 ‘‘(ii) Indian tribes. 

24 ‘‘(2) REPORT.—Not later than 18 months after 

25 the date of enactment of the Indian Health Care ImVerDate Nov 24 2008 23:56 Dec 16, 2009 Jkt 089200 PO 00000 Frm 00254 Fmt 6652 Sfmt 6203 E:\BILLS\S1790.RS S1790

jbell on DSKDVH8Z91PROD with BILLS
255 

•S 1790 RS

1 provement Reauthorization and Extension Act of 

2 2009, the Comptroller General shall submit to Con3 gress a report— 

4 ‘‘(A) describing the results of the evaluation 

5 under paragraph (1); and 

6 ‘‘(B) containing recommendations of the 

7 Comptroller General regarding measures to sup8 port and increase coordination of the provision 

9 of health care services to Indians as described in 

10 paragraph (1). 

11 ‘‘(b) PAYMENTS FOR CONTRACT HEALTH SERVICES.— 

12 ‘‘(1) IN GENERAL.—The Comptroller General 

13 shall conduct a study on the use of health care fur14 nished by health care providers under the contract 

15 health services program funded by the Service and op16 erated by the Service, an Indian tribe, or a tribal or17 ganization. 

18 ‘‘(2) ANALYSIS.—The study conducted under 

19 paragraph (1) shall include an analysis of— 

20 ‘‘(A) the amounts reimbursed under the con21 tract health services program described in para22 graph (1) for health care furnished by entities, 

23 individual providers, and suppliers, including a 

24 comparison of reimbursement for that health care 


jbell on DSKDVH8Z91PROD with BILLS
256 

•S 1790 RS

1 through other public programs and in the pri2 vate sector; 

3 ‘‘(B) barriers to accessing care under such 

4 contract health services program, including bar5 riers relating to travel distances, cultural dif6 ferences, and public and private sector reluctance 

7 to furnish care to patients under the program; 

8 ‘‘(C) the adequacy of existing Federal fund9 ing for health care under the contract health 

10 services program; 

11 ‘‘(D) the administration of the contract 

12 health service program, including the distribu13 tion of funds to Indian health programs pursu14 ant to the program; and 

15 ‘‘(E) any other items determined appro16 priate by the Comptroller General. 

17 ‘‘(3) REPORT.—Not later than 18 months after 

18 the date of enactment of the Indian Health Care Im19 provement Reauthorization and Extension Act of 

20 2009, the Comptroller General shall submit to Con21 gress a report on the study conducted under para22 graph (1), together with recommendations regard23 ing— 

24 ‘‘(A) the appropriate level of Federal fund25 ing that should be established for health care 


jbell on DSKDVH8Z91PROD with BILLS
257 

•S 1790 RS

1 under the contract health services program de2 scribed in paragraph (1); 

3 ‘‘(B) how to most efficiently use that fund4 ing; and 

5 ‘‘(C) the identification of any inequities in 

6 the current distribution formula or inequitable 

7 results for any Indian tribe under the funding 

8 level, and any recommendations for addressing 

9 any inequities or inequitable results identified. 

10 ‘‘(4) CONSULTATION.—In conducting the study 

11 under paragraph (1) and preparing the report under 

12 paragraph (3), the Comptroller General shall consult 

13 with the Service, Indian tribes, and tribal organiza14 tions.’’. 

15 SEC. 199A. TRADITIONAL HEALTH CARE PRACTICES. 

16 Title VIII of the Indian Health Care Improvement Act 

17 (25 U.S.C. 1671 et seq.) (as amended by section 199) is 

18 amended by adding at the end the following: 

19 ‘‘SEC. 831. TRADITIONAL HEALTH CARE PRACTICES. 

20 ‘‘Although the Secretary may promote traditional 

21 health care practices, consistent with the Service standards 

22 for the provision of health care, health promotion, and dis23 ease prevention under this Act, the United States is not lia24 ble for any provision of traditional health care practices 

25 pursuant to this Act that results in damage, injury, or 


jbell on DSKDVH8Z91PROD with BILLS
258 

•S 1790 RS

1 death to a patient. Nothing in this subsection shall be con2 strued to alter any liability or other obligation that the 

3 United States may otherwise have under the Indian Self4 Determination and Education Assistance Act (25 U.S.C. 

5 450 et seq.) or this Act.’’. 

6 SEC. 199B. DIRECTOR OF HIV/AIDS PREVENTION AND 

7 TREATMENT. 

8 Title VIII of the Indian Health Care Improvement Act 

9 (25 U.S.C. 1671 et seq.) (as amended by section 199A) is 

10 amended by adding at the end the following: 

11 ‘‘SEC. 832. DIRECTOR OF HIV/AIDS PREVENTION AND 

12 TREATMENT. 

13 ‘‘(a) ESTABLISHMENT.—The Secretary, acting through 

14 the Service, shall establish within the Service the position 

15 of the Director of HIV/AIDS Prevention and Treatment (re16 ferred to in this section as the ‘Director’). 

17 ‘‘(b) DUTIES.—The Director shall— 

18 ‘‘(1) coordinate and promote HIV/AIDS preven19 tion and treatment activities specific to Indians; 

20 ‘‘(2) provide technical assistance to Indian 

21 tribes, tribal organizations, and urban Indian organi22 zations regarding existing HIV/AIDS prevention and 

23 treatment programs; and 

24 ‘‘(3) ensure interagency coordination to facilitate 

25 the inclusion of Indians in Federal HIV/AIDS reVerDate Nov 24 2008 23:56 Dec 16, 2009 Jkt 089200 PO 00000 Frm 00258 Fmt 6652 Sfmt 6203 E:\BILLS\S1790.RS S1790

jbell on DSKDVH8Z91PROD with BILLS
259 

•S 1790 RS

1 search and grant opportunities, with emphasis on the 

2 programs operated under the Ryan White Comprehen3 sive Aids Resources Emergency Act of 1990 (Public 

4 Law 101–381; 104 Stat. 576) and the amendments 

5 made by that Act. 

6 ‘‘(c) REPORT.—Not later than 2 years after the date 

7 of enactment of the Indian Health Care Improvement Reau8 thorization and Extension Act of 2009, and not less fre9 quently than once every 2 years thereafter, the Director 

10 shall submit to Congress a report describing, with respect 

11 to the preceding 2-year period— 

12 ‘‘(1) each activity carried out under this section; 

13 and 

14 ‘‘(2) any findings of the Director with respect to 

15 HIV/AIDS prevention and treatment activities spe16 cific to Indians.’’. 

17 TITLE II—AMENDMENTS TO 

18 OTHER ACTS 

19 SEC. 201. SOLICITATION OF PROPOSALS FOR SAFE HAR20 BORS UNDER THE SOCIAL SECURITY ACT 

21 FOR FACILITIES OF INDIAN HEALTH PRO22 GRAMS AND URBAN INDIAN ORGANIZATIONS. 

23 The Secretary of Health and Human Services, acting 

24 through the Office of the Inspector General of the Depart25 ment of Health and Human Services, shall publish a noVerDate Nov 24 2008 23:56 Dec 16, 2009 Jkt 089200 PO 00000 Frm 00259 Fmt 6652 Sfmt 6401 E:\BILLS\S1790.RS S1790

jbell on DSKDVH8Z91PROD with BILLS
260 

•S 1790 RS

1 tice, described in section 1128D(a)(1)(A) of the Social Se2 curity Act (42 U.S.C. 1320a–7d(a)(1)(A)), soliciting a 

3 proposal, not later than July 1, 2010, on the development 

4 of safe harbors described in such section relating to health 

5 care items and services provided by facilities of Indian 

6 health programs or an urban Indian organization (as such 

7 terms are defined in section 4 of the Indian Health Care 

8 Improvement Act). Such a safe harbor may relate to areas 

9 such as transportation, housing, or cost-sharing, assist10 ance provided through such facilities or contract health 

11 services for Indians. 

12 SEC. 202. ANNUAL REPORT REGARDING INDIANS SERVED 

13 BY HEALTH BENEFITS PROGRAMS UNDER SO14 CIAL SECURITY ACT. 

15 Section 1139 of the Social Security Act (42 U.S.C. 

16 1320b–9) is amended— 

17 (1) by redesignating subsection (c) as sub18 section (d); and 

19 (2) by inserting after subsection (b) the fol20 lowing: 

21 ‘‘(c) ANNUAL REPORTS ON INDIANS SERVED BY

22 HEALTH BENEFIT PROGRAMS.— 

23 ‘‘(1) IN GENERAL.—Beginning on January 1, 

24 2011, and annually thereafter, the Secretary, acting 

25 through the Administration of the Centers for MediVerDate Nov 24 2008 23:56 Dec 16, 2009 Jkt 089200 PO 00000 Frm 00260 Fmt 6652 Sfmt 6401 E:\BILLS\S1790.RS S1790

jbell on DSKDVH8Z91PROD with BILLS
261 

•S 1790 RS

1 care & Medicaid Services and the Assistant Sec2 retary for Indian Health, shall submit to Congress 

3 a report regarding the enrollment and health status 

4 of Indians receiving items or services under health 

5 benefit programs funded under this Act during the 

6 preceding year. 

7 ‘‘(2) INCLUSIONS.—Each report under para8 graph (1) shall include the following: 

9 ‘‘(A) The total number of Indians enrolled 

10 in, or receiving items or services under, such 

11 programs, disaggregated with respect to each 

12 such program. 

13 ‘‘(B) The number of Indians described in 

14 paragraph (1) that also received health benefits 

15 under programs funded by the Indian Health 

16 Service. 

17 ‘‘(C) General information regarding the 

18 health status of the Indians described in para19 graph (1), disaggregated with respect to specific 

20 diseases or conditions and presented in a man21 ner that is consistent with protections for pri22 vacy of individually identifiable health informa23 tion under section 264(c) of the Health Insur24 ance Portability and Accountability Act of 1996 

25 (42 U.S.C. 1320d–2 note). 


jbell on DSKDVH8Z91PROD with BILLS
262 

•S 1790 RS

1 ‘‘(D) A detailed statement of the status of 

2 facilities of the Indian Health Service or an In3 dian tribe, tribal organization or urban Indian 

4 organization with respect to the compliance by 

5 such facilities with the applicable conditions and 

6 requirements of titles XVIII, XIX, and XXI, 

7 and, in the case of title XIX or XXI, under a 

8 State plan under such title or under waiver au9 thority, and of the progress being made by such 

10 facilities under plans submitted under section 

11 1880(b) or 1911(b) or otherwise toward the 

12 achievement and maintenance of such compli13 ance. 

14 ‘‘(E) Such other information as the Sec15 retary determines is appropriate.’’. 


jbell on DSKDVH8Z91PROD with BILLS
263 

•S 1790 RS

1 SEC. 203. INCLUDING COSTS INCURRED BY SERVICE, A 

2 FEDERALLY QUALIFIED HEALTH CENTER, AN 

3 AIDS DRUG ASSISTANCE PROGRAM, CERTAIN 

4 HOSPITALS, OR A PHARMACEUTICAL MANU5 FACTURER PATIENT ASSISTANCE PROGRAM 

6 IN PROVIDING PRESCRIPTION DRUGS TO7 WARD THE ANNUAL OUT OF POCKET 

8 THRESHOLD UNDER PART D. 

9 (a) IN GENERAL.—Section 1860D–2(b)(4)(C) of the 

10 Social Security Act (42 U.S.C. 1395w–102(b)(4)(C)) is 

11 amended— 

12 (1) in clause (i), by striking ‘‘and’’ at the end; 

13 (2) in clause (ii)— 

14 (A) by striking ‘‘such costs shall be treated 

15 as incurred only if’’ and inserting ‘‘subject to 

16 clause (iii), such costs shall be treated as in17 curred if’’; 

18 (B) by striking ‘‘, under section 1860D– 

19 14, or under a State Pharmaceutical Assistance 

20 Program’’; 

21 (C) by striking ‘‘(other than under such 

22 section or such a Program)’’; and 

23 (D) by striking the period at the end and 

24 inserting ‘‘; and’’; and 

25 (3) by inserting after clause (ii) the following 

26 new clause: 


jbell on DSKDVH8Z91PROD with BILLS
264 

•S 1790 RS

1 ‘‘(iii) such costs shall be treated as in2 curred and shall not be considered to be 

3 reimbursed under clause (ii) if such costs 

4 are borne or paid— 

5 ‘‘(I) under section 1860D–14; 

6 ‘‘(II) under a State Pharma7 ceutical Assistance Program; 

8 ‘‘(III) by the Indian Health Serv9 ice, an Indian tribe or tribal organiza10 tion, or an urban Indian organization 

11 (as defined in section 4 of the Indian 

12 Health Care Improvement Act); 

13 ‘‘(IV) by a Federally qualified 

14 health center (as defined in section 

15 1861(aa)(4)); 

16 ‘‘(V) under an AIDS Drug As17 sistance Program under part B of 

18 title XXVI of the Public Health Serv19 ice Act; 

20 ‘‘(VI) by a subsection (d) hos21 pital (as defined in section 

22 1886(d)(1)(B)) that meets the re23 quirements of clauses (i) and (ii) of 

24 section 340B(a)(4)(L) of the Public 

25 Health Service Act; or 


jbell on DSKDVH8Z91PROD with BILLS
265 

•S 1790 RS

1 ‘‘(VII) by a pharmaceutical man2 ufacturer patient assistance program, 

3 either directly or through the distribu4 tion or donation of covered part D 

5 drugs, which shall be valued at the 

6 negotiated price of such covered part 

7 D drug under the enrollee’s prescrip8 tion drug plan or MA–PD plan as of 

9 the date that the drug was distributed 

10 or donated.’’. 

11 (b) EFFECTIVE DATE.—The amendments made by 

12 subsection (a) shall apply to costs incurred on or after 

13 January 1, 2010. 

14 SEC. 204201. MEDICARE AMENDMENTS. 

15 (a) IN GENERAL.—Section 1880 of the Social Secu16 rity Act (42 U.S.C. 1395qq) is amended— 

17 (1) by redesignating subsection (f) as sub18 section (g); and 

19 (2) by inserting after subsection (e) the fol20 lowing: 

21 ‘‘(f) PROHIBITION.—Payments made pursuant to this 

22 section shall not be reduced as a result of any beneficiary 

23 deductible, coinsurance, or other charge under section 

24 1813.’’. 


jbell on DSKDVH8Z91PROD with BILLS
266 

•S 1790 RS

1 (b) PAYMENT OF BENEFITS.—Section 1833(a)(1)(B) 

2 of the Social Security Act (42 U.S.C. 1395l(a)(1)(B)) is 

3 amended by inserting ‘‘or 1880(e)’’ after ‘‘section 

4 1861(s)(10)(A)’’. 

5 SEC. 205. EXPANSION OF PAYMENTS UNDER MEDICARE, 

6 MEDICAID, AND CHIP FOR ALL COVERED 

7 SERVICES FURNISHED BY INDIAN HEALTH 

8 PROGRAMS. 

9 (a) MEDICAID.— 

10 (1) EXPANSION TO ALL COVERED SERVICES.— 

11 Section 1911 of the Social Security Act (42 U.S.C. 

12 1396j) is amended— 

13 (A) by amending the heading to read as 

14 follows: 

15 ‘‘SEC. 1911. INDIAN HEALTH PROGRAMS.’’; 

16 and 

17 (B) by amending subsection (a) to read as 

18 follows: 

19 ‘‘(a) ELIGIBILITY FOR PAYMENT FOR MEDICAL AS20 SISTANCE.—The Indian Health Service and an Indian 

21 tribe, tribal organization, or an urban Indian organization 

22 shall be eligible for payment for medical assistance pro23 vided under a State plan or under waiver authority with 

24 respect to items and services furnished by the Indian 

25 Health Service, Indian tribe, tribal organization, or urban 


jbell on DSKDVH8Z91PROD with BILLS
267 

•S 1790 RS

1 Indian organization if the furnishing of such services 

2 meets all the conditions and requirements which are appli3 cable generally to the furnishing of items and services 

4 under this title and under such plan or waiver authority.’’. 

5 (2) COMPLIANCE WITH CONDITIONS AND RE6 QUIREMENTS.—Subsection (b) of such section is 

7 amended to read as follows: 

8 ‘‘(b) COMPLIANCE WITH CONDITIONS AND REQUIRE9 MENTS.—A facility of the Indian Health Service or an In10 dian tribe, tribal organization, or an urban Indian organi11 zation which is eligible for payment under subsection (a) 

12 with respect to the furnishing of items and services, but 

13 which does not meet all of the conditions and requirements 

14 of this title and under a State plan or waiver authority 

15 which are applicable generally to such facility, shall make 

16 such improvements as are necessary to achieve or main17 tain compliance with such conditions and requirements in 

18 accordance with a plan submitted to and accepted by the 

19 Secretary for achieving or maintaining compliance with 

20 such conditions and requirements, and shall be deemed to 

21 meet such conditions and requirements (and to be eligible 

22 for payment under this title), without regard to the extent 

23 of its actual compliance with such conditions and require24 ments, during the first 12 months after the month in 

25 which such plan is submitted.’’. 


jbell on DSKDVH8Z91PROD with BILLS
268 

•S 1790 RS

1 (3) REVISION OF AUTHORITY TO ENTER INTO

2 AGREEMENTS.—Subsection (c) of such section is 

3 amended to read as follows: 

4 ‘‘(c) AUTHORITY TO ENTER INTO AGREEMENTS.— 

5 The Secretary may enter into an agreement with a State 

6 for the purpose of reimbursing the State for medical as7 sistance provided by the Indian Health Service, an Indian 

8 tribe, tribal organization, or an urban Indian organization 

9 (as so defined), directly, through referral, or under con10 tracts or other arrangements between the Indian Health 

11 Service, an Indian tribe, tribal organization, or an urban 

12 Indian organization and another health care provider to 

13 Indians who are eligible for medical assistance under the 

14 State plan or under waiver authority.’’. 

15 (4) CROSS-REFERENCES TO SPECIAL FUND FOR

16 IMPROVEMENT OF IHS FACILITIES; DIRECT BILLING

17 OPTION; DEFINITIONS.—Such section is further 

18 amended by striking subsection (d) and adding at 

19 the end the following new subsections: 

20 ‘‘(d) SPECIAL FUND FOR IMPROVEMENT OF IHS FA21 CILITIES.—For provisions relating to the authority of the 

22 Secretary to place payments to which a facility of the In23 dian Health Service is eligible for payment under this title 

24 into a special fund established under section 401(c)(1) of 

25 the Indian Health Care Improvement Act, and the requireVerDate Nov 24 2008 23:56 Dec 16, 2009 Jkt 089200 PO 00000 Frm 00268 Fmt 6652 Sfmt 6401 E:\BILLS\S1790.RS S1790

jbell on DSKDVH8Z91PROD with BILLS
269 

•S 1790 RS

1 ment to use amounts paid from such fund for making im2 provements in accordance with subsection (b), see sub3 paragraphs (A) and (B) of section 401(c)(1) of such Act. 

4 ‘‘(e) DIRECT BILLING OPTION.—For provisions re5 lating to the authority of a tribal health program or an 

6 urban Indian organization to elect to directly bill for, and 

7 receive payment for, health care items and services pro8 vided by such Program or Organization for which payment 

9 is made under this title, see section 401(d) of the Indian 

10 Health Care Improvement Act. 

11 ‘‘(f) DEFINITIONS.—In this section, the terms ‘In12 dian health program’, ‘Indian tribe’, ‘tribal health pro13 gram’, ‘tribal organization’, and ‘urban Indian organiza14 tion’ have the meanings given those terms in section 4 

15 of the Indian Health Care Improvement Act.’’. 

16 (b) MEDICARE.— 

17 (1) EXPANSION TO ALL COVERED SERVICES.— 

18 Section 1880 of such Act (42 U.S.C. 1395qq) is 

19 amended— 

20 (A) by amending the heading to read as 

21 follows: 

22 ‘‘SEC. 1880. INDIAN HEALTH PROGRAMS.’’; 

23 and 

24 (B) by amending subsection (a) to read as 

25 follows: 


jbell on DSKDVH8Z91PROD with BILLS
270 

•S 1790 RS

1 ‘‘(a) ELIGIBILITY FOR PAYMENTS.—Subject to sub2 section (e), the Indian Health Service and an Indian tribe, 

3 tribal organization, or an urban Indian organization shall 

4 be eligible for payments under this title with respect to 

5 items and services furnished by the Indian Health Service, 

6 Indian tribe, tribal organization, or urban Indian organi7 zation if the furnishing of such services meets all the con8 ditions and requirements which are applicable generally to 

9 the furnishing of items and services under this title.’’. 

10 (2) COMPLIANCE WITH CONDITIONS AND RE11 QUIREMENTS.—Subsection (b) of such section is 

12 amended to read as follows: 

13 ‘‘(b) COMPLIANCE WITH CONDITIONS AND REQUIRE14 MENTS.—Subject to subsection (e), a facility of the Indian 

15 Health Service or an Indian tribe, tribal organization, or 

16 an urban Indian organization which is eligible for payment 

17 under subsection (a) with respect to the furnishing of 

18 items and services, but which does not meet all of the con19 ditions and requirements of this title which are applicable 

20 generally to such facility, shall make such improvements 

21 as are necessary to achieve or maintain compliance with 

22 such conditions and requirements in accordance with a 

23 plan submitted to and accepted by the Secretary for 

24 achieving or maintaining compliance with such conditions 

25 and requirements, and shall be deemed to meet such conVerDate Nov 24 2008 23:56 Dec 16, 2009 Jkt 089200 PO 00000 Frm 00270 Fmt 6652 Sfmt 6401 E:\BILLS\S1790.RS S1790

jbell on DSKDVH8Z91PROD with BILLS
271 

•S 1790 RS

1 ditions and requirements (and to be eligible for payment 

2 under this title), without regard to the extent of its actual 

3 compliance with such conditions and requirements, during 

4 the first 12 months after the month in which such plan 

5 is submitted.’’. 

6 (3) CROSS-REFERENCES TO SPECIAL FUND FOR

7 IMPROVEMENT OF IHS FACILITIES; DIRECT BILLING

8 OPTION; DEFINITIONS.— 

9 (A) IN GENERAL.—Such section is further 

10 amended by striking subsections (c) and (d) 

11 and inserting the following new subsections: 

12 ‘‘(c) SPECIAL FUND FOR IMPROVEMENT OF IHS FA13 CILITIES.—For provisions relating to the authority of the 

14 Secretary to place payments to which a facility of the In15 dian Health Service is eligible for payment under this title 

16 into a special fund established under section 401(c)(1) of 

17 the Indian Health Care Improvement Act, and the require18 ment to use amounts paid from such fund for making im19 provements in accordance with subsection (b), see sub20 paragraphs (A) and (B) of section 401(c)(1) of such Act. 

21 ‘‘(d) DIRECT BILLING OPTION.—For provisions re22 lating to the authority of a tribal health program or an 

23 urban Indian organization to elect to directly bill for, and 

24 receive payment for, health care items and services pro25 vided by such program or organization for which payment 


jbell on DSKDVH8Z91PROD with BILLS
272 

•S 1790 RS

1 is made under this title, see section 401(d) of the Indian 

2 Health Care Improvement Act.’’. 

3 (B) CONFORMING AMENDMENT.—Para4 graph (3) of section 1880(e) of such Act (42 

5 U.S.C. 1395qq(e)) is amended by inserting 

6 ‘‘and section 401(c)(1) of the Indian Health 

7 Care Improvement Act’’ after ‘‘Subsection (c)’’. 

8 (4) DEFINITIONS.—Such section is further 

9 amended by amending subsection (g) (as redesig10 nated by section 204(a)(1) of this Act) to read as 

11 follows: 

12 ‘‘(g) DEFINITIONS.—In this section, the terms ‘In13 dian health program’, ‘Indian tribe’, ‘Service Unit’, ‘tribal 

14 health program’, ‘tribal organization’, and ‘urban Indian 

15 organization’ have the meanings given those terms in sec16 tion 4 of the Indian Health Care Improvement Act.’’. 

17 (c) APPLICATION TO CHIP.—Section 2107(e)(1) of 

18 the Social Security Act (42 U.S.C. 1397gg(e)(1)) is 

19 amended— 

20 (1) by redesignating subparagraph (D) as sub21 paragraph (E); and 

22 (2) by inserting after subparagraph (C), the fol23 lowing new subparagraph: 


jbell on DSKDVH8Z91PROD with BILLS
273 

•S 1790 RS

1 ‘‘(D) Section 1911 (relating to Indian 

2 health programs, other than subsection (d) of 

3 such section).’’. 

4 SEC. 206202. REAUTHORIZATION OF NATIVE HAWAIIAN 

5 HEALTH CARE PROGRAMS. 

6 (a) REAUTHORIZATION.—The Native Hawaiian 

7 Health Care Act of 1988 (42 U.S.C. 11701 et seq.) is 

8 amended by striking ‘‘2001’’ each place it appears in sec9 tions 6(h)(1), 7(b), and 10(c) (42 U.S.C. 11705(h)(1), 

10 11706(b), 11709(c)) and inserting ‘‘2019’’. 

11 (b) HEALTH AND EDUCATION.— 

12 (1) IN GENERAL.—Section 6(c) of the Native 

13 Hawaiian Health Care Act of 1988 (42 U.S.C. 

14 11705) is amended by adding at the end the fol15 lowing: 

16 ‘‘(4) HEALTH AND EDUCATION.—In order to 

17 enable privately funded organizations to continue to 

18 supplement public efforts to provide educational pro19 grams designed to improve the health, capability, 

20 and well-being of Native Hawaiians and to continue 

21 to provide health services to Native Hawaiians, not22 withstanding any other provision of Federal or State 

23 law, it shall be lawful for the private educational or24 ganization identified in section 7202(16) of the Ele25 mentary and Secondary Education Act of 1965 (20 


jbell on DSKDVH8Z91PROD with BILLS
274 

•S 1790 RS

1 U.S.C. 7512(16)) to continue to offer its educational 

2 programs and services to Native Hawaiians (as de3 fined in section 7207 of that Act (20 U.S.C. 7517)) 

4 first and to others only after the need for such pro5 grams and services by Native Hawaiians has been 

6 met.’’. 

7 (2) EFFECTIVE DATE.—The amendment made 

8 by paragraph (1) takes effect on December 5, 2006. 

9 (c) DEFINITION OF HEALTH PROMOTION.—Section 

10 12(2) of the Native Hawaiian Health Care Act of 1988 

11 (42 U.S.C. 11711(2)) is amended— 

12 (1) in subparagraph (F), by striking ‘‘and’’ at 

13 the end; 

14 (2) in subparagraph (G), by striking the period 

15 at the end and inserting ‘‘, and’’; and 

16 (3) by adding at the end the following: 

17 ‘‘(H) educational programs with the mis18 sion of improving the health, capability, and 

19 well-being of Native Hawaiians.’’. 


jbell on DSKDVH8Z91PROD with BILLS

jbell on DSKDVH8Z91PROD with BILLS
Calendar No. 233 

111TH CONGRESS 

1ST SESSION S. 1790 

A BILL 

To amend the Indian Health Care Improvement 

purposes. Act to revise and extend that Act, and for other 

DECEMBER 16, 2009 

Reported with amendments 


jbell on DSKDVH8Z91PROD with BILLS