Calendar No. 555

104TH CONGRESS

2D SESSION S. 1869

[Report No. 104–346]

A BILL

To make certain technical corrections in the Indian

purposes.Health Care Improvement Act, and for other

JULY 31, 1996

Reported without amendment
II

Calendar No. 555

104TH CONGRESS

2D SESSION S. 1869

[Report No. 104–346]

To make certain technical corrections in the Indian Health Care Improvement

Act, and for other purposes.

IN THE SENATE OF THE UNITED STATES

JUNE 13, 1996

Mr. MCCAIN (for himself, Mrs. KASSEBAUM, Mr. MURKOWSKI, Mr. STEVENS,

and Mr. SIMON) introduced the following bill; which was read twice and

referred to the Committee on Indian Affairs

JULY 31, 1996

Reported by Mr. MCCAIN, without amendment

A BILL

To make certain technical corrections in the Indian Health

Care Improvement Act, and for other purposes.

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

3 SECTION 1. SHORT TITLE; REFERENCES.

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

5 ‘‘Indian Health Care Improvement Technical Corrections

6 Act of 1996’’.
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1 (b) REFERENCES.—Whenever in this Act an amend2 ment or repeal is expressed in terms of an amendment

3 to or repeal of a section or other provision, the reference

4 shall be considered to be made to a section or other provi5 sion of the Indian Health Care Improvement Act.

6 SEC. 2. TECHNICAL CORRECTIONS IN THE INDIAN HEALTH

7 CARE IMPROVEMENT ACT.

8 (a) DEFINITION OF HEALTH PROFESSION.—Section

9 4(n) (25 U.S.C. 1603(n)) is amended—

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

11 ‘‘family medicine’’; and

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

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

14 other health profession’’.

15 (b) INDIAN HEALTH PROFESSIONS SCHOLAR16 SHIPS.—Section 104(b) of the Indian Health Care Im17 provement Act (25 U.S.C. 1613a(b)) is amended—

18 (1) in paragraph (3)—

19 (A) in subparagraph (A)—

20 (i) by striking the matter preceding

21 clause (i) and inserting the following:

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

23 written contract with the Secretary under section 338A

24 of the Public Health Service Act (42 U.S.C. 254l) that

25 an individual has entered into under that section shall,
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1 if that individual is a recipient of an Indian Health Schol2 arship, be met in full-time practice, by service—’’;

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

4 clause (iii);

5 (iii) by striking the period at the end

6 of clause (iv) and inserting ‘‘; or’’; and

7 (iv) by adding at the end the following

8 new clause:

9 ‘‘(v) in an academic setting (including a pro10 gram that receives funding under section 102, 112,

11 or 114, or any other academic setting that the Sec12 retary, acting through the Service, determines to be

13 appropriate for the purposes of this clause) in which

14 the major duties and responsibilities of the recipient

15 are the recruitment and training of Indian health

16 professionals in the discipline of that recipient in a

17 manner consistent with the purpose of this title, as

18 specified in section 101.’’;

19 (B) by redesignating subparagraphs (B)

20 and (C) as subparagraphs (C) and (D), respec21 tively;

22 (C) by inserting after subparagraph (A)

23 the following new subparagraph:

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

25 into a contract referred to in subparagraph (A) and who
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1 receives a degree in medicine (including osteopathic or

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

3 pharmacy, the Secretary shall defer the active duty service

4 obligation of that individual under that contract, in order

5 that such individual may complete any internship, resi6 dency, or other advanced clinical training that is required

7 for the practice of that health profession, for an appro8 priate period (in years, as determined by the Secretary),

9 subject to the following conditions:

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

11 advanced clinical training shall be counted as satis12 fying any period of obligated service that is required

13 under this section.

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

15 individual shall commence not later than 90 days

16 after the completion of that advanced clinical train17 ing (or by a date specified by the Secretary).

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

19 served in the health profession of that individual, in

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

21 subparagraph (A).’’;

22 (D) in subparagraph (C), as so redesig23 nated, by striking ‘‘prescribed under section

24 338C of the Public Health Service Act (42

25 U.S.C. 254m) by service in a program specified
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1 in subparagraph (A)’’ and inserting ‘‘described

2 in subparagraph (A) by service in a program

3 specified in that subparagraph’’; and

4 (E) in subparagraph (D), as so redesig5 nated—

6 (i) by striking ‘‘Subject to subpara7 graph (B),’’ and inserting ‘‘Subject to sub8 paragraph (C),’’; and

9 (ii) by striking ‘‘prescribed under sec10 tion 338C of the Public Health Service Act

11 (42 U.S.C. 254m)’’ and inserting ‘‘de12 scribed in subparagraph (A)’’;

13 (2) in paragraph (4)—

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

15 matter preceding clause (i) and inserting the

16 following:

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

18 paragraph (3)(A) shall be equal to the greater

19 of—’’; and

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

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

22 U.S.C. 254l(g)(1)(B))’’; and

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

24 following new subparagraphs:
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1 ‘‘(C) Upon the death of an individual who receives

2 an Indian Health Scholarship, any obligation of that indi3 vidual for service or payment that relates to that scholar4 ship shall be canceled.

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

6 total waiver or suspension of any obligation of service or

7 payment of a recipient of an Indian Health Scholarship

8 if the Secretary determines that—

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

10 that obligation or make that payment;

11 ‘‘(ii) requiring that recipient to meet that obli12 gation or make that payment would result in ex13 treme hardship to the recipient; or

14 ‘‘(iii) the enforcement of the requirement to

15 meet the obligation or make the payment would be

16 unconscionable.

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

18 any case of extreme hardship or for other good cause

19 shown, the Secretary may waive, in whole or in part, the

20 right of the United States to recover funds made available

21 under this section.

22 ‘‘(F) Notwithstanding any other provision of law,

23 with respect to a recipient of an Indian Health Scholar24 ship, no obligation for payment may be released by a dis25 charge in bankruptcy under title 11, United States Code,
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1 unless that discharge is granted after the expiration of the

2 5-year period beginning on the initial date on which that

3 payment is due, and only if the bankruptcy court finds

4 that the nondischarge of the obligation would be uncon5 scionable.’’.

6 (c) REIMBURSEMENT FROM CERTAIN THIRD PAR7 TIES OF COSTS OF HEALTH SERVICES.—Section 206 (16

8 U.S.C. 1621e) is amended—

9 (1) in subsection (a)—

10 (A) in the matter preceding paragraph

11 (1)—

12 (i) by striking ‘‘Except as provided’’

13 and inserting ‘‘(a) RIGHT OF RECOV14 ERY.—Except as provided’’;

15 (ii) by striking ‘‘the reasonable ex16 penses incurred’’ and inserting ‘‘the rea17 sonable charges billed’’;

18 (iii) by striking ‘‘in providing’’ and in19 serting ‘‘for providing’’; and

20 (iv) by striking ‘‘for such expenses’’

21 and inserting ‘‘for such charges’’; and

22 (B) in paragraph (2), by striking ‘‘such ex23 penses’’ each place it appears and inserting

24 ‘‘such charges’’;
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1 (2) in subsection (b), by striking ‘‘(b) Sub2 section (a)’’ and inserting ‘‘(b) RECOVERY AGAINST

3 STATE WITH WORKERS’ COMPENSATION LAWS OR

4 NO-FAULT AUTOMOBILE ACCIDENT INSURANCE

5 PROGRAM.—Subsection (a)’’;

6 (3) in subsection (c), by striking ‘‘(c) No law’’

7 and inserting ‘‘(c) PROHIBITION OF STATE LAW OR

8 CONTRACT PROVISION IMPEDIMENT TO RIGHT OF

9 RECOVERY.—No law’’;

10 (4) in subsection (d), by striking ‘‘(d) No ac11 tion’’ and inserting ‘‘(d) RIGHT TO DAMAGES.—No

12 action’’;

13 (5) in subsection (e)—

14 (A) in the matter preceding paragraph (1),

15 by striking ‘‘(e) The United States’’ and insert16 ing ‘‘(e) INTERVENTION OR SEPARATE CIVIL

17 ACTION.—The United States’’; and

18 (B) by striking paragraph (2) and insert19 ing the following new paragraph:

20 ‘‘(2) while making all reasonable efforts to pro21 vide notice of the action to the individual to whom

22 health services are provided prior to the filing of the

23 action, instituting a civil action.’’;

24 (6) in subsection (f), by striking ‘‘(f) The

25 United States’’ and inserting ‘‘(f) SERVICES COV-
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1 ERED UNDER A SELF-INSURANCE PLAN.—The

2 United States’’; and

3 (7) by adding at the end the following new sub4 sections:

5 ‘‘(g) COSTS OF ACTION.—In any action brought to

6 enforce this section, the court shall award any prevailing

7 plaintiff costs, including attorneys’ fees that were reason8 ably incurred in that action.

9 ‘‘(h) RIGHT OF RECOVERY FOR FAILURE TO PRO10 VIDE REASONABLE ASSURANCES.—The United States, an

11 Indian tribe, or a tribal organization shall have the right

12 to recover damages against any fiduciary of an insurance

13 company or employee benefit plan that is a provider re14 ferred to in subsection (a) who—

15 ‘‘(1) fails to provide reasonable assurances that

16 such insurance company or employee benefit plan

17 has funds that are sufficient to pay all benefits owed

18 by that insurance company or employee benefit plan

19 in its capacity as such a provider; or

20 ‘‘(2) otherwise hinders or prevents recovery

21 under subsection (a), including hindering the pursuit

22 of any claim for a remedy that may be asserted by

23 a beneficiary or participant covered under subsection

24 (a) under any other applicable Federal or State

25 law.’’.
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1 (d) CALIFORNIA CONTRACT HEALTH SERVICES

2 DEMONSTRATION PROGRAM.—Section 211(g) (25 U.S.C.

3 1621j(g)) is amended by striking ‘‘1993, 1994, 1995,

4 1996, and 1997’’ and inserting ‘‘1996 through 2000’’.

5 (e) MEDICARE AND MEDICAID DEMONSTRATION

6 PROGRAM.—Section 405(c) (25 U.S.C. 1645(c)) is

7 amended—

8 (1) in paragraph (1)(D), by striking ‘‘prior to

9 October 1, 1990’’ and inserting ‘‘on or before the

10 date which is 1 year after the date of submission of

11 the plan’’; and

12 (2) in paragraph (2)—

13 (A) by striking ‘‘, prior to October 1,

14 1989, select no more than 4’’ and inserting ‘‘se15 lect no more than 12’’; and

16 (B) by striking ‘‘September 30, 1996’’ and

17 inserting ‘‘September 30, 2000’’.

18 (f) GALLUP ALCOHOL AND SUBSTANCE ABUSE

19 TREATMENT CENTER.—Section 706(d) (25 U.S.C.

20 1665e(d)) is amended to read as follows:

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

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

23 1996 through 2000, such sums as may be necessary to

24 carry out subsection (b).’’.
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1 (g) SUBSTANCE ABUSE COUNSELOR EDUCATION

2 DEMONSTRATION PROGRAM.—Section 711(h) (25 U.S.C.

3 1665j(h)) is amended by striking ‘‘1993, 1994, 1995,

4 1996, and 1997’’ and inserting ‘‘1996 through 2000’’.

5 (h) HOME AND COMMUNITY-BASED CARE DEM6 ONSTRATION PROGRAM.—Section 821(i) (25 U.S.C.

7 1680k(i)) is amended by striking ‘‘1993, 1994, 1995,

8 1996, and 1997’’ and inserting ‘‘1996 through 2000’’.