II

104TH CONGRESS

2D SESSION S. 1869

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

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’’.

7 (b) REFERENCES.—Whenever in this Act an amend8 ment or repeal is expressed in terms of an amendment

9 to or repeal of a section or other provision, the reference
2

•S 1869 IS

1 shall be considered to be made to a section or other provi2 sion of the Indian Health Care Improvement Act.

3 SEC. 2. TECHNICAL CORRECTIONS IN THE INDIAN HEALTH

4 CARE IMPROVEMENT ACT.

5 (a) DEFINITION OF HEALTH PROFESSION.—Section

6 4(n) (25 U.S.C. 1603(n)) is amended—

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

8 ‘‘family medicine’’; and

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

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

11 other health profession’’.

12 (b) INDIAN HEALTH PROFESSIONS SCHOLAR13 SHIPS.—Section 104(b) of the Indian Health Care Im14 provement Act (25 U.S.C. 1613a(b)) is amended—

15 (1) in paragraph (3)—

16 (A) in subparagraph (A)—

17 (i) by striking the matter preceding

18 clause (i) and inserting the following:

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

20 written contract with the Secretary under section 338A

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

22 an individual has entered into under that section shall,

23 if that individual is a recipient of an Indian Health Schol24 arship, be met in full-time practice, by service—’’;
3

•S 1869 IS

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

2 clause (iii);

3 (iii) by striking the period at the end

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

5 (iv) by adding at the end the following

6 new clause:

7 ‘‘(v) in an academic setting (including a pro8 gram that receives funding under section 102, 112,

9 or 114, or any other academic setting that the Sec10 retary, acting through the Service, determines to be

11 appropriate for the purposes of this clause) in which

12 the major duties and responsibilities of the recipient

13 are the recruitment and training of Indian health

14 professionals in the discipline of that recipient in a

15 manner consistent with the purpose of this title, as

16 specified in section 101.’’;

17 (B) by redesignating subparagraphs (B)

18 and (C) as subparagraphs (C) and (D), respec19 tively;

20 (C) by inserting after subparagraph (A)

21 the following new subparagraph:

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

23 into a contract referred to in subparagraph (A) and who

24 receives a degree in medicine (including osteopathic or

25 allopathic medicine), dentistry, optometry, podiatry, or
4

•S 1869 IS

1 pharmacy, the Secretary shall defer the active duty service

2 obligation of that individual under that contract, in order

3 that such individual may complete any internship, resi4 dency, or other advanced clinical training that is required

5 for the practice of that health profession, for an appro6 priate period (in years, as determined by the Secretary),

7 subject to the following conditions:

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

9 advanced clinical training shall be counted as satis10 fying any period of obligated service that is required

11 under this section.

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

13 individual shall commence not later than 90 days

14 after the completion of that advanced clinical train15 ing (or by a date specified by the Secretary).

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

17 served in the health profession of that individual, in

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

19 subparagraph (A).’’;

20 (D) in subparagraph (C), as so redesig21 nated, by striking ‘‘prescribed under section

22 338C of the Public Health Service Act (42

23 U.S.C. 254m) by service in a program specified

24 in subparagraph (A)’’ and inserting ‘‘described
5

•S 1869 IS

1 in subparagraph (A) by service in a program

2 specified in that subparagraph’’; and

3 (E) in subparagraph (D), as so redesig4 nated—

5 (i) by striking ‘‘Subject to subpara6 graph (B),’’ and inserting ‘‘Subject to sub7 paragraph (C),’’; and

8 (ii) by striking ‘‘prescribed under sec9 tion 338C of the Public Health Service Act

10 (42 U.S.C. 254m)’’ and inserting ‘‘de11 scribed in subparagraph (A)’’;

12 (2) in paragraph (4)—

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

14 matter preceding clause (i) and inserting the

15 following:

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

17 paragraph (3)(A) shall be equal to the greater of—

18 ’’; and

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

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

21 U.S.C. 254l(g)(1)(B))’’;

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

23 following new subparagraphs:

24 ‘‘(C) Upon the death of an individual who receives

25 an Indian Health Scholarship, any obligation of that indi-
6

•S 1869 IS

1 vidual for service or payment that relates to that scholar2 ship shall be canceled.

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

4 total waiver or suspension of any obligation of service or

5 payment of a recipient of an Indian Health Scholarship

6 if the Secretary determines that—

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

8 that obligation or make that payment;

9 ‘‘(ii) requiring that recipient to meet that obli10 gation or make that payment would result in ex11 treme hardship to the recipient; or

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

13 meet the obligation or make the payment would be

14 unconscionable.

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

16 any case of extreme hardship or for other good cause

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

18 right of the United States to recover funds made available

19 under this section.

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

21 with respect to a recipient of an Indian Health Scholar22 ship, no obligation for payment may be released by a dis23 charge in bankruptcy under title 11, United States Code,

24 unless that discharge is granted after the expiration of the

25 5-year period beginning on the initial date on which that
7

•S 1869 IS

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

2 that the nondischarge of the obligation would be uncon3 scionable.’’.

4 (c) REIMBURSEMENT FROM CERTAIN THIRD PAR5 TIES OF COSTS OF HEALTH SERVICES.—Section 206 (16

6 U.S.C. 1621e) is amended—

7 (1) in subsection (a)—

8 (A) in the matter preceding paragraph

9 (1)—

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

11 and inserting ‘‘(a) RIGHT OF RECOV12 ERY.—Except as provided’’;

13 (ii) by striking ‘‘the reasonable ex14 penses incurred’’ and inserting ‘‘the rea15 sonable charges billed’’;

16 (iii) by striking ‘‘in providing’’ and in17 serting ‘‘for providing’’; and

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

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

20 (B) in paragraph (2), by striking ‘‘such ex21 penses’’ each place it appears and inserting

22 ‘‘such charges’’;

23 (2) in subsection (b), by striking ‘‘(b) Sub24 section (a)’’ and inserting ‘‘(b) RECOVERY AGAINST

25 STATE WITH WORKERS’ COMPENSATION LAWS OR
8

•S 1869 IS

1 NO-FAULT AUTOMOBILE ACCIDENT INSURANCE

2 PROGRAM.—Subsection (a)’’;

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

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

5 CONTRACT PROVISION IMPEDIMENT TO RIGHT OF

6 RECOVERY.—No law’’;

7 (4) in subsection (d), by striking ‘‘(d) No ac8 tion’’ and inserting ‘‘(d) RIGHT TO DAMAGES.—No

9 action’’;

10 (5) in subsection (e)—

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

12 by striking ‘‘(e) The United States’’ and insert13 ing ‘‘(e) INTERVENTION OR SEPARATE CIVIL

14 ACTION.—The United States’’; and

15 (B) by striking paragraph (2) and insert16 ing the following new paragraph:

17 ‘‘(2) while making all reasonable efforts to pro18 vide notice of the action to the individual to whom

19 health services are provided prior to the filing of the

20 action, instituting a civil action.’’;

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

22 United States’’ and inserting ‘‘(f) SERVICES COV23 ERED UNDER A SELF-INSURANCE PLAN.—The

24 United States’’; and
9

•S 1869 IS

1 (7) by adding at the end the following new sub2 sections:

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

4 enforce this section, the court shall award any prevailing

5 plaintiff costs, including attorneys’ fees that were reason6 ably incurred in that action.

7 ‘‘(h) RIGHT OF RECOVERY FOR FAILURE TO PRO8 VIDE REASONABLE ASSURANCES.—The United States, an

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

10 to recover damages against any fiduciary of an insurance

11 company or employee benefit plan that is a provider re12 ferred to in subsection (a) who—

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

14 such insurance company or employee benefit plan

15 has funds that are sufficient to pay all benefits owed

16 by that insurance company or employee benefit plan

17 in its capacity as such a provider; or

18 ‘‘(2) otherwise hinders or prevents recovery

19 under subsection (a), including hindering the pursuit

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

21 a beneficiary or participant covered under subsection

22 (a) under any other applicable Federal or State

23 law.’’.

24 (d) CALIFORNIA CONTRACT HEALTH SERVICES

25 DEMONSTRATION PROGRAM.—Section 211(g) (25 U.S.C.
10

•S 1869 IS

1 1621j(g)) is amended by striking ‘‘1993, 1994, 1995,

2 1996, and 1997’’ and inserting ‘‘1996 through 2000’’.

3 (e) MEDICARE AND MEDICAID DEMONSTRATION

4 PROGRAM.—Section 405(c) (42 U.S.C. 1395qq note) is

5 amended—

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

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

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

9 the plan’’; and

10 (2) in paragraph (2)—

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

12 1989, select no more than 4’’ and inserting ‘‘se13 lect no more than 12’’; and

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

15 inserting ‘‘September 30, 2000’’.

16 (f) GALLUP ALCOHOL AND SUBSTANCE ABUSE

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

18 1665e(d)) is amended to read as follows:

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

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

21 1996 through 2000, such sums as may be necessary to

22 carry out subsection (b).’’.

23 (g) SUBSTANCE ABUSE COUNSELOR EDUCATION

24 DEMONSTRATION PROGRAM.—Section 711(h) (25 U.S.C.
11

•S 1869 IS

1 1665j(h)) is amended by striking ‘‘1993, 1994, 1995,

2 1996, and 1997’’ and inserting ‘‘1996 through 2000’’.

3 (h) HOME AND COMMUNITY-BASED CARE DEM4 ONSTRATION PROGRAM.—Section 821(i) (25 U.S.C.

5 1680k(i)) is amended by striking ‘‘1993, 1994, 1995,

6 1996, and 1997’’ and inserting ‘‘1996 through 2000’’.

Æ