I 

112TH CONGRESS 

1ST SESSION H. R. 536 

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

that Act, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

FEBRUARY 8, 2011 

Mr. COLE (for himself, Mr. DUNCAN of South Carolina, Ms. FOXX, and Mr. 

SMITH of Nebraska) introduced the following bill; which was referred to 

the Committee on Natural Resources, and in addition to the Committees 

on Energy and Commerce, Ways and Means, and the Budget, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned 

A BILL 

To amend the Indian Health Care Improvement Act to revise 

and extend that Act, and for other purposes. 

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

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

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

5 ‘‘Indian Healthcare Improvement Act of 2011’’. 

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

7 this Act is as follows: 

Sec. 1. Short title; table of contents. 


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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. 124. Other authority for provision of services; shared services for longterm care. 

Sec. 125. Reimbursement from certain third parties of costs of health services. 

Sec. 126. Crediting of reimbursements. 

Sec. 127. Behavioral health training and community education programs. 

Sec. 128. Cancer screenings. 

Sec. 129. Patient travel costs. 

Sec. 130. Epidemiology centers. 

Sec. 131. Indian youth grant program. 

Sec. 132. American Indians Into Psychology Program. 

Sec. 133. Prevention, control, and elimination of communicable and infectious 

diseases. 

Sec. 134. Methods to increase clinician recruitment and retention issues. 

Sec. 135. Liability for payment. 

Sec. 136. Offices of Indian Men’s Health and Indian Women’s Health. 

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

Subtitle C—Health Facilities 

Sec. 141. Health care facility priority system. 

Sec. 142. Priority of certain projects protected. 

Sec. 143. Indian health care delivery demonstration projects. 

Sec. 144. Tribal management of federally owned quarters. 

Sec. 145. Other funding, equipment, and supplies for facilities. 

Sec. 146. Indian country modular component facilities demonstration program. 

Sec. 147. 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. 


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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. 163. Requirement to confer with urban Indian organizations. 

Sec. 164. Expanded program authority for urban Indian organizations. 

Sec. 165. 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. 

Subtitle H—Miscellaneous 

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

Sec. 192. Limitation on use of funds appropraited to the Indian Health Service. 

Sec. 193. Arizona, North Dakota, and South Dakota as contract health service 

delivery areas; eligibility of California Indians. 

Sec. 194. Methods to increase access to professionals of certain corps. 

Sec. 195. Health services for ineligible persons. 

Sec. 196. Annual budget submission. 

Sec. 197. Prescription drug monitoring. 

Sec. 198. Tribal health program option for cost sharing. 

Sec. 199. Disease and injury prevention report. 

Sec. 200. Other GAO reports. 

Sec. 201. Traditional health care practices. 

Sec. 202. Director of HIV/AIDS Prevention and Treatment. 

TITLE II—AMENDMENTS TO OTHER ACTS AND MISCELLANEOUS 

PROVISIONS 

Sec. 201. Elimination of sunset for reimbursement for all Medicare part B 

services furnished by certain Indian hospitals and clinics. 

Sec. 202. Including costs incurred by aids drug assistance programs and Indian 

health service in providing prescription drugs toward the annual out-of-pocket threshold under part D. 

Sec. 203. Prohibition of use of Federal funds for abortion. 

Sec. 204. Reauthorization of Native Hawaiian health care programs. 


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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). 


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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 Mar 15 2010 18:45 Feb 09, 2011 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H536.IH H536

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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 


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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 Mar 15 2010 18:45 Feb 09, 2011 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H536.IH H536

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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: 


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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 


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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; 


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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.’’; 


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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); 


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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; 


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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— 


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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 


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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 


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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 


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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— 


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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; 


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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 


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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 


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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). 


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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.—Subject to 

9 paragraphs (3) and (4), in establishing a national 

10 program under paragraph (1), the Secretary— 

11 ‘‘(A) shall not reduce the amounts pro12 vided for the Community Health Aide Program 

13 described in subsections (a) and (b); and 

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

16 program. 

17 ‘‘(3) ELECTION OF INDIAN TRIBE OR TRIBAL

18 ORGANIZATION.— 

19 ‘‘(A) IN GENERAL.—Subparagraph (B) of 

20 paragraph (2) shall not apply in the case of an 

21 election made by an Indian tribe or tribal orga22 nization located in a State (other than Alaska) 

23 in which the use of dental health aide therapist 

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1 ices is authorized under State law to supply 

2 such services in accordance with State law. 

3 ‘‘(B) ACTION BY SECRETARY.—On an elec4 tion by an Indian tribe or tribal organization 

5 under subparagraph (A), the Secretary, acting 

6 through the Service, shall facilitate implementa7 tion of the services elected. 

8 ‘‘(4) VACANCIES.—The Secretary shall not fill 

9 any vacancy for a certified dentist in a program op10 erated by the Service with a dental health aide ther11 apist. 

12 ‘‘(e) EFFECT OF SECTION.—Nothing in this section 

13 shall restrict the ability of the Service, an Indian tribe, 

14 or a tribal organization to participate in any program or 

15 to provide any service authorized by any other Federal 

16 law.’’. 

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, 

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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.’’. 


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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 

19 under the authority of the Indian Self-Determination and 

20 Education Assistance Act (25 U.S.C. 450 et seq.), which 

21 are appropriated under the authority of this section, for 

22 the purposes of— 

23 ‘‘(1) eliminating the deficiencies in health sta24 tus and health resources of all Indian tribes; 

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

26 health care services to Indians; 


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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; 

6 and 

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

8 meet the following health service responsibilities with 

9 respect to those Indian tribes with the highest levels 

10 of health status deficiencies and resource defi11 ciencies: 

12 ‘‘(A) Clinical care, including inpatient care, 

13 outpatient care (including audiology, clinical 

14 eye, and vision care), primary care, secondary 

15 and tertiary care, and long-term care. 

16 ‘‘(B) Preventive health, including mam17 mography and other cancer screening. 

18 ‘‘(C) Dental care. 

19 ‘‘(D) Mental health, including community 

20 mental health services, inpatient mental health 

21 services, dormitory mental health services, 

22 therapeutic and residential treatment centers, 

23 and training of traditional health care practi24 tioners. 

25 ‘‘(E) Emergency medical services. 


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1 ‘‘(F) Treatment and control of, and reha2 bilitative care related to, alcoholism and drug 

3 abuse (including fetal alcohol syndrome) among 

4 Indians. 

5 ‘‘(G) Injury prevention programs, includ6 ing data collection and evaluation, demonstra7 tion projects, training, and capacity building. 

8 ‘‘(H) Home health care. 

9 ‘‘(I) Community health representatives. 

10 ‘‘(J) Maintenance and improvement. 

11 ‘‘(b) NO OFFSET OR LIMITATION.—Any funds appro12 priated under the authority of this section shall not be 

13 used to offset or limit any other appropriations made to 

14 the Service under this Act or the Act of November 2, 1921 

15 (25 U.S.C. 13) (commonly known as the ‘Snyder Act’), 

16 or any other provision of law. 

17 ‘‘(c) ALLOCATION; USE.— 

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

19 the authority of this section shall be allocated to 

20 Service units, Indian tribes, or tribal organizations. 

21 The funds allocated to each Indian tribe, tribal orga22 nization, or Service unit under this paragraph shall 

23 be used by the Indian tribe, tribal organization, or 

24 Service unit under this paragraph to improve the 

25 health status and reduce the resource deficiency of 


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1 each Indian tribe served by such Service unit, Indian 

2 tribe, or tribal organization. 

3 ‘‘(2) APPORTIONMENT OF ALLOCATED

4 FUNDS.—The apportionment of funds allocated to a 

5 Service unit, Indian tribe, or tribal organization 

6 under paragraph (1) among the health service re7 sponsibilities described in subsection (a)(5) shall be 

8 determined by the Service in consultation with, and 

9 with the active participation of, the affected Indian 

10 tribes and tribal organizations. 

11 ‘‘(d) PROVISIONS RELATING TO HEALTH STATUS

12 AND RESOURCE DEFICIENCIES.—For the purposes of this 

13 section, the following definitions apply: 

14 ‘‘(1) DEFINITION.—The term ‘health status 

15 and resource deficiency’ means the extent to 

16 which— 

17 ‘‘(A) the health status objectives set forth 

18 in sections 3(1) and 3(2) are not being 

19 achieved; and 

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

21 does not have available to it the health re22 sources it needs, taking into account the actual 

23 cost of providing health care services given local 

24 geographic, climatic, rural, or other cir25 cumstances. 


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1 ‘‘(2) AVAILABLE RESOURCES.—The health re2 sources available to an Indian tribe or tribal organi3 zation include health resources provided by the Serv4 ice as well as health resources used by the Indian 

5 tribe or tribal organization, including services and fi6 nancing systems provided by any Federal programs, 

7 private insurance, and programs of State or local 

8 governments. 

9 ‘‘(3) PROCESS FOR REVIEW OF DETERMINA10 TIONS.—The Secretary shall establish procedures 

11 which allow any Indian tribe or tribal organization 

12 to petition the Secretary for a review of any deter13 mination of the extent of the health status and re14 source deficiency of such Indian tribe or tribal orga15 nization. 

16 ‘‘(e) ELIGIBILITY FOR FUNDS.—Tribal health pro17 grams shall be eligible for funds appropriated under the 

18 authority of this section on an equal basis with programs 

19 that are administered directly by the Service. 

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

21 years after the date of enactment of the Indian Healthcare 

22 Improvement Act of 2011, the Secretary shall submit to 

23 Congress the current health status and resource deficiency 

24 report of the Service for each Service unit, including newly 


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1 recognized or acknowledged Indian tribes. Such report 

2 shall set out— 

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

4 for determining tribal health status and resource de5 ficiencies, as well as the most recent application of 

6 that methodology; 

7 ‘‘(2) the extent of the health status and re8 source deficiency of each Indian tribe served by the 

9 Service or a tribal health program; 

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

11 the health status and resource deficiencies of all In12 dian tribes served by the Service or a tribal health 

13 program; and 

14 ‘‘(4) an estimate of— 

15 ‘‘(A) the amount of health service funds 

16 appropriated under the authority of this Act, or 

17 any other Act, including the amount of any 

18 funds transferred to the Service for the pre19 ceding fiscal year which is allocated to each 

20 Service unit, Indian tribe, or tribal organiza21 tion; 

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

23 health services in each Service unit or Indian 

24 tribe or tribal organization; and 


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1 ‘‘(C) the number of Indians using the 

2 Service resources made available to each Service 

3 unit, Indian tribe or tribal organization, and, to 

4 the extent available, information on the waiting 

5 lists and number of Indians turned away for 

6 services due to lack of resources. 

7 ‘‘(g) INCLUSION IN BASE BUDGET.—Funds appro8 priated under this section for any fiscal year shall be in9 cluded in the base budget of the Service for the purpose 

10 of determining appropriations under this section in subse11 quent fiscal years. 

12 ‘‘(h) CLARIFICATION.—Nothing in this section is in13 tended to diminish the primary responsibility of the Serv14 ice to eliminate existing backlogs in unmet health care 

15 needs, nor are the provisions of this section intended to 

16 discourage the Service from undertaking additional efforts 

17 to achieve equity among Indian tribes and tribal organiza18 tions. 

19 ‘‘(i) FUNDING DESIGNATION.—Any funds appro20 priated under the authority of this section shall be des21 ignated as the ‘Indian Health Care Improvement Fund’.’’. 

22 SEC. 122. CATASTROPHIC HEALTH EMERGENCY FUND. 

23 Section 202 of the Indian Health Care Improvement 

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


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

2 ‘‘(a) ESTABLISHMENT.—There is established an In3 dian Catastrophic Health Emergency Fund (hereafter in 

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

5 ‘‘(1) the amounts deposited under subsection 

6 (f); and 

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

8 this section. 

9 ‘‘(b) ADMINISTRATION.—CHEF shall be adminis10 tered by the Secretary, acting through the headquarters 

11 of the Service, solely for the purpose of meeting the ex12 traordinary medical costs associated with the treatment of 

13 victims of disasters or catastrophic illnesses who are with14 in the responsibility of the Service. 

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

16 CHEF or its administration shall be subject to contract 

17 or grant under any law, including the Indian Self-Deter18 mination and Education Assistance Act (25 U.S.C. 450 

19 et seq.), nor shall CHEF funds be allocated, apportioned, 

20 or delegated on an Area Office, Service Unit, or other 

21 similar basis. 

22 ‘‘(d) REGULATIONS.—The Secretary shall promul23 gate regulations consistent with the provisions of this sec24 tion to— 

25 ‘‘(1) establish a definition of disasters and cata26 strophic illnesses for which the cost of the treatment 


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•HR 536 IH

1 provided under contract would qualify for payment 

2 from CHEF; 

3 ‘‘(2) provide that a Service Unit shall not be el4 igible for reimbursement for the cost of treatment 

5 from CHEF until its cost of treating any victim of 

6 such catastrophic illness or disaster has reached a 

7 certain threshold cost which the Secretary shall es8 tablish at— 

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

10 ‘‘(B) for any subsequent year, not less 

11 than the threshold cost of the previous year in12 creased by the percentage increase in the med13 ical care expenditure category of the consumer 

14 price index for all urban consumers (United 

15 States city average) for the 12-month period 

16 ending with December of the previous year; 

17 ‘‘(3) establish a procedure for the reimburse18 ment of the portion of the costs that exceeds such 

19 threshold cost incurred by— 

20 ‘‘(A) Service Units; or 

21 ‘‘(B) whenever otherwise authorized by the 

22 Service, non-Service facilities or providers; 

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

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1 ical circumstances warrant treatment prior to the 

2 authorization of such treatment by the Service; and 

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

4 no payment shall be made from CHEF to any pro5 vider of treatment to the extent that such provider 

6 is eligible to receive payment for the treatment from 

7 any other Federal, State, local, or private source of 

8 reimbursement for which the patient is eligible. 

9 ‘‘(e) NO OFFSET OR LIMITATION.—Amounts appro10 priated to CHEF under this section shall not be used to 

11 offset or limit appropriations made to the Service under 

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

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

14 law. 

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

16 shall be deposited into CHEF all reimbursements to which 

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

18 private source (including third party insurance) by reason 

19 of treatment rendered to any victim of a disaster or cata20 strophic illness the cost of which was paid from CHEF.’’. 

21 SEC. 123. DIABETES PREVENTION, TREATMENT, AND CON22 TROL. 

23 Section 204 of the Indian Health Care Improvement 

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


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1 ‘‘SEC. 204. DIABETES PREVENTION, TREATMENT, AND CON2 TROL. 

3 ‘‘(a) DETERMINATIONS REGARDING DIABETES.— 

4 The Secretary, acting through the Service, and in con5 sultation with Indian tribes and tribal organizations, shall 

6 determine— 

7 ‘‘(1) by Indian tribe and by Service unit, the in8 cidence of, and the types of complications resulting 

9 from, diabetes among Indians; and 

10 ‘‘(2) based on the determinations made pursu11 ant to paragraph (1), the measures (including pa12 tient education and effective ongoing monitoring of 

13 disease indicators) each Service unit should take to 

14 reduce the incidence of, and prevent, treat, and con15 trol the complications resulting from, diabetes 

16 among Indian tribes within that Service unit. 

17 ‘‘(b) DIABETES SCREENING.—To the extent medi18 cally indicated and with informed consent, the Secretary 

19 shall screen each Indian who receives services from the 

20 Service for diabetes and for conditions which indicate a 

21 high risk that the individual will become diabetic and es22 tablish a cost-effective approach to ensure ongoing moni23 toring of disease indicators. Such screening and moni24 toring may be conducted by a tribal health program and 

25 may be conducted through appropriate Internet-based 

26 health care management programs. 


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1 ‘‘(c) DIABETES PROJECTS.—The Secretary shall con2 tinue to maintain each model diabetes project in existence 

3 on the date of enactment of the Indian Healthcare Im4 provement Act of 2011, any such other diabetes programs 

5 operated by the Service or tribal health programs, and any 

6 additional diabetes projects, such as the Medical Vanguard 

7 program provided for in title IV of Public Law 108–87, 

8 as implemented to serve Indian tribes. Tribal health pro9 grams shall receive recurring funding for the diabetes 

10 projects that they operate pursuant to this section, both 

11 at the date of enactment of the Indian Healthcare Im12 provement Act of 2011 and for projects which are added 

13 and funded thereafter. 

14 ‘‘(d) DIALYSIS PROGRAMS.—The Secretary is author15 ized to provide, through the Service, Indian tribes, and 

16 tribal organizations, dialysis programs, including the pur17 chase of dialysis equipment and the provision of necessary 

18 staffing. 

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

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

21 extent funding is available— 

22 ‘‘(A) in each area office, consult with In23 dian tribes and tribal organizations regarding 

24 programs for the prevention, treatment, and 

25 control of diabetes; 


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1 ‘‘(B) establish in each area office a reg2 istry of patients with diabetes to track the inci3 dence of diabetes and the complications from 

4 diabetes in that area; and 

5 ‘‘(C) ensure that data collected in each 

6 area office regarding diabetes and related com7 plications among Indians are disseminated to 

8 all other area offices, subject to applicable pa9 tient privacy laws. 

10 ‘‘(2) DIABETES CONTROL OFFICERS.— 

11 ‘‘(A) IN GENERAL.—The Secretary may es12 tablish and maintain in each area office a posi13 tion of diabetes control officer to coordinate and 

14 manage any activity of that area office relating 

15 to the prevention, treatment, or control of dia16 betes to assist the Secretary in carrying out a 

17 program under this section or section 330C of 

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

19 3). 

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

21 carried out by a diabetes control officer under 

22 subparagraph (A) that is the subject of a con23 tract or compact under the Indian Self-Deter24 mination and Education Assistance Act (25 

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1 able to carry out such an activity, shall not be 

2 divisible for purposes of that Act.’’. 

3 SEC. 124. OTHER AUTHORITY FOR PROVISION OF SERV4 ICES; SHARED SERVICES FOR LONG-TERM 

5 CARE. 

6 (a) OTHER AUTHORITY FOR PROVISION OF SERV7 ICES.— 

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

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

10 amended to read as follows: 

11 ‘‘SEC. 205. OTHER AUTHORITY FOR PROVISION OF SERV12 ICES. 

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

14 ‘‘(1) ASSISTED LIVING SERVICE.—The term ‘as15 sisted living service’ means any service provided by 

16 an assisted living facility (as defined in section 

17 232(b) of the National Housing Act (12 U.S.C. 

18 1715w(b))), except that such an assisted living facil19 ity— 

20 ‘‘(A) shall not be required to obtain a li21 cense; but 

22 ‘‘(B) shall meet all applicable standards 

23 for licensure. 

24 ‘‘(2) HOME- AND COMMUNITY-BASED SERV25 ICE.—The term ‘home- and community-based servVerDate Mar 15 2010 18:45 Feb 09, 2011 Jkt 099200 PO 00000 Frm 00039 Fmt 6652 Sfmt 6201 E:\BILLS\H536.IH H536

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1 ice’ means 1 or more of the services specified in 

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

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

4 provided by the Service or by an Indian tribe or trib5 al organization pursuant to the Indian Self-Deter6 mination and Education Assistance Act (25 U.S.C. 

7 450 et seq.)) that are or will be provided in accord8 ance with applicable standards. 

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

10 means— 

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

12 subparagraphs (A) through (H) of section 

13 1861(dd)(1) of the Social Security Act (42 

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

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

16 or tribal organization determines are necessary 

17 and appropriate to provide in furtherance of 

18 that care. 

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

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

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

22 7702B(c) of the Internal Revenue Code of 1986. 

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

24 through the Service, Indian tribes, and tribal organiza25 tions, may provide funding under this Act to meet the obVerDate Mar 15 2010 18:45 Feb 09, 2011 Jkt 099200 PO 00000 Frm 00040 Fmt 6652 Sfmt 6201 E:\BILLS\H536.IH H536

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1 jectives set forth in section 3 through health care-related 

2 services and programs not otherwise described in this Act 

3 for the following services: 

4 ‘‘(1) Hospice care. 

5 ‘‘(2) Assisted living services. 

6 ‘‘(3) Long-term care services. 

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

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

9 eligible to receive long-term care services under this sec10 tion: 

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

12 certain number of activities of daily living without 

13 assistance. 

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

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

16 disabling mental illness, who may be able to perform 

17 activities of daily living under supervision. 

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

19 tribal health program determines to be appropriate. 

20 ‘‘(d) AUTHORIZATION OF CONVENIENT CARE SERV21 ICES.—The Secretary, acting through the Service, Indian 

22 tribes, and tribal organizations, may also provide funding 

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

24 3 for convenient care services programs pursuant to sec25 tion 307(c)(2)(A).’’. 


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

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

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

5 Section 822 of the Indian Health Care Improvement Act 

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

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

8 ‘‘(a) LONG-TERM CARE.— 

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

10 provision of law, the Secretary, acting through the 

11 Service, is authorized to provide directly, or enter 

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

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

17 care) provided in a facility to Indians. 

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

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

20 or other services between the Service or a tribal 

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

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


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

2 entered into pursuant to subsection (a)— 

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

4 tribal organization, delegate to the Indian tribe or 

5 tribal organization such powers of supervision and 

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

8 of this section; 

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

11 Service and the tribal health program be allocated 

12 proportionately between the Service and the Indian 

13 tribe or tribal organization; and 

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

15 organization to construct, renovate, or expand a 

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

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

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

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

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


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

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

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

5 SEC. 125. REIMBURSEMENT FROM CERTAIN THIRD PAR6 TIES OF COSTS OF HEALTH SERVICES. 

7 Section 206 of the Indian Health Care Improvement 

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

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

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

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

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

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

17 or local governmental entity of a State) the reasonable 

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

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

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

22 services furnished by providers other than governmental 

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

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

2 or indemnification for such charges or expenses if— 

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

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

6 such charges or expenses and did pay such charges 

7 or expenses. 

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

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

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

11 health services were provided is covered under— 

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

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

14 plan or program. 

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

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

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

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

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

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


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

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

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

6 damage not covered hereunder. 

7 ‘‘(e) ENFORCEMENT.— 

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

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

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

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

14 services were provided by the Secretary, an 

15 Indian tribe, or tribal organization; or 

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

17 such individual, or 

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

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

22 of a State, such an action against an official 

23 thereof. 

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

25 made to provide notice of action instituted under 


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

2 services were provided, either before or during the 

3 pendency of such action. 

4 ‘‘(3) RECOVERY FROM TORTFEASORS.— 

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

6 an Indian tribe or tribal organization that is 

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

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

11 services to a person who is injured or suffers a 

12 disease on or after the date of enactment of the 

13 Indian Healthcare Improvement Act of 2011 

14 under circumstances that establish grounds for 

15 a claim of liability against the tortfeasor with 

16 respect to the injury or disease, the Indian tribe 

17 or tribal organization shall have a right to re18 cover from the tortfeasor (or an insurer of the 

19 tortfeasor) the reasonable value of the health 

20 services so furnished, paid for, or to be paid 

21 for, in accordance with the Federal Medical 

22 Care Recovery Act (42 U.S.C. 2651 et seq.), to 

23 the same extent and under the same cir24 cumstances as the United States may recover 

25 under that Act. 


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

3 under subparagraph (A) shall be independent of 

4 the rights of the injured or diseased person 

5 served by the Indian tribe or tribal organiza6 tion. 

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

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

11 time upon written notice by the governing body to the 

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

14 for which health services were provided is covered under 

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

19 services consistent with such authorization. 

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

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

23 fees and costs of litigation. 

24 ‘‘(h) NONAPPLICABILITY OF CLAIMS FILING RE25 QUIREMENTS.—An insurance company, health mainteVerDate Mar 15 2010 18:45 Feb 09, 2011 Jkt 099200 PO 00000 Frm 00048 Fmt 6652 Sfmt 6201 E:\BILLS\H536.IH H536

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1 nance organization, self-insurance plan, managed care 

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

4 benefits submitted by the Service or by an Indian tribe 

5 or tribal organization based on the format in which the 

6 claim is submitted if such format complies with the format 

7 required for submission of claims under title XVIII of the 

8 Social Security Act or recognized under section 1175 of 

9 such Act. 

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

12 to urban Indian organizations with respect to populations 

13 served by such Organizations in the same manner they 

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

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

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

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

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

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

25 United States, an Indian tribe, or tribal organization 


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

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

3 SEC. 126. CREDITING OF REIMBURSEMENTS. 

4 Section 207 of the Indian Health Care Improvement 

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

6 ‘‘SEC. 207. CREDITING OF REIMBURSEMENTS. 

7 ‘‘(a) USE OF AMOUNTS.— 

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

12 section 813, by reason of the provision of health 

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

14 organization, or by an urban Indian organization, 

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

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

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

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

20 credited to such unit and used for such purposes. 

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

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

24 Social Security Act. 

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


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1 ‘‘(C) Public Law 87–693. 

2 ‘‘(D) Any other provision of law. 

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

4 not offset or limit any amount obligated to any Service 

5 Unit or entity receiving funding from the Service because 

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

7 SEC. 127. BEHAVIORAL HEALTH TRAINING AND COMMU8 NITY EDUCATION PROGRAMS. 

9 Section 209 of the Indian Health Care Improvement 

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

11 (d) and inserting the following: 

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

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

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

18 of the types of staff positions specified in paragraph 

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

20 training in the identification, prevention, education, 

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

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

24 paragraph (1) are— 


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

2 Indian Affairs, including existing positions, in 

3 the fields of— 

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

6 ‘‘(ii) social services and family and 

7 child welfare; 

8 ‘‘(iii) law enforcement and judicial 

9 services; and 

10 ‘‘(iv) alcohol and substance abuse; 

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

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

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

16 source). 

17 ‘‘(3) TRAINING CRITERIA.— 

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

20 to each type of position identified in paragraphs 

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

22 training has been, or shall be provided to any 

23 individual in any such position. With respect to 

24 any such individual in a position identified pur25 suant to paragraph (2)(C), the respective SecreVerDate Mar 15 2010 18:45 Feb 09, 2011 Jkt 099200 PO 00000 Frm 00052 Fmt 6652 Sfmt 6201 E:\BILLS\H536.IH H536

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1 taries shall provide appropriate training to, or 

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

4 In the case of positions funded under a contract 

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

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

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

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

13 be culturally relevant to Indians and Indian 

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

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

19 request of an Indian tribe, tribal organization, or 

20 urban Indian organization, or assist the Indian tribe, 

21 tribal organization, or urban Indian organization to 

22 develop and implement, a program of community 

23 education on mental illness. In carrying out this 

24 paragraph, the Service shall, upon request of an In25 dian tribe, tribal organization, or urban Indian orgaVerDate Mar 15 2010 18:45 Feb 09, 2011 Jkt 099200 PO 00000 Frm 00053 Fmt 6652 Sfmt 6201 E:\BILLS\H536.IH H536

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1 nization, provide technical assistance to the Indian 

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

4 materials on the identification, prevention, referral, 

5 and treatment of mental illness and dysfunctional 

6 and self-destructive behavior. 

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

8 date of enactment of the Indian Healthcare Im9 provement Act of 2011, the Secretary shall develop 

10 a plan under which the Service will increase the 

11 health care staff providing behavioral health services 

12 by at least 500 positions within 5 years after the 

13 date of enactment of that Act, with at least 200 of 

14 such positions devoted to child, adolescent, and fam15 ily services. The plan developed under this para16 graph shall be implemented under the Act of No17 vember 2, 1921 (25 U.S.C. 13) (commonly known as 

18 the ‘Snyder Act’).’’. 

19 SEC. 128. CANCER SCREENINGS. 

20 Section 212 of the Indian Health Care Improvement 

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

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

23 SEC. 129. PATIENT TRAVEL COSTS. 

24 Section 213 of the Indian Health Care Improvement 

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


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1 ‘‘SEC. 213. PATIENT TRAVEL COSTS. 

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

3 section, the term ‘qualified escort’ means— 

4 ‘‘(1) an adult escort (including a parent, guard5 ian, or other family member) who is required be6 cause of the physical or mental condition, or age, of 

7 the applicable patient; 

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

9 providing necessary medical care during travel by 

10 the applicable patient; or 

11 ‘‘(3) other escorts, as the Secretary or applica12 ble Indian Health Program determines to be appro13 priate. 

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

15 through the Service and Tribal Health Programs, is au16 thorized to provide funds for the following patient travel 

17 costs, including qualified escorts, associated with receiving 

18 health care services provided (either through direct or con19 tract care or through a contract or compact under the In20 dian Self-Determination and Education Assistance Act 

21 (25 U.S.C. 450 et seq.)) under this Act— 

22 ‘‘(1) emergency air transportation and non23 emergency air transportation where ground trans24 portation is infeasible; 


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

2 other means of transportation is available), specially 

3 equipped vehicle, and ambulance; and 

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

5 may be available and required when air or motor ve6 hicle transportation is not available.’’. 

7 SEC. 130. EPIDEMIOLOGY CENTERS. 

8 Section 214 of the Indian Health Care Improvement 

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

10 ‘‘SEC. 214. EPIDEMIOLOGY CENTERS. 

11 ‘‘(a) ESTABLISHMENT OF CENTERS.— 

12 ‘‘(1) IN GENERAL.—The Secretary shall estab13 lish an epidemiology center in each Service area to 

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

15 ‘‘(2) NEW CENTERS.— 

16 ‘‘(A) IN GENERAL.—Subject to subpara17 graph (B), any new center established after the 

18 date of enactment of the Indian Healthcare Im19 provement Act of 2011 may be operated under 

20 a grant authorized by subsection (d). 

21 ‘‘(B) REQUIREMENT.—Funding provided 

22 in a grant described in subparagraph (A) shall 

23 not be divisible. 

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

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1 ject to the Indian Self-Determination and Education 

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

3 funds for the center shall not be divisible. 

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

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

6 and urban Indian organizations, each Service area epide7 miology center established under this section shall, with 

8 respect to the applicable Service area— 

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

10 progress made toward meeting, each of the health 

11 status objectives of the Service, the Indian tribes, 

12 tribal organizations, and urban Indian organizations 

13 in the Service area; 

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

15 systems, and other systems that impact the improve16 ment of Indian health; 

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

18 and urban Indian organizations in identifying high19 est-priority health status objectives and the services 

20 needed to achieve those objectives, based on epide21 miological data; 

22 ‘‘(4) make recommendations for the targeting 

23 of services needed by the populations served; 

24 ‘‘(5) make recommendations to improve health 

25 care delivery systems for Indians and urban Indians; 


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1 ‘‘(6) provide requested technical assistance to 

2 Indian tribes, tribal organizations, and urban Indian 

3 organizations in the development of local health 

4 service priorities and incidence and prevalence rates 

5 of disease and other illness in the community; and 

6 ‘‘(7) provide disease surveillance and assist In7 dian tribes, tribal organizations, and urban Indian 

8 communities to promote public health. 

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

10 Centers for Disease Control and Prevention shall provide 

11 technical assistance to the centers in carrying out this sec12 tion. 

13 ‘‘(d) GRANTS FOR STUDIES.— 

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

15 grants to Indian tribes, tribal organizations, Indian 

16 organizations, and eligible intertribal consortia to 

17 conduct epidemiological studies of Indian commu18 nities. 

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

20 intertribal consortium or Indian organization shall 

21 be eligible to receive a grant under this subsection 

22 if the intertribal consortium is— 

23 ‘‘(A) incorporated for the primary purpose 

24 of improving Indian health; and 


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

2 urban Indian communities residing in the area 

3 in which the intertribal consortium is located. 

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

5 grant under this subsection shall be submitted in 

6 such manner and at such time as the Secretary shall 

7 prescribe. 

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

9 grant under this subsection shall— 

10 ‘‘(A) demonstrate the technical, adminis11 trative, and financial expertise necessary to 

12 carry out the functions described in paragraph 

13 (5); 

14 ‘‘(B) consult and cooperate with providers 

15 of related health and social services in order to 

16 avoid duplication of existing services; and 

17 ‘‘(C) demonstrate cooperation from Indian 

18 tribes or urban Indian organizations in the area 

19 to be served. 

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

21 paragraph (1) may be used— 

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

23 in subsection (b); 

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

25 with, tribal leaders, urban Indian community 


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1 leaders, and related health staff regarding 

2 health care and health service management 

3 issues; and 

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

5 tribal organizations, and urban Indian organi6 zations, to provide to the Service information 

7 regarding ways to improve the health status of 

8 Indians. 

9 ‘‘(e) ACCESS TO INFORMATION.— 

10 ‘‘(1) IN GENERAL.—An epidemiology center op11 erated by a grantee pursuant to a grant awarded 

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

13 health authority (as defined in section 164.501 of 

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

15 regulation)) for purposes of the Health Insurance 

16 Portability and Accountability Act of 1996 (Public 

17 Law 104–191; 110 Stat. 1936). 

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

19 shall grant to each epidemiology center described in 

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

21 monitoring systems, delivery systems, and other pro22 tected health information in the possession of the 

23 Secretary. 

24 ‘‘(3) REQUIREMENT.—The activities of an epi25 demiology center described in paragraph (1) shall be 


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1 for the purposes of research and for preventing and 

2 controlling disease, injury, or disability (as those ac3 tivities are described in section 164.512 of title 45, 

4 Code of Federal Regulations (or a successor regula5 tion)), for purposes of the Health Insurance Port6 ability and Accountability Act of 1996 (Public Law 

7 104–191; 110 Stat. 1936).’’. 

8 SEC. 131. INDIAN YOUTH GRANT PROGRAM. 

9 Section 216(b)(2) of the Indian Health Care Im10 provement Act (25 U.S.C. 1621o(b)(2)) is amended by 

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

12 SEC. 132. AMERICAN INDIANS INTO PSYCHOLOGY PRO13 GRAM. 

14 Section 217 of the Indian Health Care Improvement 

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

16 ‘‘SEC. 217. AMERICAN INDIANS INTO PSYCHOLOGY PRO17 GRAM. 

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

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

20 $300,000 to each of 9 colleges and universities for the pur21 pose of developing and maintaining Indian psychology ca22 reer recruitment programs as a means of encouraging In23 dians to enter the behavioral health field. These programs 

24 shall be located at various locations throughout the coun25 try to maximize their availability to Indian students and 


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1 new programs shall be established in different locations 

2 from time to time. 

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

4 Secretary shall provide a grant authorized under sub5 section (a) to develop and maintain a program at the Uni6 versity of North Dakota to be known as the ‘Quentin N. 

7 Burdick American Indians Into Psychology Program’. 

8 Such program shall, to the maximum extent feasible, co9 ordinate with the Quentin N. Burdick Indian health pro10 grams authorized under section 117(b), the Quentin N. 

11 Burdick American Indians Into Nursing Program author12 ized under section 115(e), and existing university research 

13 and communications networks. 

14 ‘‘(c) REGULATIONS.—The Secretary shall issue regu15 lations pursuant to this Act for the competitive awarding 

16 of grants provided under this section. 

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

18 section shall agree to provide a program which, at a min19 imum— 

20 ‘‘(1) provides outreach and recruitment for 

21 health professions to Indian communities including 

22 elementary, secondary, and accredited and accessible 

23 community colleges that will be served by the pro24 gram; 


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1 ‘‘(2) incorporates a program advisory board 

2 comprised of representatives from the tribes and 

3 communities that will be served by the program; 

4 ‘‘(3) provides summer enrichment programs to 

5 expose Indian students to the various fields of psy6 chology through research, clinical, and experimental 

7 activities; 

8 ‘‘(4) provides stipends to undergraduate and 

9 graduate students to pursue a career in psychology; 

10 ‘‘(5) develops affiliation agreements with tribal 

11 colleges and universities, the Service, university af12 filiated programs, and other appropriate accredited 

13 and accessible entities to enhance the education of 

14 Indian students; 

15 ‘‘(6) to the maximum extent feasible, uses exist16 ing university tutoring, counseling, and student sup17 port services; and 

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

19 qualified Indians in the program. 

20 ‘‘(e) ACTIVE DUTY SERVICE REQUIREMENT.—The 

21 active duty service obligation prescribed under section 

22 338C of the Public Health Service Act (42 U.S.C. 254m) 

23 shall be met by each graduate who receives a stipend de24 scribed in subsection (d)(4) that is funded under this sec25 tion. Such obligation shall be met by service— 


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1 ‘‘(1) in an Indian health program; 

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

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

4 determined by the Secretary, in accordance with 

5 guidelines promulgated by the Secretary, such prac6 tice is situated in a physician or other health profes7 sional shortage area and addresses the health care 

8 needs of a substantial number of Indians. 

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

10 is authorized to be appropriated to carry out this section 

11 $2,700,000 for fiscal year 2011 and each fiscal year there12 after.’’. 

13 SEC. 133. PREVENTION, CONTROL, AND ELIMINATION OF 

14 COMMUNICABLE AND INFECTIOUS DISEASES. 

15 Section 218 of the Indian Health Care Improvement 

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

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

18 COMMUNICABLE AND INFECTIOUS DISEASES. 

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

20 through the Service, and after consultation with the Cen21 ters for Disease Control and Prevention, may make grants 

22 available to Indian tribes and tribal organizations for the 

23 following: 

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

25 elimination of communicable and infectious diseases, 


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1 including tuberculosis, hepatitis, HIV, respiratory 

2 syncytial virus, hanta virus, sexually transmitted dis3 eases, and H. pylori. 

4 ‘‘(2) Public information and education pro5 grams for the prevention, control, and elimination of 

6 communicable and infectious diseases. 

7 ‘‘(3) Education, training, and clinical skills im8 provement activities in the prevention, control, and 

9 elimination of communicable and infectious diseases 

10 for health professionals, including allied health pro11 fessionals. 

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

13 treatment, and prevention of hepatitis C virus 

14 (HCV). 

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

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

17 or proposal for funding is submitted to the Secretary. 

18 ‘‘(c) COORDINATION WITH HEALTH AGENCIES.—In19 dian tribes and tribal organizations receiving funding 

20 under this section are encouraged to coordinate their ac21 tivities with the Centers for Disease Control and Preven22 tion and State and local health agencies. 

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

24 out this section, the Secretary— 


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

2 tribal organization, provide technical assistance; and 

3 ‘‘(2) shall prepare and submit a report to Con4 gress biennially on the use of funds under this sec5 tion and on the progress made toward the preven6 tion, control, and elimination of communicable and 

7 infectious diseases among Indians and urban Indi8 ans.’’. 

9 SEC. 134. METHODS TO INCREASE CLINICIAN RECRUIT10 MENT AND RETENTION ISSUES. 

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

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

13 read as follows: 

14 ‘‘SEC. 221. LICENSING. 

15 ‘‘Licensed health professionals employed by a tribal 

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

17 from the licensing requirements of the State in which the 

18 tribal health program performs the services described in 

19 the contract or compact of the tribal health program under 

20 the Indian Self-Determination and Education Assistance 

21 Act (25 U.S.C. 450 et seq.).’’. 

22 (b) CONTINUING EDUCATION ALLOWANCES.—Sec23 tion 106 of the Indian Health Care Improvement Act (25 

24 U.S.C. 1615) is amended to read as follows: 


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1 ‘‘SEC. 106. CONTINUING EDUCATION ALLOWANCES. 

2 ‘‘In order to encourage scholarship and stipend re3 cipients under sections 104, 105, and 115 and health pro4 fessionals, including community health representatives 

5 and emergency medical technicians, to join or continue in 

6 an Indian health program and to provide services in the 

7 rural and remote areas in which a significant portion of 

8 Indians reside, the Secretary, acting through the Service, 

9 may— 

10 ‘‘(1) provide programs or allowances to transi11 tion into an Indian health program, including licens12 ing, board or certification examination assistance, 

13 and technical assistance in fulfilling service obliga14 tions under sections 104, 105, and 115; and 

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

16 professionals employed in an Indian health program 

17 to enable those professionals, for a period of time 

18 each year prescribed by regulation of the Secretary, 

19 to take leave of the duty stations of the professionals 

20 for professional consultation, management, leader21 ship, and refresher training courses.’’. 

22 SEC. 135. LIABILITY FOR PAYMENT. 

23 Section 222 of the Indian Health Care Improvement 

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


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1 ‘‘SEC. 222. LIABILITY FOR PAYMENT. 

2 ‘‘(a) NO PATIENT LIABILITY.—A patient who re3 ceives contract health care services that are authorized by 

4 the Service shall not be liable for the payment of any 

5 charges or costs associated with the provision of such serv6 ices. 

7 ‘‘(b) NOTIFICATION.—The Secretary shall notify a 

8 contract care provider and any patient who receives con9 tract health care services authorized by the Service that 

10 such patient is not liable for the payment of any charges 

11 or costs associated with the provision of such services not 

12 later than 5 business days after receipt of a notification 

13 of a claim by a provider of contract care services. 

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

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

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

17 have no further recourse against the patient who received 

18 the services.’’. 

19 SEC. 136. OFFICES OF INDIAN MEN’S HEALTH AND INDIAN 

20 WOMEN’S HEALTH. 

21 Section 223 of the Indian Health Care Improvement 

22 Act (25 U.S.C. 1621v) is amended— 

23 (1) by striking the section designation and 

24 heading and all that follows through ‘‘oversee efforts 

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


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

2 WOMEN’S HEALTH. 

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

4 ‘‘(1) ESTABLISHMENT.—The Secretary may es5 tablish within the Service an office, to be known as 

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

7 ‘‘(2) DIRECTOR.— 

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

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

10 be appointed by the Secretary. 

11 ‘‘(B) DUTIES.—The director shall coordi12 nate and promote the health status of Indian 

13 men in the United States. 

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

15 date of enactment of the Indian Healthcare Im16 provement Act of 2011, the Secretary, acting 

17 through the Service, shall submit to Congress a re18 port describing— 

19 ‘‘(A) any activity carried out by the direc20 tor as of the date on which the report is pre21 pared; and 

22 ‘‘(B) any finding of the director with re23 spect to the health of Indian men. 

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

25 Secretary, acting through the Service, shall establish an 


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

2 Health’, to’’; and 

3 (2) in subsection (b) (as so redesignated) by in4 serting ‘‘(including urban Indian women)’’ before 

5 ‘‘of all ages’’. 

6 SEC. 137. CONTRACT HEALTH SERVICE ADMINISTRATION 

7 AND DISBURSEMENT FORMULA. 

8 Title II of the Indian Health Care Improvement Act 

9 (25 U.S.C. 1621 et seq.) is amended by adding at the end 

10 the following: 

11 ‘‘SEC. 226. CONTRACT HEALTH SERVICE ADMINISTRATION 

12 AND DISBURSEMENT FORMULA. 

13 ‘‘(a) SUBMISSION OF REPORT.—As soon as prac14 ticable after the date of enactment of the Indian 

15 Healthcare Improvement Act of 2011, the Comptroller 

16 General of the United States shall submit to the Sec17 retary, the Committee on Indian Affairs of the Senate, 

18 and the Committee on Natural Resources of the House 

19 of Representatives, and make available to each Indian 

20 tribe, a report describing the results of the study of the 

21 Comptroller General regarding the funding of the contract 

22 health service program (including historic funding levels 

23 and a recommendation of the funding level needed for the 

24 program) and the administration of the contract health 

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1 suant to the program), as requested by Congress in March 

2 2009, or pursuant to section 830. 

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

4 the report under subsection (a), the Secretary shall con5 sult with Indian tribes regarding the contract health serv6 ice program, including the distribution of funds pursuant 

7 to the program— 

8 ‘‘(1) to determine whether the current distribu9 tion formula would require modification if the con10 tract health service program were funded at the level 

11 recommended by the Comptroller General; 

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

13 distribution formula under the current funding level 

14 or inequitable results for any Indian tribe under the 

15 funding level recommended by the Comptroller Gen16 eral; 

17 ‘‘(3) to identify any areas of program adminis18 tration that may result in the inefficient or ineffec19 tive management of the program; and 

20 ‘‘(4) to identify any other issues and rec21 ommendations to improve the administration of the 

22 contract health services program and correct any un23 fair results or funding disparities identified under 

24 paragraph (2). 


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

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

3 Secretary determines that any issue described in sub4 section (b)(2) exists, the Secretary may initiate procedures 

5 under subchapter III of chapter 5 of title 5, United States 

6 Code, to negotiate or promulgate regulations to establish 

7 a disbursement formula for the contract health service 

8 program funding.’’. 

9 Subtitle C—Health Facilities 

10 SEC. 141. HEALTH CARE FACILITY PRIORITY SYSTEM. 

11 Section 301 of the Indian Health Care Improvement 

12 Act (25 U.S.C. 1631) is amended— 

13 (1) by redesignating subsection (d) as sub14 section (h); and 

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

16 following: 

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

18 ‘‘(1) IN GENERAL.— 

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

20 acting through the Service, shall maintain a 

21 health care facility priority system, which— 

22 ‘‘(i) shall be developed in consultation 

23 with Indian tribes and tribal organizations; 

24 ‘‘(ii) shall give Indian tribes’ needs 

25 the highest priority; 


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

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

3 ‘‘(II) shall include the methodology re4 quired in paragraph (2)(B)(v); and 

5 ‘‘(III) may include such health care 

6 facilities, and such renovation or expansion 

7 needs of any health care facility, as the 

8 Service may identify; and 

9 ‘‘(iv) shall provide an opportunity for 

10 the nomination of planning, design, and 

11 construction projects by the Service, In12 dian tribes, and tribal organizations for 

13 consideration under the priority system at 

14 least once every 3 years, or more fre15 quently as the Secretary determines to be 

16 appropriate. 

17 ‘‘(B) NEEDS OF FACILITIES UNDER

18 ISDEAA AGREEMENTS.—The Secretary shall en19 sure that the planning, design, construction, 

20 renovation, and expansion needs of Service and 

21 non-Service facilities operated under contracts 

22 or compacts in accordance with the Indian Self23 Determination and Education Assistance Act 

24 (25 U.S.C. 450 et seq.) are fully and equitably 


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1 integrated into the health care facility priority 

2 system. 

3 ‘‘(C) CRITERIA FOR EVALUATING

4 NEEDS.—For purposes of this subsection, the 

5 Secretary, in evaluating the needs of facilities 

6 operated under a contract or compact under the 

7 Indian Self-Determination and Education As8 sistance Act (25 U.S.C. 450 et seq.), shall use 

9 the criteria used by the Secretary in evaluating 

10 the needs of facilities operated directly by the 

11 Service. 

12 ‘‘(D) PRIORITY OF CERTAIN PROJECTS

13 PROTECTED.—The priority of any project estab14 lished under the construction priority system in 

15 effect on the date of enactment of the Indian 

16 Healthcare Improvement Act of 2011 shall not 

17 be affected by any change in the construction 

18 priority system taking place after that date if 

19 the project— 

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

21 2008 Service budget justification as— 

22 ‘‘(I) 1 of the 10 top-priority inpa23 tient projects; 

24 ‘‘(II) 1 of the 10 top-priority out25 patient projects; 


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1 ‘‘(III) 1 of the 10 top-priority 

2 staff quarters developments; or 

3 ‘‘(IV) 1 of the 10 top-priority 

4 Youth Regional Treatment Centers; 

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

6 Phase II of the construction priority sys7 tem in effect on the date of enactment of 

8 such Act; or 

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

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

11 Secretary— 

12 ‘‘(I) on the initiative of the Sec13 retary; or 

14 ‘‘(II) pursuant to a request of an 

15 Indian tribe or tribal organization. 

16 ‘‘(2) REPORT; CONTENTS.— 

17 ‘‘(A) INITIAL COMPREHENSIVE REPORT.— 

18 ‘‘(i) DEFINITIONS.—In this subpara19 graph: 

20 ‘‘(I) FACILITIES APPROPRIATION

21 ADVISORY BOARD.—The term ‘Facili22 ties Appropriation Advisory Board’ 

23 means the advisory board, comprised 

24 of 12 members representing Indian 

25 tribes and 2 members representing 


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1 the Service, established at the discre2 tion of the Director— 

3 ‘‘(aa) to provide advice and 

4 recommendations for policies and 

5 procedures of the programs fund6 ed pursuant to facilities appro7 priations; and 

8 ‘‘(bb) to address other facili9 ties issues. 

10 ‘‘(II) FACILITIES NEEDS ASSESS11 MENT WORKGROUP.—The term ‘Fa12 cilities Needs Assessment Workgroup’ 

13 means the workgroup established at 

14 the discretion of the Director— 

15 ‘‘(aa) to review the health 

16 care facilities construction pri17 ority system; and 

18 ‘‘(bb) to make recommenda19 tions to the Facilities Appropria20 tion Advisory Board for revising 

21 the priority system. 

22 ‘‘(ii) INITIAL REPORT.— 

23 ‘‘(I) IN GENERAL.—Not later 

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1 provement Act of 2011, the Secretary 

2 shall submit to the Committee on In3 dian Affairs of the Senate and the 

4 Committee on Natural Resources of 

5 the House of Representatives a report 

6 that describes the comprehensive, na7 tional, ranked list of all health care 

8 facilities needs for the Service, Indian 

9 tribes, and tribal organizations (in10 cluding inpatient health care facilities, 

11 outpatient health care facilities, spe12 cialized health care facilities (such as 

13 for long-term care and alcohol and 

14 drug abuse treatment), wellness cen15 ters, and staff quarters, and the ren16 ovation and expansion needs, if any, 

17 of such facilities) developed by the 

18 Service, Indian tribes, and tribal orga19 nizations for the Facilities Needs As20 sessment Workgroup and the Facili21 ties Appropriation Advisory Board. 

22 ‘‘(II) INCLUSIONS.—The initial 

23 report shall include— 

24 ‘‘(aa) the methodology and 

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1 termining the needs and estab2 lishing the ranking of the facili3 ties needs; and 

4 ‘‘(bb) such other information 

5 as the Secretary determines to be 

6 appropriate. 

7 ‘‘(iii) UPDATES OF REPORT.—Begin8 ning in calendar year 2011, the Secretary 

9 shall— 

10 ‘‘(I) update the report under 

11 clause (ii) not less frequently that 

12 once every 5 years; and 

13 ‘‘(II) include the updated report 

14 in the appropriate annual report 

15 under subparagraph (B) for submis16 sion to Congress under section 801. 

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

18 shall submit to the President, for inclusion in 

19 the report required to be transmitted to Con20 gress under section 801, a report which sets 

21 forth the following: 

22 ‘‘(i) A description of the health care 

23 facility priority system of the Service es24 tablished under paragraph (1). 


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

2 may include— 

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

4 health care facilities; 

5 ‘‘(II) the 10 top-priority out6 patient health care facilities; 

7 ‘‘(III) the 10 top-priority special8 ized health care facilities (such as 

9 long-term care and alcohol and drug 

10 abuse treatment); and 

11 ‘‘(IV) the 10 top-priority staff 

12 quarters developments associated with 

13 health care facilities. 

14 ‘‘(iii) The justification for such order 

15 of priority. 

16 ‘‘(iv) The projected cost of such 

17 projects. 

18 ‘‘(v) The methodology adopted by the 

19 Service in establishing priorities under its 

20 health care facility priority system. 

21 ‘‘(3) REQUIREMENTS FOR PREPARATION OF RE22 PORTS.—In preparing the report required under 

23 paragraph (2), the Secretary shall— 


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1 ‘‘(A) consult with and obtain information 

2 on all health care facilities needs from Indian 

3 tribes and tribal organizations; and 

4 ‘‘(B) review the total unmet needs of all 

5 Indian tribes and tribal organizations for health 

6 care facilities (including staff quarters), includ7 ing needs for renovation and expansion of exist8 ing facilities. 

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

10 FACILITIES CONSTRUCTION PRIORITY SYSTEM.— 

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

12 the establishment of the priority system under sub13 section (c)(1)(A), the Comptroller General of the 

14 United States shall prepare and finalize a report re15 viewing the methodologies applied, and the processes 

16 followed, by the Service in making each assessment 

17 of needs for the list under subsection (c)(2)(A)(ii) 

18 and developing the priority system under subsection 

19 (c)(1), including a review of— 

20 ‘‘(A) the recommendations of the Facilities 

21 Appropriation Advisory Board and the Facili22 ties Needs Assessment Workgroup (as those 

23 terms are defined in subsection (c)(2)(A)(i)); 

24 and 


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

2 or prioritizing facilities other than hospitals or 

3 clinics. 

4 ‘‘(2) SUBMISSION TO CONGRESS.—The Comp5 troller General of the United States shall submit the 

6 report under paragraph (1) to— 

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

8 Appropriations of the Senate; 

9 ‘‘(B) the Committees on Natural Re10 sources and Appropriations of the House of 

11 Representatives; and 

12 ‘‘(C) the Secretary. 

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

14 under the Act of November 2, 1921 (25 U.S.C. 13) (com15 monly known as the ‘Snyder Act’), for the planning, de16 sign, construction, or renovation of health facilities for the 

17 benefit of 1 or more Indian Tribes shall be subject to the 

18 provisions of section 102 of the Indian Self-Determination 

19 and Education Assistance Act (25 U.S.C. 450f) or sec20 tions 504 and 505 of that Act (25 U.S.C. 458aaa–3, 

21 458aaa–4). 

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

23 The Secretary shall consult and cooperate with Indian 

24 tribes and tribal organizations, and confer with urban In25 dian organizations, in developing innovative approaches to 


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1 address all or part of the total unmet need for construc2 tion of health facilities, that may include— 

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

4 fund in which a portion of health facility construc5 tion funding could be devoted to all Service areas; 

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

7 of this title; and 

8 ‘‘(3) other approaches, as the Secretary deter9 mines to be appropriate.’’. 

10 SEC. 142. PRIORITY OF CERTAIN PROJECTS PROTECTED. 

11 Section 301 of the Indian Health Care Improvement 

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

13 amended by adding at the end the following: 

14 ‘‘(g) PRIORITY OF CERTAIN PROJECTS PRO15 TECTED.—The priority of any project established under 

16 the construction priority system in effect on the date of 

17 enactment of this Indian Healthcare Improvement Act of 

18 2011 shall not be affected by any change in the construc19 tion priority system taking place after that date if the 

20 project— 

21 ‘‘(1) was identified in the fiscal year 2008 Serv22 ice budget justification as— 

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

24 projects; 


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

2 projects; 

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

4 developments; or 

5 ‘‘(D) 1 of the 10 top-priority Youth Re6 gional Treatment Centers; 

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

8 of the construction priority system in effect on the 

9 date of enactment of such Act; or 

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

11 selected, as determined by the Secretary— 

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

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

14 tribe or tribal organization.’’. 

15 SEC. 143. INDIAN HEALTH CARE DELIVERY DEMONSTRA16 TION PROJECTS. 

17 Section 307 of the Indian Health Care Improvement 

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

19 ‘‘SEC. 307. INDIAN HEALTH CARE DELIVERY DEMONSTRA20 TION PROJECTS. 

21 ‘‘(a) PURPOSE AND GENERAL AUTHORITY.— 

22 ‘‘(1) PURPOSE.—The purpose of this section is 

23 to encourage the establishment of demonstration 

24 projects that meet the applicable criteria of this sec25 tion to be carried out by the Secretary, acting 


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1 through the Service, or Indian tribes or tribal orga2 nizations acting pursuant to contracts or compacts 

3 under the Indian Self Determination and Education 

4 Assistance Act (25 U.S.C. 450 et seq.)— 

5 ‘‘(A) to test alternative means of delivering 

6 health care and services to Indians through fa7 cilities; or 

8 ‘‘(B) to use alternative or innovative meth9 ods or models of delivering health care services 

10 to Indians (including primary care services, 

11 contract health services, or any other program 

12 or service authorized by this Act) through con13 venient care services (as defined in subsection 

14 (c)), community health centers, or cooperative 

15 agreements or arrangements with other health 

16 care providers that share or coordinate the use 

17 of facilities, funding, or other resources, or oth18 erwise coordinate or improve the coordination of 

19 activities of the Service, Indian tribes, or tribal 

20 organizations, with those of the other health 

21 care providers. 

22 ‘‘(2) AUTHORITY.—The Secretary, acting 

23 through the Service, is authorized to carry out, or to 

24 enter into contracts or compacts under the Indian 

25 Self-Determination and Education Assistance Act 


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1 (25 U.S.C. 450 et seq.) with Indian tribes or tribal 

2 organizations to carry out, health care delivery dem3 onstration projects that— 

4 ‘‘(A) test alternative means of delivering 

5 health care and services to Indians through fa6 cilities; or 

7 ‘‘(B) otherwise carry out the purposes of 

8 this section. 

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

10 projects pursuant to this section— 

11 ‘‘(1) may authorize such contracts for the con12 struction and renovation of hospitals, health centers, 

13 health stations, and other facilities to deliver health 

14 care services; and 

15 ‘‘(2) is authorized— 

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

17 ‘‘(B) to permit use and carryover of funds 

18 appropriated for the provision of health care 

19 services under this Act (including for the pur20 chase of health benefits coverage, as authorized 

21 by section 402(a)); 

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

23 funds, including other Federal funds, funds 

24 from third-party collections in accordance with 

25 sections 206, 207, and 401, and non-Federal 


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1 funds contributed by State or local govern2 mental agencies or facilities or private health 

3 care providers pursuant to cooperative or other 

4 agreements with the Service, 1 or more Indian 

5 tribes, or tribal organizations; 

6 ‘‘(D) to permit the use of funds or prop7 erty donated or otherwise provided from any 

8 source for project purposes; 

9 ‘‘(E) to provide for the reversion of do10 nated real or personal property to the donor; 

11 and 

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

13 match other funds, including Federal funds. 

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

15 ‘‘(1) DEFINITION OF CONVENIENT CARE SERV16 ICE.—In this subsection, the term ‘convenient care 

17 service’ means any primary health care service, such 

18 as urgent care services, nonemergent care services, 

19 prevention services and screenings, and any service 

20 authorized by section 203 or 205(d), that is of21 fered— 

22 ‘‘(A) at an alternative setting; or 

23 ‘‘(B) during hours other than regular 

24 working hours. 

25 ‘‘(2) GENERAL PROJECTS.— 


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1 ‘‘(A) CRITERIA.—The Secretary may ap2 prove under this section demonstration projects 

3 that meet the following criteria: 

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

5 or program, such as a program for conven6 ient care services, or an improvement in, 

7 increased efficiency at, or reorientation of 

8 an existing facility or program. 

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

10 including Indians with low health status, 

11 will be served by the project. 

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

13 deliver services in an efficient and effective 

14 manner. 

15 ‘‘(iv) The project is economically via16 ble. 

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

18 Indian tribe or tribal organization, the In19 dian tribe or tribal organization has the 

20 administrative and financial capability to 

21 administer the project. 

22 ‘‘(vi) The project is integrated with 

23 providers of related health or social serv24 ices (including State and local health care 

25 agencies or other health care providers) 


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1 and is coordinated with, and avoids dupli2 cation of, existing services in order to ex3 pand the availability of services. 

4 ‘‘(B) PRIORITY.—In approving demonstra5 tion projects under this paragraph, the Sec6 retary shall give priority to demonstration 

7 projects, to the extent the projects meet the cri8 teria described in subparagraph (A), located in 

9 any of the following Service units: 

10 ‘‘(i) Cass Lake, Minnesota. 

11 ‘‘(ii) Mescalero, New Mexico. 

12 ‘‘(iii) Owyhee and Elko, Nevada. 

13 ‘‘(iv) Schurz, Nevada. 

14 ‘‘(v) Ft. Yuma, California. 

15 ‘‘(3) INNOVATIVE HEALTH SERVICES DELIVERY

16 DEMONSTRATION PROJECT.— 

17 ‘‘(A) APPLICATION OR REQUEST.—On re18 ceipt of an application or request from an In19 dian tribe, a consortium of Indian tribes, or a 

20 tribal organization within a Service area, the 

21 Secretary shall take into consideration alter22 native or innovated methods to deliver health 

23 care services within the Service area (or a por24 tion of, or facility within, the Service area) as 

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1 ing medical, dental, pharmaceutical, nursing, 

2 clinical laboratory, contract health services, con3 venient care services, community health centers, 

4 or any other health care services delivery mod5 els designed to improve access to, or efficiency 

6 or quality of, the health care, health promotion, 

7 or disease prevention services and programs 

8 under this Act. 

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

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

11 the Secretary is authorized under this para12 graph to approve not more than 10 applications 

13 for health care delivery demonstration projects 

14 that meet the criteria described in subpara15 graph (C). 

16 ‘‘(C) CRITERIA.—The Secretary shall ap17 prove under subparagraph (B) demonstration 

18 projects that meet all of the following criteria: 

19 ‘‘(i) The criteria set forth in para20 graph (2)(A). 

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

22 health care services at existing health care 

23 facilities, which may be due to limited 

24 hours of operation at those facilities or 

25 other factors. 


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1 ‘‘(iii) The project— 

2 ‘‘(I) expands the availability of 

3 services; or 

4 ‘‘(II) reduces— 

5 ‘‘(aa) the burden on Con6 tract Health Services; or 

7 ‘‘(bb) the need for emer8 gency room visits. 

9 ‘‘(d) TECHNICAL ASSISTANCE.—On receipt of an ap10 plication or request from an Indian tribe, a consortium 

11 of Indian tribes, or a tribal organization, the Secretary 

12 shall provide such technical and other assistance as may 

13 be necessary to enable applicants to comply with this sec14 tion, including information regarding the Service unit 

15 budget and available funding for carrying out the pro16 posed demonstration project. 

17 ‘‘(e) SERVICE TO INELIGIBLE PERSONS.—Subject to 

18 section 813, the authority to provide services to persons 

19 otherwise ineligible for the health care benefits of the 

20 Service, and the authority to extend hospital privileges in 

21 Service facilities to non-Service health practitioners as 

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

23 terms of that section, in any demonstration project ap24 proved pursuant to this section. 


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1 ‘‘(f) EQUITABLE TREATMENT.—For purposes of sub2 section (c), the Secretary, in evaluating facilities operated 

3 under any contract or compact under the Indian Self-De4 termination and Education Assistance Act (25 U.S.C. 450 

5 et seq.), shall use the same criteria that the Secretary uses 

6 in evaluating facilities operated directly by the Service. 

7 ‘‘(g) EQUITABLE INTEGRATION OF FACILITIES.— 

8 The Secretary shall ensure that the planning, design, con9 struction, renovation, and expansion needs of Service and 

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

11 compact under the Indian Self-Determination and Edu12 cation Assistance Act (25 U.S.C. 450 et seq.) for health 

13 services are fully and equitably integrated into the imple14 mentation of the health care delivery demonstration 

15 projects under this section.’’. 

16 SEC. 144. TRIBAL MANAGEMENT OF FEDERALLY OWNED 

17 QUARTERS. 

18 Title III of the Indian Health Care Improvement Act 

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

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

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

22 QUARTERS. 

23 ‘‘(a) RENTAL RATES.— 

24 ‘‘(1) ESTABLISHMENT.—Notwithstanding any 

25 other provision of law, a tribal health program that 


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1 operates a hospital or other health facility and the 

2 federally owned quarters associated with such a fa3 cility pursuant to a contract or compact under the 

4 Indian Self-Determination and Education Assistance 

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

6 rates charged to the occupants of those quarters, on 

7 providing notice to the Secretary. 

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

9 under this subsection, a tribal health program shall 

10 attempt— 

11 ‘‘(A) to base the rental rates on the rea12 sonable value of the quarters to the occupants 

13 of the quarters; and 

14 ‘‘(B) to generate sufficient funds to pru15 dently provide for the operation and mainte16 nance of the quarters, and at the discretion of 

17 the tribal health program, to supply reserve 

18 funds for capital repairs and replacement of the 

19 quarters. 

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

21 quarters the rental rates for which are established 

22 by a tribal health program under this subsection 

23 shall remain eligible to receive improvement and re24 pair funds to the same extent that all federally 


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1 owned quarters used to house personnel in programs 

2 of the Service are eligible to receive those funds. 

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

4 health program that establishes a rental rate under 

5 this subsection shall provide occupants of the feder6 ally owned quarters a notice of any change in the 

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

8 notice before the effective date of the change. 

9 ‘‘(5) RATES IN ALASKA.—A rental rate estab10 lished by a tribal health program under this section 

11 for a federally owned quarters in the State of Alaska 

12 may be based on the cost of comparable private 

13 rental housing in the nearest established community 

14 with a year-round population of 1,500 or more indi15 viduals. 

16 ‘‘(b) DIRECT COLLECTION OF RENT.— 

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

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

19 tribal health program may collect rent directly from 

20 Federal employees who occupy federally owned quar21 ters if the tribal health program submits to the Sec22 retary and the employees a notice of the election of 

23 the tribal health program to collect rents directly 

24 from the employees. 


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

2 notice described in paragraph (1)— 

3 ‘‘(A) the affected Federal employees shall 

4 pay rent for occupancy of a federally owned 

5 quarters directly to the applicable tribal health 

6 program; and 

7 ‘‘(B) the Secretary shall not have the au8 thority to collect rent from the employees 

9 through payroll deduction or otherwise. 

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

11 under this subsection— 

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

13 tribal health program in a separate account, 

14 which shall be used by the tribal health pro15 gram for the maintenance (including capital re16 pairs and replacement) and operation of the 

17 quarters, as the tribal health program deter18 mines to be appropriate; and 

19 ‘‘(B) shall not be made payable to, or oth20 erwise be deposited with, the United States. 

21 ‘‘(4) RETROCESSION OF AUTHORITY.—If a trib22 al health program that elected to collect rent directly 

23 under paragraph (1) requests retrocession of the au24 thority of the tribal health program to collect that 


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1 rent, the retrocession shall take effect on the earlier 

2 of— 

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

4 not less than 180 days after the tribal health 

5 program submits the request; and 

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

7 agreed on by the Secretary and the tribal health 

8 program.’’. 

9 SEC. 145. OTHER FUNDING, EQUIPMENT, AND SUPPLIES 

10 FOR FACILITIES. 

11 Title III of the Indian Health Care Improvement Act 

12 (25 U.S.C. 1631 et seq.) is amended by adding at the end 

13 the following: 

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

15 FOR FACILITIES. 

16 ‘‘(a) AUTHORIZATION.— 

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

18 head of any Federal agency to which funds, equip19 ment, or other supplies are made available for the 

20 planning, design, construction, or operation of a 

21 health care or sanitation facility may transfer the 

22 funds, equipment, or supplies to the Secretary for 

23 the planning, design, construction, or operation of a 

24 health care or sanitation facility to achieve— 

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


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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, construct, and operate 

13 health care or sanitation facilities for Indians, 

14 including pursuant to a contract or compact 

15 under the Indian Self-Determination and Edu16 cation Assistance Act (25 U.S.C. 450 et seq.). 

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

18 by the Secretary under this subsection shall not af19 fect any priority established under section 301. 

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

21 may enter into interagency agreements with Federal or 

22 State agencies and other entities, and accept funds, equip23 ment, or other supplies from those entities, to provide for 

24 the planning, design, construction, and operation of health 


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1 care or sanitation facilities to be administered by Indian 

2 health programs to achieve— 

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

4 ‘‘(2) the purposes for which the funds were ap5 propriated or otherwise provided.’’ 

6 ‘‘(c) ESTABLISHMENT OF STANDARDS.— 

7 ‘‘(1) IN GENERAL.—The Secretary, acting 

8 through the Service, shall establish, by regulation, 

9 standards for the planning, design, construction, and 

10 operation of health care or sanitation facilities serv11 ing Indians under this Act. 

12 ‘‘(2) OTHER REGULATIONS.—Notwithstanding 

13 any other provision of law, any other applicable reg14 ulations of the Department shall apply in carrying 

15 out projects using funds transferred under this sec16 tion. 

17 ‘‘(d) DEFINITION OF SANITATION FACILITY.—In this 

18 section, the term ‘sanitation facility’ means a safe and 

19 adequate water supply system, sanitary sewage disposal 

20 system, or sanitary solid waste system (including all re21 lated equipment and support infrastructure).’’. 


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1 SEC. 146. INDIAN COUNTRY MODULAR COMPONENT FACILI2 TIES DEMONSTRATION PROGRAM. 

3 Title III of the Indian Health Care Improvement Act 

4 (25 U.S.C. 1631 et seq.) (as amended by section 145) is 

5 amended by adding at the end the following: 

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

8 ‘‘(a) DEFINITION OF MODULAR COMPONENT

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

11 facility that is constructed— 

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

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

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

16 provision of health care facility than a traditionally 

17 constructed health care building. 

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

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

21 3 grants for purchase, installation and maintenance of 

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

24 ‘‘(c) SELECTION OF LOCATIONS.— 

25 ‘‘(1) PETITIONS.— 


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

2 solicit from Indian tribes petitions for location 

3 of the modular component health care facilities 

4 in the Service areas of the petitioning Indian 

5 tribes. 

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

7 a grant under this section, an Indian tribe or 

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

12 manner, and containing such information as the 

13 Secretary may require. 

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

15 each modular component health care facility to be 

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

18 Indian Health Service facilities construction priority 

19 list and petitions which demonstrate that erection of 

20 a modular component health facility— 

21 ‘‘(A) is more economical than construction 

22 of a traditionally constructed health care facil23 ity; 


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

2 selected location in less time than traditional 

3 construction; and 

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

5 services needed by the Indian population to be 

6 served. 

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

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

12 2011 Planned Construction Budget’ and dated May 

13 7, 2009 (or any successor list). 

14 ‘‘(d) ELIGIBILITY.— 

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

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

20 et seq.). 

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

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

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

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

4 on which funds are made available for the demonstration 

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

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

9 success of the activity; and 

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

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

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

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

15 out the demonstration program under this section for the 

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

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

18 SEC. 147. 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 146) is 

22 amended by adding at the end the following: 

23 ‘‘SEC. 313. MOBILE HEALTH STATIONS DEMONSTRATION 

24 PROGRAM. 

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


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

2 term ‘eligible tribal consortium’ means a consortium 

3 composed of 2 or more Service units between which 

4 a mobile health station can be transported by road 

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

6 Service or by an Indian tribe or tribal organization 

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

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

10 ‘mobile health station’ means a health care unit 

11 that— 

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

14 truck or similar vehicle; 

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

16 more specialty health care services; and 

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

18 stationary health care facility when appropriate. 

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

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

21 health care service’ means a health care service 

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


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

2 health care service’ includes any service relating 

3 to— 

4 ‘‘(i) dialysis; 

5 ‘‘(ii) surgery; 

6 ‘‘(iii) mammography; 

7 ‘‘(iv) dentistry; or 

8 ‘‘(v) any other specialty health care 

9 service. 

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

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

13 mobile health station projects. 

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

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

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

19 be served; 

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

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

24 to be served; and 


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

2 may require. 

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

4 amounts made available to carry out the demonstration 

5 program under this section— 

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

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

12 necessary for the Indian population served; 

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

14 (regardless of whether the mobile health station is 

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

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

19 equipment for a mobile health station, including the 

20 establishment or maintenance of such equipment at 

21 a modular component health care facility (as defined 

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

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

24 on which the demonstration program is established under 

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

2 describing— 

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

5 success of the activity; and 

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

7 mobile health stations to provide specialty health 

8 care services for Indian communities. 

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

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

11 carry out the demonstration program under this section 

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

14 Subtitle D—Access to Health 

15 Services 

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

18 Section 401 of the Indian Health Care Improvement 

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

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

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

23 CHIP PAYMENTS IN DETERMINING APPROPRIATIONS.— 

24 Any payments received by an Indian health program or 

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


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1 or XXI of the Social Security Act for services provided 

2 to Indians eligible for benefits under such respective titles 

3 shall not be considered in determining appropriations for 

4 the provision of health care and services to Indians. 

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

6 this Act authorizes the Secretary to provide services to an 

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

8 Social Security Act in preference to an Indian without 

9 such coverage. 

10 ‘‘(c) USE OF FUNDS.— 

11 ‘‘(1) SPECIAL FUND.— 

12 ‘‘(A) 100 PERCENT PASS-THROUGH OF

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

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

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

19 held by the Secretary. In making payments 

20 from such fund, the Secretary shall ensure that 

21 each Service unit of the Service receives 100 

22 percent of the amount to which the facilities of 

23 the Service, for which such Service unit makes 

24 collections, are entitled by reason of a provision 

25 of either such title. 


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

2 by a facility of the Service under subparagraph 

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

4 XIX of the Social Security Act shall first be 

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

6 provided in appropriation Acts) for the purpose 

7 of making any improvements in the programs 

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

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

12 Any amounts so received that are in excess of 

13 the amount necessary to achieve or maintain 

14 such conditions and requirements shall, subject 

15 to consultation with the Indian tribes being 

16 served by the Service unit, be used for reducing 

17 the health resource deficiencies (as determined 

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

20 205. 

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

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

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

24 receive payments directly. No payment may be made 

25 out of the special fund described in such paragraph 


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1 with respect to reimbursement made for services 

2 provided by such program during the period of such 

3 election. 

4 ‘‘(d) DIRECT BILLING.— 

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

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

7 program may elect to directly bill for, and receive 

8 payment for, health care items and services provided 

9 by such program for which payment is made under 

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

11 or from any other third party payor. 

12 ‘‘(2) DIRECT REIMBURSEMENT.— 

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

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

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

18 services furnished without regard to subsection 

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

20 shall be used by the tribal health program for 

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

23 necessary to achieve or maintain compliance 

24 with the conditions and requirements applicable 

25 generally to such items and services under the 


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

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

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

8 that would otherwise be provided as a contract 

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

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

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

16 requirements applicable to the program under 

17 such title, as well as all auditing requirements 

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

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

22 amounts paid under title XVIII, XIX, or XXI 

23 of the Social Security Act. 

24 ‘‘(C) IDENTIFICATION OF SOURCE OF PAY25 MENTS.—Any tribal health program that reVerDate Mar 15 2010 18:45 Feb 09, 2011 Jkt 099200 PO 00000 Frm 00109 Fmt 6652 Sfmt 6201 E:\BILLS\H536.IH H536

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1 ceives reimbursements or payments under title 

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

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

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

7 ‘‘(3) EXAMINATION AND IMPLEMENTATION OF

8 CHANGES.— 

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

10 through the Service and with the assistance of 

11 the Administrator of the Centers for Medicare 

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

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

18 necessary to provide for direct billing under a 

19 program under title XIX or XXI of the Social 

20 Security Act. 

21 ‘‘(B) COORDINATION OF INFORMATION.— 

22 The Service shall provide the Administrator of 

23 the Centers for Medicare & Medicaid Services 

24 with copies of the lists submitted to the Service 

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1 garding patients served by the Service (and by 

2 tribal health programs, to the extent such data 

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

5 purposes of administering title XVIII, XIX, or 

6 XXI of the Social Security Act. 

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

8 health program that bills directly under the program 

9 established under this subsection may withdraw 

10 from participation in the same manner and under 

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

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

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

16 authority under the program established under this 

17 subsection shall be returned to the Secretary upon 

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

20 ‘‘(5) TERMINATION FOR FAILURE TO COMPLY

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

23 in the direct billing program established under this 

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


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

2 health program with notice of a determination that 

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

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

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

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

11 the Social Security Act.’’. 

12 SEC. 152. PURCHASING HEALTH CARE COVERAGE. 

13 Section 402 of the Indian Health Care Improvement 

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

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

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

17 available under law (including a provision of the Social 

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

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

21 organizations, and urban Indian organizations for health 

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

24 amounts to purchase health benefits coverage (including 

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


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

2 service delivery area that would otherwise be provided as 

3 a contract health service) for such beneficiaries in any 

4 manner, including through— 

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

6 plan; 

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

8 health care plan; 

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

10 care organization; 

11 ‘‘(4) a self-insured plan; or 

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

13 plan. 

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

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

17 financial needs of such beneficiaries (as determined by the 

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

19 of income levels developed or implemented by such 1 ore 

20 more Indian tribes). 

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

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

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

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


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

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

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

5 INDIAN TRIBES, TRIBAL ORGANIZATIONS, 

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

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

10 OTHER HEALTH BENEFITS PROGRAMS. 

11 Section 404 of the Indian Health Care Improvement 

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

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

16 TO FACILITATE OUTREACH, ENROLLMENT, 

17 AND COVERAGE OF INDIANS UNDER SOCIAL 

18 SECURITY ACT HEALTH BENEFIT PROGRAMS 

19 AND OTHER HEALTH BENEFITS PROGRAMS. 

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

22 make grants to or enter into contracts with Indian tribes 

23 and tribal organizations to assist such tribes and tribal 

24 organizations in establishing and administering programs 

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1 grams to provide outreach and enrollment through video, 

2 electronic delivery methods, or telecommunication devices 

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

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

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

11 the charging of premiums and cost sharing is not 

12 prohibited under such programs, to pay premiums or 

13 cost sharing for coverage for such benefits, which 

14 may be based on financial need (as determined by 

15 the Indian tribe or tribes or tribal organizations 

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

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

20 the Service, shall place conditions as deemed necessary to 

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

22 which the Secretary makes with any Indian tribe or tribal 

23 organization pursuant to this section. Such conditions 

24 shall include requirements that the Indian tribe or tribal 

25 organization successfully undertake— 


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

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

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

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

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

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

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

17 the same manner they apply to grants and contracts 

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

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

22 under paragraph (1) requirements that are— 

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


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

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

4 this section. 

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

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

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

11 provision of health care items and services to Indians 

12 under the programs established under title XVIII, XIX, 

13 or XXI of the Social Security Act. 

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

16 HEALTH BENEFITS PROGRAMS.—For provisions relating 

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

20 and children’s health insurance programs established 

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

22 benefits under the Medicare program established under 

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


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

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

4 any enrollment fee or similar charge. 

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

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

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

10 Section 405 of the Indian Health Care Improvement 

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

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

14 ‘‘(a) AUTHORITY.— 

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

16 into (or expand) arrangements for the sharing of 

17 medical facilities and services between the Service, 

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

20 Defense. 

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

24 described in paragraph (1) without first consulting 


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

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

4 any action under this section or under subchapter IV of 

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

6 impair— 

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

8 care services provided through the Service and the 

9 eligibility of any Indian to receive health services 

10 through the Service; 

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

12 to any Indian through the Service; 

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

14 care services provided by the Department of Vet15 erans Affairs; 

16 ‘‘(4) the quality of health care services provided 

17 by the Department of Veterans Affairs or the De18 partment of Defense; or 

19 ‘‘(5) the eligibility of any Indian who is a vet20 eran to receive health services through the Depart21 ment of Veterans Affairs. 

22 ‘‘(c) REIMBURSEMENT.—The Service, Indian tribe, 

23 or tribal organization shall be reimbursed by the Depart24 ment of Veterans Affairs or the Department of Defense 

25 (as the case may be) where services are provided through 


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1 the Service, an Indian tribe, or a tribal organization to 

2 beneficiaries eligible for services from either such Depart3 ment, notwithstanding any other provision of law. 

4 ‘‘(d) CONSTRUCTION.—Nothing in this section may 

5 be construed as creating any right of a non-Indian veteran 

6 to obtain health services from the Service.’’. 

7 SEC. 155. ELIGIBLE INDIAN VETERAN SERVICES. 

8 Title IV of the Indian Health Care Improvement Act 

9 (25 U.S.C. 1641 et seq.) (as amended by section 101(b)) 

10 is amended by adding at the end the following: 

11 ‘‘SEC. 407. ELIGIBLE INDIAN VETERAN SERVICES. 

12 ‘‘(a) FINDINGS; PURPOSE.— 

13 ‘‘(1) FINDINGS.—Congress finds that— 

14 ‘‘(A) collaborations between the Secretary 

15 and the Secretary of Veterans Affairs regarding 

16 the treatment of Indian veterans at facilities of 

17 the Service should be encouraged to the max18 imum extent practicable; and 

19 ‘‘(B) increased enrollment for services of 

20 the Department of Veterans Affairs by veterans 

21 who are members of Indian tribes should be en22 couraged to the maximum extent practicable. 

23 ‘‘(2) PURPOSE.—The purpose of this section is 

24 to reaffirm the goals stated in the document entitled 

25 ‘Memorandum of Understanding Between the VA/ 


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1 Veterans Health Administration And HHS/Indian 

2 Health Service’ and dated February 25, 2003 (relat3 ing to cooperation and resource sharing between the 

4 Veterans Health Administration and Service). 

5 ‘‘(b) DEFINITIONS.—In this section: 

6 ‘‘(1) ELIGIBLE INDIAN VETERAN.—The term 

7 ‘eligible Indian veteran’ means an Indian or Alaska 

8 Native veteran who receives any medical service that 

9 is— 

10 ‘‘(A) authorized under the laws adminis11 tered by the Secretary of Veterans Affairs; and 

12 ‘‘(B) administered at a facility of the Serv13 ice (including a facility operated by an Indian 

14 tribe or tribal organization through a contract 

15 or compact with the Service under the Indian 

16 Self-Determination and Education Assistance 

17 Act (25 U.S.C. 450 et seq.)) pursuant to a local 

18 memorandum of understanding. 

19 ‘‘(2) LOCAL MEMORANDUM OF UNDER20 STANDING.—The term ‘local memorandum of under21 standing’ means a memorandum of understanding 

22 between the Secretary (or a designee, including the 

23 director of any area office of the Service) and the 

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1 derstanding Between the VA/Veterans Health Ad2 ministration And HHS/Indian Health Service’ and 

3 dated February 25, 2003 (relating to cooperation 

4 and resource sharing between the Veterans Health 

5 Administration and Indian Health Service). 

6 ‘‘(c) ELIGIBLE INDIAN VETERANS EXPENSES.— 

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

8 provision of law, the Secretary shall provide for vet9 eran-related expenses incurred by eligible Indian vet10 erans as described in subsection (b)(1)(B). 

11 ‘‘(2) METHOD OF PAYMENT.—The Secretary 

12 shall establish such guidelines as the Secretary de13 termines to be appropriate regarding the method of 

14 payments to the Secretary of Veterans Affairs under 

15 paragraph (1). 

16 ‘‘(d) TRIBAL APPROVAL OF MEMORANDA.—In nego17 tiating a local memorandum of understanding with the 

18 Secretary of Veterans Affairs regarding the provision of 

19 services to eligible Indian veterans, the Secretary shall 

20 consult with each Indian tribe that would be affected by 

21 the local memorandum of understanding. 

22 ‘‘(e) FUNDING.— 

23 ‘‘(1) TREATMENT.—Expenses incurred by the 

24 Secretary in carrying out subsection (c)(1) shall not 


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1 be considered to be Contract Health Service ex2 penses. 

3 ‘‘(2) USE OF FUNDS.—Of funds made available 

4 to the Secretary in appropriations Acts for the Serv5 ice (excluding funds made available for facilities, 

6 Contract Health Services, or contract support costs), 

7 the Secretary shall use such sums as are necessary 

8 to carry out this section.’’. 

9 SEC. 156. NONDISCRIMINATION UNDER FEDERAL HEALTH 

10 CARE PROGRAMS IN QUALIFICATIONS FOR 

11 REIMBURSEMENT FOR SERVICES. 

12 Title IV of the Indian Health Care Improvement Act 

13 (25 U.S.C. 1641 et seq.) (as amended by section 155) is 

14 amended by adding at the end the following: 

15 ‘‘SEC. 408. NONDISCRIMINATION UNDER FEDERAL HEALTH 

16 CARE PROGRAMS IN QUALIFICATIONS FOR 

17 REIMBURSEMENT FOR SERVICES. 

18 ‘‘(a) REQUIREMENT TO SATISFY GENERALLY APPLI19 CABLE PARTICIPATION REQUIREMENTS.— 

20 ‘‘(1) IN GENERAL.—A Federal health care pro21 gram must accept an entity that is operated by the 

22 Service, an Indian tribe, tribal organization, or 

23 urban Indian organization as a provider eligible to 

24 receive payment under the program for health care 

25 services furnished to an Indian on the same basis as 


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1 any other provider qualified to participate as a pro2 vider of health care services under the program if 

3 the entity meets generally applicable State or other 

4 requirements for participation as a provider of 

5 health care services under the program. 

6 ‘‘(2) SATISFACTION OF STATE OR LOCAL LICEN7 SURE OR RECOGNITION REQUIREMENTS.—Any re8 quirement for participation as a provider of health 

9 care services under a Federal health care program 

10 that an entity be licensed or recognized under the 

11 State or local law where the entity is located to fur12 nish health care services shall be deemed to have 

13 been met in the case of an entity operated by the 

14 Service, an Indian tribe, tribal organization, or 

15 urban Indian organization if the entity meets all the 

16 applicable standards for such licensure or recogni17 tion, regardless of whether the entity obtains a li18 cense or other documentation under such State or 

19 local law. In accordance with section 221, the ab20 sence of the licensure of a health professional em21 ployed by such an entity under the State or local law 

22 where the entity is located shall not be taken into 

23 account for purposes of determining whether the en24 tity meets such standards, if the professional is li25 censed in another State. 


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1 ‘‘(b) APPLICATION OF EXCLUSION FROM PARTICIPA2 TION IN FEDERAL HEALTH CARE PROGRAMS.— 

3 ‘‘(1) EXCLUDED ENTITIES.—No entity operated 

4 by the Service, an Indian tribe, tribal organization, 

5 or urban Indian organization that has been excluded 

6 from participation in any Federal health care pro7 gram or for which a license is under suspension or 

8 has been revoked by the State where the entity is lo9 cated shall be eligible to receive payment or reim10 bursement under any such program for health care 

11 services furnished to an Indian. 

12 ‘‘(2) EXCLUDED INDIVIDUALS.—No individual 

13 who has been excluded from participation in any 

14 Federal health care program or whose State license 

15 is under suspension shall be eligible to receive pay16 ment or reimbursement under any such program for 

17 health care services furnished by that individual, di18 rectly or through an entity that is otherwise eligible 

19 to receive payment for health care services, to an In20 dian. 

21 ‘‘(3) FEDERAL HEALTH CARE PROGRAM DE22 FINED.—In this subsection, the term, ‘Federal 

23 health care program’ has the meaning given that 

24 term in section 1128B(f) of the Social Security Act 

25 (42 U.S.C. 1320a–7b(f)), except that, for purposes 


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1 of this subsection, such term shall include the health 

2 insurance program under chapter 89 of title 5, 

3 United States Code. 

4 ‘‘(c) RELATED PROVISIONS.—For provisions related 

5 to nondiscrimination against providers operated by the 

6 Service, an Indian tribe, tribal organization, or urban In7 dian organization, see section 1139(c) of the Social Secu8 rity Act (42 U.S.C. 1320b–9(c)).’’. 

9 SEC. 157. ACCESS TO FEDERAL INSURANCE. 

10 Title IV of the Indian Health Care Improvement Act 

11 (25 U.S.C. 1641 et seq.) (as amended by section 156) is 

12 amended by adding at the end the following: 

13 ‘‘SEC. 409. ACCESS TO FEDERAL INSURANCE. 

14 ‘‘Notwithstanding the provisions of title 5, United 

15 States Code, Executive order, or administrative regula16 tion, an Indian tribe or tribal organization carrying out 

17 programs under the Indian Self-Determination and Edu18 cation Assistance Act (25 U.S.C. 450 et seq.) or an urban 

19 Indian organization carrying out programs under title V 

20 of this Act shall be entitled to purchase coverage, rights, 

21 and benefits for the employees of such Indian tribe or trib22 al organization, or urban Indian organization, under chap23 ter 89 of title 5, United States Code, and chapter 87 of 

24 such title if necessary employee deductions and agency 

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1 efits for the period of employment with such Indian tribe 

2 or tribal organization, or urban Indian organization, are 

3 currently deposited in the applicable Employee’s Fund 

4 under such title.’’. 

5 SEC. 158. GENERAL EXCEPTIONS. 

6 Title IV of the Indian Health Care Improvement Act 

7 (25 U.S.C. 1641 et seq.) (as amended by section 157) is 

8 amended by adding at the end the following: 

9 ‘‘SEC. 410. GENERAL EXCEPTIONS. 

10 ‘‘The requirements of this title shall not apply to any 

11 excepted benefits described in paragraph (1)(A) or (3) of 

12 section 2791(c) of the Public Health Service Act (42 

13 U.S.C. 300gg–91).’’. 

14 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 FEASI20 BILITY STUDY. 

21 ‘‘(a) STUDY.—The Secretary shall conduct a study 

22 to determine the feasibility of treating the Navajo Nation 

23 as a State for the purposes of title XIX of the Social Secu24 rity Act, to provide services to Indians living within the 

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1 lished having the same authority and performing the same 

2 functions as single-State medicaid agencies responsible for 

3 the administration of the State plan under title XIX of 

4 the Social Security Act. 

5 ‘‘(b) CONSIDERATIONS.—In conducting the study, 

6 the 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 

13 Utah; 

14 ‘‘(2) providing assistance to the Navajo Nation 

15 in the development and implementation of such enti16 ty for the administration, eligibility, payment, and 

17 delivery of medical assistance under title XIX of the 

18 Social Security Act; 

19 ‘‘(3) providing an appropriate level of matching 

20 funds for Federal medical assistance with respect to 

21 amounts such entity expends for medical assistance 

22 for services and related administrative costs; and 

23 ‘‘(4) authorizing the Secretary, at the option of 

24 the Navajo Nation, to treat the Navajo Nation as a 

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1 curity Act (relating to the State children’s health in2 surance program) under terms equivalent to those 

3 described in paragraphs (2) through (4). 

4 ‘‘(c) REPORT.—Not later then 3 years after the date 

5 of enactment of the Indian Healthcare Improvement Act 

6 of 2011, the Secretary shall submit to the Committee on 

7 Indian Affairs and Committee on Finance of the Senate 

8 and the Committee on Natural Resources and Committee 

9 on Energy and Commerce of the House of Representatives 

10 a report that includes— 

11 ‘‘(1) the results of the study under this section; 

12 ‘‘(2) a summary of any consultation that oc13 curred between the Secretary and the Navajo Na14 tion, other Indian Tribes, the States of Arizona, 

15 New Mexico, and Utah, counties which include Nav16 ajo Lands, and other interested parties, in con17 ducting this study; 

18 ‘‘(3) projected costs or savings associated with 

19 establishment of such entity, and any estimated im20 pact on services provided as described in this section 

21 in relation to probable costs or savings; and 

22 ‘‘(4) legislative actions that would be required 

23 to authorize the establishment of such entity if such 

24 entity is determined by the Secretary to be fea25 sible.’’. 


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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 con6 struction or expansion of facilities’’ after ‘‘renovations to 

7 facilities’’. 

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 Serv18 ice’s 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 

23 definitions of an urban Indian organization in this 

24 Act, and shall not be subject to the provisions of the 


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1 Indian Self-Determination and Education Assistance 

2 Act (25 U.S.C. 450 et seq.).’’. 

3 SEC. 163. REQUIREMENT TO CONFER WITH URBAN INDIAN 

4 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: 


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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. 164. EXPANDED PROGRAM AUTHORITY FOR URBAN IN17 DIAN 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 


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1 programs established pursuant to sections 218, 702, and 

2 708(g).’’. 

3 SEC. 165. 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 


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1 the contract or grant, to use, in accordance with such 

2 terms and conditions for use and maintenance as are 

3 agreed on by the Secretary and the urban Indian organiza4 tions— 

5 ‘‘(1) any existing facility under the jurisdiction 

6 of the Secretary; 

7 ‘‘(2) all equipment contained in or pertaining to 

8 such an existing facility; and 

9 ‘‘(3) any other personal property of the Federal 

10 Government under the jurisdiction of the Secretary. 

11 ‘‘(b) DONATIONS.—Subject to subsection (d), the 

12 Secretary may donate to an urban Indian organization 

13 that has entered into a contract or received a grant pursu14 ant to this title any personal or real property determined 

15 to be excess to the needs of the Service or the General 

16 Services Administration for the purposes of carrying out 

17 the contract or grant. 

18 ‘‘(c) ACQUISITION OF PROPERTY.—The Secretary 

19 may acquire excess or surplus personal or real property 

20 of the Federal Government for donation, subject to sub21 section (d), to an urban Indian organization that has en22 tered into a contract or received a grant pursuant to this 

23 title if the Secretary determines that the property is ap24 propriate for use by the urban Indian organization for 

25 purposes of the contract or grant. 


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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 

7 request 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 organi14 zation. 

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 

18 received a grant pursuant to this title may be considered 

19 to be an Executive agency in carrying out the contract 

20 or grant. 

21 ‘‘SEC. 518. HEALTH INFORMATION TECHNOLOGY. 

22 ‘‘The Secretary, acting through the Service, may 

23 make grants to urban Indian organizations under this title 

24 for the development, adoption, and implementation of 

25 health information technology (as defined in section 3000 


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1 of the Public Health Service Act (42 U.S.C. 300jj)), tele2 medicine services development, and related infrastruc3 ture.’’. 

4 Subtitle F—Organizational 

5 Improvements 

6 SEC. 171. ESTABLISHMENT OF THE INDIAN HEALTH SERV7 ICE AS AN AGENCY OF THE PUBLIC HEALTH 

8 SERVICE. 

9 Section 601 of the Indian Health Care Improvement 

10 Act (25 U.S.C. 1661) is amended to read as follows: 

11 ‘‘SEC. 601. ESTABLISHMENT OF THE INDIAN HEALTH SERV12 ICE AS AN AGENCY OF THE PUBLIC HEALTH 

13 SERVICE. 

14 ‘‘(a) ESTABLISHMENT.— 

15 ‘‘(1) IN GENERAL.—In order to more effectively 

16 and efficiently carry out the responsibilities, authori17 ties, and functions of the United States to provide 

18 health care services to Indians and Indian tribes, as 

19 are or may be hereafter provided by Federal statute 

20 or treaties, there is established within the Public 

21 Health Service of the Department the Indian Health 

22 Service. 

23 ‘‘(2) DIRECTOR.—The Service shall be adminis24 tered by a Director, who shall be appointed by the 

25 President, by and with the advice and consent of the 


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1 Senate. The Director shall report to the Secretary. 

2 Effective with respect to an individual appointed by 

3 the President, by and with the advice and consent 

4 of the Senate, after January 1, 2008, the term of 

5 service of the Director shall be 4 years. A Director 

6 may serve more than 1 term. 

7 ‘‘(3) INCUMBENT.—The individual serving in 

8 the position of Director of the Service on the day be9 fore the date of enactment of the Indian Healthcare 

10 Improvement Act of 2011 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 


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1 Healthcare Improvement Act of 2011, carried out by 

2 or under the direction of the individual serving as 

3 Director of the Service on that day; 

4 ‘‘(2) perform all functions of the Secretary re5 lating to the maintenance and operation of hospital 

6 and health facilities for Indians and the planning 

7 for, and provision and utilization of, health services 

8 for Indians, including by ensuring that all agency di9 rectors, managers, and chief executive officers have 

10 appropriate and adequate training, experience, skill 

11 levels, knowledge, abilities, and education (including 

12 continuing training requirements) to competently 

13 fulfill the duties of the positions and the mission of 

14 the Service; 

15 ‘‘(3) administer all health programs under 

16 which health care is provided to Indians based upon 

17 their status as Indians which are administered by 

18 the Secretary, including programs under— 

19 ‘‘(A) this Act; 

20 ‘‘(B) the Act of November 2, 1921 (25 

21 U.S.C. 13); 

22 ‘‘(C) the Act of August 5, 1954 (42 U.S.C. 

23 2001 et seq.); 

24 ‘‘(D) the Act of August 16, 1957 (42 

25 U.S.C. 2005 et seq.); and 


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1 ‘‘(E) the Indian Self-Determination and 

2 Education Assistance Act (25 U.S.C. 450 et 

3 seq.); 

4 ‘‘(4) administer all scholarship and loan func5 tions carried out under title I; 

6 ‘‘(5) directly advise the Secretary concerning 

7 the development of all policy- and budget-related 

8 matters affecting Indian health; 

9 ‘‘(6) collaborate with the Assistant Secretary 

10 for Health concerning appropriate matters of Indian 

11 health that affect the agencies of the Public Health 

12 Service; 

13 ‘‘(7) advise each Assistant Secretary of the De14 partment concerning matters of Indian health with 

15 respect to which that Assistant Secretary has au16 thority and responsibility; 

17 ‘‘(8) advise the heads of other agencies and pro18 grams of the Department concerning matters of In19 dian health with respect to which those heads have 

20 authority and responsibility; 

21 ‘‘(9) coordinate the activities of the Department 

22 concerning matters of Indian health; and 

23 ‘‘(10) perform such other functions as the Sec24 retary may designate. 

25 ‘‘(d) AUTHORITY.— 


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1 ‘‘(1) IN GENERAL.—The Secretary, acting 

2 through the Director, shall have the authority— 

3 ‘‘(A) except to the extent provided for in 

4 paragraph (2), to appoint and compensate em5 ployees for the Service in accordance with title 

6 5, United States Code; 

7 ‘‘(B) to enter into contracts for the pro8 curement of goods and services to carry out the 

9 functions of the Service; and 

10 ‘‘(C) to manage, expend, and obligate all 

11 funds appropriated for the Service. 

12 ‘‘(2) PERSONNEL ACTIONS.—Notwithstanding 

13 any other provision of law, the provisions of section 

14 12 of the Act of June 18, 1934 (48 Stat. 986; 25 

15 U.S.C. 472), shall apply to all personnel actions 

16 taken with respect to new positions created within 

17 the Service as a result of its establishment under 

18 subsection (a).’’. 

19 SEC. 172. OFFICE OF DIRECT SERVICE TRIBES. 

20 Title VI of the Indian Health Care Improvement Act 

21 (25 U.S.C. 1661 et seq.) (as amended by section 101(b)) 

22 is amended by adding at the end the following: 


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1 ‘‘SEC. 603. OFFICE OF DIRECT SERVICE TRIBES. 

2 ‘‘(a) ESTABLISHMENT.—There is established within 

3 the Service an office, to be known as the ‘Office of Direct 

4 Service Tribes’. 

5 ‘‘(b) TREATMENT.—The Office of Direct Service 

6 Tribes shall be located in the Office of the Director. 

7 ‘‘(c) DUTIES.—The Office of Direct Service Tribes 

8 shall be responsible for— 

9 ‘‘(1) providing Service-wide leadership, guidance 

10 and support for direct service tribes to include stra11 tegic planning and program evaluation; 

12 ‘‘(2) ensuring maximum flexibility to tribal 

13 health and related support systems for Indian bene14 ficiaries; 

15 ‘‘(3) serving as the focal point for consultation 

16 and participation between direct service tribes and 

17 organizations and the Service in the development of 

18 Service policy; 

19 ‘‘(4) holding no less than biannual consultations 

20 with direct service tribes in appropriate locations to 

21 gather information and aid in the development of 

22 health policy; and 

23 ‘‘(5) directing a national program and providing 

24 leadership and advocacy in the development of 

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1 lation, resource allocation, and delegation support 

2 for direct service tribes.’’. 

3 SEC. 173. NEVADA AREA OFFICE. 

4 Title VI of the Indian Health Care Improvement Act 

5 (25 U.S.C. 1661 et seq.) (as amended by section 172) is 

6 amended by adding at the end the following: 

7 ‘‘SEC. 604. NEVADA AREA OFFICE. 

8 ‘‘(a) IN GENERAL.—Not later than 1 year after the 

9 date of enactment of this section, in a manner consistent 

10 with the tribal consultation policy of the Service, the Sec11 retary shall submit to Congress a plan describing the man12 ner and schedule by which an area office, separate and 

13 distinct from the Phoenix Area Office of the Service, can 

14 be established in the State of Nevada. 

15 ‘‘(b) FAILURE TO SUBMIT PLAN.— 

16 ‘‘(1) DEFINITION OF OPERATIONS FUNDS.—In 

17 this subsection, the term ‘operations funds’ means 

18 only the funds used for— 

19 ‘‘(A) the administration of services, includ20 ing functional expenses such as overtime, per21 sonnel salaries, and associated benefits; or 

22 ‘‘(B) related tasks that directly affect the 

23 operations described in subparagraph (A). 

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1 section (a), the Secretary shall withhold the oper2 ations funds reserved for the Office of the Director, 

3 subject to the condition that the withholding shall 

4 not adversely impact the capacity of the Service to 

5 deliver health care services. 

6 ‘‘(3) RESTORATION.—The operations funds 

7 withheld pursuant to paragraph (2) may be restored, 

8 at the discretion of the Secretary, to the Office of 

9 the Director on achievement by that Office of com10 pliance with this section.’’. 

11 Subtitle G—Behavioral Health 

12 Programs 

13 SEC. 181. BEHAVIORAL HEALTH PROGRAMS. 

14 Title VII of the Indian Health Care Improvement Act 

15 (25 U.S.C. 1665 et seq.) is amended to read as follows: 

16 ‘‘TITLE VII—BEHAVIORAL 

17 HEALTH PROGRAMS 

18 ‘‘Subtitle A—General Programs 

19 ‘‘SEC. 701. DEFINITIONS. 

20 ‘‘In this subtitle: 

21 ‘‘(1) ALCOHOL-RELATED

22 NEURODEVELOPMENTAL DISORDERS; ARND.—The 

23 term ‘alcohol-related neurodevelopmental disorders’ 

24 or ‘ARND’ means, with a history of maternal alco25 hol consumption during pregnancy, central nervous 


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1 system abnormalities, which may range from minor 

2 intellectual deficits and developmental delays to 

3 mental retardation. ARND children may have behav4 ioral problems, learning disabilities, problems with 

5 executive functioning, and attention disorders. The 

6 neurological defects of ARND may be as severe as 

7 FAS, but facial anomalies and other physical char8 acteristics are not present in ARND, thus making 

9 diagnosis difficult. 

10 ‘‘(2) ASSESSMENT.—The term ‘assessment’ 

11 means the systematic collection, analysis, and dis12 semination of information on health status, health 

13 needs, and health problems. 

14 ‘‘(3) BEHAVIORAL HEALTH AFTERCARE.—The 

15 term ‘behavioral health aftercare’ includes those ac16 tivities and resources used to support recovery fol17 lowing inpatient, residential, intensive substance 

18 abuse, or mental health outpatient or outpatient 

19 treatment. The purpose is to help prevent or deal 

20 with relapse by ensuring that by the time a client or 

21 patient is discharged from a level of care, such as 

22 outpatient treatment, an aftercare plan has been de23 veloped with the client. An aftercare plan may use 

24 such resources as a community-based therapeutic 

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1 sor, a local 12-step or other related support group, 

2 and other community-based providers. 

3 ‘‘(4) DUAL DIAGNOSIS.—The term ‘dual diag4 nosis’ means coexisting substance abuse and mental 

5 illness conditions or diagnosis. Such clients are 

6 sometimes referred to as mentally ill chemical abus7 ers (MICAs). 

8 ‘‘(5) FETAL ALCOHOL SPECTRUM DIS9 ORDERS.— 

10 ‘‘(A) IN GENERAL.—The term ‘fetal alco11 hol spectrum disorders’ includes a range of ef12 fects that can occur in an individual whose 

13 mother drank alcohol during pregnancy, includ14 ing physical, mental, behavioral, and/or learning 

15 disabilities with possible lifelong implications. 

16 ‘‘(B) INCLUSIONS.—The term ‘fetal alcohol 

17 spectrum disorders’ may include— 

18 ‘‘(i) fetal alcohol syndrome (FAS); 

19 ‘‘(ii) partial fetal alcohol syndrome 

20 (partial FAS); 

21 ‘‘(iii) alcohol-related birth defects 

22 (ARBD); and 

23 ‘‘(iv) alcohol-related 

24 neurodevelopmental disorders (ARND). 


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1 ‘‘(6) FAS OR FETAL ALCOHOL SYNDROME.— 

2 The term ‘FAS’ or ‘fetal alcohol syndrome’ means a 

3 syndrome in which, with a history of maternal alco4 hol consumption during pregnancy, the following cri5 teria are met: 

6 ‘‘(A) Central nervous system involvement, 

7 such as mental retardation, developmental 

8 delay, intellectual deficit, microencephaly, or 

9 neurological abnormalities. 

10 ‘‘(B) Craniofacial abnormalities with at 

11 least 2 of the following: 

12 ‘‘(i) Microophthalmia. 

13 ‘‘(ii) Short palpebral fissures. 

14 ‘‘(iii) Poorly developed philtrum. 

15 ‘‘(iv) Thin upper lip. 

16 ‘‘(v) Flat nasal bridge. 

17 ‘‘(vi) Short upturned nose. 

18 ‘‘(C) Prenatal or postnatal growth delay. 

19 ‘‘(7) REHABILITATION.—The term ‘rehabilita20 tion’ means medical and health care services that— 

21 ‘‘(A) are recommended by a physician or 

22 licensed practitioner of the healing arts within 

23 the scope of their practice under applicable law; 


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1 ‘‘(B) are furnished in a facility, home, or 

2 other setting in accordance with applicable 

3 standards; and 

4 ‘‘(C) have as their purpose any of the fol5 lowing: 

6 ‘‘(i) The maximum attainment of 

7 physical, mental, and developmental func8 tioning. 

9 ‘‘(ii) Averting deterioration in physical 

10 or mental functional status. 

11 ‘‘(iii) The maintenance of physical or 

12 mental health functional status. 

13 ‘‘(8) SUBSTANCE ABUSE.—The term ‘substance 

14 abuse’ includes inhalant abuse. 

15 ‘‘SEC. 702. BEHAVIORAL HEALTH PREVENTION AND TREAT16 MENT SERVICES. 

17 ‘‘(a) PURPOSES.—The purposes of this section are as 

18 follows: 

19 ‘‘(1) To authorize and direct the Secretary, act20 ing through the Service, Indian tribes, and tribal or21 ganizations, to develop a comprehensive behavioral 

22 health prevention and treatment program which em23 phasizes collaboration among alcohol and substance 

24 abuse, social services, and mental health programs. 


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1 ‘‘(2) To provide information, direction, and 

2 guidance relating to mental illness and dysfunction 

3 and self-destructive behavior, including child abuse 

4 and family violence, to those Federal, tribal, State, 

5 and local agencies responsible for programs in In6 dian communities in areas of health care, education, 

7 social services, child and family welfare, alcohol and 

8 substance abuse, law enforcement, and judicial serv9 ices. 

10 ‘‘(3) To assist Indian tribes to identify services 

11 and resources available to address mental illness and 

12 dysfunctional and self-destructive behavior. 

13 ‘‘(4) To provide authority and opportunities for 

14 Indian tribes and tribal organizations to develop, im15 plement, and coordinate with community-based pro16 grams which include identification, prevention, edu17 cation, referral, and treatment services, including 

18 through multidisciplinary resource teams. 

19 ‘‘(5) To ensure that Indians, as citizens of the 

20 United States and of the States in which they re21 side, have the same access to behavioral health serv22 ices to which all citizens have access. 

23 ‘‘(6) To modify or supplement existing pro24 grams and authorities in the areas identified in 

25 paragraph (2). 


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1 ‘‘(b) PLANS.— 

2 ‘‘(1) DEVELOPMENT.—The Secretary, acting 

3 through the Service, Indian tribes, and tribal organi4 zations, shall encourage Indian tribes and tribal or5 ganizations to develop tribal plans, and urban Indian 

6 organizations to develop local plans, and for all such 

7 groups to participate in developing areawide plans 

8 for Indian Behavioral Health Services. The plans 

9 shall include, to the extent feasible, the following 

10 components: 

11 ‘‘(A) An assessment of the scope of alcohol 

12 or other substance abuse, mental illness, and 

13 dysfunctional and self-destructive behavior, in14 cluding suicide, child abuse, and family vio15 lence, among Indians, including— 

16 ‘‘(i) the number of Indians served who 

17 are directly or indirectly affected by such 

18 illness or behavior; or 

19 ‘‘(ii) an estimate of the financial and 

20 human cost attributable to such illness or 

21 behavior. 

22 ‘‘(B) An assessment of the existing and 

23 additional resources necessary for the preven24 tion and treatment of such illness and behavior, 

25 including an assessment of the progress toward 


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1 achieving the availability of the full continuum 

2 of care described in subsection (c). 

3 ‘‘(C) An estimate of the additional funding 

4 needed by the Service, Indian tribes, tribal or5 ganizations, and urban Indian organizations to 

6 meet their responsibilities under the plans. 

7 ‘‘(2) NATIONAL CLEARINGHOUSE.—The Sec8 retary, acting through the Service, shall coordinate 

9 with existing national clearinghouses and informa10 tion centers to include at the clearinghouses and 

11 centers plans and reports on the outcomes of such 

12 plans developed by Indian tribes, tribal organiza13 tions, urban Indian organizations, and Service areas 

14 relating to behavioral health. The Secretary shall en15 sure access to these plans and outcomes by any In16 dian tribe, tribal organization, urban Indian organi17 zation, or the Service. 

18 ‘‘(3) TECHNICAL ASSISTANCE.—The Secretary 

19 shall provide technical assistance to Indian tribes, 

20 tribal organizations, and urban Indian organizations 

21 in preparation of plans under this section and in de22 veloping standards of care that may be used and 

23 adopted locally. 


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1 ‘‘(c) PROGRAMS.—The Secretary, acting through the 

2 Service, shall provide, to the extent feasible and if funding 

3 is available, programs including the following: 

4 ‘‘(1) COMPREHENSIVE CARE.—A comprehensive 

5 continuum of behavioral health care which pro6 vides— 

7 ‘‘(A) community-based prevention, inter8 vention, outpatient, and behavioral health 

9 aftercare; 

10 ‘‘(B) detoxification (social and medical); 

11 ‘‘(C) acute hospitalization; 

12 ‘‘(D) intensive outpatient/day treatment; 

13 ‘‘(E) residential treatment; 

14 ‘‘(F) transitional living for those needing a 

15 temporary, stable living environment that is 

16 supportive of treatment and recovery goals; 

17 ‘‘(G) emergency shelter; 

18 ‘‘(H) intensive case management; 

19 ‘‘(I) diagnostic services; and 

20 ‘‘(J) promotion of healthy approaches to 

21 risk and safety issues, including injury preven22 tion. 

23 ‘‘(2) CHILD CARE.—Behavioral health services 

24 for Indians from birth through age 17, including— 


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1 ‘‘(A) preschool and school age fetal alcohol 

2 spectrum disorder services, including assess3 ment and behavioral intervention; 

4 ‘‘(B) mental health and substance abuse 

5 services (emotional, organic, alcohol, drug, in6 halant, and tobacco); 

7 ‘‘(C) identification and treatment of co-oc8 curring disorders and comorbidity; 

9 ‘‘(D) prevention of alcohol, drug, inhalant, 

10 and tobacco use; 

11 ‘‘(E) early intervention, treatment, and 

12 aftercare; 

13 ‘‘(F) promotion of healthy approaches to 

14 risk and safety issues; and 

15 ‘‘(G) identification and treatment of ne16 glect and physical, mental, and sexual abuse. 

17 ‘‘(3) ADULT CARE.—Behavioral health services 

18 for Indians from age 18 through 55, including— 

19 ‘‘(A) early intervention, treatment, and 

20 aftercare; 

21 ‘‘(B) mental health and substance abuse 

22 services (emotional, alcohol, drug, inhalant, and 

23 tobacco), including sex specific services; 


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1 ‘‘(C) identification and treatment of co-oc2 curring disorders (dual diagnosis) and comor3 bidity; 

4 ‘‘(D) promotion of healthy approaches for 

5 risk-related behavior; 

6 ‘‘(E) treatment services for women at risk 

7 of giving birth to a child with a fetal alcohol 

8 spectrum disorder; and 

9 ‘‘(F) sex specific treatment for sexual as10 sault and domestic violence. 

11 ‘‘(4) FAMILY CARE.—Behavioral health services 

12 for families, including— 

13 ‘‘(A) early intervention, treatment, and 

14 aftercare for affected families; 

15 ‘‘(B) treatment for sexual assault and do16 mestic violence; and 

17 ‘‘(C) promotion of healthy approaches re18 lating to parenting, domestic violence, and other 

19 abuse issues. 

20 ‘‘(5) ELDER CARE.—Behavioral health services 

21 for Indians 56 years of age and older, including— 

22 ‘‘(A) early intervention, treatment, and 

23 aftercare; 


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1 ‘‘(B) mental health and substance abuse 

2 services (emotional, alcohol, drug, inhalant, and 

3 tobacco), including sex specific services; 

4 ‘‘(C) identification and treatment of co-oc5 curring disorders (dual diagnosis) and comor6 bidity; 

7 ‘‘(D) promotion of healthy approaches to 

8 managing conditions related to aging; 

9 ‘‘(E) sex specific treatment for sexual as10 sault, domestic violence, neglect, physical and 

11 mental abuse and exploitation; and 

12 ‘‘(F) identification and treatment of de13 mentias regardless of cause. 

14 ‘‘(d) COMMUNITY BEHAVIORAL HEALTH PLAN.— 

15 ‘‘(1) ESTABLISHMENT.—The governing body of 

16 any Indian tribe, tribal organization, or urban In17 dian organization may adopt a resolution for the es18 tablishment of a community behavioral health plan 

19 providing for the identification and coordination of 

20 available resources and programs to identify, pre21 vent, or treat substance abuse, mental illness, or 

22 dysfunctional and self-destructive behavior, including 

23 child abuse and family violence, among its members 

24 or its service population. This plan should include 


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1 behavioral health services, social services, intensive 

2 outpatient services, and continuing aftercare. 

3 ‘‘(2) TECHNICAL ASSISTANCE.—At the request 

4 of an Indian tribe, tribal organization, or urban In5 dian organization, the Bureau of Indian Affairs and 

6 the Service shall cooperate with and provide tech7 nical assistance to the Indian tribe, tribal organiza8 tion, or urban Indian organization in the develop9 ment and implementation of such plan. 

10 ‘‘(3) FUNDING.—The Secretary, acting through 

11 the Service, Indian tribes, and tribal organizations, 

12 may make funding available to Indian tribes and 

13 tribal organizations which adopt a resolution pursu14 ant to paragraph (1) to obtain technical assistance 

15 for the development of a community behavioral 

16 health plan and to provide administrative support in 

17 the implementation of such plan. 

18 ‘‘(e) COORDINATION FOR AVAILABILITY OF SERV19 ICES.—The Secretary, acting through the Service, shall 

20 coordinate behavioral health planning, to the extent fea21 sible, with other Federal agencies and with State agencies, 

22 to encourage comprehensive behavioral health services for 

23 Indians regardless of their place of residence. 

24 ‘‘(f) MENTAL HEALTH CARE NEED ASSESSMENT.— 

25 Not later than 1 year after the date of enactment of the 


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1 Indian Healthcare Improvement Act of 2011, the Sec2 retary, acting through the Service, shall make an assess3 ment of the need for inpatient mental health care among 

4 Indians and the availability and cost of inpatient mental 

5 health facilities which can meet such need. In making such 

6 assessment, the Secretary shall consider the possible con7 version of existing, underused Service hospital beds into 

8 psychiatric units to meet such need. 

9 ‘‘SEC. 703. MEMORANDA OF AGREEMENT WITH THE DE10 PARTMENT OF INTERIOR. 

11 ‘‘(a) CONTENTS.—Not later than 1 year after the 

12 date of enactment of the Indian Healthcare Improvement 

13 Act of 2011, the Secretary, acting through the Service, 

14 and the Secretary of the Interior shall develop and enter 

15 into a memoranda of agreement, or review and update any 

16 existing memoranda of agreement, as required by section 

17 4205 of the Indian Alcohol and Substance Abuse Preven18 tion and Treatment Act of 1986 (25 U.S.C. 2411) under 

19 which the Secretaries address the following: 

20 ‘‘(1) The scope and nature of mental illness and 

21 dysfunctional and self-destructive behavior, including 

22 child abuse and family violence, among Indians. 

23 ‘‘(2) The existing Federal, tribal, State, local, 

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1 able to provide behavioral health services for Indi2 ans. 

3 ‘‘(3) The unmet need for additional services, re4 sources, and programs necessary to meet the needs 

5 identified pursuant to paragraph (1). 

6 ‘‘(4)(A) The right of Indians, as citizens of the 

7 United States and of the States in which they re8 side, to have access to behavioral health services to 

9 which all citizens have access. 

10 ‘‘(B) The right of Indians to participate in, and 

11 receive the benefit of, such services. 

12 ‘‘(C) The actions necessary to protect the exer13 cise of such right. 

14 ‘‘(5) The responsibilities of the Bureau of In15 dian Affairs and the Service, including mental illness 

16 identification, prevention, education, referral, and 

17 treatment services (including services through multi18 disciplinary resource teams), at the central, area, 

19 and agency and Service unit, Service area, and head20 quarters levels to address the problems identified in 

21 paragraph (1). 

22 ‘‘(6) A strategy for the comprehensive coordina23 tion of the behavioral health services provided by the 

24 Bureau of Indian Affairs and the Service to meet 


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1 the problems identified pursuant to paragraph (1), 

2 including— 

3 ‘‘(A) the coordination of alcohol and sub4 stance abuse programs of the Service, the Bu5 reau of Indian Affairs, and Indian tribes and 

6 tribal organizations (developed under the Indian 

7 Alcohol and Substance Abuse Prevention and 

8 Treatment Act of 1986 (25 U.S.C. 2401 et 

9 seq.)) with behavioral health initiatives pursu10 ant to this Act, particularly with respect to the 

11 referral and treatment of dually diagnosed indi12 viduals requiring behavioral health and sub13 stance abuse treatment; and 

14 ‘‘(B) ensuring that the Bureau of Indian 

15 Affairs and Service programs and services (in16 cluding multidisciplinary resource teams) ad17 dressing child abuse and family violence are co18 ordinated with such non-Federal programs and 

19 services. 

20 ‘‘(7) Directing appropriate officials of the Bu21 reau of Indian Affairs and the Service, particularly 

22 at the agency and Service unit levels, to cooperate 

23 fully with tribal requests made pursuant to commu24 nity behavioral health plans adopted under section 

25 702(c) and section 4206 of the Indian Alcohol and 


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1 Substance Abuse Prevention and Treatment Act of 

2 1986 (25 U.S.C. 2412). 

3 ‘‘(8) Providing for an annual review of such 

4 agreement by the Secretaries which shall be provided 

5 to Congress and Indian tribes and tribal organiza6 tions. 

7 ‘‘(b) SPECIFIC PROVISIONS REQUIRED.—The memo8 randa of agreement updated or entered into pursuant to 

9 subsection (a) shall include specific provisions pursuant to 

10 which the Service shall assume responsibility for— 

11 ‘‘(1) the determination of the scope of the prob12 lem of alcohol and substance abuse among Indians, 

13 including the number of Indians within the jurisdic14 tion of the Service who are directly or indirectly af15 fected by alcohol and substance abuse and the finan16 cial and human cost; 

17 ‘‘(2) an assessment of the existing and needed 

18 resources necessary for the prevention of alcohol and 

19 substance abuse and the treatment of Indians af20 fected by alcohol and substance abuse; and 

21 ‘‘(3) an estimate of the funding necessary to 

22 adequately support a program of prevention of alco23 hol and substance abuse and treatment of Indians 

24 affected by alcohol and substance abuse. 


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1 ‘‘(c) PUBLICATION.—Each memorandum of agree2 ment entered into or renewed (and amendments or modi3 fications thereto) under subsection (a) shall be published 

4 in the Federal Register. At the same time as publication 

5 in the Federal Register, the Secretary shall provide a copy 

6 of such memoranda, amendment, or modification to each 

7 Indian tribe, tribal organization, and urban Indian organi8 zation. 

9 ‘‘SEC. 704. COMPREHENSIVE BEHAVIORAL HEALTH PRE10 VENTION AND TREATMENT PROGRAM. 

11 ‘‘(a) ESTABLISHMENT.— 

12 ‘‘(1) IN GENERAL.—The Secretary, acting 

13 through the Service, shall provide a program of com14 prehensive behavioral health, prevention, treatment, 

15 and aftercare, which may include, if feasible and ap16 propriate, systems of care, and shall include— 

17 ‘‘(A) prevention, through educational inter18 vention, in Indian communities; 

19 ‘‘(B) acute detoxification, psychiatric hos20 pitalization, residential, and intensive outpatient 

21 treatment; 

22 ‘‘(C) community-based rehabilitation and 

23 aftercare; 

24 ‘‘(D) community education and involve25 ment, including extensive training of health 


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1 care, educational, and community-based per2 sonnel; 

3 ‘‘(E) specialized residential treatment pro4 grams for high-risk populations, including preg5 nant and postpartum women and their children; 

6 and 

7 ‘‘(F) diagnostic services. 

8 ‘‘(2) TARGET POPULATIONS.—The target popu9 lation of such programs shall be members of Indian 

10 tribes. Efforts to train and educate key members of 

11 the Indian community shall also target employees of 

12 health, education, judicial, law enforcement, legal, 

13 and social service programs. 

14 ‘‘(b) CONTRACT HEALTH SERVICES.— 

15 ‘‘(1) IN GENERAL.—The Secretary, acting 

16 through the Service, may enter into contracts with 

17 public or private providers of behavioral health treat18 ment services for the purpose of carrying out the 

19 program required under subsection (a). 

20 ‘‘(2) PROVISION OF ASSISTANCE.—In carrying 

21 out this subsection, the Secretary shall provide as22 sistance to Indian tribes and tribal organizations to 

23 develop criteria for the certification of behavioral 

24 health service providers and accreditation of service 


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1 facilities which meet minimum standards for such 

2 services and facilities. 

3 ‘‘SEC. 705. MENTAL HEALTH TECHNICIAN PROGRAM. 

4 ‘‘(a) IN GENERAL.—Pursuant to the Act of Novem5 ber 2, 1921 (25 U.S.C. 13) (commonly known as the ‘Sny6 der Act’), the Secretary shall establish and maintain a 

7 mental health technician program within the Service 

8 which— 

9 ‘‘(1) provides for the training of Indians as 

10 mental health technicians; and 

11 ‘‘(2) employs such technicians in the provision 

12 of community-based mental health care that includes 

13 identification, prevention, education, referral, and 

14 treatment services. 

15 ‘‘(b) PARAPROFESSIONAL TRAINING.—In carrying 

16 out subsection (a), the Secretary, acting through the Serv17 ice, shall provide high-standard paraprofessional training 

18 in mental health care necessary to provide quality care to 

19 the Indian communities to be served. Such training shall 

20 be based upon a curriculum developed or approved by the 

21 Secretary which combines education in the theory of men22 tal health care with supervised practical experience in the 

23 provision of such care. 

24 ‘‘(c) SUPERVISION AND EVALUATION OF TECHNI25 CIANS.—The Secretary, acting through the Service, shall 


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1 supervise and evaluate the mental health technicians in 

2 the training program. 

3 ‘‘(d) TRADITIONAL HEALTH CARE PRACTICES.—The 

4 Secretary, acting through the Service, shall ensure that 

5 the program established pursuant to this section involves 

6 the use and promotion of the traditional health care prac7 tices of the Indian tribes to be served. 

8 ‘‘SEC. 706. LICENSING REQUIREMENT FOR MENTAL 

9 HEALTH CARE WORKERS. 

10 ‘‘(a) IN GENERAL.—Subject to section 221, and ex11 cept as provided in subsection (b), any individual employed 

12 as a psychologist, social worker, or marriage and family 

13 therapist for the purpose of providing mental health care 

14 services to Indians in a clinical setting under this Act is 

15 required to be licensed as a psychologist, social worker, 

16 or marriage and family therapist, respectively. 

17 ‘‘(b) TRAINEES.—An individual may be employed as 

18 a trainee in psychology, social work, or marriage and fam19 ily therapy to provide mental health care services de20 scribed in subsection (a) if such individual— 

21 ‘‘(1) works under the direct supervision of a li22 censed psychologist, social worker, or marriage and 

23 family therapist, respectively; 

24 ‘‘(2) is enrolled in or has completed at least 2 

25 years of course work at a post-secondary, accredited 


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1 education program for psychology, social work, mar2 riage and family therapy, or counseling; and 

3 ‘‘(3) meets such other training, supervision, and 

4 quality review requirements as the Secretary may es5 tablish. 

6 ‘‘SEC. 707. INDIAN WOMEN TREATMENT PROGRAMS. 

7 ‘‘(a) GRANTS.—The Secretary, consistent with sec8 tion 702, may make grants to Indian tribes, tribal organi9 zations, and urban Indian organizations to develop and 

10 implement a comprehensive behavioral health program of 

11 prevention, intervention, treatment, and relapse preven12 tion services that specifically addresses the cultural, his13 torical, social, and child care needs of Indian women, re14 gardless of age. 

15 ‘‘(b) USE OF GRANT FUNDS.—A grant made pursu16 ant to this section may be used— 

17 ‘‘(1) to develop and provide community train18 ing, education, and prevention programs for Indian 

19 women relating to behavioral health issues, including 

20 fetal alcohol spectrum disorders; 

21 ‘‘(2) to identify and provide psychological serv22 ices, counseling, advocacy, support, and relapse pre23 vention to Indian women and their families; and 

24 ‘‘(3) to develop prevention and intervention 

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1 tional health care practices, cultural values, and 

2 community and family involvement. 

3 ‘‘(c) CRITERIA.—The Secretary, in consultation with 

4 Indian tribes and tribal organizations, shall establish cri5 teria for the review and approval of applications and pro6 posals for funding under this section. 

7 ‘‘(d) ALLOCATION OF FUNDS FOR URBAN INDIAN

8 ORGANIZATIONS.—Twenty percent of the funds appro9 priated pursuant to this section shall be used to make 

10 grants to urban Indian organizations. 

11 ‘‘SEC. 708. INDIAN YOUTH PROGRAM. 

12 ‘‘(a) DETOXIFICATION AND REHABILITATION.—The 

13 Secretary, acting through the Service, consistent with sec14 tion 702, shall develop and implement a program for acute 

15 detoxification and treatment for Indian youths, including 

16 behavioral health services. The program shall include re17 gional treatment centers designed to include detoxification 

18 and rehabilitation for both sexes on a referral basis and 

19 programs developed and implemented by Indian tribes or 

20 tribal organizations at the local level under the Indian 

21 Self-Determination and Education Assistance Act (25 

22 U.S.C. 450 et seq.). Regional centers shall be integrated 

23 with the intake and rehabilitation programs based in the 

24 referring Indian community. 


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1 ‘‘(b) ALCOHOL AND SUBSTANCE ABUSE TREATMENT

2 CENTERS OR FACILITIES.— 

3 ‘‘(1) ESTABLISHMENT.— 

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

5 through the Service, shall construct, renovate, 

6 or, as necessary, purchase, and appropriately 

7 staff and operate, at least 1 youth regional 

8 treatment center or treatment network in each 

9 area under the jurisdiction of an area office. 

10 ‘‘(B) AREA OFFICE IN CALIFORNIA.—For 

11 the purposes of this subsection, the area office 

12 in California shall be considered to be 2 area 

13 offices, 1 office whose jurisdiction shall be con14 sidered to encompass the northern area of the 

15 State of California, and 1 office whose jurisdic16 tion shall be considered to encompass the re17 mainder of the State of California for the pur18 pose of implementing California treatment net19 works. 

20 ‘‘(2) FUNDING.—For the purpose of staffing 

21 and operating such centers or facilities, funding 

22 shall be pursuant to the Act of November 2, 1921 

23 (25 U.S.C. 13). 

24 ‘‘(3) LOCATION.—A youth treatment center 

25 constructed or purchased under this subsection shall 


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1 be constructed or purchased at a location within the 

2 area described in paragraph (1) agreed upon (by ap3 propriate tribal resolution) by a majority of the In4 dian tribes to be served by such center. 

5 ‘‘(4) SPECIFIC PROVISION OF FUNDS.— 

6 ‘‘(A) IN GENERAL.—Notwithstanding any 

7 other provision of this title, the Secretary may, 

8 from amounts authorized to be appropriated for 

9 the purposes of carrying out this section, make 

10 funds available to— 

11 ‘‘(i) the Tanana Chiefs Conference, 

12 Incorporated, for the purpose of leasing, 

13 constructing, renovating, operating, and 

14 maintaining a residential youth treatment 

15 facility in Fairbanks, Alaska; and 

16 ‘‘(ii) the Southeast Alaska Regional 

17 Health Corporation to staff and operate a 

18 residential youth treatment facility without 

19 regard to the proviso set forth in section 

20 4(l) of the Indian Self-Determination and 

21 Education Assistance Act (25 U.S.C. 

22 450b(l)). 

23 ‘‘(B) PROVISION OF SERVICES TO ELIGI24 BLE YOUTHS.—Until additional residential 

25 youth treatment facilities are established in 


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1 Alaska pursuant to this section, the facilities 

2 specified in subparagraph (A) shall make every 

3 effort to provide services to all eligible Indian 

4 youths residing in Alaska. 

5 ‘‘(c) INTERMEDIATE ADOLESCENT BEHAVIORAL

6 HEALTH SERVICES.— 

7 ‘‘(1) IN GENERAL.—The Secretary, acting 

8 through the Service, may provide intermediate be9 havioral health services, which may , if feasible and 

10 appropriate, incorporate systems of care, to Indian 

11 children and adolescents, including— 

12 ‘‘(A) pretreatment assistance; 

13 ‘‘(B) inpatient, outpatient, and aftercare 

14 services; 

15 ‘‘(C) emergency care; 

16 ‘‘(D) suicide prevention and crisis interven17 tion; and 

18 ‘‘(E) prevention and treatment of mental 

19 illness and dysfunctional and self-destructive 

20 behavior, including child abuse and family vio21 lence. 

22 ‘‘(2) USE OF FUNDS.—Funds provided under 

23 this subsection may be used— 


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1 ‘‘(A) to construct or renovate an existing 

2 health facility to provide intermediate behav3 ioral health services; 

4 ‘‘(B) to hire behavioral health profes5 sionals; 

6 ‘‘(C) to staff, operate, and maintain an in7 termediate mental health facility, group home, 

8 sober housing, transitional housing or similar 

9 facilities, or youth shelter where intermediate 

10 behavioral health services are being provided; 

11 ‘‘(D) to make renovations and hire appro12 priate staff to convert existing hospital beds 

13 into adolescent psychiatric units; and 

14 ‘‘(E) for intensive home- and community15 based services. 

16 ‘‘(3) CRITERIA.—The Secretary, acting through 

17 the Service, shall, in consultation with Indian tribes 

18 and tribal organizations, establish criteria for the re19 view and approval of applications or proposals for 

20 funding made available pursuant to this subsection. 

21 ‘‘(d) FEDERALLY OWNED STRUCTURES.— 

22 ‘‘(1) IN GENERAL.—The Secretary, in consulta23 tion with Indian tribes and tribal organizations, 

24 shall— 


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1 ‘‘(A) identify and use, where appropriate, 

2 federally owned structures suitable for local res3 idential or regional behavioral health treatment 

4 for Indian youths; and 

5 ‘‘(B) establish guidelines for determining 

6 the suitability of any such federally owned 

7 structure to be used for local residential or re8 gional behavioral health treatment for Indian 

9 youths. 

10 ‘‘(2) TERMS AND CONDITIONS FOR USE OF

11 STRUCTURE.—Any structure described in paragraph 

12 (1) may be used under such terms and conditions as 

13 may be agreed upon by the Secretary and the agency 

14 having responsibility for the structure and any In15 dian tribe or tribal organization operating the pro16 gram. 

17 ‘‘(e) REHABILITATION AND AFTERCARE SERVICES.— 

18 ‘‘(1) IN GENERAL.—The Secretary, Indian 

19 tribes, or tribal organizations, in cooperation with 

20 the Secretary of the Interior, shall develop and im21 plement within each Service unit, community-based 

22 rehabilitation and follow-up services for Indian 

23 youths who are having significant behavioral health 

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1 dian youths after their return to their home commu2 nity. 

3 ‘‘(2) ADMINISTRATION.—Services under para4 graph (1) shall be provided by trained staff within 

5 the community who can assist the Indian youths in 

6 their continuing development of self-image, positive 

7 problem-solving skills, and nonalcohol or substance 

8 abusing behaviors. Such staff may include alcohol 

9 and substance abuse counselors, mental health pro10 fessionals, and other health professionals and para11 professionals, including community health represent12 atives. 

13 ‘‘(f) INCLUSION OF FAMILY IN YOUTH TREATMENT

14 PROGRAM.—In providing the treatment and other services 

15 to Indian youths authorized by this section, the Secretary, 

16 acting through the Service, shall provide for the inclusion 

17 of family members of such youths in the treatment pro18 grams or other services as may be appropriate. Not less 

19 than 10 percent of the funds appropriated for the pur20 poses of carrying out subsection (e) shall be used for out21 patient care of adult family members related to the treat22 ment of an Indian youth under that subsection. 

23 ‘‘(g) MULTIDRUG ABUSE PROGRAM.—The Secretary, 

24 acting through the Service, shall provide, consistent with 

25 section 702, programs and services to prevent and treat 


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1 the abuse of multiple forms of substances, including alco2 hol, drugs, inhalants, and tobacco, among Indian youths 

3 residing in Indian communities, on or near reservations, 

4 and in urban areas and provide appropriate mental health 

5 services to address the incidence of mental illness among 

6 such youths. 

7 ‘‘(h) INDIAN YOUTH MENTAL HEALTH.—The Sec8 retary, acting through the Service, shall collect data for 

9 the report under section 801 with respect to— 

10 ‘‘(1) the number of Indian youth who are being 

11 provided mental health services through the Service 

12 and tribal health programs; 

13 ‘‘(2) a description of, and costs associated with, 

14 the mental health services provided for Indian youth 

15 through the Service and tribal health programs; 

16 ‘‘(3) the number of youth referred to the Serv17 ice or tribal health programs for mental health serv18 ices; 

19 ‘‘(4) the number of Indian youth provided resi20 dential treatment for mental health and behavioral 

21 problems through the Service and tribal health pro22 grams, reported separately for on- and off-reserva23 tion facilities; and 

24 ‘‘(5) the costs of the services described in para25 graph (4). 


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1 ‘‘SEC. 709. INPATIENT AND COMMUNITY-BASED MENTAL 

2 HEALTH FACILITIES DESIGN, CONSTRUC3 TION, AND STAFFING. 

4 ‘‘Not later than 1 year after the date of enactment 

5 of the Indian Healthcare Improvement Act of 2011, the 

6 Secretary, acting through the Service, may provide, in 

7 each area of the Service, not less than 1 inpatient mental 

8 health care facility, or the equivalent, for Indians with be9 havioral health problems. For the purposes of this sub10 section, California shall be considered to be 2 area offices, 

11 1 office whose location shall be considered to encompass 

12 the northern area of the State of California and 1 office 

13 whose jurisdiction shall be considered to encompass the 

14 remainder of the State of California. The Secretary shall 

15 consider the possible conversion of existing, underused 

16 Service hospital beds into psychiatric units to meet such 

17 need. 

18 ‘‘SEC. 710. TRAINING AND COMMUNITY EDUCATION. 

19 ‘‘(a) PROGRAM.—The Secretary, in cooperation with 

20 the Secretary of the Interior, shall develop and implement 

21 or assist Indian tribes and tribal organizations to develop 

22 and implement, within each Service unit or tribal program, 

23 a program of community education and involvement which 

24 shall be designed to provide concise and timely information 

25 to the community leadership of each tribal community. 

26 Such program shall include education about behavioral 


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1 health issues to political leaders, tribal judges, law en2 forcement personnel, members of tribal health and edu3 cation boards, health care providers including traditional 

4 practitioners, and other critical members of each tribal 

5 community. Such program may also include community6 based training to develop local capacity and tribal commu7 nity provider training for prevention, intervention, treat8 ment, and aftercare. 

9 ‘‘(b) INSTRUCTION.—The Secretary, acting through 

10 the Service, shall provide instruction in the area of behav11 ioral health issues, including instruction in crisis interven12 tion and family relations in the context of alcohol and sub13 stance abuse, child sexual abuse, youth alcohol and sub14 stance abuse, and the causes and effects of fetal alcohol 

15 spectrum disorders to appropriate employees of the Bu16 reau of Indian Affairs and the Service, and to personnel 

17 in schools or programs operated under any contract with 

18 the Bureau of Indian Affairs or the Service, including su19 pervisors of emergency shelters and halfway houses de20 scribed in section 4213 of the Indian Alcohol and Sub21 stance Abuse Prevention and Treatment Act of 1986 (25 

22 U.S.C. 2433). 

23 ‘‘(c) TRAINING MODELS.—In carrying out the edu24 cation and training programs required by this section, the 

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1 zations, Indian behavioral health experts, and Indian alco2 hol and substance abuse prevention experts, shall develop 

3 and provide community-based training models. Such mod4 els shall address— 

5 ‘‘(1) the elevated risk of alcohol abuse and 

6 other behavioral health problems faced by children of 

7 alcoholics; 

8 ‘‘(2) the cultural, spiritual, and multigenera9 tional aspects of behavioral health problem preven10 tion and recovery; and 

11 ‘‘(3) community-based and multidisciplinary 

12 strategies for preventing and treating behavioral 

13 health problems. 

14 ‘‘SEC. 711. BEHAVIORAL HEALTH PROGRAM. 

15 ‘‘(a) INNOVATIVE PROGRAMS.—The Secretary, acting 

16 through the Service, consistent with section 702, may 

17 plan, develop, implement, and carry out programs to de18 liver innovative community-based behavioral health serv19 ices to Indians. 

20 ‘‘(b) AWARDS; CRITERIA.—The Secretary may award 

21 a grant for a project under subsection (a) to an Indian 

22 tribe or tribal organization and may consider the following 

23 criteria: 

24 ‘‘(1) The project will address significant unmet 

25 behavioral health needs among Indians. 


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1 ‘‘(2) The project will serve a significant number 

2 of Indians. 

3 ‘‘(3) The project has the potential to deliver 

4 services in an efficient and effective manner. 

5 ‘‘(4) The Indian tribe or tribal organization has 

6 the administrative and financial capability to admin7 ister the project. 

8 ‘‘(5) The project may deliver services in a man9 ner consistent with traditional health care practices. 

10 ‘‘(6) The project is coordinated with, and avoids 

11 duplication of, existing services. 

12 ‘‘(c) EQUITABLE TREATMENT.—For purposes of this 

13 subsection, the Secretary shall, in evaluating project appli14 cations or proposals, use the same criteria that the Sec15 retary uses in evaluating any other application or proposal 

16 for such funding. 

17 ‘‘SEC. 712. FETAL ALCOHOL SPECTRUM DISORDERS PRO18 GRAMS. 

19 ‘‘(a) PROGRAMS.— 

20 ‘‘(1) ESTABLISHMENT.—The Secretary, con21 sistent with section 702, acting through the Service, 

22 Indian Tribes, and Tribal Organizations, is author23 ized to establish and operate fetal alcohol spectrum 

24 disorders programs as provided in this section for 


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1 the purposes of meeting the health status objectives 

2 specified in section 3. 

3 ‘‘(2) USE OF FUNDS.— 

4 ‘‘(A) IN GENERAL.—Funding provided 

5 pursuant to this section shall be used for the 

6 following: 

7 ‘‘(i) To develop and provide for Indi8 ans community and in-school training, edu9 cation, and prevention programs relating 

10 to fetal alcohol spectrum disorders. 

11 ‘‘(ii) To identify and provide behav12 ioral health treatment to high-risk Indian 

13 women and high-risk women pregnant with 

14 an Indian’s child. 

15 ‘‘(iii) To identify and provide appro16 priate psychological services, educational 

17 and vocational support, counseling, advo18 cacy, and information to fetal alcohol spec19 trum disorders-affected Indians and their 

20 families or caretakers. 

21 ‘‘(iv) To develop and implement coun22 seling and support programs in schools for 

23 fetal alcohol spectrum disorders-affected 

24 Indian children. 


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1 ‘‘(v) To develop prevention and inter2 vention models which incorporate practi3 tioners of traditional health care practices, 

4 cultural values, and community involve5 ment. 

6 ‘‘(vi) To develop, print, and dissemi7 nate education and prevention materials on 

8 fetal alcohol spectrum disorders. 

9 ‘‘(vii) To develop and implement, in 

10 consultation with Indian Tribes and Tribal 

11 Organizations, and in conference with 

12 urban Indian Organizations, culturally sen13 sitive assessment and diagnostic tools in14 cluding dysmorphology clinics and multi15 disciplinary fetal alcohol spectrum dis16 orders clinics for use in Indian commu17 nities and urban Centers. 

18 ‘‘(viii) To develop and provide training 

19 on fetal alcohol spectrum disorders to pro20 fessionals providing services to Indians, in21 cluding medical and allied health practi22 tioners, social service providers, educators, 

23 and law enforcement, court officials and 

24 corrections personnel in the juvenile and 

25 criminal justice systems. 


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1 ‘‘(B) ADDITIONAL USES.—In addition to 

2 any purpose under subparagraph (A), funding 

3 provided pursuant to this section may be used 

4 for 1 or more of the following: 

5 ‘‘(i) Early childhood intervention 

6 projects from birth on to mitigate the ef7 fects of fetal alcohol spectrum disorders 

8 among Indians. 

9 ‘‘(ii) Community-based support serv10 ices for Indians and women pregnant with 

11 Indian children. 

12 ‘‘(iii) Community-based housing for 

13 adult Indians with fetal alcohol spectrum 

14 disorders. 

15 ‘‘(3) CRITERIA FOR APPLICATIONS.—The Sec16 retary shall establish criteria for the review and ap17 proval of applications for funding under this section. 

18 ‘‘(b) SERVICES.—The Secretary, acting through the 

19 Service, Indian Tribes, and Tribal Organizations, shall— 

20 ‘‘(1) develop and provide services for the pre21 vention, intervention, treatment, and aftercare for 

22 those affected by fetal alcohol spectrum disorders in 

23 Indian communities; and 

24 ‘‘(2) provide supportive services, including serv25 ices to meet the special educational, vocational, 


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1 school-to-work transition, and independent living 

2 needs of adolescent and adult Indians with fetal al3 cohol spectrum disorders. 

4 ‘‘(c) APPLIED RESEARCH PROJECTS.—The Sec5 retary, acting through the Substance Abuse and Mental 

6 Health Services Administration, shall make grants to In7 dian Tribes, Tribal Organizations, and urban Indian Or8 ganizations for applied research projects which propose to 

9 elevate the understanding of methods to prevent, inter10 vene, treat, or provide rehabilitation and behavioral health 

11 aftercare for Indians and urban Indians affected by fetal 

12 alcohol spectrum disorders. 

13 ‘‘(d) FUNDING FOR URBAN INDIAN ORGANIZA14 TIONS.—Ten percent of the funds appropriated pursuant 

15 to this section shall be used to make grants to urban In16 dian Organizations funded under title V. 

17 ‘‘SEC. 713. CHILD SEXUAL ABUSE PREVENTION AND TREAT18 MENT PROGRAMS. 

19 ‘‘(a) ESTABLISHMENT.—The Secretary, acting 

20 through the Service, shall establish, consistent with section 

21 702, in every Service area, programs involving treatment 

22 for— 

23 ‘‘(1) victims of sexual abuse who are Indian 

24 children or children in an Indian household; and 


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1 ‘‘(2) other members of the household or family 

2 of the victims described in paragraph (1). 

3 ‘‘(b) USE OF FUNDS.—Funding provided pursuant to 

4 this section shall be used for the following: 

5 ‘‘(1) To develop and provide community edu6 cation and prevention programs related to sexual 

7 abuse of Indian children or children in an Indian 

8 household. 

9 ‘‘(2) To identify and provide behavioral health 

10 treatment to victims of sexual abuse who are Indian 

11 children or children in an Indian household, and to 

12 their family members who are affected by sexual 

13 abuse. 

14 ‘‘(3) To develop prevention and intervention 

15 models which incorporate traditional health care 

16 practices, cultural values, and community involve17 ment. 

18 ‘‘(4) To develop and implement culturally sen19 sitive assessment and diagnostic tools for use in In20 dian communities and urban centers. 

21 ‘‘(c) COORDINATION.—The programs established 

22 under subsection (a) shall be carried out in coordination 

23 with programs and services authorized under the Indian 

24 Child Protection and Family Violence Prevention Act (25 

25 U.S.C. 3201 et seq.). 


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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) other members of the household or family 

10 of the victims described in paragraph (1). 

11 ‘‘(b) USE OF FUNDS.—Funds made available to carry 

12 out this section shall be used— 

13 ‘‘(1) to develop and implement prevention pro14 grams and community education programs relating 

15 to domestic violence and sexual abuse; 

16 ‘‘(2) to provide behavioral health services, in17 cluding victim support services, and medical treat18 ment (including examinations performed by sexual 

19 assault nurse examiners) to Indian victims of domes20 tic violence or sexual abuse; 

21 ‘‘(3) to purchase rape kits; and 

22 ‘‘(4) to develop prevention and intervention 

23 models, which may incorporate traditional health 

24 care practices. 

25 ‘‘(c) TRAINING AND CERTIFICATION.— 


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

2 the date of enactment of the Indian Healthcare Im3 provement Act of 2011, the Secretary shall establish 

4 appropriate protocols, policies, procedures, standards 

5 of practice, and, if not available elsewhere, training 

6 curricula and training and certification requirements 

7 for services for victims of domestic violence and sex8 ual abuse. 

9 ‘‘(2) REPORT.—Not later than 18 months after 

10 the date of enactment of the Indian Healthcare Im11 provement Act of 2011, the Secretary shall submit 

12 to the Committee on Indian Affairs of the Senate 

13 and the Committee on Natural Resources of the 

14 House of Representatives a report that describes the 

15 means and extent to which the Secretary has carried 

16 out paragraph (1). 

17 ‘‘(d) COORDINATION.— 

18 ‘‘(1) IN GENERAL.—The Secretary, in coordina19 tion with the Attorney General, Federal and tribal 

20 law enforcement agencies, Indian health programs, 

21 and domestic violence or sexual assault victim orga22 nizations, shall develop appropriate victim services 

23 and victim advocate training programs— 

24 ‘‘(A) to improve domestic violence or sex25 ual abuse responses; 


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1 ‘‘(B) to improve forensic examinations and 

2 collection; 

3 ‘‘(C) to identify problems or obstacles in 

4 the prosecution of domestic violence or sexual 

5 abuse; and 

6 ‘‘(D) to meet other needs or carry out 

7 other activities required to prevent, treat, and 

8 improve prosecutions of domestic violence and 

9 sexual abuse. 

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

11 date of enactment of the Indian Healthcare Im12 provement Act of 2011, the Secretary shall submit 

13 to the Committee on Indian Affairs of the Senate 

14 and the Committee on Natural Resources of the 

15 House of Representatives a report that describes, 

16 with respect to the matters described in paragraph 

17 (1), the improvements made and needed, problems 

18 or obstacles identified, and costs necessary to ad19 dress the problems or obstacles, and any other rec20 ommendations that the Secretary determines to be 

21 appropriate. 

22 ‘‘SEC. 715. BEHAVIORAL HEALTH RESEARCH. 

23 ‘‘(a) IN GENERAL.—The Secretary, in consultation 

24 with appropriate Federal agencies, shall make grants to, 

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1 tions, and urban Indian organizations or enter into con2 tracts with, or make grants to appropriate institutions for, 

3 the conduct of research on the incidence and prevalence 

4 of behavioral health problems among Indians served by the 

5 Service, Indian tribes, or tribal organizations and among 

6 Indians in urban areas. Research priorities under this sec7 tion shall include— 

8 ‘‘(1) the multifactorial causes of Indian youth 

9 suicide, including— 

10 ‘‘(A) protective and risk factors and sci11 entific data that identifies those factors; and 

12 ‘‘(B) the effects of loss of cultural identity 

13 and the development of scientific data on those 

14 effects; 

15 ‘‘(2) the interrelationship and interdependence 

16 of behavioral health problems with alcoholism and 

17 other substance abuse, suicide, homicides, other in18 juries, and the incidence of family violence; and 

19 ‘‘(3) the development of models of prevention 

20 techniques. 

21 ‘‘(b) EMPHASIS.—The effect of the interrelationships 

22 and interdependencies referred to in subsection (a)(2) on 

23 children, and the development of prevention techniques 

24 under subsection (a)(3) applicable to children, shall be em25 phasized. 


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1 ‘‘Subtitle B—Indian Youth Suicide 

2 Prevention 

3 ‘‘SEC. 721. FINDINGS AND PURPOSE. 

4 ‘‘(a) FINDINGS.—Congress finds that— 

5 ‘‘(1)(A) the rate of suicide of American Indians 

6 and Alaska Natives is 1.9 times higher than the na7 tional average rate; and 

8 ‘‘(B) the rate of suicide of Indian and Alaska 

9 Native youth aged 15 through 24 is— 

10 ‘‘(i) 3.5 times the national average rate; 

11 and 

12 ‘‘(ii) the highest rate of any population 

13 group in the United States; 

14 ‘‘(2) many risk behaviors and contributing fac15 tors for suicide are more prevalent in Indian country 

16 than in other areas, including— 

17 ‘‘(A) history of previous suicide attempts; 

18 ‘‘(B) family history of suicide; 

19 ‘‘(C) history of depression or other mental 

20 illness; 

21 ‘‘(D) alcohol or drug abuse; 

22 ‘‘(E) health disparities; 

23 ‘‘(F) stressful life events and losses; 

24 ‘‘(G) easy access to lethal methods; 


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1 ‘‘(H) exposure to the suicidal behavior of 

2 others; 

3 ‘‘(I) isolation; and 

4 ‘‘(J) incarceration; 

5 ‘‘(3) according to national data for 2005, sui6 cide was the second-leading cause of death for Indi7 ans and Alaska Natives of both sexes aged 10 

8 through 34; 

9 ‘‘(4)(A) the suicide rates of Indian and Alaska 

10 Native males aged 15 through 24 are— 

11 ‘‘(i) as compared to suicide rates of males 

12 of any other racial group, up to 4 times greater; 

13 and 

14 ‘‘(ii) as compared to suicide rates of fe15 males of any other racial group, up to 11 times 

16 greater; and 

17 ‘‘(B) data demonstrates that, over their life18 times, females attempt suicide 2 to 3 times more 

19 often than males; 

20 ‘‘(5)(A) Indian tribes, especially Indian tribes 

21 located in the Great Plains, have experienced epi22 demic levels of suicide, up to 10 times the national 

23 average; and 

24 ‘‘(B) suicide clustering in Indian country affects 

25 entire tribal communities; 


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1 ‘‘(6) death rates for Indians and Alaska Natives 

2 are statistically underestimated because many areas 

3 of Indian country lack the proper resources to iden4 tify and monitor the presence of disease; 

5 ‘‘(7)(A) the Indian Health Service experiences 

6 health professional shortages, with physician vacancy 

7 rates of approximately 17 percent, and nursing va8 cancy rates of approximately 18 percent, in 2007; 

9 ‘‘(B) 90 percent of all teens who die by suicide 

10 suffer from a diagnosable mental illness at time of 

11 death; 

‘‘(C) more than 1 12 ⁄2 of teens who die by suicide 

13 have never been seen by a mental health provider; 

14 and 

‘‘(D) 1 15 ⁄3 of health needs in Indian country re16 late to mental health; 

17 ‘‘(8) often, the lack of resources of Indian 

18 tribes and the remote nature of Indian reservations 

19 make it difficult to meet the requirements necessary 

20 to access Federal assistance, including grants; 

21 ‘‘(9) the Substance Abuse and Mental Health 

22 Services Administration and the Service have estab23 lished specific initiatives to combat youth suicide in 

24 Indian country and among Indians and Alaska Na25 tives throughout the United States, including the 


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1 National Suicide Prevention Initiative of the Service, 

2 which has worked with Service, tribal, and urban In3 dian health programs since 2003; 

4 ‘‘(10) the National Strategy for Suicide Preven5 tion was established in 2001 through a Department 

6 of Health and Human Services collaboration 

7 among— 

8 ‘‘(A) the Substance Abuse and Mental 

9 Health Services Administration; 

10 ‘‘(B) the Service; 

11 ‘‘(C) the Centers for Disease Control and 

12 Prevention; 

13 ‘‘(D) the National Institutes of Health; 

14 and 

15 ‘‘(E) the Health Resources and Services 

16 Administration; and 

17 ‘‘(11) the Service and other agencies of the De18 partment of Health and Human Services use infor19 mation technology and other programs to address 

20 the suicide prevention and mental health needs of 

21 Indians and Alaska Natives. 

22 ‘‘(b) PURPOSES.—The purposes of this subtitle are— 

23 ‘‘(1) to authorize the Secretary to carry out a 

24 demonstration project to test the use of telemental 


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1 health services in suicide prevention, intervention, 

2 and treatment of Indian youth, including through— 

3 ‘‘(A) the use of psychotherapy, psychiatric 

4 assessments, diagnostic interviews, therapies for 

5 mental health conditions predisposing to sui6 cide, and alcohol and substance abuse treat7 ment; 

8 ‘‘(B) the provision of clinical expertise to, 

9 consultation services with, and medical advice 

10 and training for frontline health care providers 

11 working with Indian youth; 

12 ‘‘(C) training and related support for com13 munity leaders, family members, and health 

14 and education workers who work with Indian 

15 youth; 

16 ‘‘(D) the development of culturally relevant 

17 educational materials on suicide; and 

18 ‘‘(E) data collection and reporting; 

19 ‘‘(2) to encourage Indian tribes, tribal organiza20 tions, and other mental health care providers serving 

21 residents of Indian country to obtain the services of 

22 predoctoral psychology and psychiatry interns; and 

23 ‘‘(3) to enhance the provision of mental health 

24 care services to Indian youth through existing grant 


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1 programs of the Substance Abuse and Mental 

2 Health Services Administration. 

3 ‘‘SEC. 722. DEFINITIONS. 

4 ‘‘In this subtitle: 

5 ‘‘(1) ADMINISTRATION.—The term ‘Administra6 tion’ means the Substance Abuse and Mental Health 

7 Services Administration. 

8 ‘‘(2) DEMONSTRATION PROJECT.—The term 

9 ‘demonstration project’ means the Indian youth tele10 mental health demonstration project authorized 

11 under section 723(a). 

12 ‘‘(3) TELEMENTAL HEALTH.—The term ‘tele13 mental health’ means the use of electronic informa14 tion and telecommunications technologies to support 

15 long-distance mental health care, patient and profes16 sional-related education, public health, and health 

17 administration. 

18 ‘‘SEC. 723. INDIAN YOUTH TELEMENTAL HEALTH DEM19 ONSTRATION PROJECT. 

20 ‘‘(a) AUTHORIZATION.— 

21 ‘‘(1) IN GENERAL.—The Secretary, acting 

22 through the Service, is authorized to carry out a 

23 demonstration project to award grants for the provi24 sion of telemental health services to Indian youth 

25 who— 


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1 ‘‘(A) have expressed suicidal ideas; 

2 ‘‘(B) have attempted suicide; or 

3 ‘‘(C) have behavioral health conditions that 

4 increase or could increase the risk of suicide. 

5 ‘‘(2) ELIGIBILITY FOR GRANTS.—Grants under 

6 paragraph (1) shall be awarded to Indian tribes and 

7 tribal organizations that operate 1 or more facili8 ties— 

9 ‘‘(A) located in an area with documented 

10 disproportionately high rates of suicide; 

11 ‘‘(B) reporting active clinical telehealth ca12 pabilities; or 

13 ‘‘(C) offering school-based telemental 

14 health services to Indian youth. 

15 ‘‘(3) GRANT PERIOD.—The Secretary shall 

16 award grants under this section for a period of up 

17 to 4 years. 

18 ‘‘(4) MAXIMUM NUMBER OF GRANTS.—Not 

19 more than 5 grants shall be provided under para20 graph (1), with priority consideration given to In21 dian tribes and tribal organizations that— 

22 ‘‘(A) serve a particular community or geo23 graphic area in which there is a demonstrated 

24 need to address Indian youth suicide; 


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1 ‘‘(B) enter into collaborative partnerships 

2 with Service or other tribal health programs or 

3 facilities to provide services under this dem4 onstration project; 

5 ‘‘(C) serve an isolated community or geo6 graphic area that has limited or no access to 

7 behavioral health services; or 

8 ‘‘(D) operate a detention facility at which 

9 Indian youth are detained. 

10 ‘‘(5) CONSULTATION WITH ADMINISTRATION.— 

11 In developing and carrying out the demonstration 

12 project under this subsection, the Secretary shall 

13 consult with the Administration as the Federal agen14 cy focused on mental health issues, including suicide. 

15 ‘‘(b) USE OF FUNDS.— 

16 ‘‘(1) IN GENERAL.—An Indian tribe or tribal 

17 organization shall use a grant received under sub18 section (a) for the following purposes: 

19 ‘‘(A) To provide telemental health services 

20 to Indian youth, including the provision of— 

21 ‘‘(i) psychotherapy; 

22 ‘‘(ii) psychiatric assessments and di23 agnostic interviews, therapies for mental 

24 health conditions predisposing to suicide, 

25 and treatment; and 


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1 ‘‘(iii) alcohol and substance abuse 

2 treatment. 

3 ‘‘(B) To provide clinician-interactive med4 ical advice, guidance and training, assistance in 

5 diagnosis and interpretation, crisis counseling 

6 and intervention, and related assistance to 

7 Service or tribal clinicians and health services 

8 providers working with youth being served 

9 under the demonstration project. 

10 ‘‘(C) To assist, educate, and train commu11 nity leaders, health education professionals and 

12 paraprofessionals, tribal outreach workers, and 

13 family members who work with the youth re14 ceiving telemental health services under the 

15 demonstration project, including with identifica16 tion of suicidal tendencies, crisis intervention 

17 and suicide prevention, emergency skill develop18 ment, and building and expanding networks 

19 among those individuals and with State and 

20 local health services providers. 

21 ‘‘(D) To develop and distribute culturally 

22 appropriate community educational materials 

23 regarding— 

24 ‘‘(i) suicide prevention; 

25 ‘‘(ii) suicide education; 


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1 ‘‘(iii) suicide screening; 

2 ‘‘(iv) suicide intervention; and 

3 ‘‘(v) ways to mobilize communities 

4 with respect to the identification of risk 

5 factors for suicide. 

6 ‘‘(E) To conduct data collection and re7 porting relating to Indian youth suicide preven8 tion efforts. 

9 ‘‘(2) TRADITIONAL HEALTH CARE PRAC10 TICES.—In carrying out the purposes described in 

11 paragraph (1), an Indian tribe or tribal organization 

12 may use and promote the traditional health care 

13 practices of the Indian tribes of the youth to be 

14 served. 

15 ‘‘(c) APPLICATIONS.— 

16 ‘‘(1) IN GENERAL.—Subject to paragraph (2), 

17 to be eligible to receive a grant under subsection (a), 

18 an Indian tribe or tribal organization shall prepare 

19 and submit to the Secretary an application, at such 

20 time, in such manner, and containing such informa21 tion as the Secretary may require, including— 

22 ‘‘(A) a description of the project that the 

23 Indian tribe or tribal organization will carry out 

24 using the funds provided under the grant; 


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1 ‘‘(B) a description of the manner in which 

2 the project funded under the grant would— 

3 ‘‘(i) meet the telemental health care 

4 needs of the Indian youth population to be 

5 served by the project; or 

6 ‘‘(ii) improve the access of the Indian 

7 youth population to be served to suicide 

8 prevention and treatment services; 

9 ‘‘(C) evidence of support for the project 

10 from the local community to be served by the 

11 project; 

12 ‘‘(D) a description of how the families and 

13 leadership of the communities or populations to 

14 be served by the project would be involved in 

15 the development and ongoing operations of the 

16 project; 

17 ‘‘(E) a plan to involve the tribal commu18 nity of the youth who are provided services by 

19 the project in planning and evaluating the be20 havioral health care and suicide prevention ef21 forts provided, in order to ensure the integra22 tion of community, clinical, environmental, and 

23 cultural components of the treatment; and 


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1 ‘‘(F) a plan for sustaining the project after 

2 Federal assistance for the demonstration 

3 project has terminated. 

4 ‘‘(2) EFFICIENCY OF GRANT APPLICATION

5 PROCESS.—The Secretary shall carry out such meas6 ures as the Secretary determines to be necessary to 

7 maximize the time and workload efficiency of the 

8 process by which Indian tribes and tribal organiza9 tions apply for grants under paragraph (1). 

10 ‘‘(d) COLLABORATION.—The Secretary, acting 

11 through the Service, shall encourage Indian tribes and 

12 tribal organizations receiving grants under this section to 

13 collaborate to enable comparisons regarding best practices 

14 across projects. 

15 ‘‘(e) ANNUAL REPORT.—Each grant recipient shall 

16 submit to the Secretary an annual report that— 

17 ‘‘(1) describes the number of telemental health 

18 services provided; and 

19 ‘‘(2) includes any other information that the 

20 Secretary may require. 

21 ‘‘(f) REPORTS TO CONGRESS.— 

22 ‘‘(1) INITIAL REPORT.— 

23 ‘‘(A) IN GENERAL.—Not later than 2 years 

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1 mit to the Committee on Indian Affairs of the 

2 Senate and the Committee on Natural Re3 sources and the Committee on Energy and 

4 Commerce of the House of Representatives a 

5 report that— 

6 ‘‘(i) describes each project funded by 

7 a grant under this section during the pre8 ceding 2-year period, including a descrip9 tion of the level of success achieved by the 

10 project; and 

11 ‘‘(ii) evaluates whether the demonstra12 tion project should be continued during the 

13 period beginning on the date of termi14 nation of funding for the demonstration 

15 project under subsection (g) and ending on 

16 the date on which the final report is sub17 mitted under paragraph (2). 

18 ‘‘(B) CONTINUATION OF DEMONSTRATION

19 PROJECT.—On a determination by the Sec20 retary under clause (ii) of subparagraph (A) 

21 that the demonstration project should be con22 tinued, the Secretary may carry out the dem23 onstration project during the period described 

24 in that clause using such sums otherwise made 


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1 available to the Secretary as the Secretary de2 termines to be appropriate. 

3 ‘‘(2) FINAL REPORT.—Not later than 270 days 

4 after the date of termination of funding for the dem5 onstration project under subsection (g), the Sec6 retary shall submit to the Committee on Indian Af7 fairs of the Senate and the Committee on Natural 

8 Resources and the Committee on Energy and Com9 merce of the House of Representatives a final report 

10 that— 

11 ‘‘(A) describes the results of the projects 

12 funded by grants awarded under this section, 

13 including any data available that indicate the 

14 number of attempted suicides; 

15 ‘‘(B) evaluates the impact of the tele16 mental health services funded by the grants in 

17 reducing the number of completed suicides 

18 among Indian youth; 

19 ‘‘(C) evaluates whether the demonstration 

20 project should be— 

21 ‘‘(i) expanded to provide more than 5 

22 grants; and 

23 ‘‘(ii) designated as a permanent pro24 gram; and 


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1 ‘‘(D) evaluates the benefits of expanding 

2 the demonstration project to include urban In3 dian organizations. 

4 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There 

5 is authorized to be appropriated to carry out this section 

6 $1,500,000 for each of fiscal years 2011 through 2013. 

7 ‘‘SEC. 724. SUBSTANCE ABUSE AND MENTAL HEALTH SERV8 ICES ADMINISTRATION GRANTS. 

9 ‘‘(a) GRANT APPLICATIONS.— 

10 ‘‘(1) EFFICIENCY OF GRANT APPLICATION

11 PROCESS.—The Secretary, acting through the Ad12 ministration, shall carry out such measures as the 

13 Secretary determines to be necessary to maximize 

14 the time and workload efficiency of the process by 

15 which Indian tribes and tribal organizations apply 

16 for grants under any program administered by the 

17 Administration, including by providing methods 

18 other than electronic methods of submitting applica19 tions for those grants, if necessary. 

20 ‘‘(2) PRIORITY FOR CERTAIN GRANTS.— 

21 ‘‘(A) IN GENERAL.—To fulfill the trust re22 sponsibility of the United States to Indian 

23 tribes, in awarding relevant grants pursuant to 

24 a program described in subparagraph (B), the 

25 Secretary shall take into consideration the 


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1 needs of Indian tribes or tribal organizations, 

2 as applicable, that serve populations with docu3 mented high suicide rates, regardless of whether 

4 those Indian tribes or tribal organizations pos5 sess adequate personnel or infrastructure to ful6 fill all applicable requirements of the relevant 

7 program. 

8 ‘‘(B) DESCRIPTION OF GRANT PRO9 GRAMS.—A grant program referred to in sub10 paragraph (A) is a grant program— 

11 ‘‘(i) administered by the Administra12 tion to fund activities relating to mental 

13 health, suicide prevention, or suicide-re14 lated risk factors; and 

15 ‘‘(ii) under which an Indian tribe or 

16 tribal organization is an eligible recipient. 

17 ‘‘(3) CLARIFICATION REGARDING INDIAN

18 TRIBES AND TRIBAL ORGANIZATIONS.—Notwith19 standing any other provision of law, in applying for 

20 a grant under any program administered by the Ad21 ministration, no Indian tribe or tribal organization 

22 shall be required to apply through a State or State 

23 agency. 

24 ‘‘(4) REQUIREMENTS FOR AFFECTED

25 STATES.— 


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1 ‘‘(A) DEFINITIONS.—In this paragraph: 

2 ‘‘(i) AFFECTED STATE.—The term 

3 ‘affected State’ means a State— 

4 ‘‘(I) the boundaries of which in5 clude 1 or more Indian tribes; and 

6 ‘‘(II) the application for a grant 

7 under any program administered by 

8 the Administration of which includes 

9 statewide data. 

10 ‘‘(ii) INDIAN POPULATION.—The term 

11 ‘Indian population’ means the total num12 ber of residents of an affected State who 

13 are Indian. 

14 ‘‘(B) REQUIREMENTS.—As a condition of 

15 receipt of a grant under any program adminis16 tered by the Administration, each affected State 

17 shall— 

18 ‘‘(i) describe in the grant applica19 tion— 

20 ‘‘(I) the Indian population of the 

21 affected State; and 

22 ‘‘(II) the contribution of that In23 dian population to the statewide data 

24 used by the affected State in the ap25 plication; and 


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1 ‘‘(ii) demonstrate to the satisfaction 

2 of the Secretary that— 

3 ‘‘(I) of the total amount of the 

4 grant, the affected State will allocate 

5 for use for the Indian population of 

6 the affected State an amount equal to 

7 the proportion that— 

8 ‘‘(aa) the Indian population 

9 of the affected State; bears to 

10 ‘‘(bb) the total population of 

11 the affected State; and 

12 ‘‘(II) the affected State will take 

13 reasonable efforts to collaborate with 

14 each Indian tribe located within the 

15 affected State to carry out youth sui16 cide prevention and treatment meas17 ures for members of the Indian tribe. 

18 ‘‘(C) REPORT.—Not later than 1 year 

19 after the date of receipt of a grant described in 

20 subparagraph (B), an affected State shall sub21 mit to the Secretary a report describing the 

22 measures carried out by the affected State to 

23 ensure compliance with the requirements of 

24 subparagraph (B)(ii). 


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1 ‘‘(b) NO NON-FEDERAL SHARE REQUIREMENT.— 

2 Notwithstanding any other provision of law, no Indian 

3 tribe or tribal organization shall be required to provide a 

4 non-Federal share of the cost of any project or activity 

5 carried out using a grant provided under any program ad6 ministered by the Administration. 

7 ‘‘(c) OUTREACH FOR RURAL AND ISOLATED INDIAN

8 TRIBES.—Due to the rural, isolated nature of most Indian 

9 reservations and communities (especially those reserva10 tions and communities in the Great Plains region), the 

11 Secretary shall conduct outreach activities, with a par12 ticular emphasis on the provision of telemental health 

13 services, to achieve the purposes of this subtitle with re14 spect to Indian tribes located in rural, isolated areas. 

15 ‘‘(d) PROVISION OF OTHER ASSISTANCE.— 

16 ‘‘(1) IN GENERAL.—The Secretary, acting 

17 through the Administration, shall carry out such 

18 measures (including monitoring and the provision of 

19 required assistance) as the Secretary determines to 

20 be necessary to ensure the provision of adequate sui21 cide prevention and mental health services to Indian 

22 tribes described in paragraph (2), regardless of 

23 whether those Indian tribes possess adequate per24 sonnel or infrastructure— 


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1 ‘‘(A) to submit an application for a grant 

2 under any program administered by the Admin3 istration, including due to problems relating to 

4 access to the Internet or other electronic means 

5 that may have resulted in previous obstacles to 

6 submission of a grant application; or 

7 ‘‘(B) to fulfill all applicable requirements 

8 of the relevant program. 

9 ‘‘(2) DESCRIPTION OF INDIAN TRIBES.—An In10 dian tribe referred to in paragraph (1) is an Indian 

11 tribe— 

12 ‘‘(A) the members of which experience— 

13 ‘‘(i) a high rate of youth suicide; 

14 ‘‘(ii) low socioeconomic status; and 

15 ‘‘(iii) extreme health disparity; 

16 ‘‘(B) that is located in a remote and iso17 lated area; and 

18 ‘‘(C) that lacks technology and commu19 nication infrastructure. 

20 ‘‘(3) AUTHORIZATION OF APPROPRIATIONS.— 

21 There are authorized to be appropriated to the Sec22 retary such sums as the Secretary determines to be 

23 necessary to carry out this subsection. 

24 ‘‘(e) EARLY INTERVENTION AND ASSESSMENT SERV25 ICES.— 


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1 ‘‘(1) DEFINITION OF AFFECTED ENTITY.—In 

2 this subsection, the term ‘affected entity’ means any 

3 entity— 

4 ‘‘(A) that receives a grant for suicide inter5 vention, prevention, or treatment under a pro6 gram administered by the Administration; and 

7 ‘‘(B) the population to be served by which 

8 includes Indian youth. 

9 ‘‘(2) REQUIREMENT.—The Secretary, acting 

10 through the Administration, shall ensure that each 

11 affected entity carrying out a youth suicide early 

12 intervention and prevention strategy described in 

13 section 520E(c)(1) of the Public Health Service Act 

14 (42 U.S.C. 290bb–36(c)(1)), or any other youth sui15 cide-related early intervention and assessment activ16 ity, provides training or education to individuals who 

17 interact frequently with the Indian youth to be 

18 served by the affected entity (including parents, 

19 teachers, coaches, and mentors) on identifying warn20 ing signs of Indian youth who are at risk of commit21 ting suicide. 

22 ‘‘SEC. 725. USE OF PREDOCTORAL PSYCHOLOGY AND PSY23 CHIATRY INTERNS. 

24 ‘‘The Secretary shall carry out such activities as the 

25 Secretary determines to be necessary to encourage Indian 


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1 tribes, tribal organizations, and other mental health care 

2 providers to obtain the services of predoctoral psychology 

3 and psychiatry interns— 

4 ‘‘(1) to increase the quantity of patients served 

5 by the Indian tribes, tribal organizations, and other 

6 mental health care providers; and 

7 ‘‘(2) for purposes of recruitment and retention. 

8 ‘‘SEC. 726. INDIAN YOUTH LIFE SKILLS DEVELOPMENT 

9 DEMONSTRATION PROGRAM. 

10 ‘‘(a) PURPOSE.—The purpose of this section is to au11 thorize the Secretary, acting through the Administration, 

12 to carry out a demonstration program to test the effective13 ness of a culturally compatible, school-based, life skills 

14 curriculum for the prevention of Indian and Alaska Native 

15 adolescent suicide, including through— 

16 ‘‘(1) the establishment of tribal partnerships to 

17 develop and implement such a curriculum, in co18 operation with— 

19 ‘‘(A) behavioral health professionals, with 

20 a priority for tribal partnerships cooperating 

21 with mental health professionals employed by 

22 the Service; 

23 ‘‘(B) tribal or local school agencies; and 

24 ‘‘(C) parent and community groups; 


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1 ‘‘(2) the provision by the Administration or the 

2 Service of— 

3 ‘‘(A) technical expertise; and 

4 ‘‘(B) clinicians, analysts, and educators, as 

5 appropriate; 

6 ‘‘(3) training for teachers, school administra7 tors, and community members to implement the cur8 riculum; 

9 ‘‘(4) the establishment of advisory councils com10 posed of parents, educators, community members, 

11 trained peers, and others to provide advice regarding 

12 the curriculum and other components of the dem13 onstration program; 

14 ‘‘(5) the development of culturally appropriate 

15 support measures to supplement the effectiveness of 

16 the curriculum; and 

17 ‘‘(6) projects modeled after evidence-based 

18 projects, such as programs evaluated and published 

19 in relevant literature. 

20 ‘‘(b) DEMONSTRATION GRANT PROGRAM.— 

21 ‘‘(1) DEFINITIONS.—In this subsection: 

22 ‘‘(A) CURRICULUM.—The term ‘cur23 riculum’ means the culturally compatible, 

24 school-based, life skills curriculum for the pre25 vention of Indian and Alaska Native adolescent 


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1 suicide identified by the Secretary under para2 graph (2)(A). 

3 ‘‘(B) ELIGIBLE ENTITY.—The term ‘eligi4 ble entity’ means— 

5 ‘‘(i) an Indian tribe; 

6 ‘‘(ii) a tribal organization; 

7 ‘‘(iii) any other tribally authorized en8 tity; and 

9 ‘‘(iv) any partnership composed of 2 

10 or more entities described in clause (i), (ii), 

11 or (iii). 

12 ‘‘(2) ESTABLISHMENT.—The Secretary, acting 

13 through the Administration, may establish and carry 

14 out a demonstration program under which the Sec15 retary shall— 

16 ‘‘(A) identify a culturally compatible, 

17 school-based, life skills curriculum for the pre18 vention of Indian and Alaska Native adolescent 

19 suicide; 

20 ‘‘(B) identify the Indian tribes that are at 

21 greatest risk for adolescent suicide; 

22 ‘‘(C) invite those Indian tribes to partici23 pate in the demonstration program by— 


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1 ‘‘(i) responding to a comprehensive 

2 program requirement request of the Sec3 retary; or 

4 ‘‘(ii) submitting, through an eligible 

5 entity, an application in accordance with 

6 paragraph (4); and 

7 ‘‘(D) provide grants to the Indian tribes 

8 identified under subparagraph (B) and eligible 

9 entities to implement the curriculum with re10 spect to Indian and Alaska Native youths 

11 who— 

12 ‘‘(i) are between the ages of 10 and 

13 19; and 

14 ‘‘(ii) attend school in a region that is 

15 at risk of high youth suicide rates, as de16 termined by the Administration. 

17 ‘‘(3) REQUIREMENTS.— 

18 ‘‘(A) TERM.—The term of a grant pro19 vided under the demonstration program under 

20 this section shall be not less than 4 years. 

21 ‘‘(B) MAXIMUM NUMBER.—The Secretary 

22 may provide not more than 5 grants under the 

23 demonstration program under this section. 

24 ‘‘(C) AMOUNT.—The grants provided 

25 under this section shall be of equal amounts. 


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1 ‘‘(D) CERTAIN SCHOOLS.—In selecting eli2 gible entities to receive grants under this sec3 tion, the Secretary shall ensure that not less 

4 than 1 demonstration program shall be carried 

5 out at each of— 

6 ‘‘(i) a school operated by the Bureau 

7 of Indian Education; 

8 ‘‘(ii) a Tribal school; and 

9 ‘‘(iii) a school receiving payments 

10 under section 8002 or 8003 of the Elemen11 tary and Secondary Education Act of 1965 

12 (20 U.S.C. 7702, 7703). 

13 ‘‘(4) APPLICATIONS.—To be eligible to receive a 

14 grant under the demonstration program, an eligible 

15 entity shall submit to the Secretary an application, 

16 at such time, in such manner, and containing such 

17 information as the Secretary may require, includ18 ing— 

19 ‘‘(A) an assurance that, in implementing 

20 the curriculum, the eligible entity will collabo21 rate with 1 or more local educational agencies, 

22 including elementary schools, middle schools, 

23 and high schools; 

24 ‘‘(B) an assurance that the eligible entity 

25 will collaborate, for the purpose of curriculum 


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1 development, implementation, and training and 

2 technical assistance, with 1 or more— 

3 ‘‘(i) nonprofit entities with dem4 onstrated expertise regarding the develop5 ment of culturally sensitive, school-based, 

6 youth suicide prevention and intervention 

7 programs; or 

8 ‘‘(ii) institutions of higher education 

9 with demonstrated interest and knowledge 

10 regarding culturally sensitive, school-based, 

11 life skills youth suicide prevention and 

12 intervention programs; 

13 ‘‘(C) an assurance that the curriculum will 

14 be carried out in an academic setting in con15 junction with at least 1 classroom teacher not 

16 less frequently than twice each school week for 

17 the duration of the academic year; 

18 ‘‘(D) a description of the methods by 

19 which curriculum participants will be— 

20 ‘‘(i) screened for mental health at-risk 

21 indicators; and 

22 ‘‘(ii) if needed and on a case-by-case 

23 basis, referred to a mental health clinician 

24 for further assessment and treatment and 

25 with crisis response capability; and 


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1 ‘‘(E) an assurance that supportive services 

2 will be provided to curriculum participants iden3 tified as high-risk participants, including refer4 ral, counseling, and follow-up services for— 

5 ‘‘(i) drug or alcohol abuse; 

6 ‘‘(ii) sexual or domestic abuse; and 

7 ‘‘(iii) depression and other relevant 

8 mental health concerns. 

9 ‘‘(5) USE OF FUNDS.—An Indian tribe identi10 fied under paragraph (2)(B) or an eligible entity 

11 may use a grant provided under this subsection— 

12 ‘‘(A) to develop and implement the cur13 riculum in a school-based setting; 

14 ‘‘(B) to establish an advisory council— 

15 ‘‘(i) to advise the Indian tribe or eligi16 ble entity regarding curriculum develop17 ment; and 

18 ‘‘(ii) to provide support services iden19 tified as necessary by the community being 

20 served by the Indian tribe or eligible enti21 ty; 

22 ‘‘(C) to appoint and train a school- and 

23 community-based cultural resource liaison, who 

24 will act as an intermediary among the Indian 

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1 ministrators, and the advisory council estab2 lished by the Indian tribe or eligible entity; 

3 ‘‘(D) to establish an on-site, school-based, 

4 M.A.- or Ph.D.-level mental health practitioner 

5 (employed by the Service, if practicable) to 

6 work with tribal educators and other personnel; 

7 ‘‘(E) to provide for the training of peer 

8 counselors to assist in carrying out the cur9 riculum; 

10 ‘‘(F) to procure technical and training sup11 port from nonprofit or State entities or institu12 tions of higher education identified by the com13 munity being served by the Indian tribe or eligi14 ble entity as the best suited to develop and im15 plement the curriculum; 

16 ‘‘(G) to train teachers and school adminis17 trators to effectively carry out the curriculum; 

18 ‘‘(H) to establish an effective referral pro19 cedure and network; 

20 ‘‘(I) to identify and develop culturally com21 patible curriculum support measures; 

22 ‘‘(J) to obtain educational materials and 

23 other resources from the Administration or 

24 other appropriate entities to ensure the success 

25 of the demonstration program; and 


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1 ‘‘(K) to evaluate the effectiveness of the 

2 curriculum in preventing Indian and Alaska 

3 Native adolescent suicide. 

4 ‘‘(c) EVALUATIONS.—Using such amounts made 

5 available pursuant to subsection (e) as the Secretary de6 termines to be appropriate, the Secretary shall conduct, 

7 directly or through a grant, contract, or cooperative agree8 ment with an entity that has experience regarding the de9 velopment and operation of successful culturally compat10 ible, school-based, life skills suicide prevention and inter11 vention programs or evaluations, an annual evaluation of 

12 the demonstration program under this section, including 

13 an evaluation of— 

14 ‘‘(1) the effectiveness of the curriculum in pre15 venting Indian and Alaska Native adolescent suicide; 

16 ‘‘(2) areas for program improvement; and 

17 ‘‘(3) additional development of the goals and 

18 objectives of the demonstration program. 

19 ‘‘(d) REPORT TO CONGRESS.— 

20 ‘‘(1) IN GENERAL.—Subject to paragraph (2), 

21 not later than 180 days after the date of termination 

22 of the demonstration program, the Secretary shall 

23 submit to the Committee on Indian Affairs and the 

24 Committee on Health, Education, Labor, and Pen25 sions of the Senate and the Committee on Natural 


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1 Resources and the Committee on Education and 

2 Labor of the House of Representatives a final report 

3 that— 

4 ‘‘(A) describes the results of the program 

5 of each Indian tribe or eligible entity under this 

6 section; 

7 ‘‘(B) evaluates the effectiveness of the cur8 riculum in preventing Indian and Alaska Native 

9 adolescent suicide; 

10 ‘‘(C) makes recommendations regarding— 

11 ‘‘(i) the expansion of the demonstra12 tion program under this section to addi13 tional eligible entities; 

14 ‘‘(ii) designating the demonstration 

15 program as a permanent program; and 

16 ‘‘(iii) identifying and distributing the 

17 curriculum through the Suicide Prevention 

18 Resource Center of the Administration; 

19 and 

20 ‘‘(D) incorporates any public comments re21 ceived under paragraph (2). 

22 ‘‘(2) PUBLIC COMMENT.—The Secretary shall 

23 provide a notice of the report under paragraph (1) 

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1 port for a period of not less than 90 days before 

2 submitting the report to Congress. 

3 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 

4 is authorized to be appropriated to carry out this section 

5 $1,000,000 for each of fiscal years 2011 through 2014.’’. 

6 Subtitle H—Miscellaneous 

7 SEC. 191. CONFIDENTIALITY OF MEDICAL QUALITY ASSUR8 ANCE RECORDS; QUALIFIED IMMUNITY FOR 

9 PARTICIPANTS. 

10 Title VIII of the Indian Health Care Improvement 

11 Act (as amended by section 101(b)) is amended by insert12 ing after section 804 (25 U.S.C. 1674) the following: 

13 ‘‘SEC. 805. CONFIDENTIALITY OF MEDICAL QUALITY ASSUR14 ANCE RECORDS; QUALIFIED IMMUNITY FOR 

15 PARTICIPANTS. 

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

17 ‘‘(1) HEALTH CARE PROVIDER.—The term 

18 ‘health care provider’ means any health care profes19 sional, including community health aides and practi20 tioners certified under section 119, who is— 

21 ‘‘(A) granted clinical practice privileges or 

22 employed to provide health care services at— 

23 ‘‘(i) an Indian health program; or 

24 ‘‘(ii) a health program of an urban In25 dian organization; and 


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1 ‘‘(B) licensed or certified to perform health 

2 care services by a governmental board or agen3 cy or professional health care society or organi4 zation. 

5 ‘‘(2) MEDICAL QUALITY ASSURANCE PRO6 GRAM.—The term ‘medical quality assurance pro7 gram’ means any activity carried out before, on, or 

8 after the date of enactment of the Indian Healthcare 

9 Improvement Act of 2011 by or for any Indian 

10 health program or urban Indian organization to as11 sess the quality of medical care, including activities 

12 conducted by or on behalf of individuals, Indian 

13 health program or urban Indian organization med14 ical or dental treatment review committees, or other 

15 review bodies responsible for quality assurance, cre16 dentials, infection control, patient safety, patient 

17 care assessment (including treatment procedures, 

18 blood, drugs, and therapeutics), medical records, 

19 health resources management review, and identifica20 tion and prevention of medical or dental incidents 

21 and risks. 

22 ‘‘(3) MEDICAL QUALITY ASSURANCE RECORD.— 

23 The term ‘medical quality assurance record’ means 

24 the proceedings, records, minutes, and reports 

25 that— 


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1 ‘‘(A) emanate from quality assurance pro2 gram activities described in paragraph (2); and 

3 ‘‘(B) are produced or compiled by or for an 

4 Indian health program or urban Indian organi5 zation as part of a medical quality assurance 

6 program. 

7 ‘‘(b) CONFIDENTIALITY OF RECORDS.—Medical qual8 ity assurance records created by or for any Indian health 

9 program or a health program of an urban Indian organiza10 tion as part of a medical quality assurance program are 

11 confidential and privileged. Such records may not be dis12 closed to any person or entity, except as provided in sub13 section (d). 

14 ‘‘(c) PROHIBITION ON DISCLOSURE AND TESTI15 MONY.— 

16 ‘‘(1) IN GENERAL.—No part of any medical 

17 quality assurance record described in subsection (b) 

18 may be subject to discovery or admitted into evi19 dence in any judicial or administrative proceeding, 

20 except as provided in subsection (d). 

21 ‘‘(2) TESTIMONY.—An individual who reviews 

22 or creates medical quality assurance records for any 

23 Indian health program or urban Indian organization 

24 who participates in any proceeding that reviews or 

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1 quired to testify in any judicial or administrative 

2 proceeding with respect to such records or with re3 spect to any finding, recommendation, evaluation, 

4 opinion, or action taken by such person or body in 

5 connection with such records except as provided in 

6 this section. 

7 ‘‘(d) AUTHORIZED DISCLOSURE AND TESTIMONY.— 

8 ‘‘(1) IN GENERAL.—Subject to paragraph (2), a 

9 medical quality assurance record described in sub10 section (b) may be disclosed, and an individual re11 ferred to in subsection (c) may give testimony in 

12 connection with such a record, only as follows: 

13 ‘‘(A) To a Federal agency or private orga14 nization, if such medical quality assurance 

15 record or testimony is needed by such agency or 

16 organization to perform licensing or accredita17 tion functions related to any Indian health pro18 gram or to a health program of an urban In19 dian organization to perform monitoring, re20 quired by law, of such program or organization. 

21 ‘‘(B) To an administrative or judicial pro22 ceeding commenced by a present or former In23 dian health program or urban Indian organiza24 tion provider concerning the termination, susVerDate Mar 15 2010 18:45 Feb 09, 2011 Jkt 099200 PO 00000 Frm 00220 Fmt 6652 Sfmt 6201 E:\BILLS\H536.IH H536

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1 pension, or limitation of clinical privileges of 

2 such health care provider. 

3 ‘‘(C) To a governmental board or agency 

4 or to a professional health care society or orga5 nization, if such medical quality assurance 

6 record or testimony is needed by such board, 

7 agency, society, or organization to perform li8 censing, credentialing, or the monitoring of pro9 fessional standards with respect to any health 

10 care provider who is or was an employee of any 

11 Indian health program or urban Indian organi12 zation. 

13 ‘‘(D) To a hospital, medical center, or 

14 other institution that provides health care serv15 ices, if such medical quality assurance record or 

16 testimony is needed by such institution to as17 sess the professional qualifications of any health 

18 care provider who is or was an employee of any 

19 Indian health program or urban Indian organi20 zation and who has applied for or been granted 

21 authority or employment to provide health care 

22 services in or on behalf of such program or or23 ganization. 

24 ‘‘(E) To an officer, employee, or contractor 

25 of the Indian health program or urban Indian 


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1 organization that created the records or for 

2 which the records were created. If that officer, 

3 employee, or contractor has a need for such 

4 record or testimony to perform official duties. 

5 ‘‘(F) To a criminal or civil law enforce6 ment agency or instrumentality charged under 

7 applicable law with the protection of the public 

8 health or safety, if a qualified representative of 

9 such agency or instrumentality makes a written 

10 request that such record or testimony be pro11 vided for a purpose authorized by law. 

12 ‘‘(G) In an administrative or judicial pro13 ceeding commenced by a criminal or civil law 

14 enforcement agency or instrumentality referred 

15 to in subparagraph (F), but only with respect 

16 to the subject of such proceeding. 

17 ‘‘(2) IDENTITY OF PARTICIPANTS.—With the 

18 exception of the subject of a quality assurance ac19 tion, the identity of any person receiving health care 

20 services from any Indian health program or urban 

21 Indian organization or the identity of any other per22 son associated with such program or organization 

23 for purposes of a medical quality assurance program 

24 that is disclosed in a medical quality assurance 

25 record described in subsection (b) shall be deleted 


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1 from that record or document before any disclosure 

2 of such record is made outside such program or or3 ganization. 

4 ‘‘(e) DISCLOSURE FOR CERTAIN PURPOSES.— 

5 ‘‘(1) IN GENERAL.—Nothing in this section 

6 shall be construed as authorizing or requiring the 

7 withholding from any person or entity aggregate sta8 tistical information regarding the results of any In9 dian health program or urban Indian organization’s 

10 medical quality assurance programs. 

11 ‘‘(2) WITHHOLDING FROM CONGRESS.—Noth12 ing in this section shall be construed as authority to 

13 withhold any medical quality assurance record from 

14 a committee of either House of Congress, any joint 

15 committee of Congress, or the Government Account16 ability Office if such record pertains to any matter 

17 within their respective jurisdictions. 

18 ‘‘(f) PROHIBITION ON DISCLOSURE OF RECORD OR

19 TESTIMONY.—An individual or entity having possession of 

20 or access to a record or testimony described by this section 

21 may not disclose the contents of such record or testimony 

22 in any manner or for any purpose except as provided in 

23 this section. 

24 ‘‘(g) EXEMPTION FROM FREEDOM OF INFORMATION

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1 section (b) may not be made available to any person under 

2 section 552 of title 5, United States Code. 

3 ‘‘(h) LIMITATION ON CIVIL LIABILITY.—An indi4 vidual who participates in or provides information to a 

5 person or body that reviews or creates medical quality as6 surance records described in subsection (b) shall not be 

7 civilly liable for such participation or for providing such 

8 information if the participation or provision of information 

9 was in good faith based on prevailing professional stand10 ards at the time the medical quality assurance program 

11 activity took place. 

12 ‘‘(i) APPLICATION TO INFORMATION IN CERTAIN

13 OTHER RECORDS.—Nothing in this section shall be con14 strued as limiting access to the information in a record 

15 created and maintained outside a medical quality assur16 ance program, including a patient’s medical records, on 

17 the grounds that the information was presented during 

18 meetings of a review body that are part of a medical qual19 ity assurance program. 

20 ‘‘(j) REGULATIONS.—The Secretary, acting through 

21 the Service, shall promulgate regulations pursuant to sec22 tion 802. 

23 ‘‘(k) CONTINUED PROTECTION.—Disclosure under 

24 subsection (d) does not permit redisclosure except to the 

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1 section (d) or is otherwise authorized to be disclosed under 

2 this section. 

3 ‘‘(l) INCONSISTENCIES.—To the extent that the pro4 tections under part C of title IX of the Public Health Serv5 ice Act (42 U.S.C. 229b–21 et seq.) (as amended by the 

6 Patient Safety and Quality Improvement Act of 2005 

7 (Public Law 109–41; 119 Stat. 424)) and this section are 

8 inconsistent, the provisions of whichever is more protective 

9 shall control. 

10 ‘‘(m) RELATIONSHIP TO OTHER LAW.—This section 

11 shall continue in force and effect, except as otherwise spe12 cifically provided in any Federal law enacted after the date 

13 of enactment of the Indian Healthcare Improvement Act 

14 of 2011.’’. 

15 SEC. 192. LIMITATION ON USE OF FUNDS APPROPRAITED 

16 TO THE INDIAN HEALTH SERVICE. 

17 Section 806 of the Indian Health Care Improvement 

18 Act is amended— 

19 (1) by striking ‘‘Any limitation’’ and inserting 

20 the following: 

21 ‘‘(a) HHS APPROPRIATIONS.—Any limitation’’; and 

22 (2) by adding at the end the following: 

23 ‘‘(b) LIMITATIONS PURSUANT TO OTHER FEDERAL

24 LAW.—Any limitation pursuant to other Federal laws on 

25 the use of Federal funds appropriated to the Service shall 


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1 apply with respect to the performance or coverage of abor2 tions.’’. 

3 SEC. 193. ARIZONA, NORTH DAKOTA, AND SOUTH DAKOTA 

4 AS CONTRACT HEALTH SERVICE DELIVERY 

5 AREAS; ELIGIBILITY OF CALIFORNIA INDI6 ANS. 

7 Title VIII of the Indian Health Care Improvement 

8 Act is amended— 

9 (1) by striking section 808 (25 U.S.C. 1678) 

10 and inserting the following: 

11 ‘‘SEC. 808. ARIZONA AS CONTRACT HEALTH SERVICE DELIV12 ERY AREA. 

13 ‘‘(a) IN GENERAL.—The State of Arizona shall be 

14 designated as a contract health service delivery area by 

15 the Service for the purpose of providing contract health 

16 care services to members of Indian tribes in the State of 

17 Arizona. 

18 ‘‘(b) MAINTENANCE OF SERVICES.—The Service 

19 shall not curtail any health care services provided to Indi20 ans residing on reservations in the State of Arizona if the 

21 curtailment is due to the provision of contract services in 

22 that State pursuant to the designation of the State as a 

23 contract health service delivery area by subsection (a).’’; 

24 (2) by inserting after section 808 (25 U.S.C. 

25 1678) the following: 


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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— 


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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 of California who is listed on 

9 the plans for distribution of the assets of rancherias 

10 and reservations located within the State of Cali11 fornia under the Act of August 18, 1958 (72 Stat. 

12 619), and any descendant of such an Indian. 

13 ‘‘(b) CLARIFICATION.—Nothing in this section may 

14 be construed as expanding the eligibility of California Indi15 ans for health services provided by the Service beyond the 

16 scope of eligibility for such health services that applied on 

17 May 1, 1986.’’. 

18 SEC. 194. METHODS TO INCREASE ACCESS TO PROFES19 SIONALS OF CERTAIN CORPS. 

20 Section 812 of the Indian Health Care Improvement 

21 Act (25 U.S.C. 1680b) is amended to read as follows: 

22 ‘‘SEC. 812. NATIONAL HEALTH SERVICE CORPS. 

23 ‘‘(a) NO REDUCTION IN SERVICES.—The Secretary 

24 shall not remove a member of the National Health Service 

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1 ganization or withdraw funding used to support such a 

2 member, unless the Secretary, acting through the Service, 

3 has ensured that the Indians receiving services from the 

4 member will experience no reduction in services. 

5 ‘‘(b) TREATMENT OF INDIAN HEALTH PROGRAMS.— 

6 At the request of an Indian health program, the services 

7 of a member of the National Health Service Corps as8 signed to the Indian health program may be limited to 

9 the individuals who are eligible for services from that In10 dian health program.’’. 

11 SEC. 195. HEALTH SERVICES FOR INELIGIBLE PERSONS. 

12 Section 813 of the Indian Health Care Improvement 

13 Act (25 U.S.C. 1680c) is amended to read as follows: 

14 ‘‘SEC. 813. HEALTH SERVICES FOR INELIGIBLE PERSONS. 

15 ‘‘(a) CHILDREN.—Any individual who— 

16 ‘‘(1) has not attained 19 years of age; 

17 ‘‘(2) is the natural or adopted child, stepchild, 

18 foster child, legal ward, or orphan of an eligible In19 dian; and 

20 ‘‘(3) is not otherwise eligible for health services 

21 provided by the Service, 

22 shall be eligible for all health services provided by the 

23 Service on the same basis and subject to the same rules 

24 that apply to eligible Indians until such individual attains 

25 19 years of age. The existing and potential health needs 


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1 of all such individuals shall be taken into consideration 

2 by the Service in determining the need for, or the alloca3 tion of, the health resources of the Service. If such an indi4 vidual has been determined to be legally incompetent prior 

5 to attaining 19 years of age, such individual shall remain 

6 eligible for such services until 1 year after the date of a 

7 determination of competency. 

8 ‘‘(b) SPOUSES.—Any spouse of an eligible Indian who 

9 is not an Indian, or who is of Indian descent but is not 

10 otherwise eligible for the health services provided by the 

11 Service, shall be eligible for such health services if all such 

12 spouses or spouses who are married to members of each 

13 Indian tribe being served are made eligible, as a class, by 

14 an appropriate resolution of the governing body of the In15 dian tribe or tribal organization providing such services. 

16 The health needs of persons made eligible under this para17 graph shall not be taken into consideration by the Service 

18 in determining the need for, or allocation of, its health 

19 resources. 

20 ‘‘(c) HEALTH FACILITIES PROVIDING HEALTH

21 SERVICES.— 

22 ‘‘(1) IN GENERAL.—The Secretary is authorized 

23 to provide health services under this subsection 

24 through health facilities operated directly by the 

25 Service to individuals who reside within the Service 


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1 unit and who are not otherwise eligible for such 

2 health services if— 

3 ‘‘(A) the Indian tribes served by such Serv4 ice unit requests such provision of health serv5 ices to such individuals, and 

6 ‘‘(B) the Secretary and the served Indian 

7 tribes have jointly determined that the provision 

8 of such health services will not result in a de9 nial or diminution of health services to eligible 

10 Indians. 

11 ‘‘(2) ISDEAA PROGRAMS.—In the case of 

12 health facilities operated under a contract or com13 pact entered into under the Indian Self-Determina14 tion and Education Assistance Act (25 U.S.C. 450 

15 et seq.), the governing body of the Indian tribe or 

16 tribal organization providing health services under 

17 such contract or compact is authorized to determine 

18 whether health services should be provided under 

19 such contract or compact to individuals who are not 

20 eligible for such health services under any other sub21 section of this section or under any other provision 

22 of law. In making such determinations, the gov23 erning body of the Indian tribe or tribal organization 

24 shall take into account the consideration described in 

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1 dian tribe or tribal organization pursuant to a deter2 mination made under this subparagraph shall be 

3 deemed to be provided under the agreement entered 

4 into by the Indian tribe or tribal organization under 

5 the Indian Self-Determination and Education Assist6 ance Act. The provisions of section 314 of Public 

7 Law 101–512 (104 Stat. 1959), as amended by sec8 tion 308 of Public Law 103–138 (107 Stat. 1416), 

9 shall apply to any services provided by the Indian 

10 tribe or tribal organization pursuant to a determina11 tion made under this subparagraph. 

12 ‘‘(3) PAYMENT FOR SERVICES.— 

13 ‘‘(A) IN GENERAL.—Persons receiving 

14 health services provided by the Service under 

15 this subsection shall be liable for payment of 

16 such health services under a schedule of charges 

17 prescribed by the Secretary which, in the judg18 ment of the Secretary, results in reimbursement 

19 in an amount not less than the actual cost of 

20 providing the health services. Notwithstanding 

21 section 207 of this Act or any other provision 

22 of law, amounts collected under this subsection, 

23 including Medicare, Medicaid, or children’s 

24 health insurance program reimbursements 

25 under titles XVIII, XIX, and XXI of the Social 


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1 Security Act (42 U.S.C. 1395 et seq.), shall be 

2 credited to the account of the program pro3 viding the service and shall be used for the pur4 poses listed in section 401(d)(2) and amounts 

5 collected under this subsection shall be available 

6 for expenditure within such program. 

7 ‘‘(B) INDIGENT PEOPLE.—Health services 

8 may be provided by the Secretary through the 

9 Service under this subsection to an indigent in10 dividual who would not be otherwise eligible for 

11 such health services but for the provisions of 

12 paragraph (1) only if an agreement has been 

13 entered into with a State or local government 

14 under which the State or local government 

15 agrees to reimburse the Service for the expenses 

16 incurred by the Service in providing such health 

17 services to such indigent individual. 

18 ‘‘(4) REVOCATION OF CONSENT FOR SERV19 ICES.— 

20 ‘‘(A) SINGLE TRIBE SERVICE AREA.—In 

21 the case of a Service Area which serves only 1 

22 Indian tribe, the authority of the Secretary to 

23 provide health services under paragraph (1) 

24 shall terminate at the end of the fiscal year suc25 ceeding the fiscal year in which the governing 


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1 body of the Indian tribe revokes its concurrence 

2 to the provision of such health services. 

3 ‘‘(B) MULTITRIBAL SERVICE AREA.—In 

4 the case of a multitribal Service Area, the au5 thority of the Secretary to provide health serv6 ices under paragraph (1) shall terminate at the 

7 end of the fiscal year succeeding the fiscal year 

8 in which at least 51 percent of the number of 

9 Indian tribes in the Service Area revoke their 

10 concurrence to the provisions of such health 

11 services. 

12 ‘‘(d) OTHER SERVICES.—The Service may provide 

13 health services under this subsection to individuals who 

14 are not eligible for health services provided by the Service 

15 under any other provision of law in order to— 

16 ‘‘(1) achieve stability in a medical emergency; 

17 ‘‘(2) prevent the spread of a communicable dis18 ease or otherwise deal with a public health hazard; 

19 ‘‘(3) provide care to non-Indian women preg20 nant with an eligible Indian’s child for the duration 

21 of the pregnancy through postpartum; or 

22 ‘‘(4) provide care to immediate family members 

23 of an eligible individual if such care is directly re24 lated to the treatment of the eligible individual. 

25 ‘‘(e) HOSPITAL PRIVILEGES FOR PRACTITIONERS.— 


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1 ‘‘(1) IN GENERAL.—Hospital privileges in 

2 health facilities operated and maintained by the 

3 Service or operated under a contract or compact 

4 pursuant to the Indian Self-Determination and Edu5 cation Assistance Act (25 U.S.C. 450 et seq.) may 

6 be extended to non-Service health care practitioners 

7 who provide services to individuals described in sub8 section (a), (b), (c), or (d). Such non-Service health 

9 care practitioners may, as part of the privileging 

10 process, be designated as employees of the Federal 

11 Government for purposes of section 1346(b) and 

12 chapter 171 of title 28, United States Code (relating 

13 to Federal tort claims) only with respect to acts or 

14 omissions which occur in the course of providing 

15 services to eligible individuals as a part of the condi16 tions under which such hospital privileges are ex17 tended. 

18 ‘‘(2) DEFINITION.—For purposes of this sub19 section, the term ‘non-Service health care practi20 tioner’ means a practitioner who is not— 

21 ‘‘(A) an employee of the Service; or 

22 ‘‘(B) an employee of an Indian tribe or 

23 tribal organization operating a contract or com24 pact under the Indian Self-Determination and 

25 Education Assistance Act (25 U.S.C. 450 et 


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1 seq.) or an individual who provides health care 

2 services pursuant to a personal services con3 tract with such Indian tribe or tribal organiza4 tion. 

5 ‘‘(f) ELIGIBLE INDIAN.—For purposes of this sec6 tion, the term ‘eligible Indian’ means any Indian who is 

7 eligible for health services provided by the Service without 

8 regard to the provisions of this section.’’. 

9 SEC. 196. ANNUAL BUDGET SUBMISSION. 

10 Title VIII of the Indian Health Care Improvement 

11 Act (25 U.S.C. 1671 et seq.) is amended by adding at 

12 the end the following: 

13 ‘‘SEC. 826. ANNUAL BUDGET SUBMISSION. 

14 ‘‘Effective beginning with the submission of the an15 nual budget request to Congress for fiscal year 2011, the 

16 President shall include, in the amount requested and the 

17 budget justification, amounts that reflect any changes 

18 in— 

19 ‘‘(1) the cost of health care services, as indexed 

20 for United States dollar inflation (as measured by 

21 the Consumer Price Index); and 

22 ‘‘(2) the size of the population served by the 

23 Service.’’. 


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1 SEC. 197. PRESCRIPTION DRUG MONITORING. 

2 Title VIII of the Indian Health Care Improvement 

3 Act (25 U.S.C. 1671 et seq.) (as amended by section 195) 

4 is 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 Healthcare Im15 provement Act of 2011, the Secretary shall submit 

16 to the Committee on Indian Affairs of the Senate 

17 and the Committee on Natural Resources of the 

18 House of Representatives a report that describes— 

19 ‘‘(A) the needs of the Service, tribal health 

20 care facilities, and urban Indian health care fa21 cilities with respect to the prescription drug 

22 monitoring program under paragraph (1); 

23 ‘‘(B) the planned development of that pro24 gram, including any relevant statutory or ad25 ministrative limitations; and 


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1 ‘‘(C) the means by which the program 

2 could be carried out in coordination with any 

3 State 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 agen15 cies and Indian health programs informa16 tion relating to prescription drug abuse in 

17 Indian communities, including statutory 

18 and administrative requirements and limi19 tations 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 

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1 dressing prescription drug abuse in Indian com2 munities. 

3 ‘‘(2) REPORT.—Not later than 18 months after 

4 the date of enactment of the Indian Healthcare Im5 provement Act of 2011, the Attorney General shall 

6 submit to the Committee on Indian Affairs of the 

7 Senate and the Committee on Natural Resources of 

8 the House of Representatives a report that de9 scribes— 

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. 198. TRIBAL HEALTH PROGRAM OPTION FOR COST 

22 SHARING. 

23 Title VIII of the Indian Health Care Improvement 

24 Act (25 U.S.C. 1671 et seq.) (as amended by section 196) 

25 is amended by adding at the end the following: 


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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 

5 program, 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 In8 dian Self-Determination and Education Assistance Act 

9 (25 U.S.C. 458aaa et seq.) to charge an Indian for serv10 ices provided 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. 199. DISEASE AND INJURY PREVENTION REPORT. 

17 Title VIII of the Indian Health Care Improvement 

18 Act (25 U.S.C. 1671 et seq.) (as amended by section 197) 

19 is 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 enact22 ment of the Indian Healthcare Improvement Act of 2011, 

23 the Secretary shall submit to the Committee on Indian Af24 fairs of the Senate and the Committees on Natural Re25 sources and Energy and Commerce of the House of Rep26 resentatives describing— 


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1 ‘‘(1) all disease and injury prevention activities 

2 conducted by the Service, independently or in con3 junction with other Federal departments and agen4 cies and Indian tribes; and 

5 ‘‘(2) the effectiveness of those activities, includ6 ing the reductions of injury or disease conditions 

7 achieved by the activities.’’. 

8 SEC. 200. OTHER GAO REPORTS. 

9 Title VIII of the Indian Health Care Improvement 

10 Act (25 U.S.C. 1671 et seq.) (as amended by section 198) 

11 is 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 Comp15 troller General of the United States shall conduct a 

16 study, and evaluate the effectiveness, of coordination 

17 of 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 

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1 provement Act of 2011, the Comptroller General 

2 shall submit to Congress a report— 

3 ‘‘(A) describing the results of the evalua4 tion under paragraph (1); and 

5 ‘‘(B) containing recommendations of the 

6 Comptroller General regarding measures to 

7 support and increase coordination of the provi8 sion of health care services to Indians as de9 scribed in paragraph (1). 

10 ‘‘(b) PAYMENTS FOR CONTRACT HEALTH SERV11 ICES.— 

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 

16 operated by the Service, an Indian tribe, or a tribal 

17 organization. 

18 ‘‘(2) ANALYSIS.—The study conducted under 

19 paragraph (1) shall include an analysis of— 

20 ‘‘(A) the amounts reimbursed under the 

21 contract health services program described in 

22 paragraph (1) for health care furnished by enti23 ties, individual providers, and suppliers, includ24 ing a comparison of reimbursement for that 


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1 health care through other public programs and 

2 in the private 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 reluc7 tance to furnish care to patients under the pro8 gram; 

9 ‘‘(C) the adequacy of existing Federal 

10 funding for health care under the contract 

11 health services program; 

12 ‘‘(D) the administration of the contract 

13 health service program, including the distribu14 tion of funds to Indian health programs pursu15 ant to the program; and 

16 ‘‘(E) any other items determined appro17 priate by the Comptroller General. 

18 ‘‘(3) REPORT.—Not later than 18 months after 

19 the date of enactment of the Indian Healthcare Im20 provement Act of 2011, the Comptroller General 

21 shall submit to Congress a report on the study con22 ducted under paragraph (1), together with rec23 ommendations regarding— 

24 ‘‘(A) the appropriate level of Federal fund25 ing that should be established for health care 


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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. 201. TRADITIONAL HEALTH CARE PRACTICES. 

16 Title VIII of the Indian Health Care Improvement 

17 Act (25 U.S.C. 1671 et seq.) (as amended by section 199) 

18 is 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 stand22 ards for the provision of health care, health promotion, 

23 and disease prevention under this Act, the United States 

24 is not liable for any provision of traditional health care 

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1 jury, or death to a patient. Nothing in this subsection shall 

2 be construed to alter any liability or other obligation that 

3 the United States may otherwise have under the Indian 

4 Self-Determination and Education Assistance Act (25 

5 U.S.C. 450 et seq.) or this Act.’’. 

6 SEC. 202. DIRECTOR OF HIV/AIDS PREVENTION AND TREAT7 MENT. 

8 Title VIII of the Indian Health Care Improvement 

9 Act (25 U.S.C. 1671 et seq.) (as amended by section 

10 199A) is 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 

14 through the Service, shall establish within the Service the 

15 position of the Director of HIV/AIDS Prevention and 

16 Treatment (referred 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 orga22 nizations regarding existing HIV/AIDS prevention 

23 and treatment programs; and 

24 ‘‘(3) ensure interagency coordination to facili25 tate the inclusion of Indians in Federal HIV/AIDS 


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1 research and grant opportunities, with emphasis on 

2 the programs operated under the Ryan White Com3 prehensive Aids Resources Emergency Act of 1990 

4 (Public Law 101–381; 104 Stat. 576) and the 

5 amendments made by that Act. 

6 ‘‘(c) REPORT.—Not later than 2 years after the date 

7 of enactment of the Indian Healthcare Improvement Act 

8 of 2011, and not less frequently than once every 2 years 

9 thereafter, the Director shall submit to Congress a report 

10 describing, with respect to the preceding 2-year period— 

11 ‘‘(1) each activity carried out under this sec12 tion; and 

13 ‘‘(2) any findings of the Director with respect 

14 to HIV/AIDS prevention and treatment activities 

15 specific to Indians.’’. 

16 TITLE II—AMENDMENTS TO 

17 OTHER ACTS AND MISCELLA18 NEOUS PROVISIONS 

19 SEC. 201. ELIMINATION OF SUNSET FOR REIMBURSEMENT 

20 FOR ALL MEDICARE PART B SERVICES FUR21 NISHED BY CERTAIN INDIAN HOSPITALS AND 

22 CLINICS. 

23 (a) REIMBURSEMENT FOR ALL MEDICARE PART B 

24 SERVICES FURNISHED BY CERTAIN INDIAN HOSPITALS

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1 rity Act (42 U.S.C. 1395qq(e)(1)(A)) is amended by strik2 ing ‘‘during the 5-year period beginning on’’ and inserting 

3 ‘‘on or after’’. 

4 (b) EFFECTIVE DATE.—The amendments made by 

5 this section shall apply to items or services furnished on 

6 or after January 1, 2010. 

7 SEC. 202. INCLUDING COSTS INCURRED BY AIDS DRUG AS8 SISTANCE PROGRAMS AND INDIAN HEALTH 

9 SERVICE IN PROVIDING PRESCRIPTION 

10 DRUGS TOWARD THE ANNUAL OUT-OF-POCK11 ET THRESHOLD UNDER PART D. 

12 (a) IN GENERAL.—Section 1860D–2(b)(4)(C) of the 

13 Social Security Act (42 U.S.C. 1395w–102(b)(4)(C)) is 

14 amended— 

15 (1) in clause (i), by striking ‘‘and’’ at the end; 

16 (2) in clause (ii)— 

17 (A) by striking ‘‘such costs shall be treated 

18 as incurred only if’’ and inserting ‘‘subject to 

19 clause (iii), such costs shall be treated as in20 curred only if’’; 

21 (B) by striking ‘‘, under section 1860D– 

22 14, or under a State Pharmaceutical Assistance 

23 Program’’; 

24 (C) by striking the period at the end and 

25 inserting ‘‘; and’’; and 


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1 (3) by inserting after clause (ii) the following 

2 new clause: 

3 ‘‘(iii) such costs shall be treated as in4 curred and shall not be considered to be 

5 reimbursed under clause (ii) if such costs 

6 are borne or paid— 

7 ‘‘(I) under section 1860D–14; 

8 ‘‘(II) under a State Pharma9 ceutical Assistance Program; 

10 ‘‘(III) by the Indian Health Serv11 ice, an Indian tribe or tribal organiza12 tion, or an urban Indian organization 

13 (as defined in section 4 of the Indian 

14 Health Care Improvement Act); or 

15 ‘‘(IV) under an AIDS Drug As16 sistance Program under part B of 

17 title XXVI of the Public Health Serv18 ice Act.’’. 

19 (b) EFFECTIVE DATE.—The amendments made by 

20 subsection (a) shall apply to costs incurred on or after 

21 January 1, 2011. 

22 SEC. 203. PROHIBITION OF USE OF FEDERAL FUNDS FOR 

23 ABORTION. 

24 No funds authorized or appropriated by this Act (or 

25 an amendment made by this Act) may be used to pay for 


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1 any abortion or to cover any part of the costs of any health 

2 plan that includes coverage of abortion, except in the case 

3 where a woman suffers from a physical disorder, physical 

4 injury, or physical illness that would, as certified by a phy5 sician, place the woman in danger of death unless an abor6 tion is performed, including a life-endangering physical 

7 condition caused by or arising from the pregnancy itself, 

8 or unless the pregnancy is the result of an act of rape 

9 or incest. 

10 SEC. 204. REAUTHORIZATION OF NATIVE HAWAIIAN 

11 HEALTH CARE PROGRAMS. 

12 (a) REAUTHORIZATION.—The Native Hawaiian 

13 Health Care Act of 1988 (42 U.S.C. 11701 et seq.) is 

14 amended by striking ‘‘2001’’ each place it appears in sec15 tions 6(h)(1), 7(b), and 10(c) (42 U.S.C. 11705(h)(1), 

16 11706(b), 11709(c)) and inserting ‘‘2019’’. 

17 (b) HEALTH AND EDUCATION.— 

18 (1) IN GENERAL.—Section 6(c) of the Native 

19 Hawaiian Health Care Act of 1988 (42 U.S.C. 

20 11705) is amended by adding at the end the fol21 lowing: 

22 ‘‘(4) HEALTH AND EDUCATION.—In order to 

23 enable privately funded organizations to continue to 

24 supplement public efforts to provide educational pro25 grams designed to improve the health, capability, 


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1 and well-being of Native Hawaiians and to continue 

2 to provide health services to Native Hawaiians, not3 withstanding any other provision of Federal or State 

4 law, it shall be lawful for the private educational or5 ganization identified in section 7202(16) of the Ele6 mentary and Secondary Education Act of 1965 (20 

7 U.S.C. 7512(16)) to continue to offer its educational 

8 programs and services to Native Hawaiians (as de9 fined in section 7207 of that Act (20 U.S.C. 7517)) 

10 first and to others only after the need for such pro11 grams and services by Native Hawaiians has been 

12 met.’’. 

13 (2) EFFECTIVE DATE.—The amendment made 

14 by paragraph (1) takes effect on December 5, 2006. 

15 (c) DEFINITION OF HEALTH PROMOTION.—Section 

16 12(2) of the Native Hawaiian Health Care Act of 1988 

17 (42 U.S.C. 11711(2)) is amended— 

18 (1) in subparagraph (F), by striking ‘‘and’’ at 

19 the end; 

20 (2) in subparagraph (G), by striking the period 

21 at the end and inserting ‘‘, and’’; and 

22 (3) by adding at the end the following: 


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1 ‘‘(H) educational programs with the mis2 sion of improving the health, capability, and 

3 well-being of Native Hawaiians.’’. 

Æ 


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