I 

109TH CONGRESS 

2D SESSION H. R. 5312 

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

that Act. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 9, 2006 

Mr. YOUNG of Alaska (for himself, Mr. HAYWORTH, Mr. RENZI, Mr. COLE

of Oklahoma, Mr. RAHALL, Mr. OBERSTAR, Mr. PALLONE, Mr. BACA, 

Mr. CASE, Ms. BORDALLO, Mr. HONDA, Mr. UDALL of New Mexico, Mr. 

KILDEE, and Mr. WAXMAN) introduced the following bill; which was referred to the Committee on Resources, and in addition to the Committees 

on Energy and Commerce and Ways and Means, 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. 

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. 

4 This Act may be cited as the ‘‘Indian Health Care 

5 Improvement Act Amendments of 2006’’. 


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1 SEC. 2. INDIAN HEALTH CARE IMPROVEMENT ACT AMEND2 ED. 

3 (a) IN GENERAL.—The Indian Health Care Improve4 ment Act (25 U.S.C. 1601 et seq.) is amended to read 

5 as follows: 

6 ‘‘SEC. 1. SHORT TITLE; TABLE OF CONTENTS. 

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

8 ‘Indian Health Care Improvement Act’. 

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

10 for this Act is as follows: 

‘‘Sec. 1. Short title; table of contents. 

‘‘Sec. 2. Findings. 

‘‘Sec. 3. Declaration of National Indian health policy. 

‘‘Sec. 4. Definitions. 

‘‘TITLE I—INDIAN HEALTH, HUMAN RESOURCES, AND 

DEVELOPMENT 

‘‘Sec. 101. Purpose. 

‘‘Sec. 102. Health professions recruitment program for Indians. 

‘‘Sec. 103. Health professions preparatory scholarship program for Indians. 

‘‘Sec. 104. Indian health professions scholarships. 

‘‘Sec. 105. American Indians Into Psychology program. 

‘‘Sec. 106. Scholarship programs for Indian Tribes. 

‘‘Sec. 107. Indian Health Service extern programs. 

‘‘Sec. 108. Continuing education allowances. 

‘‘Sec. 109. Community health representative program. 

‘‘Sec. 110. Indian Health Service loan repayment program. 

‘‘Sec. 111. Scholarship and Loan Repayment Recovery Fund. 

‘‘Sec. 112. Recruitment activities. 

‘‘Sec. 113. Indian recruitment and retention program. 

‘‘Sec. 114. Advanced training and research. 

‘‘Sec. 115. Quentin N. Burdick American Indians Into Nursing program. 

‘‘Sec. 116. Tribal cultural orientation. 

‘‘Sec. 117. INMED program. 

‘‘Sec. 118. Health training programs of community colleges. 

‘‘Sec. 119. Retention bonus. 

‘‘Sec. 120. Nursing residency program. 

‘‘Sec. 121. Community health aide program. 

‘‘Sec. 122. Tribal health program administration. 

‘‘Sec. 123. Health professional chronic shortage demonstration programs. 

‘‘Sec. 124. National Health Service Corps. 

‘‘Sec. 125. Substance abuse counselor educational curricula demonstration programs. 


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‘‘Sec. 126. Behavioral health training and community education programs. 

‘‘Sec. 127. Authorization of appropriations. 

‘‘TITLE II—HEALTH SERVICES 

‘‘Sec. 201. Indian Health Care Improvement Fund. 

‘‘Sec. 202. Catastrophic Health Emergency Fund. 

‘‘Sec. 203. Health promotion and disease prevention services. 

‘‘Sec. 204. Diabetes prevention, treatment, and control. 

‘‘Sec. 205. Shared services for long-term care. 

‘‘Sec. 206. Health services research. 

‘‘Sec. 207. Mammography and other cancer screening. 

‘‘Sec. 208. Patient travel costs. 

‘‘Sec. 209. Epidemiology centers. 

‘‘Sec. 210. Comprehensive school health education programs. 

‘‘Sec. 211. Indian youth program. 

‘‘Sec. 212. Prevention, control, and elimination of communicable and infectious 

diseases. 

‘‘Sec. 213. Authority for provision of other services. 

‘‘Sec. 214. Indian women’s health care. 

‘‘Sec. 215. Environmental and nuclear health hazards. 

‘‘Sec. 216. Arizona as a contract health service delivery area. 

‘‘Sec. 216A. North Dakota and South Dakota as a contract health service delivery area. 

‘‘Sec. 217. California contract health services program. 

‘‘Sec. 218. California as a contract health service delivery area. 

‘‘Sec. 219. Contract health services for the Trenton service area. 

‘‘Sec. 220. Programs operated by Indian Tribes and Tribal Organizations. 

‘‘Sec. 221. Licensing. 

‘‘Sec. 222. Notification of provision of emergency contract health services. 

‘‘Sec. 223. Prompt action on payment of claims. 

‘‘Sec. 224. Liability for payment. 

‘‘Sec. 225. Office of Indian Men’s Health. 

‘‘Sec. 226. Authorization of appropriations. 

‘‘TITLE III—FACILITIES 

‘‘Sec. 301. Consultation; construction and renovation of facilities; reports. 

‘‘Sec. 302. Sanitation facilities. 

‘‘Sec. 303. Preference to Indians and Indian firms. 

‘‘Sec. 304. Expenditure of nonservice funds for renovation. 

‘‘Sec. 305. Funding for the construction, expansion, and modernization of small 

ambulatory care facilities. 

‘‘Sec. 306. Indian health care delivery demonstration project. 

‘‘Sec. 307. Land transfer. 

‘‘Sec. 308. Leases, contracts, and other agreements. 

‘‘Sec. 309. Study on loans, loan guarantees, and loan repayment. 

‘‘Sec. 310. Tribal leasing. 

‘‘Sec. 311. Indian Health Service/tribal facilities joint venture program. 

‘‘Sec. 312. Location of facilities. 

‘‘Sec. 313. Maintenance and improvement of health care facilities. 

‘‘Sec. 314. Tribal management of Federally owned quarters. 

‘‘Sec. 315. Applicability of Buy American Act requirement. 

‘‘Sec. 316. Other funding for facilities. 

‘‘Sec. 317. Authorization of appropriations. 


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‘‘TITLE IV—ACCESS TO HEALTH SERVICES 

‘‘Sec. 401. Treatment of payments under Social Security Act health care programs. 

‘‘Sec. 402. Grants to and contracts with the Service, Indian Tribes, Tribal Organizations, and Urban Indian Organizations. 

‘‘Sec. 403. Reimbursement from certain third parties of costs of health services. 

‘‘Sec. 404. Crediting of reimbursements. 

‘‘Sec. 405. Purchasing health care coverage. 

‘‘Sec. 406. Sharing arrangements with Federal agencies. 

‘‘Sec. 407. Payor of last resort. 

‘‘Sec. 408. Nondiscrimination in qualifications for reimbursement for services. 

‘‘Sec. 409. Consultation. 

‘‘Sec. 410. State Children’s Health Insurance Program (SCHIP). 

‘‘Sec. 411. Social Security Act sanctions. 

‘‘Sec. 412. Cost sharing. 

‘‘Sec. 413. Treatment under Medicaid managed care. 

‘‘Sec. 414. Navajo Nation Medicaid Agency feasibility study. 

‘‘Sec. 415. Authorization of appropriations. 

‘‘TITLE V—HEALTH SERVICES FOR URBAN INDIANS 

‘‘Sec. 501. Purpose. 

‘‘Sec. 502. Contracts with, and grants to, Urban Indian Organizations. 

‘‘Sec. 503. Contracts and grants for the provision of health care and referral 

services. 

‘‘Sec. 504. Contracts and grants for the determination of unmet health care 

needs. 

‘‘Sec. 505. Evaluations; renewals. 

‘‘Sec. 506. Other contract and grant requirements. 

‘‘Sec. 507. Reports and records. 

‘‘Sec. 508. Limitation on contract authority. 

‘‘Sec. 509. Facilities. 

‘‘Sec. 510. Division of Urban Indian Health. 

‘‘Sec. 511. Grants for alcohol and substance abuse-related services. 

‘‘Sec. 512. Treatment of certain demonstration projects. 

‘‘Sec. 513. Urban NIAAA transferred programs. 

‘‘Sec. 514. Consultation with Urban Indian Organizations. 

‘‘Sec. 515. Urban youth treatment center demonstration. 

‘‘Sec. 516. Use of Federal Government facilities and sources of supply 

‘‘Sec. 517. Grants for diabetes prevention, treatment, and control. 

‘‘Sec. 518. Community health representatives. 

‘‘Sec. 519. Effective date. 

‘‘Sec. 520. Eligibility for services. 

‘‘Sec. 521. Authorization of appropriations. 

‘‘TITLE VI—ORGANIZATIONAL IMPROVEMENTS 

‘‘Sec. 601. Establishment of the Indian Health Service as an agency of the 

Public Health Service. 

‘‘Sec. 602. Automated management information system. 

‘‘Sec. 603. Authorization of appropriations. 

‘‘TITLE VII—BEHAVIORAL HEALTH PROGRAMS 

‘‘Sec. 701. Behavioral health prevention and treatment services. 

‘‘Sec. 702. Memoranda of agreement with the Department of the Interior. 


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‘‘Sec. 703. Comprehensive behavioral health prevention and treatment program. 

‘‘Sec. 704. Mental health technician program. 

‘‘Sec. 705. Licensing requirement for mental health care workers. 

‘‘Sec. 706. Indian women treatment programs. 

‘‘Sec. 707. Indian youth program. 

‘‘Sec. 708. Indian youth telemental health demonstration project. 

‘‘Sec. 709. Inpatient and community-based mental health facilities design, construction, and staffing. 

‘‘Sec. 710. Training and community education. 

‘‘Sec. 711. Behavioral health program. 

‘‘Sec. 712. Fetal alcohol disorder programs. 

‘‘Sec. 713. Child sexual abuse and prevention treatment programs. 

‘‘Sec. 714. Behavioral health research. 

‘‘Sec. 715. Definitions. 

‘‘Sec. 716. Authorization of appropriations. 

‘‘TITLE VIII—MISCELLANEOUS 

‘‘Sec. 801. Reports. 

‘‘Sec. 802. Regulations. 

‘‘Sec. 803. Plan of implementation. 

‘‘Sec. 804. Availability of funds. 

‘‘Sec. 805. Limitation on use of funds appropriated to the Indian Health Service. 

‘‘Sec. 806. Eligibility of California Indians. 

‘‘Sec. 807. Health services for ineligible persons. 

‘‘Sec. 808. Reallocation of base resources. 

‘‘Sec. 809. Results of demonstration projects. 

‘‘Sec. 810. Provision of services in Montana. 

‘‘Sec. 811. Moratorium. 

‘‘Sec. 812. Tribal employment. 

‘‘Sec. 813. Severability provisions. 

‘‘Sec. 814. Establishment of National Bipartisan Commission on Indian Health 

Care. 

‘‘Sec. 815. Appropriations; availability. 

‘‘Sec. 816. Authorization of appropriations. 

1 ‘‘SEC. 2. FINDINGS. 

2 ‘‘Congress makes the following findings: 

3 ‘‘(1) Federal health services to maintain and 

4 improve the health of the Indians are consonant 

5 with and required by the Federal Government’s his6 torical and unique legal relationship with, and re7 sulting responsibility to, the American Indian people. 

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

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1 ices which will permit the health status of Indians 

2 to be raised to the highest possible level and to en3 courage the maximum participation of Indians in the 

4 planning and management of those services. 

5 ‘‘(3) Federal health services to Indians have re6 sulted in a reduction in the prevalence and incidence 

7 of preventable illnesses among, and unnecessary and 

8 premature deaths of, Indians. 

9 ‘‘(4) Despite such services, the unmet health 

10 needs of the American Indian people are severe and 

11 the health status of the Indians is far below that of 

12 the general population of the United States. 

13 ‘‘SEC. 3. DECLARATION OF NATIONAL INDIAN HEALTH POL14 ICY. 

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

16 in fulfillment of its special trust responsibilities and legal 

17 obligations to Indians— 

18 ‘‘(1) to assure the highest possible health status 

19 for Indians and to provide all resources necessary to 

20 effect that policy; 

21 ‘‘(2) to raise the health status of Indians by the 

22 year 2010 to at least the levels set forth in the goals 

23 contained within the Healthy People 2010 or suc24 cessor objectives; 


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1 ‘‘(3) to the greatest extent possible, to allow In2 dians to set their own health care priorities and es3 tablish goals that reflect their unmet needs; 

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

5 the health professions and allied and associated 

6 health professions awarded to Indians so that the 

7 proportion of Indian health professionals in each 

8 Service Area is raised to at least the level of that of 

9 the general population; 

10 ‘‘(5) to require meaningful consultation with In11 dian Tribes, Tribal Organizations, and Urban Indian 

12 Organizations to implement this Act and the na13 tional policy of Indian self-determination; and 

14 ‘‘(6) to provide funding for programs and facili15 ties operated by Indian Tribes and Tribal Organiza16 tions in amounts that are not less than the amounts 

17 provided to programs and facilities operated directly 

18 by the Service. 

19 ‘‘SEC. 4. DEFINITIONS. 

20 ‘‘For purposes of this Act: 

21 ‘‘(1) The term ‘accredited and accessible’ means 

22 on or near a reservation and accredited by a na23 tional or regional organization with accrediting au24 thority. 


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1 ‘‘(2) The term ‘Area Office’ means an adminis2 trative entity, including a program office, within the 

3 Service through which services and funds are pro4 vided to the Service Units within a defined geo5 graphic area. 

6 ‘‘(3) The term ‘Assistant Secretary’ means the 

7 Assistant Secretary of Indian Health. 

8 ‘‘(4)(A) The term ‘behavioral health’ means the 

9 blending of substance (alcohol, drugs, inhalants, and 

10 tobacco) abuse and mental health prevention and 

11 treatment, for the purpose of providing comprehen12 sive services. 

13 ‘‘(B) The term ‘behavioral health’ includes the 

14 joint development of substance abuse and mental 

15 health treatment planning and coordinated case 

16 management using a multidisciplinary approach. 

17 ‘‘(5) The term ‘California Indians’ means those 

18 Indians who are eligible for health services of the 

19 Service pursuant to section 806. 

20 ‘‘(6) The term ‘community college’ means— 

21 ‘‘(A) a tribal college or university, or 

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

23 ‘‘(7) The term ‘contract health service’ means 

24 health services provided at the expense of the Serv25 ice or a Tribal Health Program by public or private 


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1 medical providers or hospitals, other than the Serv2 ice Unit or the Tribal Health Program at whose ex3 pense the services are provided. 

4 ‘‘(8) The term ‘Department’ means, unless oth5 erwise designated, the Department of Health and 

6 Human Services. 

7 ‘‘(9) The term ‘disease prevention’ means the 

8 reduction, limitation, and prevention of disease and 

9 its complications and reduction in the consequences 

10 of disease, including— 

11 ‘‘(A) controlling— 

12 ‘‘(i) the development of diabetes; 

13 ‘‘(ii) high blood pressure; 

14 ‘‘(iii) infectious agents; 

15 ‘‘(iv) injuries; 

16 ‘‘(v) occupational hazards and disabil17 ities; 

18 ‘‘(vi) sexually transmittable diseases; 

19 and 

20 ‘‘(vii) toxic agents; and 

21 ‘‘(B) providing— 

22 ‘‘(i) fluoridation of water; and 

23 ‘‘(ii) immunizations. 

24 ‘‘(10) The term ‘health profession’ means 

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1 cine, pediatrics, geriatric medicine, obstetrics and 

2 gynecology, podiatric medicine, nursing, public 

3 health nursing, dentistry, psychiatry, osteopathy, op4 tometry, pharmacy, psychology, public health, social 

5 work, marriage and family therapy, chiropractic 

6 medicine, environmental health and engineering, al7 lied health professions, naturopathic medicine, and 

8 any other health profession. 

9 ‘‘(11) The term ‘health promotion’ means— 

10 ‘‘(A) fostering social, economic, environ11 mental, and personal factors conducive to 

12 health, including raising public awareness about 

13 health matters and enabling the people to cope 

14 with health problems by increasing their knowl15 edge and providing them with valid information; 

16 ‘‘(B) encouraging adequate and appro17 priate diet, exercise, and sleep; 

18 ‘‘(C) promoting education and work in con19 formity with physical and mental capacity; 

20 ‘‘(D) making available suitable housing, 

21 safe water, and sanitary facilities; 

22 ‘‘(E) improving the physical, economic, cul23 tural, psychological, and social environment; 


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1 ‘‘(F) promoting adequate opportunity for 

2 spiritual, religious, and traditional health care 

3 practices; and 

4 ‘‘(G) providing adequate and appropriate 

5 programs, including— 

6 ‘‘(i) abuse prevention (mental and 

7 physical); 

8 ‘‘(ii) community health; 

9 ‘‘(iii) community safety; 

10 ‘‘(iv) consumer health education; 

11 ‘‘(v) diet and nutrition; 

12 ‘‘(vi) immunization and other preven13 tion of communicable diseases, including 

14 HIV/AIDS; 

15 ‘‘(vii) environmental health; 

16 ‘‘(viii) exercise and physical fitness; 

17 ‘‘(ix) avoidance of fetal alcohol dis18 orders; 

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

20 ‘‘(xi) human growth and development; 

21 ‘‘(xii) injury prevention and personal 

22 safety; 

23 ‘‘(xiii) behavioral health; 

24 ‘‘(xiv) monitoring of disease indicators 

25 between health care provider visits, 


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1 through appropriate means, including 

2 Internet-based health care management 

3 systems; 

4 ‘‘(xv) personal health and wellness 

5 practices; 

6 ‘‘(xvi) personal capacity building; 

7 ‘‘(xvii) prenatal, pregnancy, and in8 fant care; 

9 ‘‘(xviii) psychological well-being; 

10 ‘‘(xix) reproductive health and family 

11 planning; 

12 ‘‘(xx) safe and adequate water; 

13 ‘‘(xxi) safe housing, relating to elimi14 nation, reduction, and prevention of con15 taminants that create unhealthy housing 

16 conditions; 

17 ‘‘(xxii) safe work environments; 

18 ‘‘(xxiii) stress control; 

19 ‘‘(xxiv) substance abuse; 

20 ‘‘(xxv) sanitary facilities; 

21 ‘‘(xxvi) sudden infant death syndrome 

22 prevention; 

23 ‘‘(xxvii) tobacco use cessation and re24 duction; 

25 ‘‘(xxviii) violence prevention; and 


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1 ‘‘(xxix) such other activities identified 

2 by the Service, a Tribal Health Program, 

3 or an Urban Indian Organization, to pro4 mote achievement of any of the objectives 

5 described in section 3(2). 

6 ‘‘(12) The term ‘Indian’, unless otherwise des7 ignated, means any person who is a member of an 

8 Indian Tribe or is eligible for health services under 

9 section 806, except that, for the purpose of sections 

10 102 and 103, the term also means any individual 

11 who— 

12 ‘‘(A)(i) irrespective of whether the indi13 vidual lives on or near a reservation, is a mem14 ber of a tribe, band, or other organized group 

15 of Indians, including those tribes, bands, or 

16 groups terminated since 1940 and those recog17 nized now or in the future by the State in 

18 which they reside; or 

19 ‘‘(ii) is a descendant, in the first or second 

20 degree, of any such member; 

21 ‘‘(B) is an Eskimo or Aleut or other Alas22 ka Native; 

23 ‘‘(C) is considered by the Secretary of the 

24 Interior to be an Indian for any purpose; or 


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1 ‘‘(D) is determined to be an Indian under 

2 regulations promulgated by the Secretary. 

3 ‘‘(13) The term ‘Indian Health Program’ 

4 means— 

5 ‘‘(A) any health program administered di6 rectly by the Service; 

7 ‘‘(B) any Tribal Health Program; or 

8 ‘‘(C) any Indian Tribe or Tribal Organiza9 tion to which the Secretary provides funding 

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

11 1910 (25 U.S.C. 47) (commonly known as the 

12 ‘Buy Indian Act’). 

13 ‘‘(14) The term ‘Indian Tribe’ has the meaning 

14 given the term in the Indian Self-Determination and 

15 Education Assistance Act (25 U.S.C. 450 et seq.). 

16 ‘‘(15) The term ‘junior or community college’ 

17 has the meaning given the term by section 312(e) of 

18 the Higher Education Act of 1965 (20 U.S.C. 

19 1058(e)). 

20 ‘‘(16) The term ‘reservation’ means any feder21 ally recognized Indian Tribe’s reservation, Pueblo, or 

22 colony, including former reservations in Oklahoma, 

23 Indian allotments, and Alaska Native Regions estab24 lished pursuant to the Alaska Native Claims Settle25 ment Act (25 U.S.C. 1601 et seq.). 


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1 ‘‘(17) The term ‘Secretary’, unless otherwise 

2 designated, means the Secretary of Health and 

3 Human Services. 

4 ‘‘(18) The term ‘Service’ means the Indian 

5 Health Service. 

6 ‘‘(19) The term ‘Service Area’ means the geo7 graphical area served by each Area Office. 

8 ‘‘(20) The term ‘Service Unit’ means an admin9 istrative entity of the Service, or a Tribal Health 

10 Program through which services are provided, di11 rectly or by contract, to eligible Indians within a de12 fined geographic area. 

13 ‘‘(21) The term ‘telehealth’ has the meaning 

14 given the term in section 330K(a) of the Public 

15 Health Service Act (42 U.S.C. 254c–16(a)). 

16 ‘‘(22) The term ‘telemedicine’ means a tele17 communications link to an end user through the use 

18 of eligible equipment that electronically links health 

19 professionals or patients and health professionals at 

20 separate sites in order to exchange health care infor21 mation in audio, video, graphic, or other format for 

22 the purpose of providing improved health care serv23 ices. 


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1 ‘‘(23) The term ‘tribal college or university’ has 

2 the meaning given the term in section 316(b)(3) of 

3 the Higher Education Act (20 U.S.C. 1059c(b)(3)). 

4 ‘‘(24) The term ‘Tribal Health Program’ means 

5 an Indian Tribe or Tribal Organization that oper6 ates any health program, service, function, activity, 

7 or facility funded, in whole or part, by the Service 

8 through, or provided for in, a contract or compact 

9 with the Service under the Indian Self-Determina10 tion and Education Assistance Act (25 U.S.C. 450 

11 et seq.). 

12 ‘‘(25) The term ‘Tribal Organization’ has the 

13 meaning given the term in the Indian Self-Deter14 mination and Education Assistance Act (25 U.S.C. 

15 450 et seq.). 

16 ‘‘(26) The term ‘Urban Center’ means any com17 munity which has a sufficient Urban Indian popu18 lation with unmet health needs to warrant assistance 

19 under title V of this Act, as determined by the Sec20 retary. 

21 ‘‘(27) The term ‘Urban Indian’ means any indi22 vidual who resides in an Urban Center and who 

23 meets 1 or more of the following criteria: 

24 ‘‘(A) Irrespective of whether the individual 

25 lives on or near a reservation, the individual is 


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1 a member of a tribe, band, or other organized 

2 group of Indians, including those tribes, bands, 

3 or groups terminated since 1940 and those 

4 tribes, bands, or groups that are recognized by 

5 the States in which they reside, or who is a de6 scendant in the first or second degree of any 

7 such member. 

8 ‘‘(B) The individual is an Eskimo, Aleut, 

9 or other Alaska Native. 

10 ‘‘(C) The individual is considered by the 

11 Secretary of the Interior to be an Indian for 

12 any purpose. 

13 ‘‘(D) The individual is determined to be an 

14 Indian under regulations promulgated by the 

15 Secretary. 

16 ‘‘(28) The term ‘Urban Indian Organization’ 

17 means a nonprofit corporate body that (A) is situ18 ated in an Urban Center; (B) is governed by an 

19 Urban Indian-controlled board of directors; (C) pro20 vides for the participation of all interested Indian 

21 groups and individuals; and (D) is capable of legally 

22 cooperating with other public and private entities for 

23 the purpose of performing the activities described in 

24 section 503(a). 


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1 ‘‘TITLE I—INDIAN HEALTH, 

2 HUMAN RESOURCES, AND DE3 VELOPMENT 

4 ‘‘SEC. 101. PURPOSE. 

5 ‘‘The purpose of this title is to increase, to the max6 imum extent feasible, the number of Indians entering the 

7 health professions and providing health services, and to 

8 assure an optimum supply of health professionals to the 

9 Indian Health Programs and Urban Indian Organizations 

10 involved in the provision of health services to Indians. 

11 ‘‘SEC. 102. HEALTH PROFESSIONS RECRUITMENT PROGRAM 

12 FOR INDIANS. 

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

14 the Service, shall make grants to public or nonprofit pri15 vate health or educational entities, Tribal Health Pro16 grams, or Urban Indian Organizations to assist such enti17 ties in meeting the costs of— 

18 ‘‘(1) identifying Indians with a potential for 

19 education or training in the health professions and 

20 encouraging and assisting them— 

21 ‘‘(A) to enroll in courses of study in such 

22 health professions; or 

23 ‘‘(B) if they are not qualified to enroll in 

24 any such courses of study, to undertake such 


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1 postsecondary education or training as may be 

2 required to qualify them for enrollment; 

3 ‘‘(2) publicizing existing sources of financial aid 

4 available to Indians enrolled in any course of study 

5 referred to in paragraph (1) or who are undertaking 

6 training necessary to qualify them to enroll in any 

7 such course of study; or 

8 ‘‘(3) establishing other programs which the Sec9 retary determines will enhance and facilitate the en10 rollment of Indians in, and the subsequent pursuit 

11 and completion by them of, courses of study referred 

12 to in paragraph (1). 

13 ‘‘(b) FUNDING.— 

14 ‘‘(1) APPLICATION.—The Secretary shall not 

15 make a grant under this section unless an applica16 tion has been submitted to, and approved by, the 

17 Secretary. Such application shall be in such form, 

18 submitted in such manner, and contain such infor19 mation, as the Secretary shall by regulation pre20 scribe pursuant to this Act. The Secretary shall give 

21 a preference to applications submitted by Tribal 

22 Health Programs or Urban Indian Organizations. 

23 ‘‘(2) AMOUNT OF GRANTS; PAYMENT.—The 

24 amount of a grant under this section shall be deter25 mined by the Secretary. Payments pursuant to this 


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1 section may be made in advance or by way of reim2 bursement, and at such intervals and on such condi3 tions as provided for in regulations issued pursuant 

4 to this Act. To the extent not otherwise prohibited 

5 by law, funding commitments shall be for 3 years, 

6 as provided in regulations issued pursuant to this 

7 Act. 

8 ‘‘SEC. 103. HEALTH PROFESSIONS PREPARATORY SCHOL9 ARSHIP PROGRAM FOR INDIANS. 

10 ‘‘(a) SCHOLARSHIPS AUTHORIZED.—The Secretary, 

11 acting through the Service, shall provide scholarship 

12 grants to Indians who— 

13 ‘‘(1) have successfully completed their high 

14 school education or high school equivalency; and 

15 ‘‘(2) have demonstrated the potential to suc16 cessfully complete courses of study in the health pro17 fessions. 

18 ‘‘(b) PURPOSES.—Scholarship grants provided pursu19 ant to this section shall be for the following purposes: 

20 ‘‘(1) Compensatory preprofessional education of 

21 any recipient, such scholarship not to exceed 2 years 

22 on a full-time basis (or the part-time equivalent 

23 thereof, as determined by the Secretary pursuant to 

24 regulations issued under this Act). 


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1 ‘‘(2) Pregraduate education of any recipient 

2 leading to a baccalaureate degree in an approved 

3 course of study preparatory to a field of study in a 

4 health profession, such scholarship not to exceed 4 

5 years. An extension of up to 2 years (or the part6 time equivalent thereof, as determined by the Sec7 retary pursuant to regulations issued pursuant to 

8 this Act) may be approved. 

9 ‘‘(c) OTHER CONDITIONS.—Scholarships under this 

10 section— 

11 ‘‘(1) may cover costs of tuition, books, trans12 portation, board, and other necessary related ex13 penses of a recipient while attending school; 

14 ‘‘(2) shall not be denied solely on the basis of 

15 the applicant’s scholastic achievement if such appli16 cant has been admitted to, or maintained good 

17 standing at, an accredited institution; and 

18 ‘‘(3) shall not be denied solely by reason of such 

19 applicant’s eligibility for assistance or benefits under 

20 any other Federal program. 

21 ‘‘SEC. 104. INDIAN HEALTH PROFESSIONS SCHOLARSHIPS. 

22 ‘‘(a) IN GENERAL.— 

23 ‘‘(1) AUTHORITY.—The Secretary, acting 

24 through the Service, shall make scholarship grants 

25 to Indians who are enrolled full or part time in acVerDate Aug 31 2005 03:45 May 16, 2006 Jkt 049200 PO 00000 Frm 00021 Fmt 6652 Sfmt 6201 E:\BILLS\H5312.IH H5312

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1 credited schools pursuing courses of study in the 

2 health professions. Such scholarships shall be des3 ignated Indian Health Scholarships and shall be 

4 made in accordance with section 338A of the Public 

5 Health Services Act (42 U.S.C. 2541), except as 

6 provided in subsection (b) of this section. 

7 ‘‘(2) DETERMINATIONS BY SECRETARY.—The 

8 Secretary, acting through the Service, shall deter9 mine— 

10 ‘‘(A) who shall receive scholarship grants 

11 under subsection (a); and 

12 ‘‘(B) the distribution of the scholarships 

13 among health professions on the basis of the 

14 relative needs of Indians for additional service 

15 in the health professions. 

16 ‘‘(3) CERTAIN DELEGATION NOT ALLOWED.— 

17 The administration of this section shall be a respon18 sibility of the Assistant Secretary and shall not be 

19 delegated in a contract or compact under the Indian 

20 Self-Determination and Education Assistance Act 

21 (25 U.S.C. 450 et seq.). 

22 ‘‘(b) ACTIVE DUTY SERVICE OBLIGATION.— 

23 ‘‘(1) OBLIGATION MET.—The active duty serv24 ice obligation under a written contract with the Sec25 retary under this section that an Indian has entered 


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1 into shall, if that individual is a recipient of an In2 dian Health Scholarship, be met in full-time practice 

3 on an equivalent year-for-year obligation, by service 

4 in 1 or more of the following: 

5 ‘‘(A) In an Indian Health Program. 

6 ‘‘(B) In a program assisted under title V 

7 of this Act. 

8 ‘‘(C) In the private practice of the applica9 ble profession if, as determined by the Sec10 retary, in accordance with guidelines promul11 gated by the Secretary, such practice is situated 

12 in a physician or other health professional 

13 shortage area and addresses the health care 

14 needs of a substantial number of Indians. 

15 ‘‘(D) In a teaching capacity in a tribal col16 lege or university nursing program (or a related 

17 health profession program) if, as determined by 

18 the Secretary, the health service provided to In19 dians would not decrease. 

20 ‘‘(2) OBLIGATION DEFERRED.—At the request 

21 of any individual who has entered into a contract re22 ferred to in paragraph (1) and who receives a degree 

23 in medicine (including osteopathic or allopathic med24 icine), dentistry, optometry, podiatry, or pharmacy, 

25 the Secretary shall defer the active duty service obliVerDate Aug 31 2005 03:45 May 16, 2006 Jkt 049200 PO 00000 Frm 00023 Fmt 6652 Sfmt 6201 E:\BILLS\H5312.IH H5312

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1 gation of that individual under that contract, in 

2 order that such individual may complete any intern3 ship, residency, or other advanced clinical training 

4 that is required for the practice of that health pro5 fession, for an appropriate period (in years, as deter6 mined by the Secretary), subject to the following 

7 conditions: 

8 ‘‘(A) No period of internship, residency, or 

9 other advanced clinical training shall be counted 

10 as satisfying any period of obligated service 

11 under this subsection. 

12 ‘‘(B) The active duty service obligation of 

13 that individual shall commence not later than 

14 90 days after the completion of that advanced 

15 clinical training (or by a date specified by the 

16 Secretary). 

17 ‘‘(C) The active duty service obligation will 

18 be served in the health profession of that indi19 vidual in a manner consistent with paragraph 

20 (1). 

21 ‘‘(D) A recipient of a scholarship under 

22 this section may, at the election of the recipient, 

23 meet the active duty service obligation described 

24 in paragraph (1) by service in a program speci25 fied under that paragraph that— 


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1 ‘‘(i) is located on the reservation of 

2 the Indian Tribe in which the recipient is 

3 enrolled; or 

4 ‘‘(ii) serves the Indian Tribe in which 

5 the recipient is enrolled. 

6 ‘‘(3) PRIORITY WHEN MAKING ASSIGNMENTS.— 

7 Subject to paragraph (2), the Secretary, in making 

8 assignments of Indian Health Scholarship recipients 

9 required to meet the active duty service obligation 

10 described in paragraph (1), shall give priority to as11 signing individuals to service in those programs 

12 specified in paragraph (1) that have a need for 

13 health professionals to provide health care services 

14 as a result of individuals having breached contracts 

15 entered into under this section. 

16 ‘‘(c) PART-TIME STUDENTS.—In the case of an indi17 vidual receiving a scholarship under this section who is 

18 enrolled part time in an approved course of study— 

19 ‘‘(1) such scholarship shall be for a period of 

20 years not to exceed the part-time equivalent of 4 

21 years, as determined by the Area Office; 

22 ‘‘(2) the period of obligated service described in 

23 subsection (b)(1) shall be equal to the greater of— 

24 ‘‘(A) the part-time equivalent of 1 year for 

25 each year for which the individual was provided 


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1 a scholarship (as determined by the Area Of2 fice); or 

3 ‘‘(B) 2 years; and 

4 ‘‘(3) the amount of the monthly stipend speci5 fied in section 338A(g)(1)(B) of the Public Health 

6 Service Act (42 U.S.C. 254l(g)(1)(B)) shall be re7 duced pro rata (as determined by the Secretary) 

8 based on the number of hours such student is en9 rolled. 

10 ‘‘(d) BREACH OF CONTRACT.— 

11 ‘‘(1) SPECIFIED BREACHES.—An individual 

12 shall be liable to the United States for the amount 

13 which has been paid to the individual, or on behalf 

14 of the individual, under a contract entered into with 

15 the Secretary under this section on or after the date 

16 of enactment of the Indian Health Care Improve17 ment Act Amendments of 2006 if that individual— 

18 ‘‘(A) fails to maintain an acceptable level 

19 of academic standing in the educational institu20 tion in which he or she is enrolled (such level 

21 determined by the educational institution under 

22 regulations of the Secretary); 

23 ‘‘(B) is dismissed from such educational 

24 institution for disciplinary reasons; 


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1 ‘‘(C) voluntarily terminates the training in 

2 such an educational institution for which he or 

3 she is provided a scholarship under such con4 tract before the completion of such training; or 

5 ‘‘(D) fails to accept payment, or instructs 

6 the educational institution in which he or she is 

7 enrolled not to accept payment, in whole or in 

8 part, of a scholarship under such contract, in 

9 lieu of any service obligation arising under such 

10 contract. 

11 ‘‘(2) OTHER BREACHES.—If for any reason not 

12 specified in paragraph (1) an individual breaches a 

13 written contract by failing either to begin such indi14 vidual’s service obligation required under such con15 tract or to complete such service obligation, the 

16 United States shall be entitled to recover from the 

17 individual an amount determined in accordance with 

18 the formula specified in subsection (l) of section 110 

19 in the manner provided for in such subsection. 

20 ‘‘(3) CANCELLATION UPON DEATH OF RECIPI21 ENT.—Upon the death of an individual who receives 

22 an Indian Health Scholarship, any outstanding obli23 gation of that individual for service or payment that 

24 relates to that scholarship shall be canceled. 

25 ‘‘(4) WAIVERS AND SUSPENSIONS.— 


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1 ‘‘(A) IN GENERAL.—The Secretary shall 

2 provide for the partial or total waiver or sus3 pension of any obligation of service or payment 

4 of a recipient of an Indian Health Scholarship 

5 if the Secretary, in consultation with the af6 fected Area Office, Indian Tribes, Tribal Orga7 nizations, and Urban Indian Organizations, de8 termines that— 

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

10 to meet that obligation or make that pay11 ment; 

12 ‘‘(ii) requiring that recipient to meet 

13 that obligation or make that payment 

14 would result in extreme hardship to the re15 cipient; or 

16 ‘‘(iii) the enforcement of the require17 ment to meet the obligation or make the 

18 payment would be unconscionable. 

19 ‘‘(B) FACTORS FOR CONSIDERATION.—Be20 fore waiving or suspending an obligation of 

21 service or payment under subparagraph (A), the 

22 Secretary may take into consideration whether 

23 the obligation may be satisfied in a teaching ca24 pacity at a tribal college or university nursing 

25 program under subsection (b)(1)(D). 


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1 ‘‘(5) EXTREME HARDSHIP.—Notwithstanding 

2 any other provision of law, in any case of extreme 

3 hardship or for other good cause shown, the Sec4 retary may waive, in whole or in part, the right of 

5 the United States to recover funds made available 

6 under this section. 

7 ‘‘(6) BANKRUPTCY.—Notwithstanding any 

8 other provision of law, with respect to a recipient of 

9 an Indian Health Scholarship, no obligation for pay10 ment may be released by a discharge in bankruptcy 

11 under title 11, United States Code, unless that dis12 charge is granted after the expiration of the 5-year 

13 period beginning on the initial date on which that 

14 payment is due, and only if the bankruptcy court 

15 finds that the nondischarge of the obligation would 

16 be unconscionable. 

17 ‘‘SEC. 105. AMERICAN INDIANS INTO PSYCHOLOGY PRO18 GRAM. 

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

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

21 $300,000 to each of 9 colleges and universities for the pur22 pose of developing and maintaining Indian psychology ca23 reer recruitment programs as a means of encouraging In24 dians to enter the behavioral health field. These programs 

25 shall be located at various locations throughout the counVerDate Aug 31 2005 03:45 May 16, 2006 Jkt 049200 PO 00000 Frm 00029 Fmt 6652 Sfmt 6201 E:\BILLS\H5312.IH H5312

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1 try to maximize their availability to Indian students and 

2 new programs shall be established in different locations 

3 from time to time. 

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

5 Secretary shall provide a grant authorized under sub6 section (a) to develop and maintain a program at the Uni7 versity of North Dakota to be known as the ‘Quentin N. 

8 Burdick American Indians Into Psychology Program’. 

9 Such program shall, to the maximum extent feasible, co10 ordinate with the Quentin N. Burdick Indian Health Pro11 grams authorized under section 117(b), the Quentin N. 

12 Burdick American Indians Into Nursing Program author13 ized under section 115(e), and existing university research 

14 and communications networks. 

15 ‘‘(c) REGULATIONS.—The Secretary shall issue regu16 lations pursuant to this Act for the competitive awarding 

17 of grants provided under this section. 

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

19 section shall agree to provide a program which, at a min20 imum— 

21 ‘‘(1) provides outreach and recruitment for 

22 health professions to Indian communities including 

23 elementary, secondary, and accredited and accessible 

24 community colleges that will be served by the pro25 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 of this 

3 Act; or 

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

5 determined by the Secretary, in accordance with 

6 guidelines promulgated by the Secretary, such prac7 tice is situated in a physician or other health profes8 sional shortage area and addresses the health care 

9 needs of a substantial number of Indians. 

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

11 is authorized to be appropriated to carry out this section 

12 $2,700,000 for each of fiscal years 2006 through 2015. 

13 ‘‘SEC. 106. SCHOLARSHIP PROGRAMS FOR INDIAN TRIBES. 

14 ‘‘(a) IN GENERAL.— 

15 ‘‘(1) GRANTS AUTHORIZED.—The Secretary, 

16 acting through the Service, shall make grants to 

17 Tribal Health Programs for the purpose of providing 

18 scholarships for Indians to serve as health profes19 sionals in Indian communities. 

20 ‘‘(2) AMOUNT.—Amounts available under para21 graph (1) for any fiscal year shall not exceed 5 per22 cent of the amounts available for each fiscal year for 

23 Indian Health Scholarships under section 104. 

24 ‘‘(3) APPLICATION.—An application for a grant 

25 under paragraph (1) shall be in such form and conVerDate Aug 31 2005 03:45 May 16, 2006 Jkt 049200 PO 00000 Frm 00032 Fmt 6652 Sfmt 6201 E:\BILLS\H5312.IH H5312

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1 tain such agreements, assurances, and information 

2 as consistent with this section. 

3 ‘‘(b) REQUIREMENTS.— 

4 ‘‘(1) IN GENERAL.—A Tribal Health Program 

5 receiving a grant under subsection (a) shall provide 

6 scholarships to Indians in accordance with the re7 quirements of this section. 

8 ‘‘(2) COSTS.—With respect to costs of providing 

9 any scholarship pursuant to subsection (a)— 

10 ‘‘(A) 80 percent of the costs of the scholar11 ship shall be paid from the funds made avail12 able pursuant to subsection (a)(1) provided to 

13 the Tribal Health Program; and 

14 ‘‘(B) 20 percent of such costs may be paid 

15 from any other source of funds. 

16 ‘‘(c) COURSE OF STUDY.—A Tribal Health Program 

17 shall provide scholarships under this section only to Indi18 ans enrolled or accepted for enrollment in a course of 

19 study (approved by the Secretary) in 1 of the health pro20 fessions contemplated by this Act. 

21 ‘‘(d) CONTRACT.—In providing scholarships under 

22 subsection (b), the Secretary and the Tribal Health Pro23 gram shall enter into a written contract with each recipi24 ent of such scholarship. Such contract shall— 


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1 ‘‘(1) obligate such recipient to provide service in 

2 an Indian Health Program or Urban Indian Organi3 zation, in the same Service Area where the Tribal 

4 Health Program providing the scholarship is located, 

5 for— 

6 ‘‘(A) a number of years for which the 

7 scholarship is provided (or the part-time equiva8 lent thereof, as determined by the Secretary), 

9 or for a period of 2 years, whichever period is 

10 greater; or 

11 ‘‘(B) such greater period of time as the re12 cipient and the Tribal Health Program may 

13 agree; 

14 ‘‘(2) provide that the amount of the scholar15 ship— 

16 ‘‘(A) may only be expended for— 

17 ‘‘(i) tuition expenses, other reasonable 

18 educational expenses, and reasonable living 

19 expenses incurred in attendance at the 

20 educational institution; and 

21 ‘‘(ii) payment to the recipient of a 

22 monthly stipend of not more than the 

23 amount authorized by section 338(g)(1)(B) 

24 of the Public Health Service Act (42 

25 U.S.C. 254m(g)(1)(B)), with such amount 


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1 to be reduced pro rata (as determined by 

2 the Secretary) based on the number of 

3 hours such student is enrolled, and not to 

4 exceed, for any year of attendance for 

5 which the scholarship is provided, the total 

6 amount required for the year for the pur7 poses authorized in this clause; and 

8 ‘‘(B) may not exceed, for any year of at9 tendance for which the scholarship is provided, 

10 the total amount required for the year for the 

11 purposes authorized in subparagraph (A); 

12 ‘‘(3) require the recipient of such scholarship to 

13 maintain an acceptable level of academic standing as 

14 determined by the educational institution in accord15 ance with regulations issued pursuant to this Act; 

16 and 

17 ‘‘(4) require the recipient of such scholarship to 

18 meet the educational and licensure requirements ap19 propriate to each health profession. 

20 ‘‘(e) BREACH OF CONTRACT.— 

21 ‘‘(1) SPECIFIC BREACHES.—An individual who 

22 has entered into a written contract with the Sec23 retary and a Tribal Health Program under sub24 section (d) shall be liable to the United States for 

25 the Federal share of the amount which has been 


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1 paid to him or her, or on his or her behalf, under 

2 the contract if that individual— 

3 ‘‘(A) fails to maintain an acceptable level 

4 of academic standing in the educational institu5 tion in which he or she is enrolled (such level 

6 as determined by the educational institution 

7 under regulations of the Secretary); 

8 ‘‘(B) is dismissed from such educational 

9 institution for disciplinary reasons; 

10 ‘‘(C) voluntarily terminates the training in 

11 such an educational institution for which he or 

12 she is provided a scholarship under such con13 tract before the completion of such training; or 

14 ‘‘(D) fails to accept payment, or instructs 

15 the educational institution in which he or she is 

16 enrolled not to accept payment, in whole or in 

17 part, of a scholarship under such contract, in 

18 lieu of any service obligation arising under such 

19 contract. 

20 ‘‘(2) OTHER BREACHES.—If for any reason not 

21 specified in paragraph (1), an individual breaches a 

22 written contract by failing to either begin such indi23 vidual’s service obligation required under such con24 tract or to complete such service obligation, the 

25 United States shall be entitled to recover from the 


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1 individual an amount determined in accordance with 

2 the formula specified in subsection (l) of section 110 

3 in the manner provided for in such subsection. 

4 ‘‘(3) CANCELLATION UPON DEATH OF RECIPI5 ENT.—Upon the death of an individual who receives 

6 an Indian Health Scholarship, any outstanding obli7 gation of that individual for service or payment that 

8 relates to that scholarship shall be canceled. 

9 ‘‘(4) INFORMATION.—The Secretary may carry 

10 out this subsection on the basis of information re11 ceived from Tribal Health Programs involved or on 

12 the basis of information collected through such other 

13 means as the Secretary deems appropriate. 

14 ‘‘(f) RELATION TO SOCIAL SECURITY ACT.—The re15 cipient of a scholarship under this section shall agree, in 

16 providing health care pursuant to the requirements here17 in— 

18 ‘‘(1) not to discriminate against an individual 

19 seeking care on the basis of the ability of the indi20 vidual to pay for such care or on the basis that pay21 ment for such care will be made pursuant to a pro22 gram established in title XVIII of the Social Secu23 rity Act or pursuant to the programs established in 

24 title XIX or title XXI of such Act; and 


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1 ‘‘(2) to accept assignment under section 

2 1842(b)(3)(B)(ii) of the Social Security Act for all 

3 services for which payment may be made under part 

4 B of title XVIII of such Act, and to enter into an 

5 appropriate agreement with the State agency that 

6 administers the State plan for medical assistance 

7 under title XIX, or the State child health plan under 

8 title XXI, of such Act to provide service to individ9 uals entitled to medical assistance or child health as10 sistance, respectively, under the plan. 

11 ‘‘(g) CONTINUANCE OF FUNDING.—The Secretary 

12 shall make payments under this section to a Tribal Health 

13 Program for any fiscal year subsequent to the first fiscal 

14 year of such payments unless the Secretary determines 

15 that, for the immediately preceding fiscal year, the Tribal 

16 Health Program has not complied with the requirements 

17 of this section. 

18 ‘‘SEC. 107. INDIAN HEALTH SERVICE EXTERN PROGRAMS. 

19 ‘‘(a) EMPLOYMENT PREFERENCE.—Any individual 

20 who receives a scholarship pursuant to section 104 or 106 

21 shall be given preference for employment in the Service, 

22 or may be employed by a Tribal Health Program or an 

23 Urban Indian Organization, or other agencies of the De24 partment as available, during any nonacademic period of 

25 the year. 


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1 ‘‘(b) NOT COUNTED TOWARD ACTIVE DUTY SERVICE

2 OBLIGATION.—Periods of employment pursuant to this 

3 subsection shall not be counted in determining fulfillment 

4 of the service obligation incurred as a condition of the 

5 scholarship. 

6 ‘‘(c) TIMING; LENGTH OF EMPLOYMENT.—Any indi7 vidual enrolled in a program, including a high school pro8 gram, authorized under section 102(a) may be employed 

9 by the Service or by a Tribal Health Program or an Urban 

10 Indian Organization during any nonacademic period of the 

11 year. Any such employment shall not exceed 120 days dur12 ing any calendar year. 

13 ‘‘(d) NONAPPLICABILITY OF COMPETITIVE PER14 SONNEL SYSTEM.—Any employment pursuant to this sec15 tion shall be made without regard to any competitive per16 sonnel system or agency personnel limitation and to a po17 sition which will enable the individual so employed to re18 ceive practical experience in the health profession in which 

19 he or she is engaged in study. Any individual so employed 

20 shall receive payment for his or her services comparable 

21 to the salary he or she would receive if he or she were 

22 employed in the competitive system. Any individual so em23 ployed shall not be counted against any employment ceil24 ing affecting the Service or the Department. 


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1 ‘‘SEC. 108. CONTINUING EDUCATION ALLOWANCES. 

2 ‘‘In order to encourage health professionals, including 

3 community health representatives and emergency medical 

4 technicians, to join or continue in an Indian Health Pro5 gram or an Urban Indian Organization and to provide 

6 their services in the rural and remote areas where a sig7 nificant portion of Indians reside, the Secretary, acting 

8 through the Service, may provide allowances to health pro9 fessionals employed in an Indian Health Program or an 

10 Urban Indian Organization to enable them for a period 

11 of time each year prescribed by regulation of the Secretary 

12 to take leave of their duty stations for professional con13 sultation and refresher training courses. 

14 ‘‘SEC. 109. COMMUNITY HEALTH REPRESENTATIVE PRO15 GRAM. 

16 ‘‘(a) IN GENERAL.—Under the authority of the Act 

17 of November 2, 1921 (25 U.S.C. 13) (commonly known 

18 as the ‘Snyder Act’), the Secretary, acting through the 

19 Service, shall maintain a Community Health Representa20 tive Program under which Indian Health Programs— 

21 ‘‘(1) provide for the training of Indians as com22 munity health representatives; and 

23 ‘‘(2) use such community health representatives 

24 in the provision of health care, health promotion, 

25 and disease prevention services to Indian commu26 nities. 


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1 ‘‘(b) DUTIES.—The Community Health Representa2 tive Program of the Service, shall— 

3 ‘‘(1) provide a high standard of training for 

4 community health representatives to ensure that the 

5 community health representatives provide quality 

6 health care, health promotion, and disease preven7 tion services to the Indian communities served by 

8 the Program; 

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

10 and maintain a curriculum that— 

11 ‘‘(A) combines education in the theory of 

12 health care with supervised practical experience 

13 in the provision of health care; and 

14 ‘‘(B) provides instruction and practical ex15 perience in health promotion and disease pre16 vention activities, with appropriate consider17 ation given to lifestyle factors that have an im18 pact on Indian health status, such as alco19 holism, family dysfunction, and poverty; 

20 ‘‘(3) maintain a system which identifies the 

21 needs of community health representatives for con22 tinuing education in health care, health promotion, 

23 and disease prevention and develop programs that 

24 meet the needs for continuing education; 


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1 ‘‘(4) maintain a system that provides close su2 pervision of Community Health Representatives; 

3 ‘‘(5) maintain a system under which the work 

4 of Community Health Representatives is reviewed 

5 and evaluated; and 

6 ‘‘(6) promote traditional health care practices 

7 of the Indian Tribes served consistent with the Serv8 ice standards for the provision of health care, health 

9 promotion, and disease prevention. 

10 ‘‘SEC. 110. INDIAN HEALTH SERVICE LOAN REPAYMENT 

11 PROGRAM. 

12 ‘‘(a) ESTABLISHMENT.—The Secretary, acting 

13 through the Service, shall establish and administer a pro14 gram to be known as the Service Loan Repayment Pro15 gram (hereinafter referred to as the ‘Loan Repayment 

16 Program’) in order to ensure an adequate supply of 

17 trained health professionals necessary to maintain accredi18 tation of, and provide health care services to Indians 

19 through, Indian Health Programs and Urban Indian Or20 ganizations. 

21 ‘‘(b) ELIGIBLE INDIVIDUALS.—To be eligible to par22 ticipate in the Loan Repayment Program, an individual 

23 must— 

24 ‘‘(1)(A) be enrolled— 


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1 ‘‘(i) in a course of study or program in an 

2 accredited educational institution (as deter3 mined by the Secretary under section 

4 338B(b)(1)(c)(i) of the Public Health Service 

5 Act (42 U.S.C. 254l–1(b)(1)(c)(i))) and be 

6 scheduled to complete such course of study in 

7 the same year such individual applies to partici8 pate in such program; or 

9 ‘‘(ii) in an approved graduate training pro10 gram in a health profession; or 

11 ‘‘(B) have— 

12 ‘‘(i) a degree in a health profession; and 

13 ‘‘(ii) a license to practice a health profes14 sion; 

15 ‘‘(2)(A) be eligible for, or hold, an appointment 

16 as a commissioned officer in the Regular or Reserve 

17 Corps of the Public Health Service; 

18 ‘‘(B) be eligible for selection for civilian service 

19 in the Regular or Reserve Corps of the Public 

20 Health Service; 

21 ‘‘(C) meet the professional standards for civil 

22 service employment in the Service; or 

23 ‘‘(D) be employed in an Indian Health Program 

24 or Urban Indian Organization without a service obli25 gation; and 


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1 ‘‘(3) submit to the Secretary an application for 

2 a contract described in subsection (e). 

3 ‘‘(c) APPLICATION.— 

4 ‘‘(1) INFORMATION TO BE INCLUDED WITH

5 FORMS.—In disseminating application forms and 

6 contract forms to individuals desiring to participate 

7 in the Loan Repayment Program, the Secretary 

8 shall include with such forms a fair summary of the 

9 rights and liabilities of an individual whose applica10 tion is approved (and whose contract is accepted) by 

11 the Secretary, including in the summary a clear ex12 planation of the damages to which the United States 

13 is entitled under subsection (l) in the case of the in14 dividual’s breach of contract. The Secretary shall 

15 provide such individuals with sufficient information 

16 regarding the advantages and disadvantages of serv17 ice as a commissioned officer in the Regular or Re18 serve Corps of the Public Health Service or a civil19 ian employee of the Service to enable the individual 

20 to make a decision on an informed basis. 

21 ‘‘(2) CLEAR LANGUAGE.—The application form, 

22 contract form, and all other information furnished 

23 by the Secretary under this section shall be written 

24 in a manner calculated to be understood by the averVerDate Aug 31 2005 03:45 May 16, 2006 Jkt 049200 PO 00000 Frm 00044 Fmt 6652 Sfmt 6201 E:\BILLS\H5312.IH H5312

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1 age individual applying to participate in the Loan 

2 Repayment Program. 

3 ‘‘(3) TIMELY AVAILABILITY OF FORMS.—The 

4 Secretary shall make such application forms, con5 tract forms, and other information available to indi6 viduals desiring to participate in the Loan Repay7 ment Program on a date sufficiently early to ensure 

8 that such individuals have adequate time to carefully 

9 review and evaluate such forms and information. 

10 ‘‘(d) PRIORITIES.— 

11 ‘‘(1) LIST.—Consistent with subsection (k), the 

12 Secretary shall annually— 

13 ‘‘(A) identify the positions in each Indian 

14 Health Program or Urban Indian Organization 

15 for which there is a need or a vacancy; and 

16 ‘‘(B) rank those positions in order of pri17 ority. 

18 ‘‘(2) APPROVALS.—Notwithstanding the pri19 ority determined under paragraph (1), the Secretary, 

20 in determining which applications under the Loan 

21 Repayment Program to approve (and which con22 tracts to accept), shall— 

23 ‘‘(A) give first priority to applications 

24 made by individual Indians; and 


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1 ‘‘(B) after making determinations on all 

2 applications submitted by individual Indians as 

3 required under subparagraph (A), give priority 

4 to— 

5 ‘‘(i) individuals recruited through the 

6 efforts of an Indian Health Program or 

7 Urban Indian Organization; and 

8 ‘‘(ii) other individuals based on the 

9 priority rankings under paragraph (1). 

10 ‘‘(e) RECIPIENT CONTRACTS.— 

11 ‘‘(1) CONTRACT REQUIRED.—An individual be12 comes a participant in the Loan Repayment Pro13 gram only upon the Secretary and the individual en14 tering into a written contract described in paragraph 

15 (2). 

16 ‘‘(2) CONTENTS OF CONTRACT.—The written 

17 contract referred to in this section between the Sec18 retary and an individual shall contain— 

19 ‘‘(A) an agreement under which— 

20 ‘‘(i) subject to subparagraph (C), the 

21 Secretary agrees— 

22 ‘‘(I) to pay loans on behalf of the 

23 individual in accordance with the pro24 visions of this section; and 


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1 ‘‘(II) to accept (subject to the 

2 availability of appropriated funds for 

3 carrying out this section) the indi4 vidual into the Service or place the in5 dividual with a Tribal Health Pro6 gram or Urban Indian Organization 

7 as provided in clause (ii)(III); and 

8 ‘‘(ii) subject to subparagraph (C), the 

9 individual agrees— 

10 ‘‘(I) to accept loan payments on 

11 behalf of the individual; 

12 ‘‘(II) in the case of an individual 

13 described in subsection (b)(1)— 

14 ‘‘(aa) to maintain enrollment 

15 in a course of study or training 

16 described in subsection (b)(1)(A) 

17 until the individual completes the 

18 course of study or training; and 

19 ‘‘(bb) while enrolled in such 

20 course of study or training, to 

21 maintain an acceptable level of 

22 academic standing (as deter23 mined under regulations of the 

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1 stitution offering such course of 

2 study or training); and 

3 ‘‘(III) to serve for a time period 

4 (hereinafter in this section referred to 

5 as the ‘period of obligated service’) 

6 equal to 2 years or such longer period 

7 as the individual may agree to serve 

8 in the full-time clinical practice of 

9 such individual’s profession in an In10 dian Health Program or Urban In11 dian Organization to which the indi12 vidual may be assigned by the Sec13 retary; 

14 ‘‘(B) a provision permitting the Secretary 

15 to extend for such longer additional periods, as 

16 the individual may agree to, the period of obli17 gated service agreed to by the individual under 

18 subparagraph (A)(ii)(III); 

19 ‘‘(C) a provision that any financial obliga20 tion of the United States arising out of a con21 tract entered into under this section and any 

22 obligation of the individual which is conditioned 

23 thereon is contingent upon funds being appro24 priated for loan repayments under this section; 


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1 ‘‘(D) a statement of the damages to which 

2 the United States is entitled under subsection 

3 (l) for the individual’s breach of the contract; 

4 and 

5 ‘‘(E) such other statements of the rights 

6 and liabilities of the Secretary and of the indi7 vidual, not inconsistent with this section. 

8 ‘‘(f) DEADLINE FOR DECISION ON APPLICATION.— 

9 The Secretary shall provide written notice to an individual 

10 within 21 days on— 

11 ‘‘(1) the Secretary’s approving, under sub12 section (e)(1), of the individual’s participation in the 

13 Loan Repayment Program, including extensions re14 sulting in an aggregate period of obligated service in 

15 excess of 4 years; or 

16 ‘‘(2) the Secretary’s disapproving an individ17 ual’s participation in such Program. 

18 ‘‘(g) PAYMENTS.— 

19 ‘‘(1) IN GENERAL.—A loan repayment provided 

20 for an individual under a written contract under the 

21 Loan Repayment Program shall consist of payment, 

22 in accordance with paragraph (2), on behalf of the 

23 individual of the principal, interest, and related ex24 penses on government and commercial loans received 

25 by the individual regarding the undergraduate or 


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1 graduate education of the individual (or both), which 

2 loans were made for— 

3 ‘‘(A) tuition expenses; 

4 ‘‘(B) all other reasonable educational ex5 penses, including fees, books, and laboratory ex6 penses, incurred by the individual; and 

7 ‘‘(C) reasonable living expenses as deter8 mined by the Secretary. 

9 ‘‘(2) AMOUNT.—For each year of obligated 

10 service that an individual contracts to serve under 

11 subsection (e), the Secretary may pay up to $35,000 

12 or an amount equal to the amount specified in sec13 tion 338B(g)(2)(A) of the Public Health Service 

14 Act, whichever is more, on behalf of the individual 

15 for loans described in paragraph (1). In making a 

16 determination of the amount to pay for a year of 

17 such service by an individual, the Secretary shall 

18 consider the extent to which each such determina19 tion— 

20 ‘‘(A) affects the ability of the Secretary to 

21 maximize the number of contracts that can be 

22 provided under the Loan Repayment Program 

23 from the amounts appropriated for such con24 tracts; 


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1 ‘‘(B) provides an incentive to serve in In2 dian Health Programs and Urban Indian Orga3 nizations with the greatest shortages of health 

4 professionals; and 

5 ‘‘(C) provides an incentive with respect to 

6 the health professional involved remaining in an 

7 Indian Health Program or Urban Indian Orga8 nization with such a health professional short9 age, and continuing to provide primary health 

10 services, after the completion of the period of 

11 obligated service under the Loan Repayment 

12 Program. 

13 ‘‘(3) TIMING.—Any arrangement made by the 

14 Secretary for the making of loan repayments in ac15 cordance with this subsection shall provide that any 

16 repayments for a year of obligated service shall be 

17 made no later than the end of the fiscal year in 

18 which the individual completes such year of service. 

19 ‘‘(4) REIMBURSEMENTS FOR TAX LIABILITY.— 

20 For the purpose of providing reimbursements for tax 

21 liability resulting from a payment under paragraph 

22 (2) on behalf of an individual, the Secretary— 

23 ‘‘(A) in addition to such payments, may 

24 make payments to the individual in an amount 

25 equal to not less than 20 percent and not more 


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1 than 39 percent of the total amount of loan re2 payments made for the taxable year involved; 

3 and 

4 ‘‘(B) may make such additional payments 

5 as the Secretary determines to be appropriate 

6 with respect to such purpose. 

7 ‘‘(5) PAYMENT SCHEDULE.—The Secretary 

8 may enter into an agreement with the holder of any 

9 loan for which payments are made under the Loan 

10 Repayment Program to establish a schedule for the 

11 making of such payments. 

12 ‘‘(h) EMPLOYMENT CEILING.—Notwithstanding any 

13 other provision of law, individuals who have entered into 

14 written contracts with the Secretary under this section 

15 shall not be counted against any employment ceiling af16 fecting the Department while those individuals are under17 going academic training. 

18 ‘‘(i) RECRUITMENT.—The Secretary shall conduct re19 cruiting programs for the Loan Repayment Program and 

20 other manpower programs of the Service at educational 

21 institutions training health professionals or specialists 

22 identified in subsection (a). 

23 ‘‘(j) APPLICABILITY OF LAW.—Section 214 of the 

24 Public Health Service Act (42 U.S.C. 215) shall not apply 


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1 to individuals during their period of obligated service 

2 under the Loan Repayment Program. 

3 ‘‘(k) ASSIGNMENT OF INDIVIDUALS.—The Secretary, 

4 in assigning individuals to serve in Indian Health Pro5 grams or Urban Indian Organizations pursuant to con6 tracts entered into under this section, shall— 

7 ‘‘(1) ensure that the staffing needs of Tribal 

8 Health Programs and Urban Indian Organizations 

9 receive consideration on an equal basis with pro10 grams that are administered directly by the Service; 

11 and 

12 ‘‘(2) give priority to assigning individuals to In13 dian Health Programs and Urban Indian Organiza14 tions that have a need for health professionals to 

15 provide health care services as a result of individuals 

16 having breached contracts entered into under this 

17 section. 

18 ‘‘(l) BREACH OF CONTRACT.— 

19 ‘‘(1) SPECIFIC BREACHES.—An individual who 

20 has entered into a written contract with the Sec21 retary under this section and has not received a 

22 waiver under subsection (m) shall be liable, in lieu 

23 of any service obligation arising under such contract, 

24 to the United States for the amount which has been 


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1 paid on such individual’s behalf under the contract 

2 if that individual— 

3 ‘‘(A) is enrolled in the final year of a 

4 course of study and— 

5 ‘‘(i) fails to maintain an acceptable 

6 level of academic standing in the edu7 cational institution in which he or she is 

8 enrolled (such level determined by the edu9 cational institution under regulations of 

10 the Secretary); 

11 ‘‘(ii) voluntarily terminates such en12 rollment; or 

13 ‘‘(iii) is dismissed from such edu14 cational institution before completion of 

15 such course of study; or 

16 ‘‘(B) is enrolled in a graduate training pro17 gram and fails to complete such training pro18 gram. 

19 ‘‘(2) OTHER BREACHES; FORMULAFOR

20 AMOUNT OWED.—If, for any reason not specified in 

21 paragraph (1), an individual breaches his or her 

22 written contract under this section by failing either 

23 to begin, or complete, such individual’s period of ob24 ligated service in accordance with subsection (e)(2), 

25 the United States shall be entitled to recover from 


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1 such individual an amount to be determined in ac2 cordance with the following formula: A=3Z(t¥s/t) 

3 in which— 

4 ‘‘(A) ‘A’ is the amount the United States 

5 is entitled to recover; 

6 ‘‘(B) ‘Z’ is the sum of the amounts paid 

7 under this section to, or on behalf of, the indi8 vidual and the interest on such amounts which 

9 would be payable if, at the time the amounts 

10 were paid, they were loans bearing interest at 

11 the maximum legal prevailing rate, as deter12 mined by the Secretary of the Treasury; 

13 ‘‘(C) ‘t’ is the total number of months in 

14 the individual’s period of obligated service in 

15 accordance with subsection (f); and 

16 ‘‘(D) ‘s’ is the number of months of such 

17 period served by such individual in accordance 

18 with this section. 

19 ‘‘(3) DEDUCTIONS IN MEDICARE PAYMENTS.— 

20 Amounts not paid within such period shall be sub21 ject to collection through deductions in medicare 

22 payments pursuant to section 1892 of the Social Se23 curity Act. 

24 ‘‘(4) TIME PERIOD FOR REPAYMENT.—Any 

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1 tled to recover under this subsection shall be paid to 

2 the United States within the 1-year period beginning 

3 on the date of the breach or such longer period be4 ginning on such date as shall be specified by the 

5 Secretary. 

6 ‘‘(5) RECOVERY OF DELINQUENCY.— 

7 ‘‘(A) IN GENERAL.—If damages described 

8 in paragraph (4) are delinquent for 3 months, 

9 the Secretary shall, for the purpose of recov10 ering such damages— 

11 ‘‘(i) use collection agencies contracted 

12 with by the Administrator of General Serv13 ices; or 

14 ‘‘(ii) enter into contracts for the re15 covery of such damages with collection 

16 agencies selected by the Secretary. 

17 ‘‘(B) REPORT.—Each contract for recov18 ering damages pursuant to this subsection shall 

19 provide that the contractor will, not less than 

20 once each 6 months, submit to the Secretary a 

21 status report on the success of the contractor in 

22 collecting such damages. Section 3718 of title 

23 31, United States Code, shall apply to any such 

24 contract to the extent not inconsistent with this 

25 subsection. 


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1 ‘‘(m) WAIVER OR SUSPENSION OF OBLIGATION.— 

2 ‘‘(1) IN GENERAL.—The Secretary shall by reg3 ulation provide for the partial or total waiver or sus4 pension of any obligation of service or payment by 

5 an individual under the Loan Repayment Program 

6 whenever compliance by the individual is impossible 

7 or would involve extreme hardship to the individual 

8 and if enforcement of such obligation with respect to 

9 any individual would be unconscionable. 

10 ‘‘(2) CANCELED UPON DEATH.—Any obligation 

11 of an individual under the Loan Repayment Pro12 gram for service or payment of damages shall be 

13 canceled upon the death of the individual. 

14 ‘‘(3) HARDSHIP WAIVER.—The Secretary may 

15 waive, in whole or in part, the rights of the United 

16 States to recover amounts under this section in any 

17 case of extreme hardship or other good cause shown, 

18 as determined by the Secretary. 

19 ‘‘(4) BANKRUPTCY.—Any obligation of an indi20 vidual under the Loan Repayment Program for pay21 ment of damages may be released by a discharge in 

22 bankruptcy under title 11 of the United States Code 

23 only if such discharge is granted after the expiration 

24 of the 5-year period beginning on the first date that 

25 payment of such damages is required, and only if 


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•HR 5312 IH

1 the bankruptcy court finds that nondischarge of the 

2 obligation would be unconscionable. 

3 ‘‘(n) REPORT.—The Secretary shall submit to the 

4 President, for inclusion in the report required to be sub5 mitted to Congress under section 801, a report concerning 

6 the previous fiscal year which sets forth by Service Area 

7 the following: 

8 ‘‘(1) A list of the health professional positions 

9 maintained by Indian Health Programs and Urban 

10 Indian Organizations for which recruitment or reten11 tion is difficult. 

12 ‘‘(2) The number of Loan Repayment Program 

13 applications filed with respect to each type of health 

14 profession. 

15 ‘‘(3) The number of contracts described in sub16 section (e) that are entered into with respect to each 

17 health profession. 

18 ‘‘(4) The amount of loan payments made under 

19 this section, in total and by health profession. 

20 ‘‘(5) The number of scholarships that are pro21 vided under sections 104 and 106 with respect to 

22 each health profession. 

23 ‘‘(6) The amount of scholarship grants provided 

24 under section 104 and 106, in total and by health 

25 profession. 


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1 ‘‘(7) The number of providers of health care 

2 that will be needed by Indian Health Programs and 

3 Urban Indian Organizations, by location and profes4 sion, during the 3 fiscal years beginning after the 

5 date the report is filed. 

6 ‘‘(8) The measures the Secretary plans to take 

7 to fill the health professional positions maintained 

8 by Indian Health Programs or Urban Indian Orga9 nizations for which recruitment or retention is dif10 ficult. 

11 ‘‘SEC. 111. SCHOLARSHIP AND LOAN REPAYMENT RECOV12 ERY FUND. 

13 ‘‘(a) ESTABLISHMENT.—There is established in the 

14 Treasury of the United States a fund to be known as the 

15 Indian Health Scholarship and Loan Repayment Recovery 

16 Fund (hereafter in this section referred to as the ‘LRRF’). 

17 The LRRF shall consist of such amounts as may be col18 lected from individuals under section 104(d), section 

19 106(e), and section 110(l) for breach of contract, such 

20 funds as may be appropriated to the LRRF, and interest 

21 earned on amounts in the LRRF. All amounts collected, 

22 appropriated, or earned relative to the LRRF shall remain 

23 available until expended. 

24 ‘‘(b) USE OF FUNDS.— 


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1 ‘‘(1) BY SECRETARY.—Amounts in the LRRF 

2 may be expended by the Secretary, acting through 

3 the Service, to make payments to an Indian Health 

4 Program— 

5 ‘‘(A) to which a scholarship recipient under 

6 section 104 and 106 or a loan repayment pro7 gram participant under section 110 has been 

8 assigned to meet the obligated service require9 ments pursuant to such sections; and 

10 ‘‘(B) that has a need for a health profes11 sional to provide health care services as a result 

12 of such recipient or participant having breached 

13 the contract entered into under section 104, 

14 106, or section 110. 

15 ‘‘(2) BY TRIBAL HEALTH PROGRAMS.—A Tribal 

16 Health Program receiving payments pursuant to 

17 paragraph (1) may expend the payments to provide 

18 scholarships or recruit and employ, directly or by 

19 contract, health professionals to provide health care 

20 services. 

21 ‘‘(c) INVESTMENT OF FUNDS.—The Secretary of the 

22 Treasury shall invest such amounts of the LRRF as the 

23 Secretary of Health and Human Services determines are 

24 not required to meet current withdrawals from the LRRF. 

25 Such investments may be made only in interest bearing 


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1 obligations of the United States. For such purpose, such 

2 obligations may be acquired on original issue at the issue 

3 price, or by purchase of outstanding obligations at the 

4 market price. 

5 ‘‘(d) SALE OF OBLIGATIONS.—Any obligation ac6 quired by the LRRF may be sold by the Secretary of the 

7 Treasury at the market price. 

8 ‘‘SEC. 112. RECRUITMENT ACTIVITIES. 

9 ‘‘(a) REIMBURSEMENT FOR TRAVEL.—The Sec10 retary, acting through the Service, may reimburse health 

11 professionals seeking positions with Indian Health Pro12 grams or Urban Indian Organizations, including individ13 uals considering entering into a contract under section 

14 110 and their spouses, for actual and reasonable expenses 

15 incurred in traveling to and from their places of residence 

16 to an area in which they may be assigned for the purpose 

17 of evaluating such area with respect to such assignment. 

18 ‘‘(b) RECRUITMENT PERSONNEL.—The Secretary, 

19 acting through the Service, shall assign 1 individual in 

20 each Area Office to be responsible on a full-time basis for 

21 recruitment activities. 

22 ‘‘SEC. 113. INDIAN RECRUITMENT AND RETENTION PRO23 GRAM. 

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

25 the Service, shall fund, on a competitive basis, innovative 


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1 demonstration projects for a period not to exceed 3 years 

2 to enable Tribal Health Programs and Urban Indian Or3 ganizations to recruit, place, and retain health profes4 sionals to meet their staffing needs. 

5 ‘‘(b) ELIGIBLE ENTITIES; APPLICATION.—Any Trib6 al Health Program or Urban Indian Organization may 

7 submit an application for funding of a project pursuant 

8 to this section. 

9 ‘‘SEC. 114. ADVANCED TRAINING AND RESEARCH. 

10 ‘‘(a) DEMONSTRATION PROGRAM.—The Secretary, 

11 acting through the Service, shall establish a demonstration 

12 project to enable health professionals who have worked in 

13 an Indian Health Program or Urban Indian Organization 

14 for a substantial period of time to pursue advanced train15 ing or research areas of study for which the Secretary de16 termines a need exists. 

17 ‘‘(b) SERVICE OBLIGATION.—An individual who par18 ticipates in a program under subsection (a), where the 

19 educational costs are borne by the Service, shall incur an 

20 obligation to serve in an Indian Health Program or Urban 

21 Indian Organization for a period of obligated service equal 

22 to at least the period of time during which the individual 

23 participates in such program. In the event that the indi24 vidual fails to complete such obligated service, the indi25 vidual shall be liable to the United States for the period 


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•HR 5312 IH

1 of service remaining. In such event, with respect to indi2 viduals entering the program after the date of enactment 

3 of the Indian Health Care Improvement Act Amendments 

4 of 2006, the United States shall be entitled to recover 

5 from such individual an amount to be determined in ac6 cordance with the formula specified in subsection (l) of 

7 section 110 in the manner provided for in such subsection. 

8 ‘‘(c) EQUAL OPPORTUNITY FOR PARTICIPATION.— 

9 Health professionals from Tribal Health Programs and 

10 Urban Indian Organizations shall be given an equal oppor11 tunity to participate in the program under subsection (a). 

12 ‘‘SEC. 115. QUENTIN N. BURDICK AMERICAN INDIANS INTO 

13 NURSING PROGRAM. 

14 ‘‘(a) GRANTS AUTHORIZED.—For the purpose of in15 creasing the number of nurses, nurse midwives, and nurse 

16 practitioners who deliver health care services to Indians, 

17 the Secretary, acting through the Service, shall provide 

18 grants to the following: 

19 ‘‘(1) Public or private schools of nursing. 

20 ‘‘(2) Tribal colleges or universities. 

21 ‘‘(3) Nurse midwife programs and advanced 

22 practice nurse programs that are provided by any 

23 tribal college or university accredited nursing pro24 gram, or in the absence of such, any other public or 

25 private institutions. 


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1 ‘‘(b) USE OF GRANTS.—Grants provided under sub2 section (a) may be used for 1 or more of the following: 

3 ‘‘(1) To recruit individuals for programs which 

4 train individuals to be nurses, nurse midwives, or 

5 advanced practice nurses. 

6 ‘‘(2) To provide scholarships to Indians enrolled 

7 in such programs that may pay the tuition charged 

8 for such program and other expenses incurred in 

9 connection with such program, including books, fees, 

10 room and board, and stipends for living expenses. 

11 ‘‘(3) To provide a program that encourages 

12 nurses, nurse midwives, and advanced practice 

13 nurses to provide, or continue to provide, health care 

14 services to Indians. 

15 ‘‘(4) To provide a program that increases the 

16 skills of, and provides continuing education to, 

17 nurses, nurse midwives, and advanced practice 

18 nurses. 

19 ‘‘(5) To provide any program that is designed 

20 to achieve the purpose described in subsection (a). 

21 ‘‘(c) APPLICATIONS.—Each application for funding 

22 under subsection (a) shall include such information as the 

23 Secretary may require to establish the connection between 

24 the program of the applicant and a health care facility 

25 that primarily serves Indians. 


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1 ‘‘(d) PREFERENCES FOR GRANT RECIPIENTS.—In 

2 providing grants under subsection (a), the Secretary shall 

3 extend a preference to the following: 

4 ‘‘(1) Programs that provide a preference to In5 dians. 

6 ‘‘(2) Programs that train nurse midwives or ad7 vanced practice nurses. 

8 ‘‘(3) Programs that are interdisciplinary. 

9 ‘‘(4) Programs that are conducted in coopera10 tion with a program for gifted and talented Indian 

11 students. 

12 ‘‘(5) Programs conducted by tribal colleges and 

13 universities. 

14 ‘‘(e) QUENTIN N. BURDICK PROGRAM GRANT.—The 

15 Secretary shall provide 1 of the grants authorized under 

16 subsection (a) to establish and maintain a program at the 

17 University of North Dakota to be known as the ‘Quentin 

18 N. Burdick American Indians Into Nursing Program’. 

19 Such program shall, to the maximum extent feasible, co20 ordinate with the Quentin N. Burdick Indian Health Pro21 grams established under section 117(b) and the Quentin 

22 N. Burdick American Indians Into Psychology Program 

23 established under section 105(b). 

24 ‘‘(f) ACTIVE DUTY SERVICE OBLIGATION.—The ac25 tive duty service obligation prescribed under section 338C 


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•HR 5312 IH

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

2 be met by each individual who receives training or assist3 ance described in paragraph (1) or (2) of subsection (b) 

4 that is funded by a grant provided under subsection (a). 

5 Such obligation shall be met by service— 

6 ‘‘(1) in the Service; 

7 ‘‘(2) in a program of an Indian Tribe or Tribal 

8 Organization conducted under the Indian Self-Deter9 mination and Education Assistance Act (25 U.S.C. 

10 450 et seq.) (including programs under agreements 

11 with the Bureau of Indian Affairs); 

12 ‘‘(3) in a program assisted under title V of this 

13 Act; 

14 ‘‘(4) in the private practice of nursing if, as de15 termined by the Secretary, in accordance with guide16 lines promulgated by the Secretary, such practice is 

17 situated in a physician or other health shortage area 

18 and addresses the health care needs of a substantial 

19 number of Indians; or 

20 ‘‘(5) in a teaching capacity in a tribal college or 

21 university nursing program (or a related health pro22 fession program) if, as determined by the Secretary, 

23 health services provided to Indians would not de24 crease. 


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1 ‘‘SEC. 116. TRIBAL CULTURAL ORIENTATION. 

2 ‘‘(a) CULTURAL EDUCATION OF EMPLOYEES.—The 

3 Secretary, acting through the Service, shall require that 

4 appropriate employees of the Service who serve Indian 

5 Tribes in each Service Area receive educational instruction 

6 in the history and culture of such Indian Tribes and their 

7 relationship to the Service. 

8 ‘‘(b) PROGRAM.—In carrying out subsection (a), the 

9 Secretary shall establish a program which shall, to the ex10 tent feasible— 

11 ‘‘(1) be developed in consultation with the af12 fected Indian Tribes, Tribal Organizations, and 

13 Urban Indian Organizations; 

14 ‘‘(2) be carried out through tribal colleges or 

15 universities; and 

16 ‘‘(3) include instruction in American Indian 

17 studies. 

18 ‘‘SEC. 117. INMED PROGRAM. 

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

20 through the Service, is authorized to provide grants to col21 leges and universities for the purpose of maintaining and 

22 expanding the Indian health careers recruitment program 

23 known as the ‘Indians Into Medicine Program’ (herein24 after in this section referred to as ‘INMED’) as a means 

25 of encouraging Indians to enter the health professions. 


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•HR 5312 IH

1 ‘‘(b) QUENTIN N. BURDICK GRANT.—The Secretary 

2 shall provide 1 of the grants authorized under subsection 

3 (a) to maintain the INMED program at the University 

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

5 Indian Health Programs’, unless the Secretary makes a 

6 determination, based upon program reviews, that the pro7 gram is not meeting the purposes of this section. Such 

8 program shall, to the maximum extent feasible, coordinate 

9 with the Quentin N. Burdick American Indians Into Psy10 chology Program established under section 105(b) and the 

11 Quentin N. Burdick American Indians Into Nursing Pro12 gram established under section 115. 

13 ‘‘(c) REGULATIONS.—The Secretary, pursuant to this 

14 Act, shall develop regulations to govern grants pursuant 

15 to this section. 

16 ‘‘(d) REQUIREMENTS.—Applicants for grants pro17 vided under this section shall agree to provide a program 

18 which— 

19 ‘‘(1) provides outreach and recruitment for 

20 health professions to Indian communities including 

21 elementary and secondary schools and community 

22 colleges located on reservations which will be served 

23 by the program; 

24 ‘‘(2) incorporates a program advisory board 

25 comprised of representatives from the Indian Tribes 


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•HR 5312 IH

1 and Indian communities which will be served by the 

2 program; 

3 ‘‘(3) provides summer preparatory programs for 

4 Indian students who need enrichment in the subjects 

5 of math and science in order to pursue training in 

6 the health professions; 

7 ‘‘(4) provides tutoring, counseling, and support 

8 to students who are enrolled in a health career pro9 gram of study at the respective college or university; 

10 and 

11 ‘‘(5) to the maximum extent feasible, employs 

12 qualified Indians in the program. 

13 ‘‘SEC. 118. HEALTH TRAINING PROGRAMS OF COMMUNITY 

14 COLLEGES. 

15 ‘‘(a) GRANTS TO ESTABLISH PROGRAMS.— 

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

17 through the Service, shall award grants to accredited 

18 and accessible community colleges for the purpose of 

19 assisting such community colleges in the establish20 ment of programs which provide education in a 

21 health profession leading to a degree or diploma in 

22 a health profession for individuals who desire to 

23 practice such profession on or near a reservation or 

24 in an Indian Health Program. 


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1 ‘‘(2) AMOUNT OF GRANTS.—The amount of any 

2 grant awarded to a community college under para3 graph (1) for the first year in which such a grant 

4 is provided to the community college shall not exceed 

5 $250,000. 

6 ‘‘(b) GRANTS FOR MAINTENANCE AND RECRUIT7 ING.— 

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

9 through the Service, shall award grants to accredited 

10 and accessible community colleges that have estab11 lished a program described in subsection (a)(1) for 

12 the purpose of maintaining the program and recruit13 ing students for the program. 

14 ‘‘(2) REQUIREMENTS.—Grants may only be 

15 made under this section to a community college 

16 which— 

17 ‘‘(A) is accredited; 

18 ‘‘(B) has a relationship with a hospital fa19 cility, Service facility, or hospital that could 

20 provide training of nurses or health profes21 sionals; 

22 ‘‘(C) has entered into an agreement with 

23 an accredited college or university medical 

24 school, the terms of which— 


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1 ‘‘(i) provide a program that enhances 

2 the transition and recruitment of students 

3 into advanced baccalaureate or graduate 

4 programs that train health professionals; 

5 and 

6 ‘‘(ii) stipulate certifications necessary 

7 to approve internship and field placement 

8 opportunities at Indian Health Programs; 

9 ‘‘(D) has a qualified staff which has the 

10 appropriate certifications; 

11 ‘‘(E) is capable of obtaining State or re12 gional accreditation of the program described in 

13 subsection (a)(1); and 

14 ‘‘(F) agrees to provide for Indian pref15 erence for applicants for programs under this 

16 section. 

17 ‘‘(c) TECHNICAL ASSISTANCE.—The Secretary shall 

18 encourage community colleges described in subsection 

19 (b)(2) to establish and maintain programs described in 

20 subsection (a)(1) by— 

21 ‘‘(1) entering into agreements with such col22 leges for the provision of qualified personnel of the 

23 Service to teach courses of study in such programs; 

24 and 


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1 ‘‘(2) providing technical assistance and support 

2 to such colleges. 

3 ‘‘(d) ADVANCED TRAINING.— 

4 ‘‘(1) REQUIRED.—Any program receiving as5 sistance under this section that is conducted with re6 spect to a health profession shall also offer courses 

7 of study which provide advanced training for any 

8 health professional who— 

9 ‘‘(A) has already received a degree or di10 ploma in such health profession; and 

11 ‘‘(B) provides clinical services on or near a 

12 reservation or for an Indian Health Program. 

13 ‘‘(2) MAY BE OFFERED AT ALTERNATE SITE.— 

14 Such courses of study may be offered in conjunction 

15 with the college or university with which the commu16 nity college has entered into the agreement required 

17 under subsection (b)(2)(C). 

18 ‘‘(e) FUNDING PRIORITY.—Where the requirements 

19 of subsection (b) are met, funding priority shall be pro20 vided to tribal colleges and universities in Service Areas 

21 where they exist. 

22 ‘‘SEC. 119. RETENTION BONUS. 

23 ‘‘(a) BONUS AUTHORIZED.—The Secretary may pay 

24 a retention bonus to any health professional employed by, 

25 or assigned to, and serving in, an Indian Health Program 


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1 or Urban Indian Organization either as a civilian employee 

2 or as a commissioned officer in the Regular or Reserve 

3 Corps of the Public Health Service who— 

4 ‘‘(1) is assigned to, and serving in, a position 

5 for which recruitment or retention of personnel is 

6 difficult; 

7 ‘‘(2) the Secretary determines is needed by In8 dian Health Programs and Urban Indian Organiza9 tions; 

10 ‘‘(3) has— 

11 ‘‘(A) completed 3 years of employment 

12 with an Indian Health Program or Urban In13 dian Organization; or 

14 ‘‘(B) completed any service obligations in15 curred as a requirement of— 

16 ‘‘(i) any Federal scholarship program; 

17 or 

18 ‘‘(ii) any Federal education loan re19 payment program; and 

20 ‘‘(4) enters into an agreement with an Indian 

21 Health Program or Urban Indian Organization for 

22 continued employment for a period of not less than 

23 1 year. 

24 ‘‘(b) RATES.—The Secretary may establish rates for 

25 the retention bonus which shall provide for a higher anVerDate Aug 31 2005 03:45 May 16, 2006 Jkt 049200 PO 00000 Frm 00073 Fmt 6652 Sfmt 6201 E:\BILLS\H5312.IH H5312

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1 nual rate for multiyear agreements than for single year 

2 agreements referred to in subsection (a)(4), but in no 

3 event shall the annual rate be more than $25,000 per 

4 annum. 

5 ‘‘(c) DEFAULT OF RETENTION AGREEMENT.—Any 

6 health professional failing to complete the agreed upon 

7 term of service, except where such failure is through no 

8 fault of the individual, shall be obligated to refund to the 

9 Government the full amount of the retention bonus for the 

10 period covered by the agreement, plus interest as deter11 mined by the Secretary in accordance with section 

12 110(l)(2)(B). 

13 ‘‘(d) OTHER RETENTION BONUS.—The Secretary 

14 may pay a retention bonus to any health professional em15 ployed by a Tribal Health Program if such health profes16 sional is serving in a position which the Secretary deter17 mines is— 

18 ‘‘(1) a position for which recruitment or reten19 tion is difficult; and 

20 ‘‘(2) necessary for providing health care services 

21 to Indians. 

22 ‘‘SEC. 120. NURSING RESIDENCY PROGRAM. 

23 ‘‘(a) ESTABLISHMENT OF PROGRAM.—The Sec24 retary, acting through the Service, shall establish a pro25 gram to enable Indians who are licensed practical nurses, 


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1 licensed vocational nurses, and registered nurses who are 

2 working in an Indian Health Program or Urban Indian 

3 Organization, and have done so for a period of not less 

4 than 1 year, to pursue advanced training. Such program 

5 shall include a combination of education and work study 

6 in an Indian Health Program or Urban Indian Organiza7 tion leading to an associate or bachelor’s degree (in the 

8 case of a licensed practical nurse or licensed vocational 

9 nurse), a bachelor’s degree (in the case of a registered 

10 nurse), or advanced degrees or certifications in nursing 

11 and public health. 

12 ‘‘(b) SERVICE OBLIGATION.—An individual who par13 ticipates in a program under subsection (a), where the 

14 educational costs are paid by the Service, shall incur an 

15 obligation to serve in an Indian Health Program or Urban 

16 Indian Organization for a period of obligated service equal 

17 to the amount of time during which the individual partici18 pates in such program. In the event that the individual 

19 fails to complete such obligated service, the United States 

20 shall be entitled to recover from such individual an amount 

21 determined in accordance with the formula specified in 

22 subsection (l) of section 110 in the manner provided for 

23 in such subsection. 


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1 ‘‘SEC. 121. COMMUNITY HEALTH AIDE PROGRAM. 

2 ‘‘(a) GENERAL PURPOSES OF PROGRAM.—Under the 

3 authority of the Act of November 2, 1921 (25 U.S.C. 13) 

4 (commonly known as the ‘Snyder Act’), the Secretary, act5 ing through the Service, shall develop and operate a Com6 munity Health Aide Program in Alaska under which the 

7 Service— 

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

9 as health aides or community health practitioners; 

10 ‘‘(2) uses such aides or practitioners in the pro11 vision of health care, health promotion, and disease 

12 prevention services to Alaska Natives living in vil13 lages in rural Alaska; and 

14 ‘‘(3) provides for the establishment of tele15 conferencing capacity in health clinics located in or 

16 near such villages for use by community health aides 

17 or community health practitioners. 

18 ‘‘(b) SPECIFIC PROGRAM REQUIREMENTS.—The Sec19 retary, acting through the Community Health Aide Pro20 gram of the Service, shall— 

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

22 provide a high standard of training to community 

23 health aides and community health practitioners to 

24 ensure that such aides and practitioners provide 

25 quality health care, health promotion, and disease 


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1 prevention services to the villages served by the Pro2 gram; 

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

4 a curriculum that— 

5 ‘‘(A) combines education in the theory of 

6 health care with supervised practical experience 

7 in the provision of health care; 

8 ‘‘(B) provides instruction and practical ex9 perience in the provision of acute care, emer10 gency care, health promotion, disease preven11 tion, and the efficient and effective manage12 ment of clinic pharmacies, supplies, equipment, 

13 and facilities; and 

14 ‘‘(C) promotes the achievement of the 

15 health status objectives specified in section 

16 3(2); 

17 ‘‘(3) establish and maintain a Community 

18 Health Aide Certification Board to certify as com19 munity health aides or community health practi20 tioners individuals who have successfully completed 

21 the training described in paragraph (1) or can dem22 onstrate equivalent experience, provided that certifi23 cation shall not be granted to a dental health aide 

24 therapist based on training received outside the 


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1 United States during any period in which equivalent 

2 training was available in the United States; 

3 ‘‘(4) develop and maintain a system which iden4 tifies the needs of community health aides and com5 munity health practitioners for continuing education 

6 in the provision of health care, including the areas 

7 described in paragraph (2)(B), and develop pro8 grams that meet the needs for such continuing edu9 cation; 

10 ‘‘(5) develop and maintain a system that pro11 vides close supervision of community health aides 

12 and community health practitioners; and 

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

14 community health aides and community health prac15 titioners is reviewed and evaluated to assure the pro16 vision of quality health care, health promotion, and 

17 disease prevention services. 

18 ‘‘(c) PROGRAM REVIEW.— 

19 ‘‘(1) NEUTRAL PANEL.— 

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

21 acting through the Service, shall establish a 

22 neutral panel to carry out the study under 

23 paragraph (2). 

24 ‘‘(B) MEMBERSHIP.—Members of the neu25 tral panel shall be appointed by the Secretary 


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1 from among clinicians, economists, community 

2 practitioners, oral epidemiologists, and Alaska 

3 Natives. 

4 ‘‘(2) STUDY.— 

5 ‘‘(A) IN GENERAL.—The neutral panel es6 tablished under paragraph (1) shall conduct a 

7 study of the dental health aide therapist serv8 ices provided by the Community Health Aide 

9 Program under this section to ensure that the 

10 quality of care provided through those services 

11 is adequate and appropriate. 

12 ‘‘(B) PARAMETERS OF STUDY.—The Sec13 retary, in consultation with interested parties, 

14 including professional dental organizations, 

15 shall develop the parameters of the study. 

16 ‘‘(C) INCLUSIONS.—The study shall in17 clude a determination by the neutral panel with 

18 respect to— 

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

20 aide therapist services under this section to 

21 address the dental care needs of Alaska 

22 Natives; 

23 ‘‘(ii) the quality of care provided 

24 through those services, including any train25 ing, improvement, or additional oversight 


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1 required to improve the quality of care; 

2 and 

3 ‘‘(iii) whether safer and less costly al4 ternatives to the dental health aide thera5 pist services exist. 

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

7 study under this paragraph, the neutral panel 

8 shall consult with Alaska Tribal Organizations 

9 with respect to the adequacy and accuracy of 

10 the study. 

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

12 to the Secretary, the Committee on Indian Affairs of 

13 the Senate, and the Committee on Resources of the 

14 House of Representatives a report describing the re15 sults of the study under paragraph (2), including a 

16 description of— 

17 ‘‘(A) any determination of the neutral 

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

19 ‘‘(B) any comments received from an Alas20 ka Tribal Organization under paragraph 

21 (2)(D). 

22 ‘‘(d) NATIONALIZATION OF PROGRAM.— 

23 ‘‘(1) IN GENERAL.—Except as provided in para24 graph (2), the Secretary, acting through the Service, 

25 may establish a national Community Health Aide 


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1 Program in accordance with the program under this 

2 section, as the Secretary determines to be appro3 priate. 

4 ‘‘(2) EXCEPTION.—The national Community 

5 Health Aide Program under paragraph (1) shall not 

6 include dental health aide therapist services. 

7 ‘‘(3) REQUIREMENT.—In establishing a na8 tional program under paragraph (1), the Secretary 

9 shall not reduce the amount of funds provided for 

10 the Community Health Aide Program described in 

11 subsections (a) and (b). 

12 ‘‘SEC. 122. TRIBAL HEALTH PROGRAM ADMINISTRATION. 

13 ‘‘The Secretary, acting through the Service, shall, by 

14 contract or otherwise, provide training for Indians in the 

15 administration and planning of Tribal Health Programs. 

16 ‘‘SEC. 123. HEALTH PROFESSIONAL CHRONIC SHORTAGE 

17 DEMONSTRATION PROGRAMS. 

18 ‘‘(a) DEMONSTRATION PROGRAMS AUTHORIZED.— 

19 The Secretary, acting through the Service, may fund dem20 onstration programs for Tribal Health Programs to ad21 dress the chronic shortages of health professionals. 

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

23 demonstration programs funded under subsection (a) shall 

24 be— 


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1 ‘‘(1) to provide direct clinical and practical ex2 perience at a Service Unit to health profession stu3 dents and residents from medical schools; 

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

5 Indians by assuring access to qualified health care 

6 professionals; and 

7 ‘‘(3) to provide academic and scholarly opportu8 nities for health professionals serving Indians by 

9 identifying all academic and scholarly resources of 

10 the region. 

11 ‘‘(c) ADVISORY BOARD.—The demonstration pro12 grams established pursuant to subsection (a) shall incor13 porate a program advisory board composed of representa14 tives from the Indian Tribes and Indian communities in 

15 the area which will be served by the program. 

16 ‘‘SEC. 124. NATIONAL HEALTH SERVICE CORPS. 

17 ‘‘(a) NO REDUCTION IN SERVICES.—The Secretary 

18 shall not— 

19 ‘‘(1) remove a member of the National Health 

20 Service Corps from an Indian Health Program or 

21 Urban Indian Organization; or 

22 ‘‘(2) withdraw funding used to support such 

23 member, unless the Secretary, acting through the 

24 Service, Indian Tribes, or Tribal Organizations, has 

25 ensured that the Indians receiving services from 


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1 such member will experience no reduction in serv2 ices. 

3 ‘‘(b) EXEMPTION FROM LIMITATIONS.—National 

4 Health Service Corps scholars qualifying for the Commis5 sioned Corps in the United States Public Health Service 

6 shall be exempt from the full-time equivalent limitations 

7 of the National Health Service Corps and the Service 

8 when serving as a commissioned corps officer in a Tribal 

9 Health Program or an Urban Indian Organization. 

10 ‘‘SEC. 125. SUBSTANCE ABUSE COUNSELOR EDUCATIONAL 

11 CURRICULA DEMONSTRATION PROGRAMS. 

12 ‘‘(a) GRANTS AND CONTRACTS.—The Secretary, act13 ing through the Service, may enter into contracts with, 

14 or make grants to, accredited tribal colleges and univer15 sities and eligible accredited and accessible community col16 leges to establish demonstration programs to develop edu17 cational curricula for substance abuse counseling. 

18 ‘‘(b) USE OF FUNDS.—Funds provided under this 

19 section shall be used only for developing and providing 

20 educational curriculum for substance abuse counseling (in21 cluding paying salaries for instructors). Such curricula 

22 may be provided through satellite campus programs. 

23 ‘‘(c) TIME PERIOD OF ASSISTANCE; RENEWAL.—A 

24 contract entered into or a grant provided under this sec25 tion shall be for a period of 3 years. Such contract or 


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1 grant may be renewed for an additional 2-year period 

2 upon the approval of the Secretary. 

3 ‘‘(d) CRITERIAFOR REVIEW AND APPROVAL OF AP4 PLICATIONS.—Not later than 180 days after the date of 

5 enactment of the Indian Health Care Improvement Act 

6 Amendments of 2006, the Secretary, after consultation 

7 with Indian Tribes and administrators of tribal colleges 

8 and universities and eligible accredited and accessible com9 munity colleges, shall develop and issue criteria for the 

10 review and approval of applications for funding (including 

11 applications for renewals of funding) under this section. 

12 Such criteria shall ensure that demonstration programs 

13 established under this section promote the development of 

14 the capacity of such entities to educate substance abuse 

15 counselors. 

16 ‘‘(e) ASSISTANCE.—The Secretary shall provide such 

17 technical and other assistance as may be necessary to en18 able grant recipients to comply with the provisions of this 

19 section. 

20 ‘‘(f) REPORT.—Each fiscal year, the Secretary shall 

21 submit to the President, for inclusion in the report which 

22 is required to be submitted under section 801 for that fis23 cal year, a report on the findings and conclusions derived 

24 from the demonstration programs conducted under this 

25 section during that fiscal year. 


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1 ‘‘(g) DEFINITION.—For the purposes of this section, 

2 the term ‘educational curriculum’ means 1 or more of the 

3 following: 

4 ‘‘(1) Classroom education. 

5 ‘‘(2) Clinical work experience. 

6 ‘‘(3) Continuing education workshops. 

7 ‘‘SEC. 126. BEHAVIORAL HEALTH TRAINING AND COMMU8 NITY EDUCATION PROGRAMS. 

9 ‘‘(a) STUDY; LIST.—The Secretary, acting through 

10 the Service, and the Secretary of the Interior, in consulta11 tion with Indian Tribes and Tribal Organizations, shall 

12 conduct a study and compile a list of the types of staff 

13 positions specified in subsection (b) whose qualifications 

14 include, or should include, training in the identification, 

15 prevention, education, referral, or treatment of mental ill16 ness, or dysfunctional and self destructive behavior. 

17 ‘‘(b) POSITIONS.—The positions referred to in sub18 section (a) are— 

19 ‘‘(1) staff positions within the Bureau of Indian 

20 Affairs, including existing positions, in the fields 

21 of— 

22 ‘‘(A) elementary and secondary education; 

23 ‘‘(B) social services and family and child 

24 welfare; 


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1 ‘‘(C) law enforcement and judicial services; 

2 and 

3 ‘‘(D) alcohol and substance abuse; 

4 ‘‘(2) staff positions within the Service; and 

5 ‘‘(3) staff positions similar to those identified in 

6 paragraphs (1) and (2) established and maintained 

7 by Indian Tribes, Tribal Organizations (without re8 gard to the funding source), and Urban Indian Or9 ganizations. 

10 ‘‘(c) TRAINING CRITERIA.— 

11 ‘‘(1) IN GENERAL.—The appropriate Secretary 

12 shall provide training criteria appropriate to each 

13 type of position identified in subsection (b)(1) and 

14 (b)(2) and ensure that appropriate training has 

15 been, or shall be provided to any individual in any 

16 such position. With respect to any such individual in 

17 a position identified pursuant to subsection (b)(3), 

18 the respective Secretaries shall provide appropriate 

19 training to, or provide funds to, an Indian Tribe, 

20 Tribal Organization, or Urban Indian Organization 

21 for training of appropriate individuals. In the case of 

22 positions funded under a contract or compact under 

23 the Indian Self-Determination and Education Assist24 ance Act (25 U.S.C. 450 et seq.), the appropriate 

25 Secretary shall ensure that such training costs are 


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1 included in the contract or compact, as the Sec2 retary determines necessary. 

3 ‘‘(2) POSITION SPECIFIC TRAINING CRITERIA.— 

4 Position specific training criteria shall be culturally 

5 relevant to Indians and Indian Tribes and shall en6 sure that appropriate information regarding tradi7 tional Indian healing and treatment practices is pro8 vided. 

9 ‘‘(d) COMMUNITY EDUCATION ON MENTAL ILL10 NESS.—The Service shall develop and implement, on re11 quest of an Indian Tribe, Tribal Organization, or Urban 

12 Indian Organization, or assist the Indian Tribe, Tribal Or13 ganization, or Urban Indian Organization to develop and 

14 implement, a program of community education on mental 

15 illness. In carrying out this subsection, the Service shall, 

16 upon request of an Indian Tribe, Tribal Organization, or 

17 Urban Indian Organization, provide technical assistance 

18 to the Indian Tribe, Tribal Organization, or Urban Indian 

19 Organization to obtain and develop community edu20 cational materials on the identification, prevention, refer21 ral, and treatment of mental illness and dysfunctional and 

22 self-destructive behavior. 

23 ‘‘(e) PLAN.—Not later than 90 days after the date 

24 of enactment of the Indian Health Care Improvement Act 

25 Amendments of 2006, the Secretary shall develop a plan 


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1 under which the Service will increase the health care staff 

2 providing behavioral health services by at least 500 posi3 tions within 5 years after the date of enactment of this 

4 section, with at least 200 of such positions devoted to 

5 child, adolescent, and family services. The plan developed 

6 under this subsection shall be implemented under the Act 

7 of November 2, 1921 (25 U.S.C. 13) (commonly known 

8 as the ‘Snyder Act’). 

9 ‘‘SEC. 127. AUTHORIZATION OF APPROPRIATIONS. 

10 ‘‘There are authorized to be appropriated such sums 

11 as may be necessary for each fiscal year through fiscal 

12 year 2015 to carry out this title. 

13 ‘‘TITLE II—HEALTH SERVICES 

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

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

16 the Service, is authorized to expend funds, directly or 

17 under the authority of the Indian Self-Determination and 

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

19 are appropriated under the authority of this section, for 

20 the purposes of— 

21 ‘‘(1) eliminating the deficiencies in health sta22 tus and health resources of all Indian Tribes; 

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

24 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 in accord18 ance with section 207. 

19 ‘‘(C) Dental care. 

20 ‘‘(D) Mental health, including community 

21 mental health services, inpatient mental health 

22 services, dormitory mental health services, 

23 therapeutic and residential treatment centers, 

24 and training of traditional Indian practitioners. 

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. 

6 ‘‘(H) Home health care. 

7 ‘‘(I) Community health representatives. 

8 ‘‘(J) Maintenance and improvement. 

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

11 used to offset or limit any other appropriations made to 

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

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

14 or any other provision of law. 

15 ‘‘(c) ALLOCATION; USE.— 

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

17 the authority of this section shall be allocated to 

18 Service Units, Indian Tribes, or Tribal Organiza19 tions. The funds allocated to each Indian Tribe, 

20 Tribal Organization, or Service Unit under this 

21 paragraph shall be used by the Indian Tribe, Tribal 

22 Organization, or Service Unit under this paragraph 

23 to improve the health status and reduce the resource 

24 deficiency of each Indian Tribe served by such Serv25 ice Unit, Indian Tribe, or Tribal Organization. 


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1 ‘‘(2) APPORTIONMENT OF ALLOCATED

2 FUNDS.—The apportionment of funds allocated to a 

3 Service Unit, Indian Tribe, or Tribal Organization 

4 under paragraph (1) among the health service re5 sponsibilities described in subsection (a)(5) shall be 

6 determined by the Service in consultation with, and 

7 with the active participation of, the affected Indian 

8 Tribes and Tribal Organizations. 

9 ‘‘(d) PROVISIONS RELATING TO HEALTH STATUS

10 AND RESOURCE DEFICIENCIES.—For the purposes of this 

11 section, the following definitions apply: 

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

13 and resource deficiency’ means the extent to 

14 which— 

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

16 in section 3(2) are not being achieved; and 

17 ‘‘(B) the Indian Tribe or Tribal Organiza18 tion does not have available to it the health re19 sources it needs, taking into account the actual 

20 cost of providing health care services given local 

21 geographic, climatic, rural, or other cir22 cumstances. 

23 ‘‘(2) AVAILABLE RESOURCES.—The health re24 sources available to an Indian Tribe or Tribal Orga25 nization include health resources provided by the 


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1 Service as well as health resources used by the In2 dian Tribe or Tribal Organization, including services 

3 and financing systems provided by any Federal pro4 grams, private insurance, and programs of State or 

5 local governments. 

6 ‘‘(3) PROCESS FOR REVIEW OF DETERMINA7 TIONS.—The Secretary shall establish procedures 

8 which allow any Indian Tribe or Tribal Organization 

9 to petition the Secretary for a review of any deter10 mination of the extent of the health status and re11 source deficiency of such Indian Tribe or Tribal Or12 ganization. 

13 ‘‘(e) ELIGIBILITY FOR FUNDS.—Tribal Health Pro14 grams shall be eligible for funds appropriated under the 

15 authority of this section on an equal basis with programs 

16 that are administered directly by the Service. 

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

18 years after the date of enactment of the Indian Health 

19 Care Improvement Act Amendments of 2006, the Sec20 retary shall submit to Congress the current health status 

21 and resource deficiency report of the Service for each 

22 Service Unit, including newly recognized or acknowledged 

23 Indian Tribes. Such report shall set out— 

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

25 for determining Tribal health status and resource 


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1 deficiencies, as well as the most recent application of 

2 that methodology; 

3 ‘‘(2) the extent of the health status and re4 source deficiency of each Indian Tribe served by the 

5 Service or a Tribal Health Program; 

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

7 the health status and resource deficiencies of all In8 dian Tribes served by the Service or a Tribal Health 

9 Program; and 

10 ‘‘(4) an estimate of— 

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

12 appropriated under the authority of this Act, or 

13 any other Act, including the amount of any 

14 funds transferred to the Service for the pre15 ceding fiscal year which is allocated to each 

16 Service Unit, Indian Tribe, or Tribal Organiza17 tion; 

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

19 health services in each Service Unit or Indian 

20 Tribe or Tribal Organization; and 

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

22 Service resources made available to each Service 

23 Unit, Indian Tribe or Tribal Organization, and, 

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1 ing lists and number of Indians turned away for 

2 services due to lack of resources. 

3 ‘‘(g) INCLUSION IN BASE BUDGET.—Funds appro4 priated under this section for any fiscal year shall be in5 cluded in the base budget of the Service for the purpose 

6 of determining appropriations under this section in subse7 quent fiscal years. 

8 ‘‘(h) CLARIFICATION.—Nothing in this section is in9 tended to diminish the primary responsibility of the Serv10 ice to eliminate existing backlogs in unmet health care 

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

12 discourage the Service from undertaking additional efforts 

13 to achieve equity among Indian Tribes and Tribal Organi14 zations. 

15 ‘‘(i) FUNDING DESIGNATION.—Any funds appro16 priated under the authority of this section shall be des17 ignated as the ‘Indian Health Care Improvement Fund’. 

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

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

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

22 ‘‘(1) the amounts deposited under subsection 

23 (f); and 

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

25 this section. 


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1 ‘‘(b) ADMINISTRATION.—CHEF shall be adminis2 tered by the Secretary, acting through the central office 

3 of the Service, solely for the purpose of meeting the ex4 traordinary medical costs associated with the treatment of 

5 victims of disasters or catastrophic illnesses who are with6 in the responsibility of the Service. 

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

8 CHEF or its administration shall be subject to contract 

9 or grant under any law, including the Indian Self-Deter10 mination and Education Assistance Act (25 U.S.C. 450 

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

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

13 similar basis. 

14 ‘‘(d) REGULATIONS.—The Secretary shall, through 

15 the negotiated rulemaking process under title VIII, pro16 mulgate regulations consistent with the provisions of this 

17 section to— 

18 ‘‘(1) establish a definition of disasters and cata19 strophic illnesses for which the cost of the treatment 

20 provided under contract would qualify for payment 

21 from CHEF; 

22 ‘‘(2) provide that a Service Unit shall not be el23 igible for reimbursement for the cost of treatment 

24 from CHEF until its cost of treating any victim of 

25 such catastrophic illness or disaster has reached a 


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1 certain threshold cost which the Secretary shall es2 tablish at— 

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

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

5 than the threshold cost of the previous year in6 creased by the percentage increase in the med7 ical care expenditure category of the consumer 

8 price index for all urban consumers (United 

9 States city average) for the 12-month period 

10 ending with December of the previous year; 

11 ‘‘(3) establish a procedure for the reimburse12 ment of the portion of the costs that exceeds such 

13 threshold cost incurred by— 

14 ‘‘(A) Service Units; or 

15 ‘‘(B) whenever otherwise authorized by the 

16 Service, non-Service facilities or providers; 

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

18 CHEF in cases in which the exigencies of the med19 ical circumstances warrant treatment prior to the 

20 authorization of such treatment by the Service; and 

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

22 no payment shall be made from CHEF to any pro23 vider of treatment to the extent that such provider 

24 is eligible to receive payment for the treatment from 


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

2 reimbursement for which the patient is eligible. 

3 ‘‘(e) NO OFFSET OR LIMITATION.—Amounts appro4 priated to CHEF under this section shall not be used to 

5 offset or limit appropriations made to the Service under 

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

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

8 law. 

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

10 shall be deposited into CHEF all reimbursements to which 

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

12 private source (including third party insurance) by reason 

13 of treatment rendered to any victim of a disaster or cata14 strophic illness the cost of which was paid from CHEF. 

15 ‘‘SEC. 203. HEALTH PROMOTION AND DISEASE PREVENTION 

16 SERVICES. 

17 ‘‘(a) FINDINGS.—Congress finds that health pro18 motion and disease prevention activities— 

19 ‘‘(1) improve the health and well-being of Indi20 ans; and 

21 ‘‘(2) reduce the expenses for health care of In22 dians. 

23 ‘‘(b) PROVISION OF SERVICES.—The Secretary, act24 ing through the Service and Tribal Health Programs, shall 

25 provide health promotion and disease prevention services 


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1 to Indians to achieve the health status objectives set forth 

2 in section 3(2). 

3 ‘‘(c) EVALUATION.—The Secretary, after obtaining 

4 input from the affected Tribal Health Programs, shall 

5 submit to the President for inclusion in the report which 

6 is required to be submitted to Congress under section 801 

7 an evaluation of— 

8 ‘‘(1) the health promotion and disease preven9 tion needs of Indians; 

10 ‘‘(2) the health promotion and disease preven11 tion activities which would best meet such needs; 

12 ‘‘(3) the internal capacity of the Service and 

13 Tribal Health Programs to meet such needs; and 

14 ‘‘(4) the resources which would be required to 

15 enable the Service and Tribal Health Programs to 

16 undertake the health promotion and disease preven17 tion activities necessary to meet such needs. 

18 ‘‘SEC. 204. DIABETES PREVENTION, TREATMENT, AND CON19 TROL. 

20 ‘‘(a) DETERMINATIONS REGARDING DIABETES.— 

21 The Secretary, acting through the Service, and in con22 sultation with Indian Tribes and Tribal Organizations, 

23 shall determine— 


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1 ‘‘(1) by Indian Tribe and by Service Unit, the 

2 incidence of, and the types of complications resulting 

3 from, diabetes among Indians; and 

4 ‘‘(2) based on the determinations made pursu5 ant to paragraph (1), the measures (including pa6 tient education and effective ongoing monitoring of 

7 disease indicators) each Service Unit should take to 

8 reduce the incidence of, and prevent, treat, and con9 trol the complications resulting from, diabetes 

10 among Indian Tribes within that Service Unit. 

11 ‘‘(b) DIABETES SCREENING.—To the extent medi12 cally indicated and with informed consent, the Secretary 

13 shall screen each Indian who receives services from the 

14 Service for diabetes and for conditions which indicate a 

15 high risk that the individual will become diabetic and, in 

16 consultation with Indian Tribes, Urban Indian Organiza17 tions, and appropriate health care providers, establish a 

18 cost-effective approach to ensure ongoing monitoring of 

19 disease indicators. Such screening and monitoring may be 

20 conducted by a Tribal Health Program and may be con21 ducted through appropriate Internet-based health care 

22 management programs. 

23 ‘‘(c) FUNDING FOR DIABETES.—The Secretary shall 

24 continue to maintain each model diabetes project in exist25 ence on the date of enactment of the Indian Health Care 


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1 Improvement Act Amendments of 2006, any such other 

2 diabetes programs operated by the Service or Tribal 

3 Health Programs, and any additional diabetes projects, 

4 such as the Medical Vanguard program provided for in 

5 title IV of Public Law 108–87, as implemented to serve 

6 Indian Tribes. Tribal Health Programs shall receive recur7 ring funding for the diabetes projects that they operate 

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

9 of the Indian Health Care Improvement Act Amendments 

10 of 2006 and for projects which are added and funded 

11 thereafter. 

12 ‘‘(d) FUNDING FOR DIALYSIS PROGRAMS.—The Sec13 retary is authorized to provide funding through the Serv14 ice, Indian Tribes, and Tribal Organizations to establish 

15 dialysis programs, including funding to purchase dialysis 

16 equipment and provide necessary staffing. 

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

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

19 extent funding is available— 

20 ‘‘(A) in each Area Office, consult with In21 dian Tribes and Tribal Organizations regarding 

22 programs for the prevention, treatment, and 

23 control of diabetes; 

24 ‘‘(B) establish in each Area Office a reg25 istry of patients with diabetes to track the inciVerDate Aug 31 2005 03:45 May 16, 2006 Jkt 049200 PO 00000 Frm 00100 Fmt 6652 Sfmt 6201 E:\BILLS\H5312.IH H5312

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1 dence of diabetes and the complications from 

2 diabetes in that area; and 

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

4 Area Office regarding diabetes and related com5 plications among Indians are disseminated to 

6 all other Area Offices, subject to applicable pa7 tient privacy laws. 

8 ‘‘(2) DIABETES CONTROL OFFICERS.— 

9 ‘‘(A) IN GENERAL.—The Secretary may es10 tablish and maintain in each Area Office a posi11 tion of diabetes control officer to coordinate and 

12 manage any activity of that Area Office relating 

13 to the prevention, treatment, or control of dia14 betes to assist the Secretary in carrying out a 

15 program under this section or section 330C of 

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

17 3). 

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

19 carried out by a diabetes control officer under 

20 subparagraph (A) that is the subject of a con21 tract or compact under the Indian Self-Deter22 mination and Education Assistance Act (25 

23 U.S.C. 450 et seq.), and any funds made avail24 able to carry out such an activity, shall not be 

25 divisible for purposes of that Act. 


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1 ‘‘SEC. 205. SHARED SERVICES FOR LONG-TERM CARE. 

2 ‘‘(a) LONG-TERM CARE.—Notwithstanding any other 

3 provision of law, the Secretary, acting through the Service, 

4 is authorized to provide directly, or enter into contracts 

5 or compacts under the Indian Self-Determination and 

6 Education Assistance Act (25 U.S.C. 450 et seq.) with 

7 Indian Tribes or Tribal Organizations for, the delivery of 

8 long-term care and similar services to Indians. Such agree9 ments shall provide for the sharing of staff or other serv10 ices between the Service or a Tribal Health Program and 

11 a long-term care or other similar facility owned and oper12 ated (directly or through a contract or compact under the 

13 Indian Self-Determination and Education Assistance Act 

14 (25 U.S.C. 450 et seq.)) by such Indian Tribe or Tribal 

15 Organization. 

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

17 entered into pursuant to subsection (a)— 

18 ‘‘(1) may, at the request of the Indian Tribe or 

19 Tribal Organization, delegate to such Indian Tribe 

20 or Tribal Organization such powers of supervision 

21 and control over Service employees as the Secretary 

22 deems necessary to carry out the purposes of this 

23 section; 

24 ‘‘(2) shall provide that expenses (including sala25 ries) relating to services that are shared between the 

26 Service and the Tribal Health Program be allocated 


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1 proportionately between the Service and the Indian 

2 Tribe or Tribal Organization; and 

3 ‘‘(3) may authorize such Indian Tribe or Tribal 

4 Organization to construct, renovate, or expand a 

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

6 construction of a facility attached to a Service facil7 ity). 

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

9 provided for under this section shall meet the require10 ments for nursing facilities under section 1919 of the So11 cial Security Act. 

12 ‘‘(d) OTHER ASSISTANCE.—The Secretary shall pro13 vide such technical and other assistance as may be nec14 essary to enable applicants to comply with the provisions 

15 of this section. 

16 ‘‘(e) USE OF EXISTING OR UNDERUSED FACILI17 TIES.—The Secretary shall encourage the use of existing 

18 facilities that are underused or allow the use of swing beds 

19 for long-term or similar care. 

20 ‘‘SEC. 206. HEALTH SERVICES RESEARCH. 

21 ‘‘The Secretary, acting through the Service, shall 

22 make funding available for research to further the per23 formance of the health service responsibilities of Indian 

24 Health Programs. The Secretary shall also, to the max25 imum extent practicable, coordinate departmental reVerDate Aug 31 2005 03:45 May 16, 2006 Jkt 049200 PO 00000 Frm 00103 Fmt 6652 Sfmt 6201 E:\BILLS\H5312.IH H5312

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1 search resources and activities to address relevant Indian 

2 Health Program research needs. Tribal Health Programs 

3 shall be given an equal opportunity to compete for, and 

4 receive, research funds under this section. This funding 

5 may be used for both clinical and nonclinical research. 

6 ‘‘SEC. 207. MAMMOGRAPHY AND OTHER CANCER SCREEN7 ING. 

8 ‘‘The Secretary, acting through the Service or Tribal 

9 Health Programs, shall provide for screening as follows: 

10 ‘‘(1) Screening mammography (as defined in 

11 section 1861(jj) of the Social Security Act) for In12 dian women at a frequency appropriate to such 

13 women under accepted and appropriate national 

14 standards, and under such terms and conditions as 

15 are consistent with standards established by the Sec16 retary to ensure the safety and accuracy of screen17 ing mammography under part B of title XVIII of 

18 such Act. 

19 ‘‘(2) Other cancer screening meeting accepted 

20 and appropriate national standards. 

21 ‘‘SEC. 208. PATIENT TRAVEL COSTS. 

22 ‘‘The Secretary, acting through the Service and Trib23 al Health Programs, is authorized to provide funds for the 

24 following patient travel costs, including appropriate and 

25 necessary qualified escorts, associated with receiving 


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1 health care services provided (either through direct or con2 tract care or through a contract or compact under the In3 dian Self-Determination and Education Assistance Act 

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

5 ‘‘(1) emergency air transportation and non6 emergency air transportation where ground trans7 portation is infeasible; 

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

9 other means of transportation is available), specially 

10 equipped vehicle, and ambulance; and 

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

12 may be available and required when air or motor ve13 hicle transportation is not available. 

14 ‘‘SEC. 209. EPIDEMIOLOGY CENTERS. 

15 ‘‘(a) ADDITIONAL CENTERS.—In addition to those 

16 epidemiology centers already established as of the date of 

17 enactment of this Act, and without reducing the funding 

18 levels for such centers, not later than 180 days after the 

19 date of enactment of the Indian Health Care Improvement 

20 Act Amendments of 2006, the Secretary, acting through 

21 the Service, shall establish an epidemiology center in each 

22 Service Area which does not yet have one to carry out the 

23 functions described in subsection (b). Any new centers so 

24 established may be operated by Tribal Health Programs, 

25 but such funding shall not be divisible. 


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

2 and upon the request of Indian Tribes, Tribal Organiza3 tions, and Urban Indian Organizations, each Service Area 

4 epidemiology center established under this subsection 

5 shall, with respect to such Service Area— 

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

7 progress made toward meeting, each of the health 

8 status objectives of the Service, the Indian Tribes, 

9 Tribal Organizations, and Urban Indian Organiza10 tions in the Service Area; 

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

12 systems, and other systems that impact the improve13 ment of Indian health; 

14 ‘‘(3) assist Indian Tribes, Tribal Organizations, 

15 and Urban Indian Organizations in identifying their 

16 highest priority health status objectives and the 

17 services needed to achieve such objectives, based on 

18 epidemiological data; 

19 ‘‘(4) make recommendations for the targeting 

20 of services needed by the populations served; 

21 ‘‘(5) make recommendations to improve health 

22 care delivery systems for Indians and Urban Indi23 ans; 

24 ‘‘(6) provide requested technical assistance to 

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1 dian Organizations in the development of local 

2 health service priorities and incidence and prevalence 

3 rates of disease and other illness in the community; 

4 and 

5 ‘‘(7) provide disease surveillance and assist In6 dian Tribes, Tribal Organizations, and Urban Indian 

7 Organizations to promote public health. 

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

9 Centers for Disease Control and Prevention shall provide 

10 technical assistance to the centers in carrying out the re11 quirements of this subsection. 

12 ‘‘(d) FUNDING FOR STUDIES.—The Secretary may 

13 make funding available to Indian Tribes, Tribal Organiza14 tions, and Urban Indian Organizations to conduct epide15 miological studies of Indian communities. 

16 ‘‘SEC. 210. COMPREHENSIVE SCHOOL HEALTH EDUCATION 

17 PROGRAMS. 

18 ‘‘(a) FUNDING FOR DEVELOPMENT OF PROGRAMS.— 

19 In addition to carrying out any other program for health 

20 promotion or disease prevention, the Secretary, acting 

21 through the Service, is authorized to award grants to In22 dian Tribes, Tribal Organizations, and Urban Indian Or23 ganizations to develop comprehensive school health edu24 cation programs for children from pre-school through 


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1 grade 12 in schools for the benefit of Indian and Urban 

2 Indian children. 

3 ‘‘(b) USE OF GRANT FUNDS.—A grant awarded 

4 under this section may be used for purposes which may 

5 include, but are not limited to, the following: 

6 ‘‘(1) Developing and implementing health edu7 cation curricula both for regular school programs 

8 and afterschool programs. 

9 ‘‘(2) Training teachers in comprehensive school 

10 health education curricula. 

11 ‘‘(3) Integrating school-based, community12 based, and other public and private health promotion 

13 efforts. 

14 ‘‘(4) Encouraging healthy, tobacco-free school 

15 environments. 

16 ‘‘(5) Coordinating school-based health programs 

17 with existing services and programs available in the 

18 community. 

19 ‘‘(6) Developing school programs on nutrition 

20 education, personal health, oral health, and fitness. 

21 ‘‘(7) Developing behavioral health wellness pro22 grams. 

23 ‘‘(8) Developing chronic disease prevention pro24 grams. 


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1 ‘‘(9) Developing substance abuse prevention 

2 programs. 

3 ‘‘(10) Developing injury prevention and safety 

4 education programs. 

5 ‘‘(11) Developing activities for the prevention 

6 and control of communicable diseases. 

7 ‘‘(12) Developing community and environmental 

8 health education programs. 

9 ‘‘(13) Violence prevention. 

10 ‘‘(14) Such other health issues as are appro11 priate. 

12 ‘‘(c) TECHNICAL ASSISTANCE.—Upon request, the 

13 Secretary, acting through the Service, shall provide tech14 nical assistance to Indian Tribes, Tribal Organizations, 

15 and Urban Indian Organizations in the development of 

16 comprehensive health education plans and the dissemina17 tion of comprehensive health education materials and in18 formation on existing health programs and resources. 

19 ‘‘(d) CRITERIAFOR REVIEW AND APPROVAL OF AP20 PLICATIONS.—The Secretary, acting through the Service, 

21 and in consultation with Indian Tribes, Tribal Organiza22 tions, and Urban Indian Organizations, shall establish cri23 teria for the review and approval of applications for grants 

24 awarded under this section. 


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1 ‘‘(e) DEVELOPMENT OF PROGRAM FOR BIA FUNDED

2 SCHOOLS.— 

3 ‘‘(1) IN GENERAL.—The Secretary of the Inte4 rior, acting through the Bureau of Indian Affairs 

5 and in cooperation with the Secretary, acting 

6 through the Service, and affected Indian Tribes and 

7 Tribal Organizations, shall develop a comprehensive 

8 school health education program for children from 

9 preschool through grade 12 in schools for which sup10 port is provided by the Bureau of Indian Affairs. 

11 ‘‘(2) REQUIREMENTS FOR PROGRAMS.—Such 

12 programs shall include— 

13 ‘‘(A) school programs on nutrition edu14 cation, personal health, oral health, and fitness; 

15 ‘‘(B) behavioral health wellness programs; 

16 ‘‘(C) chronic disease prevention programs; 

17 ‘‘(D) substance abuse prevention pro18 grams; 

19 ‘‘(E) injury prevention and safety edu20 cation programs; and 

21 ‘‘(F) activities for the prevention and con22 trol of communicable diseases. 

23 ‘‘(3) DUTIES OF THE SECRETARY.—The Sec24 retary of the Interior shall— 


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1 ‘‘(A) provide training to teachers in com2 prehensive school health education curricula; 

3 ‘‘(B) ensure the integration and coordina4 tion of school-based programs with existing 

5 services and health programs available in the 

6 community; and 

7 ‘‘(C) encourage healthy, tobacco-free school 

8 environments. 

9 ‘‘SEC. 211. INDIAN YOUTH PROGRAM. 

10 ‘‘(a) PROGRAM AUTHORIZED.—The Secretary, acting 

11 through the Service, is authorized to establish and admin12 ister a program to provide grants to Indian Tribes, Tribal 

13 Organizations, and Urban Indian Organizations for inno14 vative mental and physical disease prevention and health 

15 promotion and treatment programs for Indian and Urban 

16 Indian preadolescent and adolescent youths. 

17 ‘‘(b) USE OF FUNDS.— 

18 ‘‘(1) ALLOWABLE USES.—Funds made available 

19 under this section may be used to— 

20 ‘‘(A) develop prevention and treatment 

21 programs for Indian youth which promote men22 tal and physical health and incorporate cultural 

23 values, community and family involvement, and 

24 traditional healers; and 


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1 ‘‘(B) develop and provide community train2 ing and education. 

3 ‘‘(2) PROHIBITED USE.—Funds made available 

4 under this section may not be used to provide serv5 ices described in section 707(c). 

6 ‘‘(c) DUTIES OF THE SECRETARY.—The Secretary 

7 shall— 

8 ‘‘(1) disseminate to Indian Tribes, Tribal Orga9 nizations, and Urban Indian Organizations informa10 tion regarding models for the delivery of comprehen11 sive health care services to Indian and Urban Indian 

12 adolescents; 

13 ‘‘(2) encourage the implementation of such 

14 models; and 

15 ‘‘(3) at the request of an Indian Tribe, Tribal 

16 Organization, or Urban Indian Organization, provide 

17 technical assistance in the implementation of such 

18 models. 

19 ‘‘(d) CRITERIAFOR REVIEW AND APPROVAL OF AP20 PLICATIONS.—The Secretary, in consultation with Indian 

21 Tribes, Tribal Organizations, and Urban Indian Organiza22 tions, shall establish criteria for the review and approval 

23 of applications or proposals under this section. 


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1 ‘‘SEC. 212. PREVENTION, CONTROL, AND ELIMINATION OF 

2 COMMUNICABLE AND INFECTIOUS DISEASES. 

3 ‘‘(a) FUNDING AUTHORIZED.—The Secretary, acting 

4 through the Service, and after consultation with Indian 

5 Tribes, Tribal Organizations, Urban Indian Organiza6 tions, and the Centers for Disease Control and Prevention, 

7 may make funding available to Indian Tribes, Tribal Or8 ganizations, and Urban Indian Organizations for the fol9 lowing: 

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

11 elimination of communicable and infectious diseases, 

12 including tuberculosis, hepatitis, HIV, respiratory 

13 syncitial virus, hanta virus, sexually transmitted dis14 eases, and H. Pylori. 

15 ‘‘(2) Public information and education pro16 grams for the prevention, control, and elimination of 

17 communicable and infectious diseases. 

18 ‘‘(3) Education, training, and clinical skills im19 provement activities in the prevention, control, and 

20 elimination of communicable and infectious diseases 

21 for health professionals, including allied health pro22 fessionals. 

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

24 treatment, and prevention of hepatitis C virus 

25 (HCV). 


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

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

3 or proposal for funding is submitted to the Secretary. 

4 ‘‘(c) COORDINATION WITH HEALTH AGENCIES.—In5 dian Tribes, Tribal Organizations, and Urban Indian Or6 ganizations receiving funding under this section are en7 couraged to coordinate their activities with the Centers for 

8 Disease Control and Prevention and State and local health 

9 agencies. 

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

11 out this section, the Secretary— 

12 ‘‘(1) may, at the request of an Indian Tribe, 

13 Tribal Organization, or Urban Indian Organization, 

14 provide technical assistance; and 

15 ‘‘(2) shall prepare and submit a report to Con16 gress biennially on the use of funds under this sec17 tion and on the progress made toward the preven18 tion, control, and elimination of communicable and 

19 infectious diseases among Indians and Urban Indi20 ans. 

21 ‘‘SEC. 213. AUTHORITY FOR PROVISION OF OTHER SERV22 ICES. 

23 ‘‘(a) 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 Aug 31 2005 03:45 May 16, 2006 Jkt 049200 PO 00000 Frm 00114 Fmt 6652 Sfmt 6201 E:\BILLS\H5312.IH H5312

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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 including— 

4 ‘‘(1) hospice care; 

5 ‘‘(2) assisted living; 

6 ‘‘(3) long-term health care; 

7 ‘‘(4) home- and community-based services, in 

8 accordance with subsection (d); and 

9 ‘‘(5) public health functions. 

10 ‘‘(b) SERVICES TO OTHERWISE INELIGIBLE PER11 SONS.—Subject to section 807, at the discretion of the 

12 Service, Indian Tribes, or Tribal Organizations, services 

13 provided for hospice care, home- and community-based 

14 care, assisted living, and long-term care may be provided 

15 (subject to reimbursement) to persons otherwise ineligible 

16 for the health care benefits of the Service. Any funds re17 ceived under this subsection shall not be used to offset 

18 or limit the funding allocated to the Service or an Indian 

19 Tribe or Tribal Organization. 

20 ‘‘(c) TERMS AND CONDITIONS.—Any service provided 

21 under this section shall be consistent with accepted and 

22 appropriate standards relating to the service, including 

23 any licensing term or condition under this Act. 

24 ‘‘(d) DEFINITIONS.—For the purposes of this section, 

25 the following definitions shall apply: 


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1 ‘‘(1)(A) The term ‘home- and community-based 

2 services’ means 1 or more of the following: 

3 ‘‘(i) Home health aide services. 

4 ‘‘(ii) Personal care services. 

5 ‘‘(iii) Nursing care services provided out6 side of a nursing facility by, or under the super7 vision of, a registered nurse. 

8 ‘‘(iv) Respite care. 

9 ‘‘(v) Training for family members. 

10 ‘‘(vi) Adult day care. 

11 ‘‘(vii) Such other home- and community12 based services as the Secretary, an Indian 

13 Tribe, or a Tribal Organization may approve. 

14 ‘‘(B) The term ‘home- and community-based 

15 services’ does not include a service provided by an 

16 immediate relative who is legally responsible for pro17 viding the service. 

18 ‘‘(2) The term ‘hospice care’ means the items 

19 and services specified in subparagraphs (A) through 

20 (H) of section 1861(dd)(1) of the Social Security 

21 Act (42 U.S.C. 1395x(dd)(1)), and such other serv22 ices which an Indian Tribe or Tribal Organization 

23 determines are necessary and appropriate to provide 

24 in furtherance of this care. 


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1 ‘‘(3)(A) The term ‘personal care services’ 

2 means services relating to assistance in carrying out 

3 activities of daily living. 

4 ‘‘(B) The term ‘personal care services’ does not 

5 include a service solely relating to assistance in car6 rying out an ancillary activity, such as housekeeping 

7 or household chores, as determined by the Secretary. 

8 ‘‘(4) The term ‘public health functions’ means 

9 the provision of public health-related programs, 

10 functions, and services, including assessment, assur11 ance, and policy development which Indian Tribes 

12 and Tribal Organizations are authorized and encour13 aged, in those circumstances where it meets their 

14 needs, to do by forming collaborative relationships 

15 with all levels of local, State, and Federal Govern16 ment. 

17 ‘‘SEC. 214. INDIAN WOMEN’S HEALTH CARE. 

18 ‘‘The Secretary, acting through the Service and In19 dian Tribes, Tribal Organizations, and Urban Indian Or20 ganizations, shall monitor and improve the quality of 

21 health care for Indian women of all ages through the plan22 ning and delivery of programs administered by the Service, 

23 in order to improve and enhance the treatment models of 

24 care for Indian women. 


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1 ‘‘SEC. 215. ENVIRONMENTAL AND NUCLEAR HEALTH HAZ2 ARDS. 

3 ‘‘(a) STUDIES AND MONITORING.—The Secretary 

4 and the Service shall conduct, in conjunction with other 

5 appropriate Federal agencies and in consultation with con6 cerned Indian Tribes and Tribal Organizations, studies 

7 and ongoing monitoring programs to determine trends in 

8 the health hazards to Indian miners and to Indians on 

9 or near reservations and Indian communities as a result 

10 of environmental hazards which may result in chronic or 

11 life threatening health problems, such as nuclear resource 

12 development, petroleum contamination, and contamination 

13 of water source and of the food chain. Such studies shall 

14 include— 

15 ‘‘(1) an evaluation of the nature and extent of 

16 health problems caused by environmental hazards 

17 currently exhibited among Indians and the causes of 

18 such health problems; 

19 ‘‘(2) an analysis of the potential effect of ongo20 ing and future environmental resource development 

21 on or near reservations and Indian communities, in22 cluding the cumulative effect over time on health; 

23 ‘‘(3) an evaluation of the types and nature of 

24 activities, practices, and conditions causing or affect25 ing such health problems, including uranium mining 

26 and milling, uranium mine tailing deposits, nuclear 


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1 power plant operation and construction, and nuclear 

2 waste disposal; oil and gas production or transpor3 tation on or near reservations or Indian commu4 nities; and other development that could affect the 

5 health of Indians and their water supply and food 

6 chain; 

7 ‘‘(4) a summary of any findings and rec8 ommendations provided in Federal and State stud9 ies, reports, investigations, and inspections during 

10 the 5 years prior to the date of enactment of the In11 dian Health Care Improvement Act Amendments of 

12 2006 that directly or indirectly relate to the activi13 ties, practices, and conditions affecting the health or 

14 safety of such Indians; and 

15 ‘‘(5) the efforts that have been made by Federal 

16 and State agencies and resource and economic devel17 opment companies to effectively carry out an edu18 cation program for such Indians regarding the 

19 health and safety hazards of such development. 

20 ‘‘(b) HEALTH CARE PLANS.—Upon completion of 

21 such studies, the Secretary and the Service shall take into 

22 account the results of such studies and, in consultation 

23 with Indian Tribes and Tribal Organizations, develop 

24 health care plans to address the health problems studied 

25 under subsection (a). The plans shall include— 


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1 ‘‘(1) methods for diagnosing and treating Indi2 ans currently exhibiting such health problems; 

3 ‘‘(2) preventive care and testing for Indians 

4 who may be exposed to such health hazards, includ5 ing the monitoring of the health of individuals who 

6 have or may have been exposed to excessive amounts 

7 of radiation or affected by other activities that have 

8 had or could have a serious impact upon the health 

9 of such individuals; and 

10 ‘‘(3) a program of education for Indians who, 

11 by reason of their work or geographic proximity to 

12 such nuclear or other development activities, may ex13 perience health problems. 

14 ‘‘(c) SUBMISSION OF REPORT AND PLAN TO CON15 GRESS.—The Secretary and the Service shall submit to 

16 Congress the study prepared under subsection (a) no later 

17 than 18 months after the date of enactment of the Indian 

18 Health Care Improvement Act Amendments of 2006. The 

19 health care plan prepared under subsection (b) shall be 

20 submitted in a report no later than 1 year after the study 

21 prepared under subsection (a) is submitted to Congress. 

22 Such report shall include recommended activities for the 

23 implementation of the plan, as well as an evaluation of 

24 any activities previously undertaken by the Service to ad25 dress such health problems. 


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1 ‘‘(d) INTERGOVERNMENTAL TASK FORCE.— 

2 ‘‘(1) ESTABLISHMENT; MEMBERS.—There is es3 tablished an Intergovernmental Task Force to be 

4 composed of the following individuals (or their des5 ignees): 

6 ‘‘(A) The Secretary of Energy. 

7 ‘‘(B) The Secretary of the Environmental 

8 Protection Agency. 

9 ‘‘(C) The Director of the Bureau of Mines. 

10 ‘‘(D) The Assistant Secretary for Occupa11 tional Safety and Health. 

12 ‘‘(E) The Secretary of the Interior. 

13 ‘‘(F) The Secretary of Health and Human 

14 Services. 

15 ‘‘(G) The Director of the Indian Health 

16 Service. 

17 ‘‘(2) DUTIES.—The Task Force shall— 

18 ‘‘(A) identify existing and potential oper19 ations related to nuclear resource development 

20 or other environmental hazards that affect or 

21 may affect the health of Indians on or near a 

22 reservation or in an Indian community; and 

23 ‘‘(B) enter into activities to correct exist24 ing health hazards and ensure that current and 

25 future health problems resulting from nuclear 


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1 resource or other development activities are 

2 minimized or reduced. 

3 ‘‘(3) CHAIRMAN; MEETINGS.—The Secretary of 

4 Health and Human Services shall be the Chairman 

5 of the Task Force. The Task Force shall meet at 

6 least twice each year. 

7 ‘‘(e) HEALTH SERVICES TO CERTAIN EMPLOYEES.— 

8 In the case of any Indian who— 

9 ‘‘(1) as a result of employment in or near a 

10 uranium mine or mill or near any other environ11 mental hazard, suffers from a work-related illness or 

12 condition; 

13 ‘‘(2) is eligible to receive diagnosis and treat14 ment services from an Indian Health Program; and 

15 ‘‘(3) by reason of such Indian’s employment, is 

16 entitled to medical care at the expense of such mine 

17 or mill operator or entity responsible for the environ18 mental hazard, the Indian Health Program shall, at 

19 the request of such Indian, render appropriate med20 ical care to such Indian for such illness or condition 

21 and may be reimbursed for any medical care so ren22 dered to which such Indian is entitled at the expense 

23 of such operator or entity from such operator or en24 tity. Nothing in this subsection shall affect the 

25 rights of such Indian to recover damages other than 


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1 such amounts paid to the Indian Health Program 

2 from the employer for providing medical care for 

3 such illness or condition. 

4 ‘‘SEC. 216. ARIZONA AS A CONTRACT HEALTH SERVICE DE5 LIVERY AREA. 

6 ‘‘(a) IN GENERAL.—For fiscal years beginning with 

7 the fiscal year ending September 30, 1983, and ending 

8 with the fiscal year ending September 30, 2015, the State 

9 of Arizona shall be designated as a contract health service 

10 delivery area by the Service for the purpose of providing 

11 contract health care services to members of federally rec12 ognized Indian Tribes of Arizona. 

13 ‘‘(b) MAINTENANCE OF SERVICES.—The Service 

14 shall not curtail any health care services provided to Indi15 ans residing on reservations in the State of Arizona if such 

16 curtailment is due to the provision of contract services in 

17 such State pursuant to the designation of such State as 

18 a contract health service delivery area pursuant to sub19 section (a). 

20 ‘‘SEC. 216A. NORTH DAKOTA AND SOUTH DAKOTA AS CON21 TRACT HEALTH SERVICE DELIVERY AREA. 

22 ‘‘(a) IN GENERAL.—Beginning in fiscal year 2003, 

23 the States of North Dakota and South Dakota shall be 

24 designated as a contract health service delivery area by 

25 the Service for the purpose of providing contract health 


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1 care services to members of federally recognized Indian 

2 Tribes of North Dakota and South Dakota. 

3 ‘‘(b) LIMITATION.—The Service shall not curtail any 

4 health care services provided to Indians residing on any 

5 reservation, or in any county that has a common boundary 

6 with any reservation, in the State of North Dakota or 

7 South Dakota if such curtailment is due to the provision 

8 of contract services in such States pursuant to the des9 ignation of such States as a contract health service deliv10 ery area pursuant to subsection (a). 

11 ‘‘SEC. 217. CALIFORNIA CONTRACT HEALTH SERVICES PRO12 GRAM. 

13 ‘‘(a) FUNDING AUTHORIZED.—The Secretary is au14 thorized to fund a program using the California Rural In15 dian Health Board (hereafter in this section referred to 

16 as the ‘CRIHB’) as a contract care intermediary to im17 prove the accessibility of health services to California Indi18 ans. 

19 ‘‘(b) REIMBURSEMENT CONTRACT.—The Secretary 

20 shall enter into an agreement with the CRIHB to reim21 burse the CRIHB for costs (including reasonable adminis22 trative costs) incurred pursuant to this section, in pro23 viding medical treatment under contract to California In24 dians described in section 806(a) throughout the CaliVerDate Aug 31 2005 03:45 May 16, 2006 Jkt 049200 PO 00000 Frm 00124 Fmt 6652 Sfmt 6201 E:\BILLS\H5312.IH H5312

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1 fornia contract health services delivery area described in 

2 section 218 with respect to high cost contract care cases. 

3 ‘‘(c) ADMINISTRATIVE EXPENSES.—Not more than 5 

4 percent of the amounts provided to the CRIHB under this 

5 section for any fiscal year may be for reimbursement for 

6 administrative expenses incurred by the CRIHB during 

7 such fiscal year. 

8 ‘‘(d) LIMITATION ON PAYMENT.—No payment may 

9 be made for treatment provided hereunder to the extent 

10 payment may be made for such treatment under the In11 dian Catastrophic Health Emergency Fund described in 

12 section 202 or from amounts appropriated or otherwise 

13 made available to the California contract health service de14 livery area for a fiscal year. 

15 ‘‘(e) ADVISORY BOARD.—There is established an ad16 visory board which shall advise the CRIHB in carrying 

17 out this section. The advisory board shall be composed of 

18 representatives, selected by the CRIHB, from not less 

19 than 8 Tribal Health Programs serving California Indians 

20 covered under this section at least one half of whom of 

21 whom are not affiliated with the CRIHB. 

22 ‘‘SEC. 218. CALIFORNIA AS A CONTRACT HEALTH SERVICE 

23 DELIVERY AREA. 

24 ‘‘The State of California, excluding the counties of 

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1 ramento, San Francisco, San Mateo, Santa Clara, Kern, 

2 Merced, Monterey, Napa, San Benito, San Joaquin, San 

3 Luis Obispo, Santa Cruz, Solano, Stanislaus, and Ven4 tura, shall be designated as a contract health service deliv5 ery area by the Service for the purpose of providing con6 tract health services to California Indians. However, any 

7 of the counties listed herein may only be included in the 

8 contract health services delivery area if funding is specifi9 cally provided by the Service for such services in those 

10 counties. 

11 ‘‘SEC. 219. CONTRACT HEALTH SERVICES FOR THE TREN12 TON SERVICE AREA. 

13 ‘‘(a) AUTHORIZATION FOR SERVICES.—The Sec14 retary, acting through the Service, is directed to provide 

15 contract health services to members of the Turtle Moun16 tain Band of Chippewa Indians that reside in the Trenton 

17 Service Area of Divide, McKenzie, and Williams counties 

18 in the State of North Dakota and the adjoining counties 

19 of Richland, Roosevelt, and Sheridan in the State of Mon20 tana. 

21 ‘‘(b) NO EXPANSION OF ELIGIBILITY.—Nothing in 

22 this section may be construed as expanding the eligibility 

23 of members of the Turtle Mountain Band of Chippewa In24 dians for health services provided by the Service beyond 


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1 the scope of eligibility for such health services that applied 

2 on May 1, 1986. 

3 ‘‘SEC. 220. PROGRAMS OPERATED BY INDIAN TRIBES AND 

4 TRIBAL ORGANIZATIONS. 

5 ‘‘The Service shall provide funds for health care pro6 grams and facilities operated by Tribal Health Programs 

7 on the same basis as such funds are provided to programs 

8 and facilities operated directly by the Service. 

9 ‘‘SEC. 221. LICENSING. 

10 ‘‘Health care professionals employed by a Tribal 

11 Health Program shall, if licensed in any State, be exempt 

12 from the licensing requirements of the State in which the 

13 Tribal Health Program performs the services described in 

14 its contract or compact under the Indian Self-Determina15 tion and Education Assistance Act (25 U.S.C. 450 et 

16 seq.). 

17 ‘‘SEC. 222. NOTIFICATION OF PROVISION OF EMERGENCY 

18 CONTRACT HEALTH SERVICES. 

19 ‘‘With respect to an elderly Indian or an Indian with 

20 a disability receiving emergency medical care or services 

21 from a non-Service provider or in a non-Service facility 

22 under the authority of this Act, the time limitation (as 

23 a condition of payment) for notifying the Service of such 

24 treatment or admission shall be 30 days. 


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1 ‘‘SEC. 223. PROMPT ACTION ON PAYMENT OF CLAIMS. 

2 ‘‘(a) DEADLINE FOR RESPONSE.—The Service shall 

3 respond to a notification of a claim by a provider of a 

4 contract care service with either an individual purchase 

5 order or a denial of the claim within 5 working days after 

6 the receipt of such notification. 

7 ‘‘(b) EFFECT OF UNTIMELY RESPONSE.—If the 

8 Service fails to respond to a notification of a claim in ac9 cordance with subsection (a), the Service shall accept as 

10 valid the claim submitted by the provider of a contract 

11 care service. 

12 ‘‘(c) DEADLINE FOR PAYMENT OF VALID CLAIM.— 

13 The Service shall pay a valid contract care service claim 

14 within 30 days after the completion of the claim. 

15 ‘‘SEC. 224. LIABILITY FOR PAYMENT. 

16 ‘‘(a) NO PATIENT LIABILITY.—A patient who re17 ceives contract health care services that are authorized by 

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

19 charges or costs associated with the provision of such serv20 ices. 

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

22 contract care provider and any patient who receives con23 tract health care services authorized by the Service that 

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

25 or costs associated with the provision of such services not 


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1 later than 5 business days after receipt of a notification 

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

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

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

5 deemed accepted under section 223(b), the provider shall 

6 have no further recourse against the patient who received 

7 the services. 

8 ‘‘SEC. 225. OFFICE OF INDIAN MEN’S HEALTH. 

9 ‘‘(a) ESTABLISHMENT.—The Secretary shall estab10 lish within the Service an office to be known as the ‘Office 

11 of Indian Men’s Health’ (referred to in this section as the 

12 ‘Office’). 

13 ‘‘(b) DIRECTOR.— 

14 ‘‘(1) IN GENERAL.—The Office shall be headed 

15 by a Director, to be appointed by the Secretary. 

16 ‘‘(2) DUTIES.—The Director shall coordinate 

17 and promote the status of the health of Indian men 

18 in the United States. 

19 ‘‘(c) REPORT.—Not later than 2 years after the date 

20 of enactment of the Indian Health Care Improvement Act 

21 Amendments of 2006, the Secretary, acting through the 

22 Director of the Office, shall submit to Congress a report 

23 describing— 

24 ‘‘(1) any activity carried out by the Director as 

25 of the date on which the report is prepared; and 


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1 ‘‘(2) any finding of the Director with respect to 

2 the health of Indian men. 

3 ‘‘SEC. 226. AUTHORIZATION OF APPROPRIATIONS. 

4 ‘‘There are authorized to be appropriated such sums 

5 as may be necessary for each fiscal year through fiscal 

6 year 2015 to carry out this title. 

7 ‘‘TITLE III—FACILITIES 

8 ‘‘SEC. 301. CONSULTATION; CONSTRUCTION AND RENOVA9 TION OF FACILITIES; REPORTS. 

10 ‘‘(a) PREREQUISITES FOR EXPENDITURE OF

11 FUNDS.—Prior to the expenditure of, or the making of 

12 any binding commitment to expend, any funds appro13 priated for the planning, design, construction, or renova14 tion of facilities pursuant to the Act of November 2, 1921 

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

16 the Secretary, acting through the Service, shall— 

17 ‘‘(1) consult with any Indian Tribe that would 

18 be significantly affected by such expenditure for the 

19 purpose of determining and, whenever practicable, 

20 honoring tribal preferences concerning size, location, 

21 type, and other characteristics of any facility on 

22 which such expenditure is to be made; and 

23 ‘‘(2) ensure, whenever practicable and applica24 ble, that such facility meets the construction stand25 ards of any accrediting body recognized by the SecVerDate Aug 31 2005 03:45 May 16, 2006 Jkt 049200 PO 00000 Frm 00130 Fmt 6652 Sfmt 6201 E:\BILLS\H5312.IH H5312

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1 retary for the purposes of the medicare, medicaid, 

2 and SCHIP programs under titles XVIII, XIX, and 

3 XXI of the Social Security Act by not later than 1 

4 year after the date on which the construction or ren5 ovation of such facility is completed. 

6 ‘‘(b) CLOSURES.— 

7 ‘‘(1) EVALUATION REQUIRED.—Notwith8 standing any other provision of law, no facility oper9 ated by the Service may be closed if the Secretary 

10 has not submitted to Congress at least 1 year prior 

11 to the date of the proposed closure an evaluation of 

12 the impact of the proposed closure which specifies, 

13 in addition to other considerations— 

14 ‘‘(A) the accessibility of alternative health 

15 care resources for the population served by such 

16 facility; 

17 ‘‘(B) the cost-effectiveness of such closure; 

18 ‘‘(C) the quality of health care to be pro19 vided to the population served by such facility 

20 after such closure; 

21 ‘‘(D) the availability of contract health 

22 care funds to maintain existing levels of service; 

23 ‘‘(E) the views of the Indian Tribes served 

24 by such facility concerning such closure; 


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1 ‘‘(F) the level of use of such facility by all 

2 eligible Indians; and 

3 ‘‘(G) the distance between such facility and 

4 the nearest operating Service hospital. 

5 ‘‘(2) EXCEPTION FOR CERTAIN TEMPORARY

6 CLOSURES.—Paragraph (1) shall not apply to any 

7 temporary closure of a facility or any portion of a 

8 facility if such closure is necessary for medical, envi9 ronmental, or construction safety reasons. 

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

11 ‘‘(1) IN GENERAL.— 

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

13 acting through the Service, shall establish a 

14 health care facility priority system, which 

15 shall— 

16 ‘‘(i) be developed with Indian Tribes 

17 and Tribal Organizations through nego18 tiated rulemaking under section 802; 

19 ‘‘(ii) give Indian Tribes’ needs the 

20 highest priority; and 

21 ‘‘(iii) at a minimum, include the lists 

22 required in paragraph (2)(B) and the 

23 methodology required in paragraph (2)(E). 

24 ‘‘(B) PRIORITY OF CERTAIN PROJECTS

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1 lished under the construction priority system in 

2 effect on the date of the Indian Health Care 

3 Improvement Act Amendments of 2006 shall 

4 not be affected by any change in the construc5 tion priority system taking place thereafter if 

6 the project was identified as 1 of the 10 top7 priority inpatient projects, 1 of the 10 top-pri8 ority outpatient projects, 1 of the 10 top-pri9 ority staff quarters developments, or 1 of the 

10 10 top-priority Youth Regional Treatment Cen11 ters in the fiscal year 2006 Indian Health Serv12 ice budget justification, or if the project had 

13 completed both Phase I and Phase II of the 

14 construction priority system in effect on the 

15 date of enactment of such Act. 

16 ‘‘(2) REPORT; CONTENTS.—The Secretary shall 

17 submit to the President, for inclusion in the report 

18 required to be transmitted to Congress under section 

19 801, a report which sets forth the following: 

20 ‘‘(A) A description of the health care facil21 ity priority system of the Service, established 

22 under paragraph (1). 

23 ‘‘(B) Health care facilities lists, includ24 ing— 


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1 ‘‘(i) the 10 top-priority inpatient 

2 health care facilities; 

3 ‘‘(ii) the 10 top-priority outpatient 

4 health care facilities; 

5 ‘‘(iii) the 10 top-priority specialized 

6 health care facilities (such as long-term 

7 care and alcohol and drug abuse treat8 ment); 

9 ‘‘(iv) the 10 top-priority staff quarters 

10 developments associated with health care 

11 facilities; and 

12 ‘‘(v) the 10 top-priority hostels associ13 ated with health care facilities. 

14 ‘‘(C) The justification for such order of 

15 priority. 

16 ‘‘(D) The projected cost of such projects. 

17 ‘‘(E) The methodology adopted by the 

18 Service in establishing priorities under its 

19 health care facility priority system. 

20 ‘‘(3) REQUIREMENTS FOR PREPARATION OF RE21 PORTS.—In preparing each report required under 

22 paragraph (2) (other than the initial report), the 

23 Secretary shall annually— 

24 ‘‘(A) consult with and obtain information 

25 on all health care facilities needs from Indian 


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1 Tribes, Tribal Organizations, and Urban Indian 

2 Organizations; and 

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

4 Indian Tribes, Tribal Organizations, and Urban 

5 Indian Organizations for health care facilities 

6 (including hostels and staff quarters), including 

7 needs for renovation and expansion of existing 

8 facilities. 

9 ‘‘(4) CRITERIA FOR EVALUATING NEEDS.—For 

10 purposes of this subsection, the Secretary shall, in 

11 evaluating the needs of facilities operated under any 

12 contract or compact under the Indian Self-Deter13 mination and Education Assistance Act (25 U.S.C. 

14 450 et seq.) use the same criteria that the Secretary 

15 uses in evaluating the needs of facilities operated di16 rectly by the Service. 

17 ‘‘(5) NEEDS OF FACILITIES UNDER ISDEAA

18 AGREEMENTS.—The Secretary shall ensure that the 

19 planning, design, construction, and renovation needs 

20 of Service and non-Service facilities operated under 

21 contracts or compacts in accordance with the Indian 

22 Self-Determination and Education Assistance Act 

23 (25 U.S.C. 450 et seq.) are fully and equitably inte24 grated into the health care facility priority system. 

25 ‘‘(d) REVIEW OF NEED FOR FACILITIES.— 


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1 ‘‘(1) INITIAL REPORT.—In the year 2006, the 

2 Government Accountability Office shall prepare and 

3 finalize a report which sets forth the needs of the 

4 Service, Indian Tribes, Tribal Organizations, and 

5 Urban Indian Organizations, for the types of facili6 ties listed under subsection (c)(2)(B), including the 

7 needs for renovation and expansion of existing facili8 ties. The Government Accountability Office shall 

9 submit the report to the appropriate authorizing and 

10 appropriations committees of Congress and to the 

11 Secretary. 

12 ‘‘(2) Beginning in the year 2006, the Secretary 

13 shall update the report required under paragraph 

14 (1) every 5 years. 

15 ‘‘(3) In preparing an updated report under 

16 paragraph (2), the Secretary shall consult with In17 dian Tribes, Tribal Organizations, and Urban Indian 

18 Organizations. The Secretary shall submit the report 

19 under paragraph (2) for inclusion in the report re20 quired to be transmitted to Congress under section 

21 801. 

22 ‘‘(4) For purposes of this subsection, the re23 ports shall, regarding the needs of facilities operated 

24 under any contract or compact under the Indian 

25 Self-Determination and Education Assistance Act 


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1 (25 U.S.C. 450 et seq.), be based on the same cri2 teria that the Secretary uses in evaluating the needs 

3 of facilities operated directly by the Service. 

4 ‘‘(5) The planning, design, construction, and 

5 renovation needs of facilities operated under con6 tracts or compacts under the Indian Self-Determina7 tion and Education Assistance Act (25 U.S.C. 450 

8 et seq.) shall be fully and equitably integrated into 

9 the development of the health facility priority sys10 tem. 

11 ‘‘(6) Beginning in 2007 and each fiscal year 

12 thereafter, the Secretary shall provide an oppor13 tunity for nomination of planning, design, and con14 struction projects by the Service, Indian Tribes, 

15 Tribal Organizations, and Urban Indian Organiza16 tions for consideration under the health care facility 

17 priority system. 

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

19 under the Act of November 2, 1921 (25 U.S.C. 13) (com20 monly known as the ‘Snyder Act’), for the planning, de21 sign, construction, or renovation of health facilities for the 

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

23 provisions of the Indian Self-Determination and Edu24 cation Assistance Act (25 U.S.C. 450 et seq.). 


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

2 The Secretary shall consult and cooperate with Indian 

3 Tribes, Tribal Organizations, and Urban Indian Organiza4 tions in developing innovative approaches to address all 

5 or part of the total unmet need for construction of health 

6 facilities, including those provided for in other sections of 

7 this title and other approaches. 

8 ‘‘SEC. 302. SANITATION FACILITIES. 

9 ‘‘(a) FINDINGS.—Congress finds the following: 

10 ‘‘(1) The provision of sanitation facilities is pri11 marily a health consideration and function. 

12 ‘‘(2) Indian people suffer an inordinately high 

13 incidence of disease, injury, and illness directly at14 tributable to the absence or inadequacy of sanitation 

15 facilities. 

16 ‘‘(3) The long-term cost to the United States of 

17 treating and curing such disease, injury, and illness 

18 is substantially greater than the short-term cost of 

19 providing sanitation facilities and other preventive 

20 health measures. 

21 ‘‘(4) Many Indian homes and Indian commu22 nities still lack sanitation facilities. 

23 ‘‘(5) It is in the interest of the United States, 

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1 dian communities and Indian homes, new and exist2 ing, be provided with sanitation facilities. 

3 ‘‘(b) FACILITIES AND SERVICES.—In furtherance of 

4 the findings made in subsection (a), Congress reaffirms 

5 the primary responsibility and authority of the Service to 

6 provide the necessary sanitation facilities and services as 

7 provided in section 7 of the Act of August 5, 1954 (42 

8 U.S.C. 2004a). Under such authority, the Secretary, act9 ing through the Service, is authorized to provide the fol10 lowing: 

11 ‘‘(1) Financial and technical assistance to In12 dian Tribes, Tribal Organizations, and Indian com13 munities in the establishment, training, and equip14 ping of utility organizations to operate and maintain 

15 sanitation facilities, including the provision of exist16 ing plans, standard details, and specifications avail17 able in the Department, to be used at the option of 

18 the Indian Tribe, Tribal Organization, or Indian 

19 community. 

20 ‘‘(2) Ongoing technical assistance and training 

21 to Indian Tribes, Tribal Organizations, and Indian 

22 communities in the management of utility organiza23 tions which operate and maintain sanitation facili24 ties. 


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1 ‘‘(3) Priority funding for operation and mainte2 nance assistance for, and emergency repairs to, sani3 tation facilities operated by an Indian Tribe, Tribal 

4 Organization or Indian community when necessary 

5 to avoid an imminent health threat or to protect the 

6 investment in sanitation facilities and the investment 

7 in the health benefits gained through the provision 

8 of sanitation facilities. 

9 ‘‘(c) FUNDING.—Notwithstanding any other provi10 sion of law— 

11 ‘‘(1) the Secretary of Housing and Urban De12 velopment is authorized to transfer funds appro13 priated under the Native American Housing Assist14 ance and Self-Determination Act of 1996 to the Sec15 retary of Health and Human Services; 

16 ‘‘(2) the Secretary of Health and Human Serv17 ices is authorized to accept and use such funds for 

18 the purpose of providing sanitation facilities and 

19 services for Indians under section 7 of the Act of 

20 August 5, 1954 (42 U.S.C. 2004a); 

21 ‘‘(3) unless specifically authorized when funds 

22 are appropriated, the Secretary shall not use funds 

23 appropriated under section 7 of the Act of August 

24 5, 1954 (42 U.S.C. 2004a), to provide sanitation fa25 cilities to new homes constructed using funds proVerDate Aug 31 2005 03:45 May 16, 2006 Jkt 049200 PO 00000 Frm 00140 Fmt 6652 Sfmt 6201 E:\BILLS\H5312.IH H5312

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1 vided by the Department of Housing and Urban De2 velopment; 

3 ‘‘(4) the Secretary of Health and Human Serv4 ices is authorized to accept from any source, includ5 ing Federal and State agencies, funds for the pur6 pose of providing sanitation facilities and services 

7 and place these funds into contracts or compacts 

8 under the Indian Self-Determination and Education 

9 Assistance Act (25 U.S.C. 450 et seq.); 

10 ‘‘(5) except as otherwise prohibited by this sec11 tion, the Secretary may use funds appropriated 

12 under the authority of section 7 of the Act of Au13 gust 5, 1954 (42 U.S.C. 2004a) to fund up to 100 

14 percent of the amount of an Indian Tribe’s loan ob15 tained under any Federal program for new projects 

16 to construct eligible sanitation facilities to serve In17 dian homes; 

18 ‘‘(6) except as otherwise prohibited by this sec19 tion, the Secretary may use funds appropriated 

20 under the authority of section 7 of the Act of Au21 gust 5, 1954 (42 U.S.C. 2004a) to meet matching 

22 or cost participation requirements under other Fed23 eral and non-Federal programs for new projects to 

24 construct eligible sanitation facilities; 


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1 ‘‘(7) all Federal agencies are authorized to 

2 transfer to the Secretary funds identified, granted, 

3 loaned, or appropriated whereby the Department’s 

4 applicable policies, rules, and regulations shall apply 

5 in the implementation of such projects; 

6 ‘‘(8) the Secretary of Health and Human Serv7 ices shall enter into interagency agreements with 

8 Federal and State agencies for the purpose of pro9 viding financial assistance for sanitation facilities 

10 and services under this Act; and 

11 ‘‘(9) the Secretary of Health and Human Serv12 ices shall, by regulation developed through rule13 making under section 802, establish standards appli14 cable to the planning, design, and construction of 

15 sanitation facilities funded under this Act. 

16 ‘‘(d) CERTAIN CAPABILITIES NOT PREREQUISITE.— 

17 The financial and technical capability of an Indian Tribe, 

18 Tribal Organization, or Indian community to safely oper19 ate, manage, and maintain a sanitation facility shall not 

20 be a prerequisite to the provision or construction of sanita21 tion facilities by the Secretary. 

22 ‘‘(e) FINANCIAL ASSISTANCE.—The Secretary is au23 thorized to provide financial assistance to Indian Tribes, 

24 Tribal Organizations, and Indian communities for operVerDate Aug 31 2005 03:45 May 16, 2006 Jkt 049200 PO 00000 Frm 00142 Fmt 6652 Sfmt 6201 E:\BILLS\H5312.IH H5312

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1 ation, management, and maintenance of their sanitation 

2 facilities. 

3 ‘‘(f) OPERATION, MANAGEMENT, AND MAINTENANCE

4 OF FACILITIES.—The Indian Tribe has the primary re5 sponsibility to establish, collect, and use reasonable user 

6 fees, or otherwise set aside funding, for the purpose of 

7 operating, managing, and maintaining sanitation facilities. 

8 If a sanitation facility serving a community that is oper9 ated by an Indian Tribe or Tribal Organization is threat10 ened with imminent failure and such operator lacks capac11 ity to maintain the integrity or the health benefits of the 

12 sanitation facility, then the Secretary is authorized to as13 sist the Indian Tribe, Tribal Organization, or Indian com14 munity in the resolution of the problem on a short-term 

15 basis through cooperation with the emergency coordinator 

16 or by providing operation, management, and maintenance 

17 service. 

18 ‘‘(g) ISDEAA PROGRAM FUNDED ON EQUAL

19 BASIS.—Tribal Health Programs shall be eligible (on an 

20 equal basis with programs that are administered directly 

21 by the Service) for— 

22 ‘‘(1) any funds appropriated pursuant to this 

23 section; and 

24 ‘‘(2) any funds appropriated for the purpose of 

25 providing sanitation facilities. 


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1 ‘‘(h) REPORT.— 

2 ‘‘(1) REQUIRED; CONTENTS.—The Secretary, in 

3 consultation with the Secretary of Housing and 

4 Urban Development, Indian Tribes, Tribal Organiza5 tions, and tribally designated housing entities (as de6 fined in section 4 of the Native American Housing 

7 Assistance and Self-Determination Act of 1996 (25 

8 U.S.C. 4103)) shall submit to the President, for in9 clusion in the report required to be transmitted to 

10 Congress under section 801, a report which sets 

11 forth— 

12 ‘‘(A) the current Indian sanitation facility 

13 priority system of the Service; 

14 ‘‘(B) the methodology for determining 

15 sanitation deficiencies and needs; 

16 ‘‘(C) the level of initial and final sanitation 

17 deficiency for each type of sanitation facility for 

18 each project of each Indian Tribe or Indian 

19 community; 

20 ‘‘(D) the amount and most effective use of 

21 funds, derived from whatever source, necessary 

22 to accommodate the sanitation facilities needs 

23 of new homes assisted with funds under the 

24 Native American Housing Assistance and Self25 Determination Act, and to reduce the identified 


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1 sanitation deficiency levels of all Indian Tribes 

2 and Indian communities to level I sanitation de3 ficiency as defined in paragraph (4)(A); and 

4 ‘‘(E) a 10-year plan to provide sanitation 

5 facilities to serve existing Indian homes and In6 dian communities and new and renovated In7 dian homes. 

8 ‘‘(2) CRITERIA.—The criteria on which the defi9 ciencies and needs will be evaluated shall be devel10 oped through negotiated rulemaking pursuant to 

11 section 802. 

12 ‘‘(3) UNIFORM METHODOLOGY.—The method13 ology used by the Secretary in determining, pre14 paring cost estimates for, and reporting sanitation 

15 deficiencies for purposes of paragraph (1) shall be 

16 applied uniformly to all Indian Tribes and Indian 

17 communities. 

18 ‘‘(4) SANITATION DEFICIENCY LEVELS.—For 

19 purposes of this subsection, the sanitation deficiency 

20 levels for an individual, Indian Tribe, or Indian com21 munity sanitation facility to serve Indian homes are 

22 determined as follows: 

23 ‘‘(A) A level I deficiency exists if a sanita24 tion facility serving an individual, Indian Tribe, 

25 or Indian community— 


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1 ‘‘(i) complies with all applicable water 

2 supply, pollution control, and solid waste 

3 disposal laws; and 

4 ‘‘(ii) deficiencies relate to routine re5 placement, repair, or maintenance needs. 

6 ‘‘(B) A level II deficiency exists if a sanita7 tion facility serving an individual, Indian Tribe, 

8 or Indian community substantially or recently 

9 complied with all applicable water supply, pollu10 tion control, and solid waste laws and any defi11 ciencies relate to— 

12 ‘‘(i) small or minor capital improve13 ments needed to bring the facility back 

14 into compliance; 

15 ‘‘(ii) capital improvements that are 

16 necessary to enlarge or improve the facili17 ties in order to meet the current needs for 

18 domestic sanitation facilities; or 

19 ‘‘(iii) the lack of equipment or train20 ing by an Indian Tribe, Tribal Organiza21 tion, or an Indian community to properly 

22 operate and maintain the sanitation facili23 ties. 

24 ‘‘(C) A level III deficiency exists if a sani25 tation facility serving an individual, Indian 


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1 Tribe or Indian community meets 1 or more of 

2 the following conditions— 

3 ‘‘(i) water or sewer service in the 

4 home is provided by a haul system with 

5 holding tanks and interior plumbing; 

6 ‘‘(ii) major significant interruptions to 

7 water supply or sewage disposal occur fre8 quently, requiring major capital improve9 ments to correct the deficiencies; or 

10 ‘‘(iii) there is no access to or no ap11 proved or permitted solid waste facility 

12 available. 

13 ‘‘(D) A level IV deficiency exists— 

14 ‘‘(i) if a sanitation facility for an indi15 vidual home, an Indian Tribe, or an Indian 

16 community exists but— 

17 ‘‘(I) lacks— 

18 ‘‘(aa) a safe water supply 

19 system; or 

20 ‘‘(bb) a waste disposal sys21 tem; 

22 ‘‘(II) contains no piped water or 

23 sewer facilities; or 

24 ‘‘(III) has become inoperable due 

25 to a major component failure; or 


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1 ‘‘(ii) if only a washeteria or central fa2 cility exists in the community. 

3 ‘‘(E) A level V deficiency exists in the ab4 sence of a sanitation facility, where individual 

5 homes do not have access to safe drinking 

6 water or adequate wastewater (including sew7 age) disposal. 

8 ‘‘(i) DEFINITIONS.—For purposes of this section, the 

9 following terms apply: 

10 ‘‘(1) INDIAN COMMUNITY.—The term ‘Indian 

11 community’ means a geographic area, a significant 

12 proportion of whose inhabitants are Indians and 

13 which is served by or capable of being served by a 

14 facility described in this section. 

15 ‘‘(2) SANITATION FACILITIES.—The terms 

16 ‘sanitation facility’ and ‘sanitation facilities’ mean 

17 safe and adequate water supply systems, sanitary 

18 sewage disposal systems, and sanitary solid waste 

19 systems (and all related equipment and support in20 frastructure). 

21 ‘‘SEC. 303. PREFERENCE TO INDIANS AND INDIAN FIRMS. 

22 ‘‘(a) BUY INDIAN ACT.—The Secretary, acting 

23 through the Service, may use the negotiating authority of 

24 section 23 of the Act of June 25, 1910 (25 U.S.C. 47, 

25 commonly known as the ‘Buy Indian Act’), to give prefVerDate Aug 31 2005 03:45 May 16, 2006 Jkt 049200 PO 00000 Frm 00148 Fmt 6652 Sfmt 6201 E:\BILLS\H5312.IH H5312

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1 erence to any Indian or any enterprise, partnership, cor2 poration, or other type of business organization owned and 

3 controlled by an Indian or Indians including former or 

4 currently federally recognized Indian Tribes in the State 

5 of New York (hereinafter referred to as an ‘Indian firm’) 

6 in the construction and renovation of Service facilities pur7 suant to section 301 and in the construction of sanitation 

8 facilities pursuant to section 302. Such preference may be 

9 accorded by the Secretary unless the Secretary finds, pur10 suant to regulations adopted pursuant to section 802, that 

11 the project or function to be contracted for will not be 

12 satisfactory or such project or function cannot be properly 

13 completed or maintained under the proposed contract. The 

14 Secretary, in arriving at such a finding, shall consider 

15 whether the Indian or Indian firm will be deficient with 

16 respect to— 

17 ‘‘(1) ownership and control by Indians; 

18 ‘‘(2) equipment; 

19 ‘‘(3) bookkeeping and accounting procedures; 

20 ‘‘(4) substantive knowledge of the project or 

21 function to be contracted for; 

22 ‘‘(5) adequately trained personnel; or 

23 ‘‘(6) other necessary components of contract 

24 performance. 

25 ‘‘(b) LABOR STANDARDS.— 


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1 ‘‘(1) IN GENERAL.—For the purposes of imple2 menting the provisions of this title, contracts for the 

3 construction or renovation of health care facilities, 

4 staff quarters, and sanitation facilities, and related 

5 support infrastructure, funded in whole or in part 

6 with funds made available pursuant to this title, 

7 shall contain a provision requiring compliance with 

8 subchapter IV of chapter 31 of title 40, United 

9 States Code (commonly known as the ‘Davis-Bacon 

10 Act’), unless such construction or renovation— 

11 ‘‘(A) is performed by a contractor pursu12 ant to a contract with an Indian Tribe or Trib13 al Organization with funds supplied through a 

14 contract or compact authorized by the Indian 

15 Self-Determination and Education Assistance 

16 Act (25 U.S.C. 450 et seq.), or other statutory 

17 authority; and 

18 ‘‘(B) is subject to prevailing wage rates for 

19 similar construction or renovation in the locality 

20 as determined by the Indian Tribes or Tribal 

21 Organizations to be served by the construction 

22 or renovation. 

23 ‘‘(2) EXCEPTION.—This subsection shall not 

24 apply to construction or renovation carried out by an 


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1 Indian Tribe or Tribal Organization with its own 

2 employees. 

3 ‘‘SEC. 304. EXPENDITURE OF NONSERVICE FUNDS FOR REN4 OVATION. 

5 ‘‘(a) IN GENERAL.—Notwithstanding any other pro6 vision of law, if the requirements of subsection (c) are met, 

7 the Secretary, acting through the Service, is authorized 

8 to accept any major expansion, renovation, or moderniza9 tion by any Indian Tribe or Tribal Organization of any 

10 Service facility or of any other Indian health facility oper11 ated pursuant to a contract or compact under the Indian 

12 Self-Determination and Education Assistance Act (25 

13 U.S.C. 450 et seq.), including— 

14 ‘‘(1) any plans or designs for such expansion, 

15 renovation, or modernization; and 

16 ‘‘(2) any expansion, renovation, or moderniza17 tion for which funds appropriated under any Federal 

18 law were lawfully expended. 

19 ‘‘(b) PRIORITY LIST.— 

20 ‘‘(1) IN GENERAL.—The Secretary shall main21 tain a separate priority list to address the needs for 

22 increased operating expenses, personnel, or equip23 ment for such facilities. The methodology for estab24 lishing priorities shall be developed through nego25 tiated rulemaking under section 802. The list of priVerDate Aug 31 2005 03:45 May 16, 2006 Jkt 049200 PO 00000 Frm 00151 Fmt 6652 Sfmt 6201 E:\BILLS\H5312.IH H5312

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1 ority facilities will be revised annually in consulta2 tion with Indian Tribes and Tribal Organizations. 

3 ‘‘(2) REPORT.—The Secretary shall submit to 

4 the President, for inclusion in the report required to 

5 be transmitted to Congress under section 801, the 

6 priority list maintained pursuant to paragraph (1). 

7 ‘‘(c) REQUIREMENTS.—The requirements of this sub8 section are met with respect to any expansion, renovation, 

9 or modernization if— 

10 ‘‘(1) the Indian Tribe or Tribal Organization— 

11 ‘‘(A) provides notice to the Secretary of its 

12 intent to expand, renovate, or modernize; and 

13 ‘‘(B) applies to the Secretary to be placed 

14 on a separate priority list to address the needs 

15 of such new facilities for increased operating ex16 penses, personnel, or equipment; and 

17 ‘‘(2) the expansion, renovation, or moderniza18 tion— 

19 ‘‘(A) is approved by the appropriate area 

20 director of the Service for Federal facilities; and 

21 ‘‘(B) is administered by the Indian Tribe 

22 or Tribal Organization in accordance with any 

23 applicable regulations prescribed by the Sec24 retary with respect to construction or renova25 tion of Service facilities. 


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1 ‘‘(d) ADDITIONAL REQUIREMENT FOR EXPANSION.— 

2 In addition to the requirements under subsection (c), for 

3 any expansion, the Indian Tribe or Tribal Organization 

4 shall provide to the Secretary additional information devel5 oped through negotiated rulemaking under section 802, 

6 including additional staffing, equipment, and other costs 

7 associated with the expansion. 

8 ‘‘(e) CLOSURE OR CONVERSION OF FACILITIES.—If 

9 any Service facility which has been expanded, renovated, 

10 or modernized by an Indian Tribe or Tribal Organization 

11 under this section ceases to be used as a Service facility 

12 during the 20-year period beginning on the date such ex13 pansion, renovation, or modernization is completed, such 

14 Indian Tribe or Tribal Organization shall be entitled to 

15 recover from the United States an amount which bears 

16 the same ratio to the value of such facility at the time 

17 of such cessation as the value of such expansion, renova18 tion, or modernization (less the total amount of any funds 

19 provided specifically for such facility under any Federal 

20 program that were expended for such expansion, renova21 tion, or modernization) bore to the value of such facility 

22 at the time of the completion of such expansion, renova23 tion, or modernization. 


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1 ‘‘SEC. 305. FUNDING FOR THE CONSTRUCTION, EXPANSION, 

2 AND MODERNIZATION OF SMALL AMBULA3 TORY CARE FACILITIES. 

4 ‘‘(a) FUNDING.— 

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

6 through the Service, shall make grants to Indian 

7 Tribes and Tribal Organizations for the construc8 tion, expansion, or modernization of facilities for the 

9 provision of ambulatory care services to eligible Indi10 ans (and noneligible persons pursuant to subsections 

11 (b)(2) and (c)(1)(C)). A grant made under this sec12 tion may cover up to 100 percent of the costs of 

13 such construction, expansion, or modernization. For 

14 the purposes of this section, the term ‘construction’ 

15 includes the replacement of an existing facility. 

16 ‘‘(2) GRANT AGREEMENT REQUIRED.—A grant 

17 under paragraph (1) may only be made available to 

18 a Tribal Health Program operating an Indian health 

19 facility (other than a facility owned or constructed 

20 by the Service, including a facility originally owned 

21 or constructed by the Service and transferred to an 

22 Indian Tribe or Tribal Organization). 

23 ‘‘(b) USE OF GRANT FUNDS.— 

24 ‘‘(1) ALLOWABLE USES.—A grant awarded 

25 under this section may be used for the construction, 

26 expansion, or modernization (including the planning 


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1 and design of such construction, expansion, or mod2 ernization) of an ambulatory care facility— 

3 ‘‘(A) located apart from a hospital; 

4 ‘‘(B) not funded under section 301 or sec5 tion 307; and 

6 ‘‘(C) which, upon completion of such con7 struction or modernization will— 

8 ‘‘(i) have a total capacity appropriate 

9 to its projected service population; 

10 ‘‘(ii) provide annually no fewer than 

11 150 patient visits by eligible Indians and 

12 other users who are eligible for services in 

13 such facility in accordance with section 

14 807(c)(2); and 

15 ‘‘(iii) provide ambulatory care in a 

16 Service Area (specified in the contract or 

17 compact under the Indian Self-Determina18 tion and Education Assistance Act (25 

19 U.S.C. 450 et seq.)) with a population of 

20 no fewer than 1,500 eligible Indians and 

21 other users who are eligible for services in 

22 such facility in accordance with section 

23 807(c)(2). 

24 ‘‘(2) ADDITIONAL ALLOWABLE USE.—The Sec25 retary may also reserve a portion of the funding proVerDate Aug 31 2005 03:45 May 16, 2006 Jkt 049200 PO 00000 Frm 00155 Fmt 6652 Sfmt 6201 E:\BILLS\H5312.IH H5312

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1 vided under this section and use those reserved 

2 funds to reduce an outstanding debt incurred by In3 dian Tribes or Tribal Organizations for the con4 struction, expansion, or modernization of an ambula5 tory care facility that meets the requirements under 

6 paragraph (1). The provisions of this section shall 

7 apply, except that such applications for funding 

8 under this paragraph shall be considered separately 

9 from applications for funding under paragraph (1). 

10 ‘‘(3) USE ONLY FOR CERTAIN PORTION OF

11 COSTS.—A grant provided under this section may be 

12 used only for the cost of that portion of a construc13 tion, expansion, or modernization project that bene14 fits the Service population identified above in sub15 section (b)(1)(C) (ii) and (iii). The requirements of 

16 clauses (ii) and (iii) of paragraph (1)(C) shall not 

17 apply to an Indian Tribe or Tribal Organization ap18 plying for a grant under this section for a health 

19 care facility located or to be constructed on an is20 land or when such facility is not located on a road 

21 system providing direct access to an inpatient hos22 pital where care is available to the Service popu23 lation. 

24 ‘‘(c) GRANTS.— 


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1 ‘‘(1) APPLICATION.—No grant may be made 

2 under this section unless an application or proposal 

3 for the grant has been approved by the Secretary in 

4 accordance with applicable regulations and has forth 

5 reasonable assurance by the applicant that, at all 

6 times after the construction, expansion, or mod7 ernization of a facility carried out using a grant re8 ceived under this section— 

9 ‘‘(A) adequate financial support will be 

10 available for the provision of services at such 

11 facility; 

12 ‘‘(B) such facility will be available to eligi13 ble Indians without regard to ability to pay or 

14 source of payment; and 

15 ‘‘(C) such facility will, as feasible without 

16 diminishing the quality or quantity of services 

17 provided to eligible Indians, serve noneligible 

18 persons on a cost basis. 

19 ‘‘(2) PRIORITY.—In awarding grants under this 

20 section, the Secretary shall give priority to Indian 

21 Tribes and Tribal Organizations that demonstrate— 

22 ‘‘(A) a need for increased ambulatory care 

23 services; and 

24 ‘‘(B) insufficient capacity to deliver such 

25 services. 


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1 ‘‘(3) PEER REVIEW PANELS.—The Secretary 

2 may provide for the establishment of peer review 

3 panels, as necessary, to review and evaluate applica4 tions and proposals and to advise the Secretary re5 garding such applications using the criteria devel6 oped pursuant to subsection (a)(1). 

7 ‘‘(d) REVERSION OF FACILITIES.—If any facility (or 

8 portion thereof) with respect to which funds have been 

9 paid under this section, ceases, within 5 years after com10 pletion of the construction, expansion, or modernization 

11 carried out with such funds, to be used for the purposes 

12 of providing health care services to eligible Indians, all of 

13 the right, title, and interest in and to such facility (or por14 tion thereof) shall transfer to the United States unless 

15 otherwise negotiated by the Service and the Indian Tribe 

16 or Tribal Organization. 

17 ‘‘(e) FUNDING NONRECURRING.—Funding provided 

18 under this section shall be nonrecurring and shall not be 

19 available for inclusion in any individual Indian Tribe’s 

20 tribal share for an award under the Indian Self-Deter21 mination and Education Assistance Act (25 U.S.C. 450 

22 et seq.) or for reallocation or redesign thereunder. 


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1 ‘‘SEC. 306. INDIAN HEALTH CARE DELIVERY DEMONSTRA2 TION PROJECT. 

3 ‘‘(a) HEALTH CARE DEMONSTRATION PROJECTS.— 

4 The Secretary, acting through the Service, and in con5 sultation with Indian Tribes and Tribal Organizations, is 

6 authorized to enter into construction agreements under 

7 the Indian Self-Determination and Education Assistance 

8 Act (25 U.S.C. 450 et seq.) with Indian Tribes or Tribal 

9 Organizations for the purpose of carrying out a health 

10 care delivery demonstration project to test alternative 

11 means of delivering health care and services to Indians 

12 through facilities. 

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

14 projects pursuant to this section, may authorize funding 

15 for the construction and renovation of hospitals, health 

16 centers, health stations, and other facilities to deliver 

17 health care services and is authorized to— 

18 ‘‘(1) waive any leasing prohibition; 

19 ‘‘(2) permit carryover of funds appropriated for 

20 the provision of health care services; 

21 ‘‘(3) permit the use of other available funds; 

22 ‘‘(4) permit the use of funds or property do23 nated from any source for project purposes; 

24 ‘‘(5) provide for the reversion of donated real or 

25 personal property to the donor; and 


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1 ‘‘(6) permit the use of Service funds to match 

2 other funds, including Federal funds. 

3 ‘‘(c) REGULATIONS.—The Secretary shall develop 

4 and promulgate regulations not later than 1 year after the 

5 date of enactment of the Indian Health Care Improvement 

6 Act Amendments of 2006. If the Secretary has not pro7 mulgated regulations by that date, the Secretary shall de8 velop and publish regulations, through rulemaking under 

9 section 802, for the review and approval of applications 

10 submitted under this section. 

11 ‘‘(d) CRITERIA.—The Secretary may approve projects 

12 that meet the following criteria: 

13 ‘‘(1) There is a need for a new facility or pro14 gram or the reorientation of an existing facility or 

15 program. 

16 ‘‘(2) A significant number of Indians, including 

17 those with low health status, will be served by the 

18 project. 

19 ‘‘(3) The project has the potential to deliver 

20 services in an efficient and effective manner. 

21 ‘‘(4) The project is economically viable. 

22 ‘‘(5) The Indian Tribe or Tribal Organization 

23 has the administrative and financial capability to ad24 minister the project. 


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1 ‘‘(6) The project is integrated with providers of 

2 related health and social services and is coordinated 

3 with, and avoids duplication of, existing services. 

4 ‘‘(e) PEER REVIEW PANELS.—The Secretary may 

5 provide for the establishment of peer review panels, as nec6 essary, to review and evaluate applications using the cri7 teria developed pursuant to subsection (d). 

8 ‘‘(f) PRIORITY.—The Secretary shall give priority to 

9 applications for demonstration projects in each of the fol10 lowing Service Units to the extent that such applications 

11 are timely filed and meet the criteria specified in sub12 section (d): 

13 ‘‘(1) Cass Lake, Minnesota. 

14 ‘‘(2) Clinton, Oklahoma. 

15 ‘‘(3) Harlem, Montana. 

16 ‘‘(4) Mescalero, New Mexico. 

17 ‘‘(5) Owyhee, Nevada. 

18 ‘‘(6) Parker, Arizona. 

19 ‘‘(7) Schurz, Nevada. 

20 ‘‘(8) Winnebago, Nebraska. 

21 ‘‘(9) Ft. Yuma, California. 

22 ‘‘(g) TECHNICAL ASSISTANCE.—The Secretary shall 

23 provide such technical and other assistance as may be nec24 essary to enable applicants to comply with the provisions 

25 of this section. 


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1 ‘‘(h) SERVICE TO INELIGIBLE PERSONS.—Subject to 

2 section 807, the authority to provide services to persons 

3 otherwise ineligible for the health care benefits of the 

4 Service and the authority to extend hospital privileges in 

5 Service facilities to non-Service health practitioners as 

6 provided in section 807 may be included, subject to the 

7 terms of such section, in any demonstration project ap8 proved pursuant to this section. 

9 ‘‘(i) EQUITABLE TREATMENT.—For purposes of sub10 section (d)(1), the Secretary shall, in evaluating facilities 

11 operated under any contract or compact under the Indian 

12 Self-Determination and Education Assistance Act (25 

13 U.S.C. 450 et seq.), use the same criteria that the Sec14 retary uses in evaluating facilities operated directly by the 

15 Service. 

16 ‘‘(j) EQUITABLE INTEGRATION OF FACILITIES.—The 

17 Secretary shall ensure that the planning, design, construc18 tion, renovation, and expansion needs of Service and non19 Service facilities which are the subject of a contract or 

20 compact under the Indian Self-Determination and Edu21 cation Assistance Act (25 U.S.C. 450 et seq.) for health 

22 services are fully and equitably integrated into the imple23 mentation of the health care delivery demonstration 

24 projects under this section. 


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1 ‘‘SEC. 307. LAND TRANSFER. 

2 ‘‘Notwithstanding any other provision of law, the Bu3 reau of Indian Affairs and all other agencies and depart4 ments of the United States are authorized to transfer, at 

5 no cost, land and improvements to the Service for the pro6 vision of health care services. The Secretary is authorized 

7 to accept such land and improvements for such purposes. 

8 ‘‘SEC. 308. LEASES, CONTRACTS, AND OTHER AGREEMENTS. 

9 ‘‘The Secretary, acting through the Service, may 

10 enter into leases, contracts, and other agreements with In11 dian Tribes and Tribal Organizations which hold (1) title 

12 to, (2) a leasehold interest in, or (3) a beneficial interest 

13 in (when title is held by the United States in trust for 

14 the benefit of an Indian Tribe) facilities used or to be used 

15 for the administration and delivery of health services by 

16 an Indian Health Program. Such leases, contracts, or 

17 agreements may include provisions for construction or ren18 ovation and provide for compensation to the Indian Tribe 

19 or Tribal Organization of rental and other costs consistent 

20 with section 105(l) of the Indian Self-Determination and 

21 Education Assistance Act (25 U.S.C. 450j(l)) and regula22 tions thereunder. 

23 ‘‘SEC. 309. STUDY ON LOANS, LOAN GUARANTEES, AND 

24 LOAN REPAYMENT. 

25 ‘‘(a) IN GENERAL.—The Secretary, in consultation 

26 with the Secretary of the Treasury, Indian Tribes, and 


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1 Tribal Organizations, shall carry out a study to determine 

2 the feasibility of establishing a loan fund to provide to In3 dian Tribes and Tribal Organizations direct loans or guar4 antees for loans for the construction of health care facili5 ties, including— 

6 ‘‘(1) inpatient facilities; 

7 ‘‘(2) outpatient facilities; 

8 ‘‘(3) staff quarters; 

9 ‘‘(4) hostels; and 

10 ‘‘(5) specialized care facilities, such as behav11 ioral health and elder care facilities. 

12 ‘‘(b) DETERMINATIONS.—In carrying out the study 

13 under subsection (a), the Secretary shall determine— 

14 ‘‘(1) the maximum principal amount of a loan 

15 or loan guarantee that should be offered to a recipi16 ent from the loan fund; 

17 ‘‘(2) the percentage of eligible costs, not to ex18 ceed 100 percent, that may be covered by a loan or 

19 loan guarantee from the loan fund (including costs 

20 relating to planning, design, financing, site land de21 velopment, construction, rehabilitation, renovation, 

22 conversion, improvements, medical equipment and 

23 furnishings, and other facility-related costs and cap24 ital purchase (but excluding staffing)); 


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1 ‘‘(3) the cumulative total of the principal of di2 rect loans and loan guarantees, respectively, that 

3 may be outstanding at any 1 time; 

4 ‘‘(4) the maximum term of a loan or loan guar5 antee that may be made for a facility from the loan 

6 fund; 

7 ‘‘(5) the maximum percentage of funds from 

8 the loan fund that should be allocated for payment 

9 of costs associated with planning and applying for a 

10 loan or loan guarantee; 

11 ‘‘(6) whether acceptance by the Secretary of an 

12 assignment of the revenue of an Indian Tribe or 

13 Tribal Organization as security for any direct loan 

14 or loan guarantee from the loan fund would be ap15 propriate; 

16 ‘‘(7) whether, in the planning and design of 

17 health facilities under this section, users eligible 

18 under section 807(c) may be included in any projec19 tion of patient population; 

20 ‘‘(8) whether funds of the Service provided 

21 through loans or loan guarantees from the loan fund 

22 should be eligible for use in matching other Federal 

23 funds under other programs; 


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1 ‘‘(9) the appropriateness of, and best methods 

2 for, coordinating the loan fund with the health care 

3 priority system of the Service under section 301; and 

4 ‘‘(10) any legislative or regulatory changes re5 quired to implement recommendations of the Sec6 retary based on results of the study. 

7 ‘‘(c) REPORT.—Not later than September 30, 2007, 

8 the Secretary shall submit to the Committee on Indian Af9 fairs of the Senate and the Committee on Resources and 

10 the Committee on Energy and Commerce of the House 

11 of Representatives a report that describes— 

12 ‘‘(1) the manner of consultation made as re13 quired by subsection (a); and 

14 ‘‘(2) the results of the study, including any rec15 ommendations of the Secretary based on results of 

16 the study. 

17 ‘‘SEC. 310. TRIBAL LEASING. 

18 ‘‘A Tribal Health Program may lease permanent 

19 structures for the purpose of providing health care services 

20 without obtaining advance approval in appropriation Acts. 

21 ‘‘SEC. 311. INDIAN HEALTH SERVICE/TRIBAL FACILITIES 

22 JOINT VENTURE PROGRAM. 

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

24 the Service, shall make arrangements with Indian Tribes 

25 and Tribal Organizations to establish joint venture demVerDate Aug 31 2005 03:45 May 16, 2006 Jkt 049200 PO 00000 Frm 00166 Fmt 6652 Sfmt 6201 E:\BILLS\H5312.IH H5312

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1 onstration projects under which an Indian Tribe or Tribal 

2 Organization shall expend tribal, private, or other avail3 able funds, for the acquisition or construction of a health 

4 facility for a minimum of 10 years, under a no-cost lease, 

5 in exchange for agreement by the Service to provide the 

6 equipment, supplies, and staffing for the operation and 

7 maintenance of such a health facility. An Indian Tribe or 

8 Tribal Organization may use tribal funds, private sector, 

9 or other available resources, including loan guarantees, to 

10 fulfill its commitment under a joint venture entered into 

11 under this subsection. An Indian Tribe or Tribal Organi12 zation shall be eligible to establish a joint venture project 

13 if, when it submits a letter of intent, it— 

14 ‘‘(1) has begun but not completed the process 

15 of acquisition or construction of a health facility to 

16 be used in the joint venture project; or 

17 ‘‘(2) has not begun the process of acquisition or 

18 construction of a health facility for use in the joint 

19 venture project. 

20 ‘‘(b) REQUIREMENTS.—The Secretary shall make 

21 such an arrangement with an Indian Tribe or Tribal Orga22 nization only if— 

23 ‘‘(1) the Secretary first determines that the In24 dian Tribe or Tribal Organization has the adminis25 trative and financial capabilities necessary to comVerDate Aug 31 2005 03:45 May 16, 2006 Jkt 049200 PO 00000 Frm 00167 Fmt 6652 Sfmt 6201 E:\BILLS\H5312.IH H5312

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1 plete the timely acquisition or construction of the 

2 relevant health facility; and 

3 ‘‘(2) the Indian Tribe or Tribal Organization 

4 meets the need criteria which shall be developed 

5 through the negotiated rulemaking process provided 

6 for under section 802. 

7 ‘‘(c) CONTINUED OPERATION.—The Secretary shall 

8 negotiate an agreement with the Indian Tribe or Tribal 

9 Organization regarding the continued operation of the fa10 cility at the end of the initial 10 year no-cost lease period. 

11 ‘‘(d) BREACH OF AGREEMENT.—An Indian Tribe or 

12 Tribal Organization that has entered into a written agree13 ment with the Secretary under this section, and that 

14 breaches or terminates without cause such agreement, 

15 shall be liable to the United States for the amount that 

16 has been paid to the Indian Tribe or Tribal Organization, 

17 or paid to a third party on the Indian Tribe’s or Tribal 

18 Organization’s behalf, under the agreement. The Sec19 retary has the right to recover tangible property (including 

20 supplies) and equipment, less depreciation, and any funds 

21 expended for operations and maintenance under this sec22 tion. The preceding sentence does not apply to any funds 

23 expended for the delivery of health care services, per24 sonnel, or staffing. 


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1 ‘‘(e) RECOVERY FOR NONUSE.—An Indian Tribe or 

2 Tribal Organization that has entered into a written agree3 ment with the Secretary under this subsection shall be en4 titled to recover from the United States an amount that 

5 is proportional to the value of such facility if, at any time 

6 within the 10-year term of the agreement, the Service 

7 ceases to use the facility or otherwise breaches the agree8 ment. 

9 ‘‘(f) DEFINITION.—For the purposes of this section, 

10 the term ‘health facility’ or ‘health facilities’ includes 

11 quarters needed to provide housing for staff of the rel12 evant Tribal Health Program. 

13 ‘‘SEC. 312. LOCATION OF FACILITIES. 

14 ‘‘(a) IN GENERAL.—In all matters involving the reor15 ganization or development of Service facilities or in the 

16 establishment of related employment projects to address 

17 unemployment conditions in economically depressed areas, 

18 the Bureau of Indian Affairs and the Service shall give 

19 priority to locating such facilities and projects on Indian 

20 lands, or lands in Alaska owned by any Alaska Native vil21 lage, or village or regional corporation under the Alaska 

22 Native Claims Settlement Act, or any land allotted to any 

23 Alaska Native, if requested by the Indian owner and the 

24 Indian Tribe with jurisdiction over such lands or other 

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1 nization. Top priority shall be given to Indian land owned 

2 by 1 or more Indian Tribes. 

3 ‘‘(b) DEFINITION.—For purposes of this section, the 

4 term ‘Indian lands’ means— 

5 ‘‘(1) all lands within the exterior boundaries of 

6 any reservation; and 

7 ‘‘(2) any lands title to which is held in trust by 

8 the United States for the benefit of any Indian 

9 Tribe or individual Indian or held by any Indian 

10 Tribe or individual Indian subject to restriction by 

11 the United States against alienation. 

12 ‘‘SEC. 313. MAINTENANCE AND IMPROVEMENT OF HEALTH 

13 CARE FACILITIES. 

14 ‘‘(a) REPORT.—The Secretary shall submit to the 

15 President, for inclusion in the report required to be trans16 mitted to Congress under section 801, a report which iden17 tifies the backlog of maintenance and repair work required 

18 at both Service and tribal health care facilities, including 

19 new health care facilities expected to be in operation in 

20 the next fiscal year. The report shall also identify the need 

21 for renovation and expansion of existing facilities to sup22 port the growth of health care programs. 

23 ‘‘(b) MAINTENANCE OF NEWLY CONSTRUCTED

24 SPACE.—The Secretary, acting through the Service, is au25 thorized to expend maintenance and improvement funds 


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1 to support maintenance of newly constructed space only 

2 if such space falls within the approved supportable space 

3 allocation for the Indian Tribe or Tribal Organization. 

4 Supportable space allocation shall be defined through the 

5 negotiated rulemaking process provided for under section 

6 802. 

7 ‘‘(c) REPLACEMENT FACILITIES.—In addition to 

8 using maintenance and improvement funds for renovation, 

9 modernization, and expansion of facilities, an Indian Tribe 

10 or Tribal Organization may use maintenance and improve11 ment funds for construction of a replacement facility if 

12 the costs of renovation of such facility would exceed a 

13 maximum renovation cost threshold. The maximum ren14 ovation cost threshold shall be determined through the ne15 gotiated rulemaking process provided for under section 

16 802. 

17 ‘‘SEC. 314. TRIBAL MANAGEMENT OF FEDERALLY OWNED 

18 QUARTERS. 

19 ‘‘(a) RENTAL RATES.— 

20 ‘‘(1) ESTABLISHMENT.—Notwithstanding any 

21 other provision of law, a Tribal Health Program 

22 which operates a hospital or other health facility and 

23 the federally owned quarters associated therewith 

24 pursuant to a contract or compact under the Indian 

25 Self-Determination and Education Assistance Act 


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1 (25 U.S.C. 450 et seq.) shall have the authority to 

2 establish the rental rates charged to the occupants 

3 of such quarters by providing notice to the Secretary 

4 of its election to exercise such authority. 

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

6 pursuant to authority of this subsection, a Tribal 

7 Health Program shall endeavor to achieve the fol8 lowing objectives: 

9 ‘‘(A) To base such rental rates on the rea10 sonable value of the quarters to the occupants 

11 thereof. 

12 ‘‘(B) To generate sufficient funds to pru13 dently provide for the operation and mainte14 nance of the quarters, and subject to the discre15 tion of the Tribal Health Program, to supply 

16 reserve funds for capital repairs and replace17 ment of the quarters. 

18 ‘‘(3) EQUITABLE FUNDING.—Any quarters 

19 whose rental rates are established by a Tribal 

20 Health Program pursuant to this subsection shall 

21 remain eligible for quarters improvement and repair 

22 funds to the same extent as all federally owned 

23 quarters used to house personnel in Services-sup24 ported programs. 


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1 ‘‘(4) NOTICE OF RATE CHANGE.—A Tribal 

2 Health Program which exercises the authority pro3 vided under this subsection shall provide occupants 

4 with no less than 60 days notice of any change in 

5 rental rates. 

6 ‘‘(b) DIRECT COLLECTION OF RENT.— 

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

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

9 Tribal Health Program shall have the authority to 

10 collect rents directly from Federal employees who oc11 cupy such quarters in accordance with the following: 

12 ‘‘(A) The Tribal Health Program shall no13 tify the Secretary and the subject Federal em14 ployees of its election to exercise its authority 

15 to collect rents directly from such Federal em16 ployees. 

17 ‘‘(B) Upon receipt of a notice described in 

18 subparagraph (A), the Federal employees shall 

19 pay rents for occupancy of such quarters di20 rectly to the Tribal Health Program and the 

21 Secretary shall have no further authority to col22 lect rents from such employees through payroll 

23 deduction or otherwise. 

24 ‘‘(C) Such rent payments shall be retained 

25 by the Tribal Health Program and shall not be 


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1 made payable to or otherwise be deposited with 

2 the United States. 

3 ‘‘(D) Such rent payments shall be depos4 ited into a separate account which shall be used 

5 by the Tribal Health Program for the mainte6 nance (including capital repairs and replace7 ment) and operation of the quarters and facili8 ties as the Tribal Health Program shall deter9 mine. 

10 ‘‘(2) RETROCESSION OF AUTHORITY.—If a 

11 Tribal Health Program which has made an election 

12 under paragraph (1) requests retrocession of its au13 thority to directly collect rents from Federal employ14 ees occupying federally owned quarters, such ret15 rocession shall become effective on the earlier of— 

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

17 no less than 180 days after the Tribal Health 

18 Program notifies the Secretary of its desire to 

19 retrocede; or 

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

21 agreed by the Secretary and the Tribal Health 

22 Program. 

23 ‘‘(c) RATES IN ALASKA.—To the extent that a Tribal 

24 Health Program, pursuant to authority granted in sub25 section (a), establishes rental rates for federally owned 


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1 quarters provided to a Federal employee in Alaska, such 

2 rents may be based on the cost of comparable private rent3 al housing in the nearest established community with a 

4 year-round population of 1,500 or more individuals. 

5 ‘‘SEC. 315. APPLICABILITY OF BUY AMERICAN ACT RE6 QUIREMENT. 

7 ‘‘(a) APPLICABILITY.—The Secretary shall ensure 

8 that the requirements of the Buy American Act apply to 

9 all procurements made with funds provided pursuant to 

10 section 317. Indian Tribes and Tribal Organizations shall 

11 be exempt from these requirements. 

12 ‘‘(b) EFFECT OF VIOLATION.—If it has been finally 

13 determined by a court or Federal agency that any person 

14 intentionally affixed a label bearing a ‘Made in America’ 

15 inscription or any inscription with the same meaning, to 

16 any product sold in or shipped to the United States that 

17 is not made in the United States, such person shall be 

18 ineligible to receive any contract or subcontract made with 

19 funds provided pursuant to section 317, pursuant to the 

20 debarment, suspension, and ineligibility procedures de21 scribed in sections 9.400 through 9.409 of title 48, Code 

22 of Federal Regulations. 

23 ‘‘(c) DEFINITIONS.—For purposes of this section, the 

24 term ‘Buy American Act’ means title III of the Act enti25 tled ‘An Act making appropriations for the Treasury and 


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1 Post Office Departments for the fiscal year ending June 

2 30, 1934, and for other purposes’, approved March 3, 

3 1933 (41 U.S.C. 10a et seq.). 

4 ‘‘SEC. 316. OTHER FUNDING FOR FACILITIES. 

5 ‘‘(a) AUTHORITY TO ACCEPT FUNDS.—The Sec6 retary is authorized to accept from any source, including 

7 Federal and State agencies, funds that are available for 

8 the construction of health care facilities and use such 

9 funds to plan, design, and construct health care facilities 

10 for Indians and to place such funds into a contract or com11 pact under the Indian Self-Determination and Education 

12 Assistance Act (25 U.S.C. 450 et seq.). Receipt of such 

13 funds shall have no effect on the priorities established pur14 suant to section 301. 

15 ‘‘(b) INTERAGENCY AGREEMENTS.—The Secretary is 

16 authorized to enter into interagency agreements with 

17 other Federal agencies or State agencies and other entities 

18 and to accept funds from such Federal or State agencies 

19 or other sources to provide for the planning, design, and 

20 construction of health care facilities to be administered by 

21 Indian Health Programs in order to carry out the pur22 poses of this Act and the purposes for which the funds 

23 were appropriated or for which the funds were otherwise 

24 provided. 


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1 ‘‘(c) TRANSFERRED FUNDS.—Any Federal agency to 

2 which funds for the construction of health care facilities 

3 are appropriated is authorized to transfer such funds to 

4 the Secretary for the construction of health care facilities 

5 to carry out the purposes of this Act as well as the pur6 poses for which such funds are appropriated to such other 

7 Federal agency. 

8 ‘‘(d) ESTABLISHMENT OF STANDARDS.—The Sec9 retary, through the Service, shall establish standards by 

10 regulation, developed by rulemaking under section 802, for 

11 the planning, design, and construction of health care fa12 cilities serving Indians under this Act. 

13 ‘‘SEC. 317. AUTHORIZATION OF APPROPRIATIONS. 

14 ‘‘There are authorized to be appropriated such sums 

15 as may be necessary for each fiscal year through fiscal 

16 year 2015 to carry out this title. 

17 ‘‘TITLE IV—ACCESS TO HEALTH 

18 SERVICES 

19 ‘‘SEC. 401. TREATMENT OF PAYMENTS UNDER SOCIAL SE20 CURITY ACT HEALTH CARE PROGRAMS. 

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

22 SCHIP PAYMENTS IN DETERMINING APPROPRIATIONS.— 

23 Any payments received by an Indian Health Program or 

24 by an Urban Indian Organization made under title XVIII, 

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1 vided to Indians eligible for benefits under such respective 

2 titles shall not be considered in determining appropria3 tions for the provision of health care and services to Indi4 ans. 

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 XXI of 

8 the Social Security Act in preference to an Indian without 

9 such coverage. 

10 ‘‘(c) USE OF FUNDS.— 

11 ‘‘(1) SPECIAL FUND.—Notwithstanding any 

12 other provision of law, but subject to paragraph (2), 

13 payments to which a facility of the Service is enti14 tled by reason of a provision of the Social Security 

15 Act shall be placed in a special fund to be held by 

16 the Secretary and first used (to such extent or in 

17 such amounts as are provided in appropriation Acts) 

18 for the purpose of making any improvements in the 

19 programs of the Service which may be necessary to 

20 achieve or maintain compliance with the applicable 

21 conditions and requirements of titles XVIII, XIX, 

22 and XXI of the Social Security Act. Any amounts to 

23 be reimbursed that are in excess of the amount nec24 essary to achieve or maintain such conditions and 

25 requirements shall, subject to the consultation with 


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1 Indian Tribes being served by the Service Unit, be 

2 used for reducing the health resource deficiencies of 

3 the Indian Tribes. In making payments from such 

4 fund, the Secretary shall ensure that each Service 

5 Unit of the Service receives 100 percent of the 

6 amount to which the facilities of the Service, for 

7 which such Service Unit makes collections, are enti8 tled by reason of a provision of the Social Security 

9 Act. 

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

11 (1) shall not apply upon the election of a Tribal 

12 Health Program under subsection (d) to receive pay13 ments directly. No payment may be made out of the 

14 special fund described in such paragraph with re15 spect to reimbursement made for services provided 

16 during the period of such election. 

17 ‘‘(d) DIRECT BILLING.— 

18 ‘‘(1) IN GENERAL.—A Tribal Health Program 

19 may directly bill for, and receive payment for, health 

20 care items and services provided by such Indian 

21 Tribe or Tribal Organization for which payment is 

22 made under title XVIII, XIX, or XXI of the Social 

23 Security Act or from any other third party payor. 

24 ‘‘(2) DIRECT REIMBURSEMENT.— 


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1 ‘‘(A) USE OF FUNDS.—Each Tribal Health 

2 Program exercising the option described in 

3 paragraph (1) with respect to a program under 

4 a title of the Social Security Act shall be reim5 bursed directly by that program for items and 

6 services furnished without regard to section 

7 401(c), but all amounts so reimbursed shall be 

8 used by the Tribal Health Program for the pur9 pose of making any improvements in Tribal fa10 cilities or Tribal Health Programs that may be 

11 necessary to achieve or maintain compliance 

12 with the conditions and requirements applicable 

13 generally to such items and services under the 

14 program under such title and to provide addi15 tional health care services, improvements in 

16 health care facilities and Tribal Health Pro17 grams, any health care-related purpose, or oth18 erwise to achieve the objectives provided in sec19 tion 3 of this Act. 

20 ‘‘(B) AUDITS.—The amounts paid to an 

21 Indian Tribe or Tribal Organization exercising 

22 the option described in paragraph (1) with re23 spect to a program under a title of the Social 

24 Security Act shall be subject to all auditing reVerDate Aug 31 2005 03:45 May 16, 2006 Jkt 049200 PO 00000 Frm 00180 Fmt 6652 Sfmt 6201 E:\BILLS\H5312.IH H5312

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1 quirements applicable to programs administered 

2 by an Indian Health Program. 

3 ‘‘(C) IDENTIFICATION OF SOURCE OF PAY4 MENTS.—If an Indian Tribe or Tribal Organi5 zation receives funding from the Service under 

6 the Indian Self-Determination and Education 

7 Assistance Act (25 U.S.C. 450 et seq.) or an 

8 Urban Indian Organization receives funding 

9 from the Service under title V of this Act and 

10 receives reimbursements or payments under 

11 title XVIII, XIX, or XXI of the Social Security 

12 Act, such Indian Tribe or Tribal Organization, 

13 or Urban Indian Organization, shall provide to 

14 the Service a list of each provider enrollment 

15 number (or other identifier) under which it re16 ceives such reimbursements or payments. 

17 ‘‘(3) EXAMINATION AND IMPLEMENTATION OF

18 CHANGES.—The Secretary, acting through the Serv19 ice and with the assistance of the Administrator of 

20 the Centers for Medicare & Medicaid Services, shall 

21 examine on an ongoing basis and implement any ad22 ministrative changes that may be necessary to facili23 tate direct billing and reimbursement under the pro24 gram established under this subsection, including 

25 any agreements with States that may be necessary 


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1 to provide for direct billing under a program under 

2 a title of the Social Security Act. 

3 ‘‘(4) WITHDRAWAL FROM PROGRAM.—A Tribal 

4 Health Program that bills directly under the pro5 gram established under this subsection may with6 draw from participation in the same manner and 

7 under the same conditions that an Indian Tribe or 

8 Tribal Organization may retrocede a contracted pro9 gram to the Secretary under the authority of the In10 dian Self-Determination and Education Assistance 

11 Act (25 U.S.C. 450 et seq.). All cost accounting and 

12 billing authority under the program established 

13 under this subsection shall be returned to the Sec14 retary upon the Secretary’s acceptance of the with15 drawal of participation in this program. 

16 ‘‘SEC. 402. GRANTS TO AND CONTRACTS WITH THE SERV17 ICE, INDIAN TRIBES, TRIBAL ORGANIZA18 TIONS, AND URBAN INDIAN ORGANIZATIONS. 

19 ‘‘(a) INDIAN TRIBES AND TRIBAL ORGANIZA20 TIONS.—The Secretary, acting through the Service, shall 

21 make grants to or enter into contracts with Indian Tribes 

22 and Tribal Organizations to assist such Tribes and Tribal 

23 Organizations in establishing and administering programs 

24 on or near reservations and trust lands to assist individual 

25 Indians— 


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1 ‘‘(1) to enroll for benefits under title XVIII, 

2 XIX, or XXI of the Social Security Act and other 

3 health benefits programs; and 

4 ‘‘(2) to pay premiums for coverage for such 

5 benefits, which may be based on financial need (as 

6 determined by the Indian Tribe or Tribes being 

7 served based on a schedule of income levels devel8 oped or implemented by such Tribe or Tribes). 

9 ‘‘(b) CONDITIONS.—The Secretary, acting through 

10 the Service, shall place conditions as deemed necessary to 

11 effect the purpose of this section in any grant or contract 

12 which the Secretary makes with any Indian Tribe or Trib13 al Organization pursuant to this section. Such conditions 

14 shall include requirements that the Indian Tribe or Tribal 

15 Organization successfully undertake— 

16 ‘‘(1) to determine the population of Indians eli17 gible for the benefits described in subsection (a); 

18 ‘‘(2) to educate Indians with respect to the ben19 efits available under the respective programs; 

20 ‘‘(3) to provide transportation for such indi21 vidual Indians to the appropriate offices for enroll22 ment or applications for such benefits; and 

23 ‘‘(4) to develop and implement methods of im24 proving the participation of Indians in receiving the 


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1 benefits provided under titles XVIII, XIX, and XXI 

2 of the Social Security Act. 

3 ‘‘(c) AGREEMENTS RELATING TO IMPROVING EN4 ROLLMENT OF INDIANS UNDER SOCIAL SECURITY ACT

5 PROGRAMS.— 

6 ‘‘(1) AGREEMENTS WITH SECRETARY TO IM7 PROVE RECEIPT AND PROCESSING OF APPLICA8 TIONS.— 

9 ‘‘(A) AUTHORIZATION.—The Secretary, 

10 acting through the Service, may enter into an 

11 agreement with an Indian Tribe, Tribal Organi12 zation, or Urban Indian Organization which 

13 provides for the receipt and processing of appli14 cations by Indians for assistance under titles 

15 XIX and XXI of the Social Security Act, and 

16 benefits under title XVIII of such Act, by an 

17 Indian Health Program or Urban Indian Orga18 nization. 

19 ‘‘(B) REIMBURSEMENT OF COSTS.—Such 

20 agreements may provide for reimbursement of 

21 costs of outreach, education regarding eligibility 

22 and benefits, and translation when such services 

23 are provided. The reimbursement may, as ap24 propriate, be added to the applicable rate per 

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1 service payment to the Indian Tribe or Tribal 

2 Organization. 

3 ‘‘(C) PROCESSING CLARIFIED.—In this 

4 paragraph, the term ‘processing’ does not in5 clude a final determination of eligibility. 

6 ‘‘(2) AGREEMENTS WITH STATES FOR OUT7 REACH ON OR NEAR RESERVATION.— 

8 ‘‘(A) IN GENERAL.—In order to improve 

9 the access of Indians residing on or near a res10 ervation to obtain benefits under title XIX or 

11 XXI of the Social Security Act, the Secretary 

12 shall encourage the State to take steps to pro13 vide for enrollment on or near the reservation. 

14 Such steps may include outreach efforts such as 

15 the outstationing of eligibility workers, entering 

16 into agreements with Indian Tribes and Tribal 

17 Organizations to provide outreach, education re18 garding eligibility and benefits, enrollment, and 

19 translation services when such services are pro20 vided. 

21 ‘‘(B) CONSTRUCTION.—Nothing in sub22 paragraph (A) shall be construed as affecting 

23 arrangements entered into between States and 

24 Indian Tribes and Tribal Organizations for 

25 such Indian Tribes and Tribal Organizations to 


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1 conduct administrative activities under such ti2 tles. 

3 ‘‘(d) FACILITATING COOPERATION.—The Secretary, 

4 acting through the Centers for Medicare & Medicaid Serv5 ices, shall take such steps as are necessary to facilitate 

6 cooperation with, and agreements between, States and the 

7 Service, Indian Tribes, Tribal Organizations, or Urban In8 dian Organizations. 

9 ‘‘(e) APPLICATION TO URBAN INDIAN ORGANIZA10 TIONS.— 

11 ‘‘(1) IN GENERAL.—The provisions of sub12 section (a) shall apply with respect to grants and 

13 other funding to Urban Indian Organizations with 

14 respect to populations served by such organizations 

15 in the same manner they apply to grants and con16 tracts with Indian Tribes and Tribal Organizations 

17 with respect to programs on or near reservations. 

18 ‘‘(2) REQUIREMENTS.—The Secretary shall in19 clude in the grants or contracts made or provided 

20 under paragraph (1) requirements that are— 

21 ‘‘(A) consistent with the requirements im22 posed by the Secretary under subsection (b); 

23 ‘‘(B) appropriate to Urban Indian Organi24 zations and Urban Indians; and 


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1 ‘‘(C) necessary to effect the purposes of 

2 this section. 

3 ‘‘SEC. 403. REIMBURSEMENT FROM CERTAIN THIRD PAR4 TIES OF COSTS OF HEALTH SERVICES. 

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

6 subsection (f), the United States, an Indian Tribe, or 

7 Tribal Organization shall have the right to recover from 

8 an insurance company, health maintenance organization, 

9 employee benefit plan, third-party tortfeasor, or any other 

10 responsible or liable third party (including a political sub11 division or local governmental entity of a State) the rea12 sonable charges billed by the Secretary, an Indian Tribe, 

13 or Tribal Organization, in providing health services, 

14 through the Service, an Indian Tribe, or Tribal Organiza15 tion to any individual to the same extent that such indi16 vidual, or any nongovernmental provider of such services, 

17 would be eligible to receive damages, reimbursement, or 

18 indemnification for such charges or expenses if— 

19 ‘‘(1) such services had been provided by a non20 governmental provider; and 

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

22 such charges or expenses and did pay such charges 

23 or expenses. 

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

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


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

2 health services were provided is covered under— 

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

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

5 plan or program. 

6 ‘‘(c) NONAPPLICATION OF OTHER LAWS.—No law of 

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

8 no provision of any contract, insurance or health mainte9 nance organization policy, employee benefit plan, self-in10 surance plan, managed care plan, or other health care plan 

11 or program entered into or renewed after the date of the 

12 enactment of the Indian Health Care Amendments of 

13 1988, shall prevent or hinder the right of recovery of the 

14 United States, an Indian Tribe, or Tribal Organization 

15 under subsection (a). 

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

17 No action taken by the United States, an Indian Tribe, 

18 or Tribal Organization to enforce the right of recovery 

19 provided under this section shall operate to deny to the 

20 injured person the recovery for that portion of the person’s 

21 damage not covered hereunder. 

22 ‘‘(e) ENFORCEMENT.— 

23 ‘‘(1) IN GENERAL.—The United States, an In24 dian Tribe, or Tribal Organization may enforce the 

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


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1 ‘‘(A) intervening or joining in any civil ac2 tion or proceeding brought— 

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

4 services were provided by the Secretary, an 

5 Indian Tribe, or Tribal Organization; or 

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

7 such individual, or 

8 ‘‘(B) instituting a civil action, including a 

9 civil action for injunctive relief and other relief, 

10 including an action under the Federal Medical 

11 Cost Recovery Act (42 U.S.C. 2651–2653), and 

12 including, with respect to a political subdivision 

13 or local governmental entity of a State, such an 

14 action against an official thereof. 

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

16 made to provide notice of action instituted under 

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

18 services were provided, either before or during the 

19 pendency of such action. 

20 ‘‘(f) LIMITATION.—Absent specific written authoriza21 tion by the governing body of an Indian Tribe for the pe22 riod of such authorization (which may not be for a period 

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

24 time upon written notice by the governing body to the 

25 Service), the United States shall not have a right of recovVerDate Aug 31 2005 03:45 May 16, 2006 Jkt 049200 PO 00000 Frm 00189 Fmt 6652 Sfmt 6201 E:\BILLS\H5312.IH H5312

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1 ery under this section if the injury, illness, or disability 

2 for which health services were provided is covered under 

3 a self-insurance plan funded by an Indian Tribe, Tribal 

4 Organization, or Urban Indian Organization. Where such 

5 authorization is provided, the Service may receive and ex6 pend such amounts for the provision of additional health 

7 services consistent with such authorization. 

8 ‘‘(g) COSTS AND ATTORNEYS’ FEES.—In any action 

9 brought to enforce the provisions of this section, a pre10 vailing plaintiff shall be awarded its reasonable attorneys’ 

11 fees and costs of litigation. 

12 ‘‘(h) NONAPPLICATION OF CLAIMS FILING REQUIRE13 MENTS.—An insurance company, health maintenance or14 ganization, self-insurance plan, managed care plan, or 

15 other health care plan or program (under the Social Secu16 rity Act or otherwise) may not deny a claim for benefits 

17 submitted by the Service or by an Indian Tribe or Tribal 

18 Organization based on the format in which the claim is 

19 submitted if such format complies with the format re20 quired for submission of claims under title XVIII of the 

21 Social Security Act or recognized under section 1175 of 

22 such Act. 

23 ‘‘(i) APPLICATION TO URBAN INDIAN ORGANIZA24 TIONS.—The previous provisions of this section shall apply 

25 to Urban Indian Organizations with respect to populations 


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1 served by such Organizations in the same manner they 

2 apply to Indian Tribes and Tribal Organizations with re3 spect to populations served by such Indian Tribes and 

4 Tribal Organizations. 

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

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

7 to all actions commenced under this section, and the ref8 erences therein to the United States are deemed to include 

9 Indian Tribes, Tribal Organizations, and Urban Indian 

10 Organizations. 

11 ‘‘(k) SAVINGS.—Nothing in this section shall be con12 strued to limit any right of recovery available to the 

13 United States, an Indian Tribe, or Tribal Organization 

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

15 Tribal law, including medical lien laws and the Federal 

16 Medical Care Recovery Act (42 U.S.C. 2651 et seq.). 

17 ‘‘SEC. 404. CREDITING OF REIMBURSEMENTS. 

18 ‘‘(a) USE OF AMOUNTS.— 

19 ‘‘(1) RETENTION BY PROGRAM.—Except as pro20 vided in section 202(g) (relating to the Catastrophic 

21 Health Emergency Fund) and section 807 (relating 

22 to health services for ineligible persons), all reim23 bursements received or recovered under any of the 

24 programs described in paragraph (2), including 

25 under section 807, by reason of the provision of 


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1 health services by the Service, by an Indian Tribe or 

2 Tribal Organization, or by an Urban Indian Organi3 zation, shall be credited to the Service, such Indian 

4 Tribe or Tribal Organization, or such Urban Indian 

5 Organization, respectively, and may be used as pro6 vided in section 401. In the case of such a service 

7 provided by or through a Service Unit, such 

8 amounts shall be credited to such unit and used for 

9 such purposes. 

10 ‘‘(2) PROGRAMS COVERED.—The programs re11 ferred to in paragraph (1) are the following: 

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

13 Social Security Act. 

14 ‘‘(B) This Act, including section 807. 

15 ‘‘(C) Public Law 87–693. 

16 ‘‘(D) Any other provision of law, including 

17 the Federal Medical Cost Recovery Act (42 

18 U.S.C. 2651–2653). 

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

20 not offset or limit any amount obligated to any Service 

21 Unit or entity receiving funding from the Service because 

22 of the receipt of reimbursements under subsection (a). 

23 ‘‘SEC. 405. PURCHASING HEALTH CARE COVERAGE. 

24 ‘‘(a) IN GENERAL.—Insofar as amounts are made 

25 available under law (including a provision of the Social 


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1 Security Act, the Indian Self-Determination and Edu2 cation Assistance Act (25 U.S.C. 450 et seq.), or other 

3 law, other than under section 402) to Indian Tribes, Trib4 al Organizations, and Urban Indian Organizations for 

5 health benefits for Service beneficiaries, Indian Tribes, 

6 Tribal Organizations, and Urban Indian Organizations 

7 may use such amounts to purchase health benefits cov8 erage for such beneficiaries in any manner, including 

9 through— 

10 ‘‘(1) a tribally owned and operated health care 

11 plan; 

12 ‘‘(2) a State or locally authorized or licensed 

13 health care plan; 

14 ‘‘(3) a health insurance provider or managed 

15 care organization; or 

16 ‘‘(4) a self-insured plan. 

17 The purchase of such coverage by an Indian Tribe, Tribal 

18 Organization, or Urban Indian Organization may be based 

19 on the financial needs of such beneficiaries (as determined 

20 by the Indian Tribe or Tribes being served based on a 

21 schedule of income levels developed or implemented by 

22 such Indian Tribe or Tribes). 

23 ‘‘(b) EXPENSES FOR SELF-INSURED PLAN.—In the 

24 case of a self-insured plan under subsection (a)(4), the 

25 amounts may be used for expenses of operating the plan, 


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1 including administration and insurance to limit the finan2 cial risks to the entity offering the plan. 

3 ‘‘(c) CONSTRUCTION.—Nothing in this section shall 

4 be construed as affecting the use of any amounts not re5 ferred to in subsection (a). 

6 ‘‘SEC. 406. SHARING ARRANGEMENTS WITH FEDERAL AGEN7 CIES. 

8 ‘‘(a) AUTHORITY.— 

9 ‘‘(1) IN GENERAL.—The Secretary may enter 

10 into (or expand) arrangements for the sharing of 

11 medical facilities and services between the Service, 

12 Indian Tribes, and Tribal Organizations and the De13 partment of Veterans Affairs and the Department of 

14 Defense. 

15 ‘‘(2) CONSULTATION BY SECRETARY RE16 QUIRED.—The Secretary may not finalize any ar17 rangement between the Service and a Department 

18 described in paragraph (1) without first consulting 

19 with the Indian Tribes which will be significantly af20 fected by the arrangement. 

21 ‘‘(b) LIMITATIONS.—The Secretary shall not take 

22 any action under this section or under subchapter IV of 

23 chapter 81 of title 38, United States Code, which would 

24 impair— 


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1 ‘‘(1) the priority access of any Indian to health 

2 care services provided through the Service and the 

3 eligibility of any Indian to receive health services 

4 through the Service; 

5 ‘‘(2) the quality of health care services provided 

6 to any Indian through the Service; 

7 ‘‘(3) the priority access of any veteran to health 

8 care services provided by the Department of Vet9 erans Affairs; 

10 ‘‘(4) the quality of health care services provided 

11 by the Department of Veterans Affairs or the De12 partment of Defense; or 

13 ‘‘(5) the eligibility of any Indian who is a vet14 eran to receive health services through the Depart15 ment of Veterans Affairs. 

16 ‘‘(c) REIMBURSEMENT.—The Service, Indian Tribe, 

17 or Tribal Organization shall be reimbursed by the Depart18 ment of Veterans Affairs or the Department of Defense 

19 (as the case may be) where services are provided through 

20 the Service, an Indian Tribe, or a Tribal Organization to 

21 beneficiaries eligible for services from either such Depart22 ment, notwithstanding any other provision of law. 

23 ‘‘(d) CONSTRUCTION.—Nothing in this section may 

24 be construed as creating any right of a non-Indian veteran 

25 to obtain health services from the Service. 


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1 ‘‘SEC. 407. PAYOR OF LAST RESORT. 

2 ‘‘Indian Health Programs and health care programs 

3 operated by Urban Indian Organizations shall be the 

4 payor of last resort for services provided to persons eligible 

5 for services from Indian Health Programs and Urban In6 dian Organizations, notwithstanding any Federal, State, 

7 or local law to the contrary. 

8 ‘‘SEC. 408. NONDISCRIMINATION IN QUALIFICATIONS FOR 

9 REIMBURSEMENT FOR SERVICES. 

10 ‘‘For purposes of determining the eligibility of an en11 tity that is operated by the Service, an Indian Tribe, Trib12 al Organization, or Urban Indian Organization to receive 

13 payment or reimbursement from any federally funded 

14 health care program for health care services the entity fur15 nishes such program must provide that such entity, meet16 ing generally applicable State or other requirements appli17 cable for participation, must be accepted as a provider on 

18 the same basis as any other qualified provider, except that 

19 any requirement that the entity be licensed or recognized 

20 under State or local law to furnish such services shall be 

21 deemed to have been met if the entity meets all the appli22 cable standards for such licensure, but the entity need not 

23 obtain a license or other documentation. In determining 

24 whether the entity meets such standards, the absence of 

25 licensure issued by the state in which the entity is located 

26 of any staff member of the entity may not be taken into 


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1 account, so long as such staff member holds a valid license 

2 in any state. 

3 ‘‘SEC. 409. CONSULTATION. 

4 ‘‘(a) TRIBAL TECHNICAL ADVISORY GROUP

5 (TTAG).—The Secretary shall maintain within the Cen6 ters for Medicaid & Medicare Services (CMS) a Tribal 

7 Technical Advisory Group, established in accordance with 

8 requirements of the charter dated September 30, 2003, 

9 and in such group shall include a representative of the 

10 Urban Indian Organizations and the Service. The rep11 resentative of the Urban Indian Organization shall be 

12 deemed to be an elected officer of a tribal government for 

13 purposes of applying section 204(b) of the Unfunded Man14 dates Reform Act of 1995 (2 U.S.C. 1534(b)). 

15 ‘‘(b) SOLICITATION OF MEDICAID ADVICE.— 

16 ‘‘(1) IN GENERAL.—As part of its plan under 

17 title XIX of the Social Security Act, a State in 

18 which the Service operates or funds health care pro19 grams, or in which 1 or more Indian Health Pro20 grams or Urban Indian Organizations provide health 

21 care in the State for which medical assistance is 

22 available under such title, may establish a process 

23 under which the State seeks advice on a regular, on24 going basis from designees of such Indian Health 

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1 ters relating to the application of such title to and 

2 likely to have a direct effect on such Indian Health 

3 Programs and Urban Indian Organizations. 

4 ‘‘(2) MANNER OF ADVICE.—The process de5 scribed in paragraph (1) should include solicitation 

6 of advice prior to submission of any plan amend7 ments, waiver requests, and proposals for dem8 onstration projects likely to have a direct effect on 

9 Indians, Indian Health Programs, or Urban Indian 

10 Organizations. Such process may include appoint11 ment of an advisory committee and of a designee of 

12 such Indian Health Programs and Urban Indian Or13 ganizations to the medical care advisory committee 

14 advising the State on its medicaid plan. 

15 ‘‘(3) PAYMENT OF EXPENSES.—The reasonable 

16 expenses of carrying out this subsection shall be eli17 gible for reimbursement under section 1903(a) of 

18 the Social Security Act. 

19 ‘‘(c) CONSTRUCTION.—Nothing in this section shall 

20 be construed as superseding existing advisory committees, 

21 working groups, or other advisory procedures established 

22 by the Secretary or by any State. 


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1 ‘‘SEC. 410. STATE CHILDREN’S HEALTH INSURANCE PRO2 GRAM (SCHIP). 

3 ‘‘(a) OPTIONAL USE OF FUNDS FOR INDIAN HEALTH

4 PROGRAM PAYMENTS.—Subject to the succeeding provi5 sions of this section, a State may provide under its State 

6 child health plan under title XXI of the Social Security 

7 Act (regardless of whether such plan is implemented under 

8 such title, title XIX of such Act, or both) for payments 

9 under this section to Indian Health Programs and Urban 

10 Indian Organizations operating in the State. Such pay11 ments shall be treated under title XXI of the Social Secu12 rity Act as expenditures described in section 

13 2105(a)(1)(A) of such Act. 

14 ‘‘(b) USE OF FUNDS.—Payments under this section 

15 may be used only for expenditures described in clauses (i) 

16 through (iii) of section 2105(a)(1)(D) of the Social Secu17 rity Act for targeted low-income children or other low-in18 come children (as defined in 2110 of such Act) who are— 

19 ‘‘(1) Indians; or 

20 ‘‘(2) otherwise eligible for health services from 

21 the Indian Health Program involved. 

22 ‘‘(c) SPECIAL RESTRICTIONS.—The following condi23 tions apply to a State electing to provide payments under 

24 this section: 

25 ‘‘(1) NO LIMITATION ON OTHER SCHIP PARTICI26 PATION OF, OR PROVIDER PAYMENTS TO, INDIAN


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1 HEALTH PROGRAMS.—The State may not exclude or 

2 limit participation of otherwise eligible Indian 

3 Health Programs in its State child health program 

4 under title XXI of the Social Security Act or its 

5 medicaid program under title XIX of such Act or 

6 pay such Programs less than they otherwise would 

7 as participating providers on the basis that pay8 ments are made to such Programs under this sec9 tion. 

10 ‘‘(2) NO LIMITATION ON OTHER SCHIP ELIGI11 BILITY OF INDIANS.—The State may not exclude or 

12 limit participation of otherwise eligible Indian chil13 dren in such State child health or medicaid program 

14 on the basis that payments are made for assistance 

15 for such children under this section. 

16 ‘‘(3) LIMITATION ON ACCEPTANCE OF CON17 TRIBUTIONS.— 

18 ‘‘(A) IN GENERAL.—The State may not ac19 cept contributions or condition making of pay20 ments under this section upon contribution of 

21 funds from any Indian Health Program to meet 

22 the State’s non-Federal matching fund require23 ments under titles XIX and XXI of the Social 

24 Security Act. 


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1 ‘‘(B) CONTRIBUTION DEFINED.—For pur2 poses of subparagraph (A), the term ‘contribu3 tion’ includes any tax, donation, fee, or other 

4 payment made, whether made voluntarily or in5 voluntarily. 

6 ‘‘(d) APPLICATION OF SEPARATE 10 PERCENT LIMI7 TATION.—Payment may be made under section 2105(a) 

8 of the Social Security Act to a State for a fiscal year for 

9 payments under this section up to an amount equal to 10 

10 percent of the total amount available under title XXI of 

11 such Act (including allotments and reallotments available 

12 from previous fiscal years) to the State with respect to 

13 the fiscal year. 

14 ‘‘(e) GENERAL TERMS.—A payment under this sec15 tion shall only be made upon application to the State from 

16 the Indian Health Program involved and under such terms 

17 and conditions, and in a form and manner, as the Sec18 retary determines appropriate. 

19 ‘‘SEC. 411. SOCIAL SECURITY ACT SANCTIONS. 

20 ‘‘(a) REQUESTS FOR WAIVER OF SANCTIONS.— 

21 ‘‘(1) IN GENERAL.—For purposes of applying 

22 any authority under a provision of title XI, XVIII, 

23 XIX, or XXI of the Social Security Act to seek a 

24 waiver of a sanction imposed against a health care 

25 provider insofar as that provider provides services to 


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1 individuals through an Indian Health Program, the 

2 Indian Health Program shall request the State to 

3 seek such waiver, and if such State has not sought 

4 the waiver within 60 days of the Indian Health Pro5 gram request, the Indian Health Program itself may 

6 petition the Secretary for such waiver. 

7 ‘‘(2) PROCEDURE.—In seeking a waiver under 

8 paragraph (1), the Indian Health Program must 

9 provide notice and a copy of the request, including 

10 the reasons for the waiver sought, to the State. The 

11 Secretary may consider the State’s views in the de12 termination of the waiver request, but may not with13 hold or delay a determination based on the lack of 

14 the State’s views. 

15 ‘‘(b) SAFE HARBOR FOR TRANSACTIONS BETWEEN

16 AND AMONG INDIAN HEALTH CARE PROGRAMS.—For 

17 purposes of applying section 1128B(b) of the Social Secu18 rity Act, the exchange of anything of value between or 

19 among the following shall not be treated as remuneration 

20 if the exchange arises from or relates to any of the fol21 lowing health programs: 

22 ‘‘(1) An exchange between or among the fol23 lowing: 

24 ‘‘(A) Any Indian Health Program. 

25 ‘‘(B) Any Urban Indian Organization. 


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1 ‘‘(2) An exchange between an Indian Tribe, 

2 Tribal Organization, or an Urban Indian Organiza3 tion and any patient served or eligible for service 

4 from an Indian Tribe, Tribal Organization, or 

5 Urban Indian Organization, including patients 

6 served or eligible for service pursuant to section 807, 

7 but only if such exchange— 

8 ‘‘(A) is for the purpose of transporting the 

9 patient for the provision of health care items or 

10 services; 

11 ‘‘(B) is for the purpose of providing hous12 ing to the patient (including a pregnant pa13 tient) and immediate family members or an es14 cort incidental to assuring the timely provision 

15 of health care items and services to the patient; 

16 ‘‘(C) is for the purpose of paying pre17 miums, copayments, deductibles, or other cost18 sharing on behalf of patients; or 

19 ‘‘(D) consists of an item or service of small 

20 value that is provided as a reasonable incentive 

21 to secure timely and necessary preventive and 

22 other items and services. 

23 ‘‘(3) Other exchanges involving an Indian 

24 Health Program, an Urban Indian Organization, or 

25 an Indian Tribe or Tribal Organization that meet 


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1 such standards as the Secretary of Health and 

2 Human Services, in consultation with the Attorney 

3 General, determines is appropriate, taking into ac4 count the special circumstances of such Indian 

5 Health Programs, Urban Indian Organizations, In6 dian Tribes, and Tribal Organizations and of pa7 tients served by Indian Health Programs, Urban In8 dian Organizations, Indian Tribes, and Tribal Orga9 nizations. 

10 ‘‘SEC. 412. COST SHARING. 

11 ‘‘(a) COINSURANCE, COPAYMENTS, AND

12 DEDUCTIBLES.—Notwithstanding any other provision of 

13 Federal or State law— 

14 ‘‘(1) PROTECTION FOR ELIGIBLE INDIANS

15 UNDER SOCIAL SECURITY ACT HEALTH PRO16 GRAMS.—No Indian who is furnished an item or 

17 service for which payment may be made under title 

18 XIX or XXI of the Social Security Act may be 

19 charged a deductible, copayment, or coinsurance if 

20 the item or service is furnished by, or upon referral 

21 made by, the Service, and Indian Tribe, Tribal Or22 ganization, or Urban Indian Organization. 

23 ‘‘(2) PROTECTION FOR INDIANS.—No Indian 

24 who is furnished an item or service by the Service 


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1 may be charged a deductible, copayment, or coinsur2 ance. 

3 ‘‘(3) NO REDUCTION IN AMOUNT OF PAYMENT

4 TO INDIAN HEALTH PROVIDERS.—The payment or 

5 reimbursement due to the Service, Indian Tribe, 

6 Tribal Organization, or Urban Indian Organization 

7 under title XIX or XXI of the Social Security Act 

8 may not be reduced by the amount of the deductible, 

9 copayment, or coinsurance that would be due from 

10 the Indian but for the operation of this section. 

11 ‘‘(b) EXEMPTION FROM MEDICAID AND SCHIP PRE12 MIUMS.—Notwithstanding any other provision of Federal 

13 or State law, no Indian who is otherwise eligible for serv14 ices under title XIX of the Social Security Act (relating 

15 to the medicaid program) or title XXI of such Act (relat16 ing to the State children’s health insurance program) may 

17 be charged a premium, enrollment fee, or similar charge 

18 as a condition of receiving benefits under the program 

19 under the respective title. 

20 ‘‘(c) TREATMENT OF CERTAIN PROPERTY FOR MED21 ICAID ELIGIBILITY.—Notwithstanding any other provision 

22 of Federal or State law, the following property may not 

23 be included when determining eligibility for services under 

24 title XIX of the Social Security Act: 


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1 ‘‘(1) Property, including real property and im2 provements, located on a reservation, including any 

3 federally recognized Indian Tribe’s reservation, 

4 Pueblo, or Colony, including former reservations in 

5 Oklahoma, Alaska Native regions established by the 

6 Alaska Native Claims Settlement Act and Indian al7 lotments on or near a reservation as designated and 

8 approved by the Bureau of Indian Affairs of the De9 partment of the Interior. 

10 ‘‘(2) For any federally recognized Tribe not de11 scribed in paragraph (1), property located within the 

12 most recent boundaries of a prior Federal reserva13 tion. 

14 ‘‘(3) Ownership interests in rents, leases, royal15 ties, or usage rights related to natural resources (in16 cluding extraction of natural resources or harvesting 

17 of timber, other plants and plant products, animals, 

18 fish, and shellfish) resulting from the exercise of fed19 erally protected rights. 

20 ‘‘(4) Ownership interests in or usage rights to 

21 items not covered by paragraphs (1) through (3) 

22 that have unique religious, spiritual, traditional, or 

23 cultural significance or rights that support subsist24 ence or a traditional life style according to applicable 

25 tribal law or custom. 


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1 ‘‘(d) CONTINUATION OF CURRENT LAW PROTEC2 TIONS OF CERTAIN INDIAN PROPERTY FROM MEDICAID

3 ESTATE RECOVERY.—Income, resources, and property 

4 that are exempt from medicaid estate recovery under title 

5 XIX of the Social Security Act as of April 1, 2003, under 

6 manual instructions issued to carry out section 1917(b)(3) 

7 of such Act because of Federal responsibility for Indian 

8 Tribes and Alaska Native Villages shall remain so exempt. 

9 Nothing in this subsection shall be construed as pre10 venting the Secretary from providing additional medicaid 

11 estate recovery exemptions for Indians. 

12 ‘‘SEC. 413. TREATMENT UNDER MEDICAID MANAGED CARE. 

13 ‘‘(a) PROVISION OF SERVICES, TO ENROLLEES WITH

14 NON-INDIAN MEDICAID MANAGED CARE ENTITIES, BY

15 INDIAN HEALTH PROGRAMS AND URBAN INDIAN ORGANI16 ZATIONS.— 

17 ‘‘(1) PAYMENT RULES.— 

18 ‘‘(A) IN GENERAL.—Subject to subpara19 graph (B), in the case of an Indian who is en20 rolled with a non-Indian medicaid managed care 

21 entity (as defined in subsection (c)) and who re22 ceives covered medicaid managed care services 

23 from an Indian Health Program or an Urban 

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1 ticipating provider with respect to such entity, 

2 the following rules apply: 

3 ‘‘(i) DIRECT PAYMENT.—The entity 

4 shall make prompt payment (in accordance 

5 with rules applicable to medicaid managed 

6 care entities under title XIX of the Social 

7 Security Act) to the Indian Health Pro8 gram or Urban Indian Organization at a 

9 rate established by the entity for such serv10 ices that is equal to the rate negotiated be11 tween such entity and the Program or Or12 ganization involved or, if such a rate has 

13 not been negotiated, a rate that is not less 

14 than the level and amount of payment 

15 which the entity would make for the serv16 ices if the services were furnished by a pro17 vider which is not such a Program or Or18 ganization. 

19 ‘‘(ii) PAYMENT THROUGH STATE.—If 

20 there is no arrangement for direct payment 

21 under clause (i) or if a State provides for 

22 this clause to apply in lieu of clause (i), 

23 the State shall provide for payment to the 

24 Indian Health Program or Urban Indian 

25 Organization under its State program 


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•HR 5312 IH

1 under title XIX of such Act at the rate 

2 that would be otherwise applicable for such 

3 services under such program and shall pro4 vide for an appropriate adjustment of the 

5 capitation payment made to the entity to 

6 take into account such payment. 

7 ‘‘(B) COMPLIANCE WITH GENERALLY AP8 PLICABLE REQUIREMENTS.— 

9 ‘‘(i) IN GENERAL.—Except as other10 wise provided, as a condition of payment 

11 under subparagraph (A), the Indian 

12 Health Program or Urban Indian Organi13 zation shall comply with the generally ap14 plicable requirements of title XIX of the 

15 Social Security Act with respect to covered 

16 services. 

17 ‘‘(ii) SATISFACTION OF CLAIM RE18 QUIREMENT.—Any requirement for the 

19 submission of a claim or other documenta20 tion for services covered under subpara21 graph (A) by the enrollee is deemed to be 

22 satisfied through the submission of a claim 

23 or other documentation by the Indian 

24 Health Program or Urban Indian Organi25 zation consistent with section 403(h). 


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1 ‘‘(C) CONSTRUCTION.—Nothing in this 

2 subsection shall be construed as waiving the ap3 plication of section 1902(a)(30)(A) of the Social 

4 Security Act (relating to application of stand5 ards to assure that payments are consistent 

6 with efficiency, economy, and quality of care). 

7 ‘‘(2) ENROLLEE OPTION TO SELECT AN INDIAN

8 HEALTH PROGRAM OR URBAN INDIAN ORGANIZATION

9 AS PRIMARY CARE PROVIDER.—In the case of a non10 Indian medicaid managed care entity that— 

11 ‘‘(A) has an Indian enrolled with the enti12 ty; and 

13 ‘‘(B) has an Indian Health Program or 

14 Urban Indian Organization that is participating 

15 as a primary care provider within the network 

16 of the entity, 

17 insofar as the Indian is otherwise eligible to receive 

18 services from such Program or Organization and the 

19 Program or Organization has the capacity to provide 

20 primary care services to such Indian, the Indian 

21 shall be allowed to choose such Program or Organi22 zation as the Indian’s primary care provider under 

23 the entity. 

24 ‘‘(b) OFFERING OF MANAGED CARE THROUGH IN25 DIAN MEDICAID MANAGED CARE ENTITIES.—If— 


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1 ‘‘(1) a State elects to provide services through 

2 medicaid managed care entities under its medicaid 

3 managed care program; and 

4 ‘‘(2) an Indian Health Program or Urban In5 dian Organization that is funded in whole or in part 

6 by the Service, or a consortium thereof, has estab7 lished an Indian medicaid managed care entity in 

8 the State that meets generally applicable standards 

9 required of such an entity under such medicaid man10 aged care program, 

11 the State shall offer to enter into an agreement with the 

12 entity to serve as a medicaid managed care entity with 

13 respect to eligible Indians served by such entity under 

14 such program. 

15 ‘‘(c) SPECIAL RULES FOR INDIAN MANAGED CARE

16 ENTITIES.—The following are special rules regarding the 

17 application of a medicaid managed care program to Indian 

18 medicaid managed care entities: 

19 ‘‘(1) ENROLLMENT.— 

20 ‘‘(A) LIMITATION TO INDIANS.—An Indian 

21 medicaid managed care entity may restrict en22 rollment under such program to Indians and to 

23 members of specific Tribes in the same manner 

24 as Indian Health Programs may restrict the deVerDate Aug 31 2005 03:45 May 16, 2006 Jkt 049200 PO 00000 Frm 00211 Fmt 6652 Sfmt 6201 E:\BILLS\H5312.IH H5312

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1 livery of services to such Indians and tribal 

2 members. 

3 ‘‘(B) NO LESS CHOICE OF PLANS.—Under 

4 such program the State may not limit the 

5 choice of an Indian among medicaid managed 

6 care entities only to Indian medicaid managed 

7 care entities or to be more restrictive than the 

8 choice of managed care entities offered to indi9 viduals who are not Indians. 

10 ‘‘(C) DEFAULT ENROLLMENT.— 

11 ‘‘(i) IN GENERAL.—If such program 

12 of a State requires the enrollment of Indi13 ans in a medicaid managed care entity in 

14 order to receive benefits, the State shall 

15 provide for the enrollment of Indians de16 scribed in clause (ii) who are not otherwise 

17 enrolled with such an entity in an Indian 

18 medicaid managed care entity described in 

19 such clause. 

20 ‘‘(ii) INDIAN DESCRIBED.—An Indian 

21 described in this clause, with respect to an 

22 Indian medicaid managed care entity, is an 

23 Indian who, based upon the service area 

24 and capacity of the entity, is eligible to be 


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1 enrolled with the entity consistent with 

2 subparagraph (A). 

3 ‘‘(D) EXCEPTION TO STATE LOCK-IN.—A 

4 request by an Indian who is enrolled under such 

5 program with a non-Indian medicaid managed 

6 care entity to change enrollment with that enti7 ty to enrollment with an Indian medicaid man8 aged care entity shall be considered cause for 

9 granting such request under procedures speci10 fied by the Secretary. 

11 ‘‘(2) FLEXIBILITY IN APPLICATION OF SOL12 VENCY.—In applying section 1903(m)(1) of the So13 cial Security Act to an Indian medicaid managed 

14 care entity— 

15 ‘‘(A) any reference to a ‘State’ in subpara16 graph (A)(ii) of that section shall be deemed to 

17 be a reference to the ‘Secretary’; and 

18 ‘‘(B) the entity shall be deemed to be a 

19 public entity described in subparagraph (C)(ii) 

20 of that section. 

21 ‘‘(3) EXCEPTIONS TO ADVANCE DIRECTIVES.— 

22 The Secretary may modify or waive the require23 ments of section 1902(w) of the Social Security Act 

24 (relating to provision of written materials on ad25 vance directives) insofar as the Secretary finds that 


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1 the requirements otherwise imposed are not an ap2 propriate or effective way of communicating the in3 formation to Indians. 

4 ‘‘(4) FLEXIBILITY IN INFORMATION AND MAR5 KETING.— 

6 ‘‘(A) MATERIALS.—The Secretary may 

7 modify requirements under section 1932(a)(5) 

8 of the Social Security Act in a manner that im9 proves the materials to take into account the 

10 special circumstances of such entities and their 

11 enrollees while maintaining and clearly commu12 nicating to potential enrollees their rights, pro13 tections, and benefits. 

14 ‘‘(B) DISTRIBUTION OF MARKETING MATE15 RIALS.—The provisions of section 

16 1932(d)(2)(B) of the Social Security Act re17 quiring the distribution of marketing materials 

18 to an entire service area shall be deemed satis19 fied in the case of an Indian medicaid managed 

20 care entity that distributes appropriate mate21 rials only to those Indians who are potentially 

22 eligible to enroll with the entity in the service 

23 area. 

24 ‘‘(d) MALPRACTICE INSURANCE.—Insofar as, under 

25 a medicaid managed care program, a health care provider 


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1 is required to have medical malpractice insurance coverage 

2 as a condition of contracting as a provider with a medicaid 

3 managed care entity, an Indian Health Program, or an 

4 Urban Indian Organization that is a Federally-qualified 

5 health center under title XIX of the Social Security Act, 

6 that is covered under the Federal Tort Claims Act (28 

7 U.S.C. 1346(b), 2671 et seq.) is deemed to satisfy such 

8 requirement. 

9 ‘‘(e) DEFINITIONS.—For purposes of this section: 

10 ‘‘(1) MEDICAID MANAGED CARE ENTITY.—The 

11 term ‘medicaid managed care entity’ means a man12 aged care entity (whether a managed care organiza13 tion or a primary care case manager) under title 

14 XIX of the Social Security Act, whether pursuant to 

15 section 1903(m) or section 1932 of such Act, a waiv16 er under section 1115 or 1915(b) of such Act, or 

17 otherwise. 

18 ‘‘(2) INDIAN MEDICAID MANAGED CARE ENTI19 TY.—The term ‘Indian medicaid managed care enti20 ty’ means a managed care entity that is controlled 

21 (within the meaning of the last sentence of section 

22 1903(m)(1)(C) of the Social Security Act) by the In23 dian Health Service, a Tribe, Tribal Organization, or 

24 Urban Indian Organization (as such terms are de25 fined in section 4), or a consortium, which may be 


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1 composed of 1 or more Tribes, Tribal Organizations, 

2 or Urban Indian Organizations, and which also may 

3 include the Service. 

4 ‘‘(3) NON-INDIAN MEDICAID MANAGED CARE

5 ENTITY.—The term ‘non-Indian medicaid managed 

6 care entity’ means a medicaid managed care entity 

7 that is not an Indian medicaid managed care entity. 

8 ‘‘(4) COVERED MEDICAID MANAGED CARE

9 SERVICES.—The term ‘covered medicaid managed 

10 care services’ means, with respect to an individual 

11 enrolled with a medicaid managed care entity, items 

12 and services that are within the scope of items and 

13 services for which benefits are available with respect 

14 to the individual under the contract between the en15 tity and the State involved. 

16 ‘‘(5) MEDICAID MANAGED CARE PROGRAM.— 

17 The term ‘medicaid managed care program’ means 

18 a program under sections 1903(m) and 1932 of the 

19 Social Security Act and includes a managed care 

20 program operating under a waiver under section 

21 1915(b) or 1115 of such Act or otherwise. 

22 ‘‘SEC. 414. NAVAJO NATION MEDICAID AGENCY FEASI23 BILITY STUDY. 

24 ‘‘(a) STUDY.—The Secretary shall conduct a study 

25 to determine the feasibility of treating the Navajo Nation 


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1 as a State for the purposes of title XIX of the Social Secu2 rity Act, to provide services to Indians living within the 

3 boundaries of the Navajo Nation through an entity estab4 lished having the same authority and performing the same 

5 functions as single-State medicaid agencies responsible for 

6 the administration of the State plan under title XIX of 

7 the Social Security Act. 

8 ‘‘(b) CONSIDERATIONS.—In conducting the study, 

9 the Secretary shall consider the feasibility of— 

10 ‘‘(1) assigning and paying all expenditures for 

11 the provision of services and related administration 

12 funds, under title XIX of the Social Security Act, to 

13 Indians living within the boundaries of the Navajo 

14 Nation that are currently paid to or would otherwise 

15 be paid to the State of Arizona, New Mexico, or 

16 Utah; 

17 ‘‘(2) providing assistance to the Navajo Nation 

18 in the development and implementation of such enti19 ty for the administration, eligibility, payment, and 

20 delivery of medical assistance under title XIX of the 

21 Social Security Act; 

22 ‘‘(3) providing an appropriate level of matching 

23 funds for Federal medical assistance with respect to 

24 amounts such entity expends for medical assistance 

25 for services and related administrative costs; and 


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1 ‘‘(4) authorizing the Secretary, at the option of 

2 the Navajo Nation, to treat the Navajo Nation as a 

3 State for the purposes of title XIX of the Social Se4 curity Act (relating to the State children’s health in5 surance program) under terms equivalent to those 

6 described in paragraphs (2) through (4). 

7 ‘‘(c) REPORT.—Not later then 3 years after the date 

8 of enactment of the Indian Health Act Improvement Act 

9 Amendments of 2006, the Secretary shall submit to the 

10 Committee on Indian Affairs and Committee on Finance 

11 of the Senate and the Committee on Resources and Com12 mittee on Energy and Commerce of the House of Rep13 resentatives a report that includes— 

14 ‘‘(1) the results of the study under this section; 

15 ‘‘(2) a summary of any consultation that oc16 curred between the Secretary and the Navajo Na17 tion, other Indian Tribes, the States of Arizona, 

18 New Mexico, and Utah, counties which include Nav19 ajo Lands, and other interested parties, in con20 ducting this study; 

21 ‘‘(3) projected costs or savings associated with 

22 establishment of such entity, and any estimated im23 pact on services provided as described in this section 

24 in relation to probable costs or savings; and 


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1 ‘‘(4) legislative actions that would be required 

2 to authorize the establishment of such entity if such 

3 entity is determined by the Secretary to be feasible. 

4 ‘‘SEC. 415. AUTHORIZATION OF APPROPRIATIONS. 

5 ‘‘There are authorized to be appropriated such sums 

6 as may be necessary for each fiscal year through fiscal 

7 year 2015 to carry out this title. 

8 ‘‘TITLE V—HEALTH SERVICES 

9 FOR URBAN INDIANS 

10 ‘‘SEC. 501. PURPOSE. 

11 ‘‘The purpose of this title is to establish and maintain 

12 programs in Urban Centers to make health services more 

13 accessible and available to Urban Indians. 

14 ‘‘SEC. 502. CONTRACTS WITH, AND GRANTS TO, URBAN IN15 DIAN ORGANIZATIONS. 

16 ‘‘Under authority of the Act of November 2, 1921 

17 (25 U.S.C. 13) (commonly known as the ‘Snyder Act’), 

18 the Secretary, acting through the Service, shall enter into 

19 contracts with, or make grants to, Urban Indian Organi20 zations to assist such organizations in the establishment 

21 and administration, within Urban Centers, of programs 

22 which meet the requirements set forth in this title. Subject 

23 to section 506, the Secretary, acting through the Service, 

24 shall include such conditions as the Secretary considers 

25 necessary to effect the purpose of this title in any contract 


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1 into which the Secretary enters with, or in any grant the 

2 Secretary makes to, any Urban Indian Organization pur3 suant to this title. 

4 ‘‘SEC. 503. CONTRACTS AND GRANTS FOR THE PROVISION 

5 OF HEALTH CARE AND REFERRAL SERVICES. 

6 ‘‘(a) REQUIREMENTS FOR GRANTS AND CON7 TRACTS.—Under authority of the Act of November 2, 

8 1921 (25 U.S.C. 13) (commonly known as the ‘Snyder 

9 Act’), the Secretary, acting through the Service, shall 

10 enter into contracts with, and make grants to, Urban In11 dian Organizations for the provision of health care and 

12 referral services for Urban Indians. Any such contract or 

13 grant shall include requirements that the Urban Indian 

14 Organization successfully undertake to— 

15 ‘‘(1) estimate the population of Urban Indians 

16 residing in the Urban Center or centers that the or17 ganization proposes to serve who are or could be re18 cipients of health care or referral services; 

19 ‘‘(2) estimate the current health status of 

20 Urban Indians residing in such Urban Center or 

21 centers; 

22 ‘‘(3) estimate the current health care needs of 

23 Urban Indians residing in such Urban Center or 

24 centers; 


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1 ‘‘(4) provide basic health education, including 

2 health promotion and disease prevention education, 

3 to Urban Indians; 

4 ‘‘(5) make recommendations to the Secretary 

5 and Federal, State, local, and other resource agen6 cies on methods of improving health service pro7 grams to meet the needs of Urban Indians; and 

8 ‘‘(6) where necessary, provide, or enter into 

9 contracts for the provision of, health care services 

10 for Urban Indians. 

11 ‘‘(b) CRITERIA.—The Secretary, acting through the 

12 Service, shall, by regulation, prescribe the criteria for se13 lecting Urban Indian Organizations to enter into contracts 

14 or receive grants under this section. Such criteria shall, 

15 among other factors, include— 

16 ‘‘(1) the extent of unmet health care needs of 

17 Urban Indians in the Urban Center or centers in18 volved; 

19 ‘‘(2) the size of the Urban Indian population in 

20 the Urban Center or centers involved; 

21 ‘‘(3) the extent, if any, to which the activities 

22 set forth in subsection (a) would duplicate any 

23 project funded under this title; 

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1 section (a) and to enter into a contract with the Sec2 retary or to meet the requirements for receiving a 

3 grant under this section; 

4 ‘‘(5) the satisfactory performance and success5 ful completion by an Urban Indian Organization of 

6 other contracts with the Secretary under this title; 

7 ‘‘(6) the appropriateness and likely effectiveness 

8 of conducting the activities set forth in subsection 

9 (a) in an Urban Center or centers; and 

10 ‘‘(7) the extent of existing or likely future par11 ticipation in the activities set forth in subsection (a) 

12 by appropriate health and health-related Federal, 

13 State, local, and other agencies. 

14 ‘‘(c) ACCESS TO HEALTH PROMOTION AND DISEASE

15 PREVENTION PROGRAMS.—The Secretary, acting through 

16 the Service, shall facilitate access to or provide health pro17 motion and disease prevention services for Urban Indians 

18 through grants made to Urban Indian Organizations ad19 ministering contracts entered into or receiving grants 

20 under subsection (a). 

21 ‘‘(d) IMMUNIZATION SERVICES.— 

22 ‘‘(1) ACCESS OR SERVICES PROVIDED.—The 

23 Secretary, acting through the Service, shall facilitate 

24 access to, or provide, immunization services for 

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1 dian Organizations administering contracts entered 

2 into or receiving grants under this section. 

3 ‘‘(2) DEFINITION.—For purposes of this sub4 section, the term ‘immunization services’ means 

5 services to provide without charge immunizations 

6 against vaccine-preventable diseases. 

7 ‘‘(e) BEHAVIORAL HEALTH SERVICES.— 

8 ‘‘(1) ACCESS OR SERVICES PROVIDED.—The 

9 Secretary, acting through the Service, shall facilitate 

10 access to, or provide, behavioral health services for 

11 Urban Indians through grants made to Urban In12 dian Organizations administering contracts entered 

13 into or receiving grants under subsection (a). 

14 ‘‘(2) ASSESSMENT REQUIRED.—Except as pro15 vided by paragraph (3)(A), a grant may not be made 

16 under this subsection to an Urban Indian Organiza17 tion until that organization has prepared, and the 

18 Service has approved, an assessment of the fol19 lowing: 

20 ‘‘(A) The behavioral health needs of the 

21 Urban Indian population concerned. 

22 ‘‘(B) The behavioral health services and 

23 other related resources available to that popu24 lation. 


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1 ‘‘(C) The barriers to obtaining those serv2 ices and resources. 

3 ‘‘(D) The needs that are unmet by such 

4 services and resources. 

5 ‘‘(3) PURPOSES OF GRANTS.—Grants may be 

6 made under this subsection for the following: 

7 ‘‘(A) To prepare assessments required 

8 under paragraph (2). 

9 ‘‘(B) To provide outreach, educational, and 

10 referral services to Urban Indians regarding the 

11 availability of direct behavioral health services, 

12 to educate Urban Indians about behavioral 

13 health issues and services, and effect coordina14 tion with existing behavioral health providers in 

15 order to improve services to Urban Indians. 

16 ‘‘(C) To provide outpatient behavioral 

17 health services to Urban Indians, including the 

18 identification and assessment of illness, thera19 peutic treatments, case management, support 

20 groups, family treatment, and other treatment. 

21 ‘‘(D) To develop innovative behavioral 

22 health service delivery models which incorporate 

23 Indian cultural support systems and resources. 

24 ‘‘(f) PREVENTION OF CHILD ABUSE.— 


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1 ‘‘(1) ACCESS OR SERVICES PROVIDED.—The 

2 Secretary, acting through the Service, shall facilitate 

3 access to or provide services for Urban Indians 

4 through grants to Urban Indian Organizations ad5 ministering contracts entered into or receiving 

6 grants under subsection (a) to prevent and treat 

7 child abuse (including sexual abuse) among Urban 

8 Indians. 

9 ‘‘(2) EVALUATION REQUIRED.—Except as pro10 vided by paragraph (3)(A), a grant may not be made 

11 under this subsection to an Urban Indian Organiza12 tion until that organization has prepared, and the 

13 Service has approved, an assessment that documents 

14 the prevalence of child abuse in the Urban Indian 

15 population concerned and specifies the services and 

16 programs (which may not duplicate existing services 

17 and programs) for which the grant is requested. 

18 ‘‘(3) PURPOSES OF GRANTS.—Grants may be 

19 made under this subsection for the following: 

20 ‘‘(A) To prepare assessments required 

21 under paragraph (2). 

22 ‘‘(B) For the development of prevention, 

23 training, and education programs for Urban In24 dians, including child education, parent edu25 cation, provider training on identification and 


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1 intervention, education on reporting require2 ments, prevention campaigns, and establishing 

3 service networks of all those involved in Indian 

4 child protection. 

5 ‘‘(C) To provide direct outpatient treat6 ment services (including individual treatment, 

7 family treatment, group therapy, and support 

8 groups) to Urban Indians who are child victims 

9 of abuse (including sexual abuse) or adult sur10 vivors of child sexual abuse, to the families of 

11 such child victims, and to Urban Indian per12 petrators of child abuse (including sexual 

13 abuse). 

14 ‘‘(4) CONSIDERATIONS WHEN MAKING

15 GRANTS.—In making grants to carry out this sub16 section, the Secretary shall take into consideration— 

17 ‘‘(A) the support for the Urban Indian Or18 ganization demonstrated by the child protection 

19 authorities in the area, including committees or 

20 other services funded under the Indian Child 

21 Welfare Act of 1978 (25 U.S.C. 1901 et seq.), 

22 if any; 

23 ‘‘(B) the capability and expertise dem24 onstrated by the Urban Indian Organization to 


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1 address the complex problem of child sexual 

2 abuse in the community; and 

3 ‘‘(C) the assessment required under para4 graph (2). 

5 ‘‘(g) OTHER GRANTS.—The Secretary, acting 

6 through the Service, may enter into a contract with or 

7 make grants to an Urban Indian Organization that pro8 vides or arranges for the provision of health care services 

9 (through satellite facilities, provider networks, or other10 wise) to Urban Indians in more than 1 Urban Center. 

11 ‘‘SEC. 504. CONTRACTS AND GRANTS FOR THE DETERMINA12 TION OF UNMET HEALTH CARE NEEDS. 

13 ‘‘(a) GRANTS AND CONTRACTS AUTHORIZED.— 

14 Under authority of the Act of November 2, 1921 (25 

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

16 Secretary, acting through the Service, may enter into con17 tracts with or make grants to Urban Indian Organizations 

18 situated in Urban Centers for which contracts have not 

19 been entered into or grants have not been made under sec20 tion 503. 

21 ‘‘(b) PURPOSE.—The purpose of a contract or grant 

22 made under this section shall be the determination of the 

23 matters described in subsection (c)(1) in order to assist 

24 the Secretary in assessing the health status and health 

25 care needs of Urban Indians in the Urban Center involved 


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1 and determining whether the Secretary should enter into 

2 a contract or make a grant under section 503 with respect 

3 to the Urban Indian Organization which the Secretary has 

4 entered into a contract with, or made a grant to, under 

5 this section. 

6 ‘‘(c) GRANT AND CONTRACT REQUIREMENTS.—Any 

7 contract entered into, or grant made, by the Secretary 

8 under this section shall include requirements that— 

9 ‘‘(1) the Urban Indian Organization success10 fully undertakes to— 

11 ‘‘(A) document the health care status and 

12 unmet health care needs of Urban Indians in 

13 the Urban Center involved; and 

14 ‘‘(B) with respect to Urban Indians in the 

15 Urban Center involved, determine the matters 

16 described in paragraphs (2), (3), (4), and (7) of 

17 section 503(b); and 

18 ‘‘(2) the Urban Indian Organization complete 

19 performance of the contract, or carry out the re20 quirements of the grant, within 1 year after the date 

21 on which the Secretary and such organization enter 

22 into such contract, or within 1 year after such orga23 nization receives such grant, whichever is applicable. 


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1 ‘‘(d) NO RENEWALS.—The Secretary may not renew 

2 any contract entered into or grant made under this sec3 tion. 

4 ‘‘SEC. 505. EVALUATIONS; RENEWALS. 

5 ‘‘(a) PROCEDURES FOR EVALUATIONS.—The Sec6 retary, acting through the Service, shall develop proce7 dures to evaluate compliance with grant requirements and 

8 compliance with and performance of contracts entered into 

9 by Urban Indian Organizations under this title. Such pro10 cedures shall include provisions for carrying out the re11 quirements of this section. 

12 ‘‘(b) EVALUATIONS.—The Secretary, acting through 

13 the Service, shall evaluate the compliance of each Urban 

14 Indian Organization which has entered into a contract or 

15 received a grant under section 503 with the terms of such 

16 contract or grant. For purposes of this evaluation, in de17 termining the capacity of an Urban Indian Organization 

18 to deliver quality patient care the Secretary shall— 

19 ‘‘(1) acting through the Service, conduct an an20 nual onsite evaluation of the organization; or 

21 ‘‘(2) accept in lieu of such onsite evaluation evi22 dence of the organization’s provisional or full accred23 itation by a private independent entity recognized by 

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1 views of providers participating in the Medicare pro2 gram under title XVIII of the Social Security Act. 

3 ‘‘(c) NONCOMPLIANCE; UNSATISFACTORY PERFORM4 ANCE.—If, as a result of the evaluations conducted under 

5 this section, the Secretary determines that an Urban In6 dian Organization has not complied with the requirements 

7 of a grant or complied with or satisfactorily performed a 

8 contract under section 503, the Secretary shall, prior to 

9 renewing such contract or grant, attempt to resolve with 

10 the organization the areas of noncompliance or unsatisfac11 tory performance and modify the contract or grant to pre12 vent future occurrences of noncompliance or unsatisfac13 tory performance. If the Secretary determines that the 

14 noncompliance or unsatisfactory performance cannot be 

15 resolved and prevented in the future, the Secretary shall 

16 not renew the contract or grant with the organization and 

17 is authorized to enter into a contract or make a grant 

18 under section 503 with another Urban Indian Organiza19 tion which is situated in the same Urban Center as the 

20 Urban Indian Organization whose contract or grant is not 

21 renewed under this section. 

22 ‘‘(d) CONSIDERATIONS FOR RENEWALS.—In deter23 mining whether to renew a contract or grant with an 

24 Urban Indian Organization under section 503 which has 

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1 tion 504, the Secretary shall review the records of the 

2 Urban Indian Organization, the reports submitted under 

3 section 507, and shall consider the results of the onsite 

4 evaluations or accreditations under subsection (b). 

5 ‘‘SEC. 506. OTHER CONTRACT AND GRANT REQUIREMENTS. 

6 ‘‘(a) PROCUREMENT.—Contracts with Urban Indian 

7 Organizations entered into pursuant to this title shall be 

8 in accordance with all Federal contracting laws and regu9 lations relating to procurement except that in the discre10 tion of the Secretary, such contracts may be negotiated 

11 without advertising and need not conform to the provisions 

12 of sections 1304 and 3131 through 3133 of title 40, 

13 United States Code. 

14 ‘‘(b) PAYMENTS UNDER CONTRACTS OR GRANTS.— 

15 Payments under any contracts or grants pursuant to this 

16 title shall, notwithstanding any term or condition of such 

17 contract or grant— 

18 ‘‘(1) be made in their entirety by the Secretary 

19 to the Urban Indian Organization by no later than 

20 the end of the first 30 days of the funding period 

21 with respect to which the payments apply, unless the 

22 Secretary determines through an evaluation under 

23 section 505 that the organization is not capable of 

24 administering such payments in their entirety; and 


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1 ‘‘(2) if any portion thereof is unexpended by the 

2 Urban Indian Organization during the funding pe3 riod with respect to which the payments initially 

4 apply, shall be carried forward for expenditure with 

5 respect to allowable or reimbursable costs incurred 

6 by the organization during 1 or more subsequent 

7 funding periods without additional justification or 

8 documentation by the organization as a condition of 

9 carrying forward the availability for expenditure of 

10 such funds. 

11 ‘‘(c) REVISION OR AMENDMENT OF CONTRACTS.— 

12 Notwithstanding any provision of law to the contrary, the 

13 Secretary may, at the request and consent of an Urban 

14 Indian Organization, revise or amend any contract entered 

15 into by the Secretary with such organization under this 

16 title as necessary to carry out the purposes of this title. 

17 ‘‘(d) FAIR AND UNIFORM SERVICES AND ASSIST18 ANCE.—Contracts with or grants to Urban Indian Organi19 zations and regulations adopted pursuant to this title shall 

20 include provisions to assure the fair and uniform provision 

21 to Urban Indians of services and assistance under such 

22 contracts or grants by such organizations. 

23 ‘‘SEC. 507. REPORTS AND RECORDS. 

24 ‘‘(a) REPORTS.—For each fiscal year during which 

25 an Urban Indian Organization receives or expends funds 


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1 pursuant to a contract entered into or a grant received 

2 pursuant to this title, such Urban Indian Organization 

3 shall submit to the Secretary not more frequently than 

4 every 6 months, a report that includes the following: 

5 ‘‘(1) In the case of a contract or grant under 

6 section 503, recommendations pursuant to section 

7 503(a)(5). 

8 ‘‘(2) Information on activities conducted by the 

9 organization pursuant to the contract or grant. 

10 ‘‘(3) An accounting of the amounts and purpose 

11 for which Federal funds were expended. 

12 ‘‘(4) A minimum set of data, using uniformly 

13 defined elements, as specified by the Secretary after 

14 consultation with Urban Indian Organizations. 

15 ‘‘(b) AUDIT.—The reports and records of the Urban 

16 Indian Organization with respect to a contract or grant 

17 under this title shall be subject to audit by the Secretary 

18 and the Comptroller General of the United States. 

19 ‘‘(c) COSTS OF AUDITS.—The Secretary shall allow 

20 as a cost of any contract or grant entered into or awarded 

21 under section 502 or 503 the cost of an annual inde22 pendent financial audit conducted by— 

23 ‘‘(1) a certified public accountant; or 

24 ‘‘(2) a certified public accounting firm qualified 

25 to conduct Federal compliance audits. 


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1 ‘‘SEC. 508. LIMITATION ON CONTRACT AUTHORITY. 

2 ‘‘The authority of the Secretary to enter into con3 tracts or to award grants under this title shall be to the 

4 extent, and in an amount, provided for in appropriation 

5 Acts. 

6 ‘‘SEC. 509. FACILITIES. 

7 ‘‘(a) GRANTS.—The Secretary, acting through the 

8 Service, may make grants to contractors or grant recipi9 ents under this title for the lease, purchase, renovation, 

10 construction, or expansion of facilities, including leased fa11 cilities, in order to assist such contractors or grant recipi12 ents in complying with applicable licensure or certification 

13 requirements. 

14 ‘‘(b) LOAN FUND STUDY.—The Secretary, acting 

15 through the Services, may carry out a study to determine 

16 the feasibility of establishing a loan fund to provide to 

17 Urban Indian Organizations direct loans or guarantees for 

18 loans for the construction of health care facilities in a 

19 manner consistent with section 309. 

20 ‘‘SEC. 510. DIVISION OF URBAN INDIAN HEALTH. 

21 ‘‘There is established within the Service a Division 

22 of Urban Indian Health, which shall be responsible for— 

23 ‘‘(1) carrying out the provisions of this title; 

24 ‘‘(2) providing central oversight of the pro25 grams and services authorized under this title; and 


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1 ‘‘(3) providing technical assistance to Urban In2 dian Organizations. 

3 ‘‘SEC. 511. GRANTS FOR ALCOHOL AND SUBSTANCE ABUSE4 RELATED SERVICES. 

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

6 through the Service, may make grants for the provision 

7 of health-related services in prevention of, treatment of, 

8 rehabilitation of, or school- and community-based edu9 cation regarding, alcohol and substance abuse in Urban 

10 Centers to those Urban Indian Organizations with which 

11 the Secretary has entered into a contract under this title 

12 or under section 201. 

13 ‘‘(b) GOALS.—Each grant made pursuant to sub14 section (a) shall set forth the goals to be accomplished 

15 pursuant to the grant. The goals shall be specific to each 

16 grant as agreed to between the Secretary and the grantee. 

17 ‘‘(c) CRITERIA.—The Secretary shall establish cri18 teria for the grants made under subsection (a), including 

19 criteria relating to the following: 

20 ‘‘(1) The size of the Urban Indian population. 

21 ‘‘(2) Capability of the organization to ade22 quately perform the activities required under the 

23 grant. 

24 ‘‘(3) Satisfactory performance standards for the 

25 organization in meeting the goals set forth in such 


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1 grant. The standards shall be negotiated and agreed 

2 to between the Secretary and the grantee on a 

3 grant-by-grant basis. 

4 ‘‘(4) Identification of the need for services. 

5 ‘‘(d) ALLOCATION OF GRANTS.—The Secretary shall 

6 develop a methodology for allocating grants made pursu7 ant to this section based on the criteria established pursu8 ant to subsection (c). 

9 ‘‘(e) GRANTS SUBJECT TO CRITERIA.—Any funds re10 ceived by an Urban Indian Organization under this Act 

11 for substance abuse prevention, treatment, and rehabilita12 tion shall be subject to the criteria set forth in subsection 

13 (c). 

14 ‘‘SEC. 512. TREATMENT OF CERTAIN DEMONSTRATION 

15 PROJECTS. 

16 ‘‘Notwithstanding any other provision of law, the 

17 Tulsa Clinic and Oklahoma City Clinic demonstration 

18 projects shall— 

19 ‘‘(1) be permanent programs within the Serv20 ice’s direct care program; 

21 ‘‘(2) continue to be treated as Service Units in 

22 the allocation of resources and coordination of care; 

23 and 

24 ‘‘(3) shall be subject to the provisions of the In25 dian Self-Determination and Education Assistance 


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1 Act (25 U.S.C. 450 et seq.), except that the pro2 grams shall not be divisible. 

3 ‘‘SEC. 513. URBAN NIAAA TRANSFERRED PROGRAMS. 

4 ‘‘(a) GRANTS AND CONTRACTS.—The Secretary, 

5 through the Division of Urban Indian Health, shall make 

6 grants or enter into contracts with Urban Indian Organi7 zations, to take effect not later than September 30, 2008, 

8 for the administration of Urban Indian alcohol programs 

9 that were originally established under the National Insti10 tute on Alcoholism and Alcohol Abuse (hereafter in this 

11 section referred to as ‘NIAAA’) and transferred to the 

12 Service. 

13 ‘‘(b) USE OF FUNDS.—Grants provided or contracts 

14 entered into under this section shall be used to provide 

15 support for the continuation of alcohol prevention and 

16 treatment services for Urban Indian populations and such 

17 other objectives as are agreed upon between the Service 

18 and a recipient of a grant or contract under this section. 

19 ‘‘(c) ELIGIBILITY.—Urban Indian Organizations that 

20 operate Indian alcohol programs originally funded under 

21 the NIAAA and subsequently transferred to the Service 

22 are eligible for grants or contracts under this section. 

23 ‘‘(d) REPORT.—The Secretary shall evaluate and re24 port to Congress on the activities of programs funded 

25 under this section not less than every 5 years. 


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1 ‘‘SEC. 514. CONSULTATION WITH URBAN INDIAN ORGANIZA2 TIONS. 

3 ‘‘(a) IN GENERAL.—The Secretary shall ensure that 

4 the Service consults, to the greatest extent practicable, 

5 with Urban Indian Organizations. 

6 ‘‘(b) DEFINITION OF CONSULTATION.—For purposes 

7 of subsection (a), consultation is the open and free ex8 change of information and opinions which leads to mutual 

9 understanding and comprehension and which emphasizes 

10 trust, respect, and shared responsibility. 

11 ‘‘SEC. 515. URBAN YOUTH TREATMENT CENTER DEM12 ONSTRATION. 

13 ‘‘(a) CONSTRUCTION AND OPERATION.—The Sec14 retary, acting through the Service, through grant or con15 tract, is authorized to fund the construction and operation 

16 of at least 2 residential treatment centers in each State 

17 described in subsection (b) to demonstrate the provision 

18 of alcohol and substance abuse treatment services to 

19 Urban Indian youth in a culturally competent residential 

20 setting. 

21 ‘‘(b) DEFINITION OF STATE.—A State described in 

22 this subsection is a State in which— 

23 ‘‘(1) there resides Urban Indian youth with 

24 need for alcohol and substance abuse treatment serv25 ices in a residential setting; and 


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1 ‘‘(2) there is a significant shortage of culturally 

2 competent residential treatment services for Urban 

3 Indian youth. 

4 ‘‘SEC. 516. USE OF FEDERAL GOVERNMENT FACILITIES AND 

5 SOURCES OF SUPPLY. 

6 ‘‘(a) AUTHORIZATION FOR USE.—The Secretary, act7 ing through the Service, shall allow an Urban Indian Or8 ganization that has entered into a contract or received a 

9 grant pursuant to this title, in carrying out such contract 

10 or grant, to use existing facilities and all equipment there11 in or pertaining thereto and other personal property 

12 owned by the Federal Government within the Secretary’s 

13 jurisdiction under such terms and conditions as may be 

14 agreed upon for their use and maintenance. 

15 ‘‘(b) DONATIONS.—Subject to subsection (d), the 

16 Secretary may donate to an Urban Indian Organization 

17 that has entered into a contract or received a grant pursu18 ant to this title any personal or real property determined 

19 to be excess to the needs of the Service or the General 

20 Services Administration for purposes of carrying out the 

21 contract or grant. 

22 ‘‘(c) ACQUISITION OF PROPERTY FOR DONATION.— 

23 The Secretary may acquire excess or surplus government 

24 personal or real property for donation (subject to sub25 section (d)), to an Urban Indian Organization that has 


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1 entered into a contract or received a grant pursuant to 

2 this title if the Secretary determines that the property is 

3 appropriate for use by the Urban Indian Organization for 

4 a purpose for which a contract or grant is authorized 

5 under this title. 

6 ‘‘(d) PRIORITY.—In the event that the Secretary re7 ceives a request for donation of a specific item of personal 

8 or real property described in subsection (b) or (c) from 

9 both an Urban Indian Organization and from an Indian 

10 Tribe or Tribal Organization, the Secretary shall give pri11 ority to the request for donation of the Indian Tribe or 

12 Tribal Organization if the Secretary receives the request 

13 from the Indian Tribe or Tribal Organization before the 

14 date the Secretary transfers title to the property or, if ear15 lier, the date the Secretary transfers the property phys16 ically to the Urban Indian Organization. 

17 ‘‘(e) URBAN INDIAN ORGANIZATIONS DEEMED EX18 ECUTIVE AGENCY FOR CERTAIN PURPOSES.—For pur19 poses of section 501 of title 40, United States Code, (relat20 ing to Federal sources of supply, including lodging pro21 viders, airlines, and other transportation providers), an 

22 Urban Indian Organization that has entered into a con23 tract or received a grant pursuant to this title shall be 

24 deemed an executive agency when carrying out such con25 tract or grant. 


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1 ‘‘SEC. 517. GRANTS FOR DIABETES PREVENTION, TREAT2 MENT, AND CONTROL. 

3 ‘‘(a) GRANTS AUTHORIZED.—The Secretary may 

4 make grants to those Urban Indian Organizations that 

5 have entered into a contract or have received a grant 

6 under this title for the provision of services for the preven7 tion and treatment of, and control of the complications 

8 resulting from, diabetes among Urban Indians. 

9 ‘‘(b) GOALS.—Each grant made pursuant to sub10 section (a) shall set forth the goals to be accomplished 

11 under the grant. The goals shall be specific to each grant 

12 as agreed to between the Secretary and the grantee. 

13 ‘‘(c) ESTABLISHMENT OF CRITERIA.—The Secretary 

14 shall establish criteria for the grants made under sub15 section (a) relating to— 

16 ‘‘(1) the size and location of the Urban Indian 

17 population to be served; 

18 ‘‘(2) the need for prevention of and treatment 

19 of, and control of the complications resulting from, 

20 diabetes among the Urban Indian population to be 

21 served; 

22 ‘‘(3) performance standards for the organiza23 tion in meeting the goals set forth in such grant 

24 that are negotiated and agreed to by the Secretary 

25 and the grantee; 


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1 ‘‘(4) the capability of the organization to ade2 quately perform the activities required under the 

3 grant; and 

4 ‘‘(5) the willingness of the organization to col5 laborate with the registry, if any, established by the 

6 Secretary under section 204(e) in the Area Office of 

7 the Service in which the organization is located. 

8 ‘‘(d) FUNDS SUBJECT TO CRITERIA.—Any funds re9 ceived by an Urban Indian Organization under this Act 

10 for the prevention, treatment, and control of diabetes 

11 among Urban Indians shall be subject to the criteria devel12 oped by the Secretary under subsection (c). 

13 ‘‘SEC. 518. COMMUNITY HEALTH REPRESENTATIVES. 

14 ‘‘The Secretary, acting through the Service, may 

15 enter into contracts with, and make grants to, Urban In16 dian Organizations for the employment of Indians trained 

17 as health service providers through the Community Health 

18 Representatives Program under section 109 in the provi19 sion of health care, health promotion, and disease preven20 tion services to Urban Indians. 

21 ‘‘SEC. 519. EFFECTIVE DATE. 

22 ‘‘The amendments made by the Indian Health Care 

23 Improvement Act Amendments of 2006 to this title shall 

24 take effect beginning on the date of enactment of that Act, 


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1 regardless of whether the Secretary has promulgated regu2 lations implementing such amendments. 

3 ‘‘SEC. 520. ELIGIBILITY FOR SERVICES. 

4 ‘‘Urban Indians shall be eligible and the ultimate 

5 beneficiaries for health care or referral services provided 

6 pursuant to this title. 

7 ‘‘SEC. 521. AUTHORIZATION OF APPROPRIATIONS. 

8 ‘‘There are authorized to be appropriated such sums 

9 as may be necessary for each fiscal year through fiscal 

10 year 2015 to carry out this title. 

11 ‘‘TITLE VI—ORGANIZATIONAL 

12 IMPROVEMENTS 

13 ‘‘SEC. 601. ESTABLISHMENT OF THE INDIAN HEALTH SERV14 ICE AS AN AGENCY OF THE PUBLIC HEALTH 

15 SERVICE. 

16 ‘‘(a) ESTABLISHMENT.— 

17 ‘‘(1) IN GENERAL.—In order to more effectively 

18 and efficiently carry out the responsibilities, authori19 ties, and functions of the United States to provide 

20 health care services to Indians and Indian Tribes, as 

21 are or may be hereafter provided by Federal statute 

22 or treaties, there is established within the Public 

23 Health Service of the Department the Indian Health 

24 Service. 


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1 ‘‘(2) ASSISTANT SECRETARY OF INDIAN

2 HEALTH.—The Service shall be administered by an 

3 Assistant Secretary of Indian Health, who shall be 

4 appointed by the President, by and with the advice 

5 and consent of the Senate. The Assistant Secretary 

6 shall report to the Secretary. Effective with respect 

7 to an individual appointed by the President, by and 

8 with the advice and consent of the Senate, after 

9 January 1, 2005, the term of service of the Assist10 ant Secretary shall be 4 years. An Assistant Sec11 retary may serve more than 1 term. 

12 ‘‘(3) INCUMBENT.—The individual serving in 

13 the position of Director of the Indian Health Service 

14 on the day before the date of enactment of the In15 dian Health Care Improvement Act Amendments of 

16 2006 shall serve as Assistant Secretary. 

17 ‘‘(4) ADVOCACY AND CONSULTATION.—The po18 sition of Assistant Secretary is established to, in a 

19 manner consistent with the government-to-govern20 ment relationship between the United States and In21 dian Tribes— 

22 ‘‘(A) facilitate advocacy for the develop23 ment of appropriate Indian health policy; and 

24 ‘‘(B) promote consultation on matters re25 lating to Indian health. 


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1 ‘‘(b) AGENCY.—The Service shall be an agency within 

2 the Public Health Service of the Department, and shall 

3 not be an office, component, or unit of any other agency 

4 of the Department. 

5 ‘‘(c) DUTIES.—The Assistant Secretary of Indian 

6 Health shall— 

7 ‘‘(1) perform all functions that were, on the day 

8 before the date of enactment of the Indian Health 

9 Care Improvement Act Amendments of 2006, car10 ried out by or under the direction of the individual 

11 serving as Director of the Service on that day; 

12 ‘‘(2) perform all functions of the Secretary re13 lating to the maintenance and operation of hospital 

14 and health facilities for Indians and the planning 

15 for, and provision and utilization of, health services 

16 for Indians; 

17 ‘‘(3) administer all health programs under 

18 which health care is provided to Indians based upon 

19 their status as Indians which are administered by 

20 the Secretary, including programs under— 

21 ‘‘(A) this Act; 

22 ‘‘(B) the Act of November 2, 1921 (25 

23 U.S.C. 13); 

24 ‘‘(C) the Act of August 5, 1954 (42 U.S.C. 

25 2001 et seq.); 


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1 ‘‘(D) the Act of August 16, 1957 (42 

2 U.S.C. 2005 et seq.); and 

3 ‘‘(E) the Indian Self-Determination and 

4 Education Assistance Act (25 U.S.C. 450 et 

5 seq.); 

6 ‘‘(4) administer all scholarship and loan func7 tions carried out under title I; 

8 ‘‘(5) report directly to the Secretary concerning 

9 all policy- and budget-related matters affecting In10 dian health; 

11 ‘‘(6) collaborate with the Assistant Secretary 

12 for Health concerning appropriate matters of Indian 

13 health that affect the agencies of the Public Health 

14 Service; 

15 ‘‘(7) advise each Assistant Secretary of the De16 partment concerning matters of Indian health with 

17 respect to which that Assistant Secretary has au18 thority and responsibility; 

19 ‘‘(8) advise the heads of other agencies and pro20 grams of the Department concerning matters of In21 dian health with respect to which those heads have 

22 authority and responsibility; 

23 ‘‘(9) coordinate the activities of the Department 

24 concerning matters of Indian health; and 


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1 ‘‘(10) perform such other functions as the Sec2 retary may designate. 

3 ‘‘(d) AUTHORITY.— 

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

5 through the Assistant Secretary, shall have the au6 thority— 

7 ‘‘(A) except to the extent provided for in 

8 paragraph (2), to appoint and compensate em9 ployees for the Service in accordance with title 

10 5, United States Code; 

11 ‘‘(B) to enter into contracts for the pro12 curement of goods and services to carry out the 

13 functions of the Service; and 

14 ‘‘(C) to manage, expend, and obligate all 

15 funds appropriated for the Service. 

16 ‘‘(2) PERSONNEL ACTIONS.—Notwithstanding 

17 any other provision of law, the provisions of section 

18 12 of the Act of June 18, 1934 (48 Stat. 986; 25 

19 U.S.C. 472), shall apply to all personnel actions 

20 taken with respect to new positions created within 

21 the Service as a result of its establishment under 

22 subsection (a). 

23 ‘‘(e) REFERENCES.—Any reference to the Director of 

24 the Indian Health Service in any other Federal law, Exec25 utive order, rule, regulation, or delegation of authority, or 


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1 in any document of or relating to the Director of the In2 dian Health Service, shall be deemed to refer to the Assist3 ant Secretary. 

4 ‘‘SEC. 602. AUTOMATED MANAGEMENT INFORMATION SYS5 TEM. 

6 ‘‘(a) ESTABLISHMENT.— 

7 ‘‘(1) IN GENERAL.—The Secretary shall estab8 lish an automated management information system 

9 for the Service. 

10 ‘‘(2) REQUIREMENTS OF SYSTEM.—The infor11 mation system established under paragraph (1) shall 

12 include— 

13 ‘‘(A) a financial management system; 

14 ‘‘(B) a patient care information system for 

15 each area served by the Service; 

16 ‘‘(C) a privacy component that protects the 

17 privacy of patient information held by, or on be18 half of, the Service; 

19 ‘‘(D) a services-based cost accounting com20 ponent that provides estimates of the costs as21 sociated with the provision of specific medical 

22 treatments or services in each Area office of the 

23 Service; 

24 ‘‘(E) an interface mechanism for patient 

25 billing and accounts receivable system; and 


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1 ‘‘(F) a training component. 

2 ‘‘(b) PROVISION OF SYSTEMS TO TRIBES AND ORGA3 NIZATIONS.—The Secretary shall provide each Tribal 

4 Health Program automated management information sys5 tems which— 

6 ‘‘(1) meet the management information needs 

7 of such Tribal Health Program with respect to the 

8 treatment by the Tribal Health Program of patients 

9 of the Service; and 

10 ‘‘(2) meet the management information needs 

11 of the Service. 

12 ‘‘(c) ACCESS TO RECORDS.—Notwithstanding any 

13 other provision of law, each patient shall have reasonable 

14 access to the medical or health records of such patient 

15 which are held by, or on behalf of, the Service. 

16 ‘‘(d) AUTHORITY TO ENHANCE INFORMATION TECH17 NOLOGY.—The Secretary, acting through the Assistant 

18 Secretary, shall have the authority to enter into contracts, 

19 agreements, or joint ventures with other Federal agencies, 

20 States, private and nonprofit organizations, for the pur21 pose of enhancing information technology in Indian health 

22 programs and facilities. 


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1 ‘‘SEC. 603. AUTHORIZATION OF APPROPRIATIONS. 

2 ‘‘There is authorized to be appropriated such sums 

3 as may be necessary for each fiscal year through fiscal 

4 year 2015 to carry out this title. 

5 ‘‘TITLE VII—BEHAVIORAL 

6 HEALTH PROGRAMS 

7 ‘‘SEC. 701. BEHAVIORAL HEALTH PREVENTION AND TREAT8 MENT SERVICES. 

9 ‘‘(a) PURPOSES.—The purposes of this section are as 

10 follows: 

11 ‘‘(1) To authorize and direct the Secretary, act12 ing through the Service, Indian Tribes, Tribal Orga13 nizations, and Urban Indian Organizations, to de14 velop a comprehensive behavioral health prevention 

15 and treatment program which emphasizes collabora16 tion among alcohol and substance abuse, social serv17 ices, and mental health programs. 

18 ‘‘(2) To provide information, direction, and 

19 guidance relating to mental illness and dysfunction 

20 and self-destructive behavior, including child abuse 

21 and family violence, to those Federal, tribal, State, 

22 and local agencies responsible for programs in In23 dian communities in areas of health care, education, 

24 social services, child and family welfare, alcohol and 

25 substance abuse, law enforcement, and judicial serv26 ices. 


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1 ‘‘(3) To assist Indian Tribes to identify services 

2 and resources available to address mental illness and 

3 dysfunctional and self-destructive behavior. 

4 ‘‘(4) To provide authority and opportunities for 

5 Indian Tribes and Tribal Organizations to develop, 

6 implement, and coordinate with community-based 

7 programs which include identification, prevention, 

8 education, referral, and treatment services, including 

9 through multidisciplinary resource teams. 

10 ‘‘(5) To ensure that Indians, as citizens of the 

11 United States and of the States in which they re12 side, have the same access to behavioral health serv13 ices to which all citizens have access. 

14 ‘‘(6) To modify or supplement existing pro15 grams and authorities in the areas identified in 

16 paragraph (2). 

17 ‘‘(b) PLANS.— 

18 ‘‘(1) DEVELOPMENT.—The Secretary, acting 

19 through the Service, Indian Tribes, Tribal Organiza20 tions, and Urban Indian Organizations, shall encour21 age Indian Tribes and Tribal Organizations to de22 velop tribal plans, and Urban Indian Organizations 

23 to develop local plans, and for all such groups to 

24 participate in developing areawide plans for Indian 


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1 Behavioral Health Services. The plans shall include, 

2 to the extent feasible, the following components: 

3 ‘‘(A) An assessment of the scope of alcohol 

4 or other substance abuse, mental illness, and 

5 dysfunctional and self-destructive behavior, in6 cluding suicide, child abuse, and family vio7 lence, among Indians, including— 

8 ‘‘(i) the number of Indians served who 

9 are directly or indirectly affected by such 

10 illness or behavior; or 

11 ‘‘(ii) an estimate of the financial and 

12 human cost attributable to such illness or 

13 behavior. 

14 ‘‘(B) An assessment of the existing and 

15 additional resources necessary for the preven16 tion and treatment of such illness and behavior, 

17 including an assessment of the progress toward 

18 achieving the availability of the full continuum 

19 of care described in subsection (c). 

20 ‘‘(C) An estimate of the additional funding 

21 needed by the Service, Indian Tribes, Tribal 

22 Organizations, and Urban Indian Organizations 

23 to meet their responsibilities under the plans. 

24 ‘‘(2) NATIONAL CLEARINGHOUSE.—The Sec25 retary, acting through the Service, shall establish a 


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1 national clearinghouse of plans and reports on the 

2 outcomes of such plans developed by Indian Tribes, 

3 Tribal Organizations, Urban Indian Organizations, 

4 and Service Areas relating to behavioral health. The 

5 Secretary shall ensure access to these plans and out6 comes by any Indian Tribe, Tribal Organization, 

7 Urban Indian Organization, or the Service. 

8 ‘‘(3) TECHNICAL ASSISTANCE.—The Secretary 

9 shall provide technical assistance to Indian Tribes, 

10 Tribal Organizations, and Urban Indian Organiza11 tions in preparation of plans under this section and 

12 in developing standards of care that may be used 

13 and adopted locally. 

14 ‘‘(c) PROGRAMS.—The Secretary, acting through the 

15 Service, Indian Tribes, and Tribal Organizations, shall 

16 provide, to the extent feasible and if funding is available, 

17 programs including the following: 

18 ‘‘(1) COMPREHENSIVE CARE.—A comprehensive 

19 continuum of behavioral health care which pro20 vides— 

21 ‘‘(A) community-based prevention, inter22 vention, outpatient, and behavioral health 

23 aftercare; 

24 ‘‘(B) detoxification (social and medical); 

25 ‘‘(C) acute hospitalization; 


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1 ‘‘(D) intensive outpatient/day treatment; 

2 ‘‘(E) residential treatment; 

3 ‘‘(F) transitional living for those needing a 

4 temporary, stable living environment that is 

5 supportive of treatment and recovery goals; 

6 ‘‘(G) emergency shelter; 

7 ‘‘(H) intensive case management; and 

8 ‘‘(I) diagnostic services. 

9 ‘‘(2) CHILD CARE.—Behavioral health services 

10 for Indians from birth through age 17, including— 

11 ‘‘(A) preschool and school age fetal alcohol 

12 disorder services, including assessment and be13 havioral intervention; 

14 ‘‘(B) mental health and substance abuse 

15 services (emotional, organic, alcohol, drug, in16 halant, and tobacco); 

17 ‘‘(C) identification and treatment of co-oc18 curring disorders and comorbidity; 

19 ‘‘(D) prevention of alcohol, drug, inhalant, 

20 and tobacco use; 

21 ‘‘(E) early intervention, treatment, and 

22 aftercare; 

23 ‘‘(F) promotion of healthy approaches to 

24 risk and safety issues; and 


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1 ‘‘(G) identification and treatment of ne2 glect and physical, mental, and sexual abuse. 

3 ‘‘(3) ADULT CARE.—Behavioral health services 

4 for Indians from age 18 through 55, including— 

5 ‘‘(A) early intervention, treatment, and 

6 aftercare; 

7 ‘‘(B) mental health and substance abuse 

8 services (emotional, alcohol, drug, inhalant, and 

9 tobacco), including sex specific services; 

10 ‘‘(C) identification and treatment of co-oc11 curring disorders (dual diagnosis) and comor12 bidity; 

13 ‘‘(D) promotion of healthy approaches for 

14 risk-related behavior; 

15 ‘‘(E) treatment services for women at risk 

16 of giving birth to a child with a fetal alcohol 

17 disorder; and 

18 ‘‘(F) sex specific treatment for sexual as19 sault and domestic violence. 

20 ‘‘(4) FAMILY CARE.—Behavioral health services 

21 for families, including— 

22 ‘‘(A) early intervention, treatment, and 

23 aftercare for affected families; 

24 ‘‘(B) treatment for sexual assault and do25 mestic violence; and 


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1 ‘‘(C) promotion of healthy approaches re2 lating to parenting, domestic violence, and other 

3 abuse issues. 

4 ‘‘(5) ELDER CARE.—Behavioral health services 

5 for Indians 56 years of age and older, including— 

6 ‘‘(A) early intervention, treatment, and 

7 aftercare; 

8 ‘‘(B) mental health and substance abuse 

9 services (emotional, alcohol, drug, inhalant, and 

10 tobacco), including sex specific services; 

11 ‘‘(C) identification and treatment of co-oc12 curring disorders (dual diagnosis) and comor13 bidity; 

14 ‘‘(D) promotion of healthy approaches to 

15 managing conditions related to aging; 

16 ‘‘(E) sex specific treatment for sexual as17 sault, domestic violence, neglect, physical and 

18 mental abuse and exploitation; and 

19 ‘‘(F) identification and treatment of de20 mentias regardless of cause. 

21 ‘‘(d) COMMUNITY BEHAVIORAL HEALTH PLAN.— 

22 ‘‘(1) ESTABLISHMENT.—The governing body of 

23 any Indian Tribe, Tribal Organization, or Urban In24 dian Organization may adopt a resolution for the es25 tablishment of a community behavioral health plan 


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1 providing for the identification and coordination of 

2 available resources and programs to identify, pre3 vent, or treat substance abuse, mental illness, or 

4 dysfunctional and self-destructive behavior, including 

5 child abuse and family violence, among its members 

6 or its service population. This plan should include 

7 behavioral health services, social services, intensive 

8 outpatient services, and continuing aftercare. 

9 ‘‘(2) TECHNICAL ASSISTANCE.—At the request 

10 of an Indian Tribe, Tribal Organization, or Urban 

11 Indian Organization, the Bureau of Indian Affairs 

12 and the Service shall cooperate with and provide 

13 technical assistance to the Indian Tribe, Tribal Or14 ganization, or Urban Indian Organization in the de15 velopment and implementation of such plan. 

16 ‘‘(3) FUNDING.—The Secretary, acting through 

17 the Service, may make funding available to Indian 

18 Tribes and Tribal Organizations which adopt a reso19 lution pursuant to paragraph (1) to obtain technical 

20 assistance for the development of a community be21 havioral health plan and to provide administrative 

22 support in the implementation of such plan. 

23 ‘‘(e) COORDINATION FOR AVAILABILITY OF SERV24 ICES.—The Secretary, acting through the Service, Indian 

25 Tribes, Tribal Organizations, and Urban Indian OrganizaVerDate Aug 31 2005 03:45 May 16, 2006 Jkt 049200 PO 00000 Frm 00257 Fmt 6652 Sfmt 6201 E:\BILLS\H5312.IH H5312

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1 tions, shall coordinate behavioral health planning, to the 

2 extent feasible, with other Federal agencies and with State 

3 agencies, to encourage comprehensive behavioral health 

4 services for Indians regardless of their place of residence. 

5 ‘‘(f) MENTAL HEALTH CARE NEED ASSESSMENT.— 

6 Not later than 1 year after the date of enactment of the 

7 Indian Health Care Improvement Act Amendments of 

8 2006, the Secretary, acting through the Service, shall 

9 make an assessment of the need for inpatient mental 

10 health care among Indians and the availability and cost 

11 of inpatient mental health facilities which can meet such 

12 need. In making such assessment, the Secretary shall con13 sider the possible conversion of existing, underused Service 

14 hospital beds into psychiatric units to meet such need. 

15 ‘‘SEC. 702. MEMORANDA OF AGREEMENT WITH THE DE16 PARTMENT OF THE INTERIOR. 

17 ‘‘(a) CONTENTS.—Not later than 12 months after the 

18 date of enactment of the Indian Health Care Improvement 

19 Act Amendments of 2006, the Secretary, acting through 

20 the Service, and the Secretary of the Interior shall develop 

21 and enter into a memoranda of agreement, or review and 

22 update any existing memoranda of agreement, as required 

23 by section 4205 of the Indian Alcohol and Substance 

24 Abuse Prevention and Treatment Act of 1986 (25 U.S.C. 

25 2411) under which the Secretaries address the following: 


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1 ‘‘(1) The scope and nature of mental illness and 

2 dysfunctional and self-destructive behavior, including 

3 child abuse and family violence, among Indians. 

4 ‘‘(2) The existing Federal, tribal, State, local, 

5 and private services, resources, and programs avail6 able to provide behavioral health services for Indi7 ans. 

8 ‘‘(3) The unmet need for additional services, re9 sources, and programs necessary to meet the needs 

10 identified pursuant to paragraph (1). 

11 ‘‘(4)(A) The right of Indians, as citizens of the 

12 United States and of the States in which they re13 side, to have access to behavioral health services to 

14 which all citizens have access. 

15 ‘‘(B) The right of Indians to participate in, and 

16 receive the benefit of, such services. 

17 ‘‘(C) The actions necessary to protect the exer18 cise of such right. 

19 ‘‘(5) The responsibilities of the Bureau of In20 dian Affairs and the Service, including mental illness 

21 identification, prevention, education, referral, and 

22 treatment services (including services through multi23 disciplinary resource teams), at the central, area, 

24 and agency and Service Unit, Service Area, and 


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1 headquarters levels to address the problems identi2 fied in paragraph (1). 

3 ‘‘(6) A strategy for the comprehensive coordina4 tion of the behavioral health services provided by the 

5 Bureau of Indian Affairs and the Service to meet 

6 the problems identified pursuant to paragraph (1), 

7 including— 

8 ‘‘(A) the coordination of alcohol and sub9 stance abuse programs of the Service, the Bu10 reau of Indian Affairs, and Indian Tribes and 

11 Tribal Organizations (developed under the In12 dian Alcohol and Substance Abuse Prevention 

13 and Treatment Act of 1986 (25 U.S.C. 2401 et 

14 seq.)) with behavioral health initiatives pursu15 ant to this Act, particularly with respect to the 

16 referral and treatment of dually diagnosed indi17 viduals requiring behavioral health and sub18 stance abuse treatment; and 

19 ‘‘(B) ensuring that the Bureau of Indian 

20 Affairs and Service programs and services (in21 cluding multidisciplinary resource teams) ad22 dressing child abuse and family violence are co23 ordinated with such non-Federal programs and 

24 services. 


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1 ‘‘(7) Directing appropriate officials of the Bu2 reau of Indian Affairs and the Service, particularly 

3 at the agency and Service Unit levels, to cooperate 

4 fully with tribal requests made pursuant to commu5 nity behavioral health plans adopted under section 

6 701(c) and section 4206 of the Indian Alcohol and 

7 Substance Abuse Prevention and Treatment Act of 

8 1986 (25 U.S.C. 2412). 

9 ‘‘(8) Providing for an annual review of such 

10 agreement by the Secretaries which shall be provided 

11 to Congress and Indian Tribes and Tribal Organiza12 tions. 

13 ‘‘(b) SPECIFIC PROVISIONS REQUIRED.—The memo14 randa of agreement updated or entered into pursuant to 

15 subsection (a) shall include specific provisions pursuant to 

16 which the Service shall assume responsibility for— 

17 ‘‘(1) the determination of the scope of the prob18 lem of alcohol and substance abuse among Indians, 

19 including the number of Indians within the jurisdic20 tion of the Service who are directly or indirectly af21 fected by alcohol and substance abuse and the finan22 cial and human cost; 

23 ‘‘(2) an assessment of the existing and needed 

24 resources necessary for the prevention of alcohol and 


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1 substance abuse and the treatment of Indians af2 fected by alcohol and substance abuse; and 

3 ‘‘(3) an estimate of the funding necessary to 

4 adequately support a program of prevention of alco5 hol and substance abuse and treatment of Indians 

6 affected by alcohol and substance abuse. 

7 ‘‘(c) CONSULTATION.—The Secretary, acting through 

8 the Service, and the Secretary of the Interior shall, in de9 veloping the memoranda of agreement under subsection 

10 (a), consult with and solicit the comments from— 

11 ‘‘(1) Indian Tribes and Tribal Organizations; 

12 ‘‘(2) Indians; 

13 ‘‘(3) Urban Indian Organizations and other In14 dian organizations; and 

15 ‘‘(4) behavioral health service providers. 

16 ‘‘(d) PUBLICATION.—Each memorandum of agree17 ment entered into or renewed (and amendments or modi18 fications thereto) under subsection (a) shall be published 

19 in the Federal Register. At the same time as publication 

20 in the Federal Register, the Secretary shall provide a copy 

21 of such memoranda, amendment, or modification to each 

22 Indian Tribe, Tribal Organization, and Urban Indian Or23 ganization. 


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1 ‘‘SEC. 703. COMPREHENSIVE BEHAVIORAL HEALTH PRE2 VENTION AND TREATMENT PROGRAM. 

3 ‘‘(a) ESTABLISHMENT.— 

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

5 through the Service, Indian Tribes, and Tribal Orga6 nizations, shall provide a program of comprehensive 

7 behavioral health prevention, treatment, aftercare, 

8 Systems of Care, which shall include— 

9 ‘‘(A) prevention, through educational inter10 vention, in Indian communities; 

11 ‘‘(B) acute detoxification, psychiatric hos12 pitalization, residential, and intensive outpatient 

13 treatment; 

14 ‘‘(C) community-based rehabilitation and 

15 aftercare; 

16 ‘‘(D) community education and involve17 ment, including extensive training of health 

18 care, educational, and community-based per19 sonnel; 

20 ‘‘(E) specialized residential treatment pro21 grams for high-risk populations, including preg22 nant and postpartum women and their children; 

23 and 

24 ‘‘(F) diagnostic services. 

25 ‘‘(2) TARGET POPULATIONS.—The target popu26 lation of such programs shall be members of Indian 


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1 Tribes. Efforts to train and educate key members of 

2 the Indian community shall also target employees of 

3 health, education, judicial, law enforcement, legal, 

4 and social service programs. 

5 ‘‘(b) CONTRACT HEALTH SERVICES.— 

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

7 through the Service, Indian Tribes, and Tribal Orga8 nizations, may enter into contracts with public or 

9 private providers of behavioral health treatment 

10 services for the purpose of carrying out the program 

11 required under subsection (a). 

12 ‘‘(2) PROVISION OF ASSISTANCE.—In carrying 

13 out this subsection, the Secretary shall provide as14 sistance to Indian Tribes and Tribal Organizations 

15 to develop criteria for the certification of behavioral 

16 health service providers and accreditation of service 

17 facilities which meet minimum standards for such 

18 services and facilities. 

19 ‘‘SEC. 704. MENTAL HEALTH TECHNICIAN PROGRAM. 

20 ‘‘(a) IN GENERAL.—Under the authority of the Act 

21 of November 2, 1921 (25 U.S.C. 13) (commonly known 

22 as the ‘Snyder Act’), the Secretary shall establish and 

23 maintain a mental health technician program within the 

24 Service which— 


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1 ‘‘(1) provides for the training of Indians as 

2 mental health technicians; and 

3 ‘‘(2) employs such technicians in the provision 

4 of community-based mental health care that includes 

5 identification, prevention, education, referral, and 

6 treatment services. 

7 ‘‘(b) PARAPROFESSIONAL TRAINING.—In carrying 

8 out subsection (a), the Secretary, acting through the Serv9 ice, Indian Tribes, and Tribal Organizations, shall provide 

10 high-standard paraprofessional training in mental health 

11 care necessary to provide quality care to the Indian com12 munities to be served. Such training shall be based upon 

13 a curriculum developed or approved by the Secretary 

14 which combines education in the theory of mental health 

15 care with supervised practical experience in the provision 

16 of such care. 

17 ‘‘(c) SUPERVISION AND EVALUATION OF TECHNI18 CIANS.—The Secretary, acting through the Service, Indian 

19 Tribes, and Tribal Organizations, shall supervise and 

20 evaluate the mental health technicians in the training pro21 gram. 

22 ‘‘(d) TRADITIONAL HEALTH CARE PRACTICES.—The 

23 Secretary, acting through the Service, shall ensure that 

24 the program established pursuant to this subsection in25 volves the use and promotion of the traditional Indian 


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1 health care and treatment practices of the Indian Tribes 

2 to be served. 

3 ‘‘SEC. 705. LICENSING REQUIREMENT FOR MENTAL 

4 HEALTH CARE WORKERS. 

5 ‘‘Subject to the provisions of section 221, any person 

6 employed as a psychologist, social worker, or marriage and 

7 family therapist for the purpose of providing mental health 

8 care services to Indians in a clinical setting under this Act 

9 is required to be licensed as a clinical psychologist, social 

10 worker, or marriage and family therapist, respectively, or 

11 working under the direct supervision of a licensed clinical 

12 psychologist, social worker, or marriage and family thera13 pist, respectively. 

14 ‘‘SEC. 706. INDIAN WOMEN TREATMENT PROGRAMS. 

15 ‘‘(a) GRANTS.—The Secretary, consistent with sec16 tion 701, may make grants to Indian Tribes, Tribal Orga17 nizations, and Urban Indian Organizations to develop and 

18 implement a comprehensive behavioral health program of 

19 prevention, intervention, treatment, and relapse preven20 tion services that specifically addresses the spiritual, cul21 tural, historical, social, and child care needs of Indian 

22 women, regardless of age. 

23 ‘‘(b) USE OF GRANT FUNDS.—A grant made pursu24 ant to this section may be used to— 


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1 ‘‘(1) develop and provide community training, 

2 education, and prevention programs for Indian 

3 women relating to behavioral health issues, including 

4 fetal alcohol disorders; 

5 ‘‘(2) identify and provide psychological services, 

6 counseling, advocacy, support, and relapse preven7 tion to Indian women and their families; and 

8 ‘‘(3) develop prevention and intervention models 

9 for Indian women which incorporate traditional heal10 ers, cultural values, and community and family in11 volvement. 

12 ‘‘(c) CRITERIA.—The Secretary, in consultation with 

13 Indian Tribes and Tribal Organizations, shall establish 

14 criteria for the review and approval of applications and 

15 proposals for funding under this section. 

16 ‘‘(d) EARMARK OF CERTAIN FUNDS.—Twenty per17 cent of the funds appropriated pursuant to this section 

18 shall be used to make grants to Urban Indian Organiza19 tions. 

20 ‘‘SEC. 707. INDIAN YOUTH PROGRAM. 

21 ‘‘(a) DETOXIFICATION AND REHABILITATION.—The 

22 Secretary, acting through the Service, consistent with sec23 tion 701, shall develop and implement a program for acute 

24 detoxification and treatment for Indian youths, including 

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1 gional treatment centers designed to include detoxification 

2 and rehabilitation for both sexes on a referral basis and 

3 programs developed and implemented by Indian Tribes or 

4 Tribal Organizations at the local level under the Indian 

5 Self-Determination and Education Assistance Act (25 

6 U.S.C. 450 et seq.). Regional centers shall be integrated 

7 with the intake and rehabilitation programs based in the 

8 referring Indian community. 

9 ‘‘(b) ALCOHOL AND SUBSTANCE ABUSE TREATMENT

10 CENTERS OR FACILITIES.— 

11 ‘‘(1) ESTABLISHMENT.— 

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

13 through the Service, Indian Tribes, and Tribal 

14 Organizations, shall construct, renovate, or, as 

15 necessary, purchase, and appropriately staff 

16 and operate, at least 1 youth regional treatment 

17 center or treatment network in each area under 

18 the jurisdiction of an Area Office. 

19 ‘‘(B) AREAOFFICE IN CALIFORNIA.—For 

20 the purposes of this subsection, the Area Office 

21 in California shall be considered to be 2 Area 

22 Offices, 1 office whose jurisdiction shall be con23 sidered to encompass the northern area of the 

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1 mainder of the State of California for the pur2 pose of implementing California treatment net3 works. 

4 ‘‘(2) FUNDING.—For the purpose of staffing 

5 and operating such centers or facilities, funding 

6 shall be pursuant to the Act of November 2, 1921 

7 (25 U.S.C. 13). 

8 ‘‘(3) LOCATION.—A youth treatment center 

9 constructed or purchased under this subsection shall 

10 be constructed or purchased at a location within the 

11 area described in paragraph (1) agreed upon (by ap12 propriate tribal resolution) by a majority of the In13 dian Tribes to be served by such center. 

14 ‘‘(4) SPECIFIC PROVISION OF FUNDS.— 

15 ‘‘(A) IN GENERAL.—Notwithstanding any 

16 other provision of this title, the Secretary may, 

17 from amounts authorized to be appropriated for 

18 the purposes of carrying out this section, make 

19 funds available to— 

20 ‘‘(i) the Tanana Chiefs Conference, 

21 Incorporated, for the purpose of leasing, 

22 constructing, renovating, operating, and 

23 maintaining a residential youth treatment 

24 facility in Fairbanks, Alaska; and 


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1 ‘‘(ii) the Southeast Alaska Regional 

2 Health Corporation to staff and operate a 

3 residential youth treatment facility without 

4 regard to the proviso set forth in section 

5 4(l) of the Indian Self-Determination and 

6 Education Assistance Act (25 U.S.C. 

7 450b(l)). 

8 ‘‘(B) PROVISION OF SERVICES TO ELIGI9 BLE YOUTHS.—Until additional residential 

10 youth treatment facilities are established in 

11 Alaska pursuant to this section, the facilities 

12 specified in subparagraph (A) shall make every 

13 effort to provide services to all eligible Indian 

14 youths residing in Alaska. 

15 ‘‘(c) INTERMEDIATE ADOLESCENT BEHAVIORAL

16 HEALTH SERVICES.— 

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

18 through the Service, Indian Tribes, and Tribal Orga19 nizations, may provide intermediate behavioral 

20 health services to Indian children and adolescents, 

21 including— 

22 ‘‘(A) pretreatment assistance; 

23 ‘‘(B) inpatient, outpatient, and aftercare 

24 services; 

25 ‘‘(C) emergency care; 


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1 ‘‘(D) suicide prevention and crisis interven2 tion; and 

3 ‘‘(E) prevention and treatment of mental 

4 illness and dysfunctional and self-destructive 

5 behavior, including child abuse and family vio6 lence. 

7 ‘‘(2) USE OF FUNDS.—Funds provided under 

8 this subsection may be used— 

9 ‘‘(A) to construct or renovate an existing 

10 health facility to provide intermediate behav11 ioral health services; 

12 ‘‘(B) to hire behavioral health profes13 sionals; 

14 ‘‘(C) to staff, operate, and maintain an in15 termediate mental health facility, group home, 

16 sober housing, transitional housing or similar 

17 facilities, or youth shelter where intermediate 

18 behavioral health services are being provided; 

19 ‘‘(D) to make renovations and hire appro20 priate staff to convert existing hospital beds 

21 into adolescent psychiatric units; and 

22 ‘‘(E) for intensive home- and community23 based services, including collaborative Systems 

24 of Care. 


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1 ‘‘(3) CRITERIA.—The Secretary, acting through 

2 the Service, shall, in consultation with Indian Tribes 

3 and Tribal Organizations, establish criteria for the 

4 review and approval of applications or proposals for 

5 funding made available pursuant to this subsection. 

6 ‘‘(d) FEDERALLY OWNED STRUCTURES.— 

7 ‘‘(1) IN GENERAL.—The Secretary, in consulta8 tion with Indian Tribes and Tribal Organizations, 

9 shall— 

10 ‘‘(A) identify and use, where appropriate, 

11 federally owned structures suitable for local res12 idential or regional behavioral health treatment 

13 for Indian youths; and 

14 ‘‘(B) establish guidelines, in consultation 

15 with Indian Tribes and Tribal Organizations, 

16 for determining the suitability of any such fed17 erally owned structure to be used for local resi18 dential or regional behavioral health treatment 

19 for Indian youths. 

20 ‘‘(2) TERMS AND CONDITIONS FOR USE OF

21 STRUCTURE.—Any structure described in paragraph 

22 (1) may be used under such terms and conditions as 

23 may be agreed upon by the Secretary and the agency 

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1 dian Tribe or Tribal Organization operating the pro2 gram. 

3 ‘‘(e) REHABILITATION AND AFTERCARE SERVICES.— 

4 ‘‘(1) IN GENERAL.—The Secretary, Indian 

5 Tribes, or Tribal Organizations, in cooperation with 

6 the Secretary of the Interior, shall develop and im7 plement within each Service Unit, community-based 

8 rehabilitation and follow-up services for Indian 

9 youths who are having significant behavioral health 

10 problems, and require long-term treatment, commu11 nity reintegration, and monitoring to support the In12 dian youths after their return to their home commu13 nity. 

14 ‘‘(2) ADMINISTRATION.—Services under para15 graph (1) shall be provided by trained staff within 

16 the community who can assist the Indian youths in 

17 their continuing development of self-image, positive 

18 problem-solving skills, and nonalcohol or substance 

19 abusing behaviors. Such staff may include alcohol 

20 and substance abuse counselors, mental health pro21 fessionals, and other health professionals and para22 professionals, including community health represent23 atives. 

24 ‘‘(f) INCLUSION OF FAMILY IN YOUTH TREATMENT

25 PROGRAM.—In providing the treatment and other services 


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1 to Indian youths authorized by this section, the Secretary, 

2 acting through the Service, Indian Tribes, and Tribal Or3 ganizations, shall provide for the inclusion of family mem4 bers of such youths in the treatment programs or other 

5 services as may be appropriate. Not less than 10 percent 

6 of the funds appropriated for the purposes of carrying out 

7 subsection (e) shall be used for outpatient care of adult 

8 family members related to the treatment of an Indian 

9 youth under that subsection. 

10 ‘‘(g) MULTIDRUG ABUSE PROGRAM.—The Secretary, 

11 acting through the Service, Indian Tribes, Tribal Organi12 zations, and Urban Indian Organizations, shall provide, 

13 consistent with section 701, programs and services to pre14 vent and treat the abuse of multiple forms of substances, 

15 including alcohol, drugs, inhalants, and tobacco, among 

16 Indian youths residing in Indian communities, on or near 

17 reservations, and in urban areas and provide appropriate 

18 mental health services to address the incidence of mental 

19 illness among such youths. 

20 ‘‘(h) SYSTEMS OF CARE.— 

21 ‘‘(1) PURPOSE AND AUTHORIZATION.—The pur22 pose of this section is to authorize the Secretary to 

23 carry out a grant program to expand the oppor24 tunity for Tribes, Tribal Organizations, and Urban 

25 Indian Organizations to plan and implement SysVerDate Aug 31 2005 03:45 May 16, 2006 Jkt 049200 PO 00000 Frm 00274 Fmt 6652 Sfmt 6201 E:\BILLS\H5312.IH H5312

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1 tems of Care programs that make Indian families 

2 and communities partners in the development of be3 havioral health services that address suicide preven4 tion and other behavioral health needs of Indian 

5 children, youth, and families. 

6 ‘‘(2) ELIGIBILITY FOR GRANTS.—Tribes, Tribal 

7 Organizations, and Urban Indian Organizations that 

8 provide behavioral health services are eligible to re9 ceive a grant under this section. 

10 ‘‘(3) GRANT PERIOD.—Grants awarded under 

11 this section shall each be for a period of three years. 

12 ‘‘(4) TECHNICAL ASSISTANCE.—The Secretary 

13 may use up to 10 percent of the funds available for 

14 grants to provide technical assistance to grantees, 

15 directly or through contracts 

16 ‘‘(5) AUTHORIZATION OF APPROPRIATIONS.— 

17 There is authorized to be appropriated to carry out 

18 this section $2,500,000 for each of fiscal years 2007 

19 through 2010. 

20 ‘‘(i) INDIAN YOUTH MENTAL HEALTH.—The Sec21 retary, acting through the Service, shall collect data for 

22 the report under section 801 with respect to— 

23 ‘‘(1) the number of Indian youth who are being 

24 provided mental health services through the Service 

25 and Tribal Health Programs; 


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1 ‘‘(2) a description of, and costs associated with, 

2 the mental health services provided for Indian youth 

3 through the Service and Tribal Health Programs; 

4 ‘‘(3) the number of youth referred to the Serv5 ice or Tribal Health Programs for mental health 

6 services; 

7 ‘‘(4) the number of Indian youth provided resi8 dential treatment for mental health and other behav9 ioral problems through the Service and Tribal 

10 Health Programs, reported separately for on- and 

11 off-reservation facilities; and 

12 ‘‘(5) the costs of the services described in para13 graph (4). 

14 ‘‘(6) For the purposes of this subsection, 

15 ‘‘youth’’ shall include individuals under 21 years of 

16 age. 

17 ‘‘SEC. 708. INDIAN YOUTH TELEMENTAL HEALTH DEM18 ONSTRATION PROJECT. 

19 ‘‘(a) PURPOSE.—The purpose of this section is to au20 thorize the Secretary to carry out a demonstration project 

21 to test the use of telemental health services in suicide pre22 vention, intervention and treatment of Indian youth, in23 cluding through— 

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1 tal health conditions predisposing to suicide, and al2 cohol and substance abuse treatment; 

3 ‘‘(2) the provision of clinical expertise to, con4 sultation services with, and medical advice and train5 ing for frontline health care providers working with 

6 Indian youth; 

7 ‘‘(3) training and related support for commu8 nity leaders, family members and health and edu9 cation workers who work with Indian youth; 

10 ‘‘(4) the development of culturally-relevant edu11 cational materials on suicide; and 

12 ‘‘(5) data collection and reporting. 

13 ‘‘(b) DEFINITIONS.—For the purpose of this section, 

14 the following definitions shall apply: 

15 ‘‘(1) DEMONSTRATION PROJECT.—The term 

16 ‘demonstration project’ means the Indian youth tele17 mental health demonstration project authorized 

18 under subsection (c). 

19 ‘‘(2) TELEMENTAL HEALTH.—The term ‘tele20 mental health’ means the use of electronic informa21 tion and telecommunications technologies to support 

22 long distance mental health care, patient and profes23 sional-related education, public health, and health 

24 administration. 

25 ‘‘(c) AUTHORIZATION.— 


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1 ‘‘(1) IN GENERAL.—The Secretary is authorized 

2 to award grants under the demonstration project for 

3 the provision of telemental health services to Indian 

4 youth who— 

5 ‘‘(A) have expressed suicidal ideas; 

6 ‘‘(B) have attempted suicide; or 

7 ‘‘(C) have mental health conditions that in8 crease or could increase the risk of suicide. 

9 ‘‘(2) ELIGIBILITY FOR GRANTS.—Such grants 

10 shall be awarded to Indian Tribes, Tribal Organiza11 tions, and Urban Indian Organizations that operate 

12 1 or more facilities— 

13 ‘‘(A) located in Alaska and part of the 

14 Alaska Federal Health Care Access Network; 

15 ‘‘(B) reporting active clinical telehealth ca16 pabilities; or 

17 ‘‘(C) offering school-based telemental 

18 health services relating to psychiatry to Indian 

19 youth. 

20 ‘‘(3) GRANT PERIOD.—The Secretary shall 

21 award grants under this section for a period of up 

22 to 4 years. 

23 ‘‘(4) AWARDING OF GRANTS.—Not more than 5 

24 grants shall be provided under paragraph (1), with 

25 priority consideration given to Indian Tribes, Tribal 


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1 Organizations, and Urban Indian Organizations 

2 that— 

3 ‘‘(A) serve a particular community or geo4 graphic area where there is a demonstrated 

5 need to address Indian youth suicide; 

6 ‘‘(B) enter in to collaborative partnerships 

7 with Indian Health Service or other Tribal 

8 Health Programs or facilities to provide services 

9 under this demonstration project; 

10 ‘‘(C) serve an isolated community or geo11 graphic area which has limited or no access to 

12 behavioral health services; or 

13 ‘‘(D) operate a detention facility at which 

14 youth are detained. 

15 ‘‘(d) USE OF FUNDS.—An Indian Tribe, Tribal Orga16 nization, or Urban Indian Organization shall use a grant 

17 received under subsection (c) for the following purposes: 

18 ‘‘(1) To provide telemental health services to 

19 Indian youth, including the provision of— 

20 ‘‘(A) psychotherapy; 

21 ‘‘(B) psychiatric assessments and diag22 nostic interviews, therapies for mental health 

23 conditions predisposing to suicide, and treat24 ment; and 


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1 ‘‘(C) alcohol and substance abuse treat2 ment. 

3 ‘‘(2) To provide clinician-interactive medical ad4 vice, guidance and training, assistance in diagnosis 

5 and interpretation, crisis counseling and interven6 tion, and related assistance to Service, tribal, or 

7 urban clinicians and health services providers work8 ing with youth being served under this demonstra9 tion project. 

10 ‘‘(3) To assist, educate and train community 

11 leaders, health education professionals and para12 professionals, tribal outreach workers, and family 

13 members who work with the youth receiving tele14 mental health services under this demonstration 

15 project, including with identification of suicidal ten16 dencies, crisis intervention and suicide prevention, 

17 emergency skill development, and building and ex18 panding networks among these individuals and with 

19 State and local health services providers. 

20 ‘‘(4) To develop and distribute culturally appro21 priate community educational materials on— 

22 ‘‘(A) suicide prevention; 

23 ‘‘(B) suicide education; 

24 ‘‘(C) suicide screening; 

25 ‘‘(D) suicide intervention; and 


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1 ‘‘(E) ways to mobilize communities with 

2 respect to the identification of risk factors for 

3 suicide. 

4 ‘‘(5) For data collection and reporting related 

5 to Indian youth suicide prevention efforts. 

6 ‘‘(e) APPLICATIONS.—To be eligible to receive a grant 

7 under subsection (c), an Indian Tribe, Tribal Organiza8 tion, or Urban Indian Organization shall prepare and sub9 mit to the Secretary an application, at such time, in such 

10 manner, and containing such information as the Secretary 

11 may require, including— 

12 ‘‘(1) a description of the project that the Indian 

13 Tribe, Tribal Organization, or Urban Indian Organi14 zation will carry out using the funds provided under 

15 the grant; 

16 ‘‘(2) a description of the manner in which the 

17 project funded under the grant would— 

18 ‘‘(A) meet the telemental health care needs 

19 of the Indian youth population to be served by 

20 the project; or 

21 ‘‘(B) improve the access of the Indian 

22 youth population to be served to suicide preven23 tion and treatment services; 

24 ‘‘(3) evidence of support for the project from 

25 the local community to be served by the project; 


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1 ‘‘(4) a description of how the families and lead2 ership of the communities or populations to be 

3 served by the project would be involved in the devel4 opment and ongoing operations of the project; 

5 ‘‘(5) a plan to involve the tribal community of 

6 the youth who are provided services by the project 

7 in planning and evaluating the mental health care 

8 and suicide prevention efforts provided, in order to 

9 ensure the integration of community, clinical, envi10 ronmental, and cultural components of the treat11 ment; and 

12 ‘‘(6) a plan for sustaining the project after Fed13 eral assistance for the demonstration project has ter14 minated. 

15 ‘‘(f) TRADITIONAL HEALTH CARE PRACTICES.—The 

16 Secretary, acting through the Service, shall ensure that 

17 the demonstration project established pursuant to this sec18 tion involves the use and promotion of the traditional In19 dian health care and treatment practices of the Indian 

20 Tribes of the youth to be served. 

21 ‘‘(g) COLLABORATION; REPORTING TO NATIONAL

22 CLEARINGHOUSE.— 

23 ‘‘(1) COLLABORATION.—The Secretary, acting 

24 through the Service, shall encourage Indian Tribes, 

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1 tions receiving grants under this section to collabo2 rate to enable comparisons about best practices 

3 across projects. 

4 ‘‘(2) REPORTING TO NATIONAL CLEARING5 HOUSE.—The Secretary, acting through the Service, 

6 shall also encourage Indian Tribes, Tribal Organiza7 tions, and Urban Indian Organizations receiving 

8 grants under this section to submit relevant, declas9 sified project information to the national clearing10 house authorized under section 701(b)(2) in order to 

11 better facilitate program performance and improve 

12 suicide prevention, intervention, and treatment serv13 ices. 

14 ‘‘(h) ANNUAL REPORT.—Each grant recipient shall 

15 submit to the Secretary an annual report that— 

16 ‘‘(1) describes the number of telemental health 

17 services provided; and 

18 ‘‘(2) includes any other information that the 

19 Secretary may require. 

20 ‘‘(i) REPORT TO CONGRESS.—Not later than 270 

21 days after the termination of the demonstration project, 

22 the Secretary shall submit to the Committee on Indian Af23 fairs of the Senate and the Committee on Resources and 

24 Committee on Energy and Commerce of the House of 


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1 Representatives a final report, based on the annual reports 

2 provided by grant recipients under subsection (h), that— 

3 ‘‘(1) describes the results of the projects funded 

4 by grants awarded under this section, including any 

5 data available which indicates the number of at6 tempted suicides; and 

7 ‘‘(2) evaluates the impact of the telemental 

8 health services funded by the grants in reducing the 

9 number of completed suicides among Indian youth. 

10 ‘‘(j) AUTHORIZATION OF APPROPRIATIONS.—There 

11 is authorized to be appropriated to carry out this section 

12 $1,500,000 for each of fiscal years 2006 through 2009. 

13 ‘‘SEC. 709. INPATIENT AND COMMUNITY-BASED MENTAL 

14 HEALTH FACILITIES DESIGN, CONSTRUC15 TION, AND STAFFING. 

16 ‘‘Not later than 1 year after the date of enactment 

17 of the Indian Health Care Improvement Act Amendments 

18 of 2006, the Secretary, acting through the Service, Indian 

19 Tribes, and Tribal Organizations, may provide, in each 

20 area of the Service, not less than 1 inpatient mental health 

21 care facility, or the equivalent, for Indians with behavioral 

22 health problems. For the purposes of this subsection, Cali23 fornia shall be considered to be 2 Area Offices, 1 office 

24 whose location shall be considered to encompass the north25 ern area of the State of California and 1 office whose juVerDate Aug 31 2005 03:45 May 16, 2006 Jkt 049200 PO 00000 Frm 00284 Fmt 6652 Sfmt 6201 E:\BILLS\H5312.IH H5312

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1 risdiction shall be considered to encompass the remainder 

2 of the State of California. The Secretary shall consider 

3 the possible conversion of existing, underused Service hos4 pital beds into psychiatric units to meet such need. 

5 ‘‘SEC. 710. TRAINING AND COMMUNITY EDUCATION. 

6 ‘‘(a) PROGRAM.—The Secretary, in cooperation with 

7 the Secretary of the Interior, shall develop and implement 

8 or provide funding for Indian Tribes and Tribal Organiza9 tions to develop and implement, within each Service Unit 

10 or tribal program, a program of community education and 

11 involvement which shall be designed to provide concise and 

12 timely information to the community leadership of each 

13 tribal community. Such program shall include education 

14 about behavioral health issues to political leaders, Tribal 

15 judges, law enforcement personnel, members of tribal 

16 health and education boards, health care providers and 

17 other critical members of each tribal community. Commu18 nity-based training (oriented toward local capacity devel19 opment) shall also include tribal community provider 

20 training (designed for adult learners from the commu21 nities receiving services for prevention, intervention, treat22 ment, and aftercare). 

23 ‘‘(b) INSTRUCTION.—The Secretary, acting through 

24 the Service, shall, either directly or through Indian Tribes 

25 and Tribal Organizations, provide instruction in the area 


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1 of behavioral health issues, including instruction in crisis 

2 intervention and family relations in the context of alcohol 

3 and substance abuse, child sexual abuse, youth alcohol and 

4 substance abuse, and the causes and effects of fetal alco5 hol disorders to appropriate employees of the Bureau of 

6 Indian Affairs and the Service, and to personnel in schools 

7 or programs operated under any contract with the Bureau 

8 of Indian Affairs or the Service, including supervisors of 

9 emergency shelters and halfway houses described in sec10 tion 4213 of the Indian Alcohol and Substance Abuse Pre11 vention and Treatment Act of 1986 (25 U.S.C. 2433). 

12 ‘‘(c) TRAINING MODELS.—In carrying out the edu13 cation and training programs required by this section, the 

14 Secretary, in consultation with Indian Tribes, Tribal Or15 ganizations, Indian behavioral health experts, and Indian 

16 alcohol and substance abuse prevention experts, shall de17 velop and provide community-based training models. Such 

18 models shall address— 

19 ‘‘(1) the elevated risk of alcohol and behavioral 

20 health problems faced by children of alcoholics; 

21 ‘‘(2) the cultural, spiritual, and 

22 multigenerational aspects of behavioral health prob23 lem prevention and recovery; and 


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1 ‘‘(3) community-based and multidisciplinary 

2 strategies for preventing and treating behavioral 

3 health problems. 

4 ‘‘SEC. 711. BEHAVIORAL HEALTH PROGRAM. 

5 ‘‘(a) INNOVATIVE PROGRAMS.—The Secretary, acting 

6 through the Service, Indian Tribes, and Tribal Organiza7 tions, consistent with section 701, may plan, develop, im8 plement, and carry out programs to deliver innovative 

9 community-based behavioral health services to Indians. 

10 ‘‘(b) FUNDING; CRITERIA.—The Secretary may 

11 award such funding for a project under subsection (a) to 

12 an Indian Tribe or Tribal Organization and may consider 

13 the following criteria: 

14 ‘‘(1) The project will address significant unmet 

15 behavioral health needs among Indians. 

16 ‘‘(2) The project will serve a significant number 

17 of Indians. 

18 ‘‘(3) The project has the potential to deliver 

19 services in an efficient and effective manner. 

20 ‘‘(4) The Indian Tribe or Tribal Organization 

21 has the administrative and financial capability to ad22 minister the project. 

23 ‘‘(5) The project may deliver services in a man24 ner consistent with traditional Indian healing and 

25 treatment practices. 


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1 ‘‘(6) The project is coordinated with, and avoids 

2 duplication of, existing services. 

3 ‘‘(c) EQUITABLE TREATMENT.—For purposes of this 

4 subsection, the Secretary shall, in evaluating project appli5 cations or proposals, use the same criteria that the Sec6 retary uses in evaluating any other application or proposal 

7 for such funding. 

8 ‘‘SEC. 712. FETAL ALCOHOL DISORDER PROGRAMS. 

9 ‘‘(a) PROGRAMS.— 

10 ‘‘(1) ESTABLISHMENT.—The Secretary, con11 sistent with section 701, acting through the Service, 

12 Indian Tribes, and Tribal Organizations, is author13 ized to establish and operate fetal alcohol disorder 

14 programs as provided in this section for the pur15 poses of meeting the health status objectives speci16 fied in section 3. 

17 ‘‘(2) USE OF FUNDS.—Funding provided pursu18 ant to this section shall be used for the following: 

19 ‘‘(A) To develop and provide for Indians 

20 community and in school training, education, 

21 and prevention programs relating to fetal alco22 hol disorders. 

23 ‘‘(B) To identify and provide behavioral 

24 health treatment to high-risk Indian women 


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1 and high-risk women pregnant with an Indian’s 

2 child. 

3 ‘‘(C) To identify and provide appropriate 

4 psychological services, educational and voca5 tional support, counseling, advocacy, and infor6 mation to fetal alcohol disorder affected Indians 

7 and their families or caretakers. 

8 ‘‘(D) To develop and implement counseling 

9 and support programs in schools for fetal alco10 hol disorder affected Indian children. 

11 ‘‘(E) To develop prevention and interven12 tion models which incorporate traditional heal13 ers, cultural and spiritual values, and commu14 nity involvement. 

15 ‘‘(F) To develop, print, and disseminate 

16 education and prevention materials on fetal al17 cohol disorder. 

18 ‘‘(G) To develop and implement, in con19 sultation with Indian Tribes, Tribal Organiza20 tions, and Urban Indian Organizations, cul21 turally sensitive assessment and diagnostic tools 

22 including dysmorphology clinics and multidisci23 plinary fetal alcohol disorder clinics for use in 

24 Indian communities and Urban Centers. 


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1 ‘‘(H) To develop early childhood interven2 tion projects from birth on to mitigate the ef3 fects of fetal alcohol disorder among Indians. 

4 ‘‘(I) To develop— 

5 ‘‘(i) community-based support services 

6 for Indians and women pregnant with In7 dian children; and 

8 ‘‘(ii) to the extent funding is available, 

9 community-based housing for adult Indians 

10 with fetal alcohol disorder. 

11 ‘‘(3) CRITERIA FOR APPLICATIONS.—The Sec12 retary shall establish criteria for the review and ap13 proval of applications for funding under this section. 

14 ‘‘(b) SERVICES.—The Secretary, acting through the 

15 Service and Indian Tribes, Tribal Organizations, and 

16 Urban Indian Organizations, shall— 

17 ‘‘(1) develop and provide services for the pre18 vention, intervention, treatment, and aftercare for 

19 those affected by fetal alcohol disorder in Indian 

20 communities; and 

21 ‘‘(2) provide supportive services, including serv22 ices to meet the special educational, vocational, 

23 school-to-work transition, and independent living 

24 needs of adolescent and adult Indians with fetal al25 cohol disorder. 


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1 ‘‘(c) TASK FORCE.—The Secretary shall establish a 

2 task force to be known as the Fetal Alcohol Disorder Task 

3 Force to advise the Secretary in carrying out subsection 

4 (b). Such task force shall be composed of representatives 

5 from the following: 

6 ‘‘(1) The National Institute on Drug Abuse. 

7 ‘‘(2) The National Institute on Alcohol and Al8 coholism. 

9 ‘‘(3) The Office of Substance Abuse Prevention. 

10 ‘‘(4) The National Institute of Mental Health. 

11 ‘‘(5) The Service. 

12 ‘‘(6) The Office of Minority Health of the De13 partment of Health and Human Services. 

14 ‘‘(7) The Administration for Native Americans. 

15 ‘‘(8) The National Institute of Child Health 

16 and Human Development (NICHD). 

17 ‘‘(9) The Centers for Disease Control and Pre18 vention. 

19 ‘‘(10) The Bureau of Indian Affairs. 

20 ‘‘(11) Indian Tribes. 

21 ‘‘(12) Tribal Organizations. 

22 ‘‘(13) Urban Indian Organizations. 

23 ‘‘(14) Indian fetal alcohol disorder experts. 

24 ‘‘(d) APPLIED RESEARCH PROJECTS.—The Sec25 retary, acting through the Substance Abuse and Mental 


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1 Health Services Administration, shall make grants to In2 dian Tribes, Tribal Organizations, and Urban Indian Or3 ganizations for applied research projects which propose to 

4 elevate the understanding of methods to prevent, inter5 vene, treat, or provide rehabilitation and behavioral health 

6 aftercare for Indians and Urban Indians affected by fetal 

7 alcohol disorder. 

8 ‘‘(e) FUNDING FOR URBAN INDIAN ORGANIZA9 TIONS.—Ten percent of the funds appropriated pursuant 

10 to this section shall be used to make grants to Urban In11 dian Organizations funded under title V. 

12 ‘‘SEC. 713. CHILD SEXUAL ABUSE AND PREVENTION TREAT13 MENT PROGRAMS. 

14 ‘‘(a) ESTABLISHMENT.—The Secretary, acting 

15 through the Service, and the Secretary of the Interior, In16 dian Tribes, and Tribal Organizations, shall establish, 

17 consistent with section 701, in every Service Area, pro18 grams involving treatment for— 

19 ‘‘(1) victims of sexual abuse who are Indian 

20 children or children in an Indian household; and 

21 ‘‘(2) perpetrators of child sexual abuse who are 

22 Indian or members of an Indian household. 

23 ‘‘(b) USE OF FUNDS.—Funding provided pursuant to 

24 this section shall be used for the following: 


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1 ‘‘(1) To develop and provide community edu2 cation and prevention programs related to sexual 

3 abuse of Indian children or children in an Indian 

4 household. 

5 ‘‘(2) To identify and provide behavioral health 

6 treatment to victims of sexual abuse who are Indian 

7 children or children in an Indian household, and to 

8 their family members who are affected by sexual 

9 abuse. 

10 ‘‘(3) To develop prevention and intervention 

11 models which incorporate cultural and spiritual val12 ues and community involvement. 

13 ‘‘(4) To develop and implement, in consultation 

14 with Indian Tribes, Tribal Organizations, and Urban 

15 Indian Organizations, culturally sensitive assessment 

16 and diagnostic tools for use in Indian communities 

17 and Urban Centers. 

18 ‘‘(5) To identify and provide behavioral health 

19 treatment to Indian perpetrators and perpetrators 

20 who are members of an Indian household— 

21 ‘‘(A) making efforts to begin offender and 

22 behavioral health treatment while the perpe23 trator is incarcerated or at the earliest possible 

24 date if the perpetrator is not incarcerated; and 


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1 ‘‘(B) providing treatment after the perpe2 trator is released, until it is determined that the 

3 perpetrator is not a threat to children. 

4 ‘‘SEC. 714. BEHAVIORAL HEALTH RESEARCH. 

5 ‘‘The Secretary, in consultation with appropriate 

6 Federal agencies, shall make grants to, or enter into con7 tracts with, Indian Tribes, Tribal Organizations, and 

8 Urban Indian Organizations or enter into contracts with, 

9 or make grants to appropriate institutions for, the conduct 

10 of research on the incidence and prevalence of behavioral 

11 health problems among Indians served by the Service, In12 dian Tribes, or Tribal Organizations and among Indians 

13 in urban areas. Research priorities under this section shall 

14 include— 

15 ‘‘(1) the multifactorial causes of Indian youth 

16 suicide, including— 

17 ‘‘(A) protective and risk factors and sci18 entific data that identifies those factors; and 

19 ‘‘(B) the effects of loss of cultural identity 

20 and the development of scientific data on those 

21 effects; 

22 ‘‘(2) the interrelationship and interdependence 

23 of behavioral health problems with alcoholism and 

24 other substance abuse, suicide, homicides, other in25 juries, and the incidence of family violence; and 


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1 ‘‘(3) the development of models of prevention 

2 techniques. 

3 The effect of the interrelationships and interdependencies 

4 referred to in paragraph (2) on children, and the develop5 ment of prevention techniques under paragraph (3) appli6 cable to children, shall be emphasized. 

7 ‘‘SEC. 715. DEFINITIONS. 

8 ‘‘For the purpose of this title, the following defini9 tions shall apply: 

10 ‘‘(1) 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 ‘‘(2) ALCOHOL-RELATED

15 NEURODEVELOPMENTAL DISORDERS OR ARND.—The 

16 term ‘alcohol-related neurodevelopmental disorders’ 

17 or ‘ARND’ means, with a history of maternal alco18 hol consumption during pregnancy, central nervous 

19 system involvement such as developmental delay, in20 tellectual deficit, or neurologic abnormalities. Behav21 iorally, there can be problems with irritability, and 

22 failure to thrive as infants. As children become older 

23 there will likely be hyperactivity, attention deficit, 

24 language dysfunction, and perceptual and judgment 

25 problems. 


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1 ‘‘(3) BEHAVIORAL HEALTH AFTERCARE.—The 

2 term ‘behavioral health aftercare’ includes those ac3 tivities and resources used to support recovery fol4 lowing inpatient, residential, intensive substance 

5 abuse, or mental health outpatient or outpatient 

6 treatment. The purpose is to help prevent or deal 

7 with relapse by ensuring that by the time a client or 

8 patient is discharged from a level of care, such as 

9 outpatient treatment, an aftercare plan has been de10 veloped with the client. An aftercare plan may use 

11 such resources as a community-based therapeutic 

12 group, transitional living facilities, a 12-step spon13 sor, a local 12-step or other related support group, 

14 and other community-based providers (mental health 

15 professionals, community health aides, community 

16 health representatives, mental health technicians, 

17 ministers, etc.) 

18 ‘‘(4) DUAL DIAGNOSIS.—The term ‘dual diag19 nosis’ means coexisting substance abuse and mental 

20 illness conditions or diagnosis. Such clients are 

21 sometimes referred to as mentally ill chemical abus22 ers (MICAs). 

23 ‘‘(5) FETAL ALCOHOL DISORDERS.—The term 

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1 drome, partial fetal alcohol syndrome and alcohol re2 lated neurodevelopmental disorder (ARND). 

3 ‘‘(6) FETAL ALCOHOL SYNDROME OR FAS.— 

4 The term ‘fetal alcohol syndrome’ or ‘FAS’ means a 

5 syndrome in which, with a history of maternal alco6 hol consumption during pregnancy, the following cri7 teria are met: 

8 ‘‘(A) Central nervous system involvement 

9 such as developmental delay, intellectual deficit, 

10 microencephaly, or neurologic abnormalities. 

11 ‘‘(B) Craniofacial abnormalities with at 

12 least 2 of the following: microophthalmia, short 

13 palpebral fissures, poorly developed philtrum, 

14 thin upper lip, flat nasal bridge, and short 

15 upturned nose. 

16 ‘‘(C) Prenatal or postnatal growth delay. 

17 ‘‘(7) PARTIAL FAS.—The term ‘partial FAS’ 

18 means, with a history of maternal alcohol consump19 tion during pregnancy, having most of the criteria of 

20 FAS, though not meeting a minimum of at least 2 

21 of the following: microophthalmia, short palpebral 

22 fissures, poorly developed philtrum, thin upper lip, 

23 flat nasal bridge, and short upturned nose. 

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1 gage in usual and customary life activities through 

2 education and therapy. 

3 ‘‘(9) SUBSTANCE ABUSE.—The term ‘substance 

4 abuse’ includes inhalant abuse. 

5 ‘‘(10) SYSTEMS OF CARE.—The term ‘Systems 

6 of Care’ means a system for delivering services to 

7 children and their families that is child-centered, 

8 family-focused and family-driven, community-based, 

9 culturally competent, and responsive to the needs of 

10 the children and families being served. The System 

11 of Care values prevention and early identification, 

12 smooth transitions for children and families, child 

13 and family participation and advocacy, comprehen14 sive array of services, individualized service plan15 ning, services in the least restrictive environment, 

16 and integrated services with coordinated planning 

17 across the child-serving systems. 

18 ‘‘SEC. 716. AUTHORIZATION OF APPROPRIATIONS. 

19 ‘‘There is authorized to be appropriated such sums 

20 as may be necessary for each fiscal year through fiscal 

21 year 2015 to carry out the provisions of this title. 

22 ‘‘TITLE VIII—MISCELLANEOUS 

23 ‘‘SEC. 801. REPORTS. 

24 ‘‘For each fiscal year following the date of enactment 

25 of the Indian Health Care Improvement Act Amendments 


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1 of 2006, the Secretary shall transmit to Congress a report 

2 containing the following: 

3 ‘‘(1) A report on the progress made in meeting 

4 the objectives of this Act, including a review of pro5 grams established or assisted pursuant to this Act 

6 and assessments and recommendations of additional 

7 programs or additional assistance necessary to, at a 

8 minimum, provide health services to Indians and en9 sure a health status for Indians, which are at a par10 ity with the health services available to and the 

11 health status of the general population, including 

12 specific comparisons of appropriations provided and 

13 those required for such parity. 

14 ‘‘(2) A report on whether, and to what extent, 

15 new national health care programs, benefits, initia16 tives, or financing systems have had an impact on 

17 the purposes of this Act and any steps that the Sec18 retary may have taken to consult with Indian Tribes, 

19 Tribal Organizations, and Urban Indian Organiza20 tions to address such impact, including a report on 

21 proposed changes in allocation of funding pursuant 

22 to section 808. 

23 ‘‘(3) A report on the use of health services by 

24 Indians— 


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1 ‘‘(A) on a national and area or other rel2 evant geographical basis; 

3 ‘‘(B) by gender and age; 

4 ‘‘(C) by source of payment and type of 

5 service; 

6 ‘‘(D) comparing such rates of use with 

7 rates of use among comparable non-Indian pop8 ulations; and 

9 ‘‘(E) provided under contracts. 

10 ‘‘(4) A report of contractors to the Secretary on 

11 Health Care Educational Loan Repayments every 6 

12 months required by section 110. 

13 ‘‘(5) A general audit report of the Secretary on 

14 the Health Care Educational Loan Repayment Pro15 gram as required by section 110(n). 

16 ‘‘(6) A report of the findings and conclusions of 

17 demonstration programs on development of edu18 cational curricula for substance abuse counseling as 

19 required in section 125(f). 

20 ‘‘(7) A separate statement which specifies the 

21 amount of funds requested to carry out the provi22 sions of section 201. 

23 ‘‘(8) A report of the evaluations of health pro24 motion and disease prevention as required in section 

25 203(c). 


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1 ‘‘(9) A biennial report to Congress on infectious 

2 diseases as required by section 212. 

3 ‘‘(10) A report on environmental and nuclear 

4 health hazards as required by section 215. 

5 ‘‘(11) An annual report on the status of all 

6 health care facilities needs as required by section 

7 301(c)(2) and 301(d). 

8 ‘‘(12) Reports on safe water and sanitary waste 

9 disposal facilities as required by section 302(h). 

10 ‘‘(13) An annual report on the expenditure of 

11 nonservice funds for renovation as required by sec12 tions 304(b)(2). 

13 ‘‘(14) A report identifying the backlog of main14 tenance and repair required at Service and tribal fa15 cilities required by section 313(a). 

16 ‘‘(15) A report providing an accounting of reim17 bursement funds made available to the Secretary 

18 under titles XVIII, XIX, and XXI of the Social Se19 curity Act. 

20 ‘‘(16) A report on any arrangements for the 

21 sharing of medical facilities or services, as author22 ized by section 406. 

23 ‘‘(17) A report on evaluation and renewal of 

24 Urban Indian programs under section 505. 


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1 ‘‘(18) A report on the evaluation of programs 

2 as required by section 513(d). 

3 ‘‘(19) A report on alcohol and substance abuse 

4 as required by section 701(f). 

5 ‘‘(20) A report on Indian youth mental health 

6 services as required by section 707(h). 

7 ‘‘SEC. 802. REGULATIONS. 

8 ‘‘(a) DEADLINES.— 

9 ‘‘(1) PROCEDURES.—Not later than 90 days 

10 after the date of enactment of the Indian Health 

11 Care Improvement Act Amendments of 2006, the 

12 Secretary shall initiate procedures under subchapter 

13 III of chapter 5 of title 5, United States Code, to 

14 negotiate and promulgate such regulations or 

15 amendments thereto that are necessary to carry out 

16 titles I (except sections 105, 115, and 117), II, III, 

17 and VII. The Secretary may promulgate regulations 

18 to carry out sections 105, 115, 117, and titles IV 

19 and V, using the procedures required by chapter V 

20 of title 5, United States Code (commonly known as 

21 the ‘Administrative Procedure Act’). The Secretary 

22 shall issue no regulations to carry out titles VI and 

23 VIII. 

24 ‘‘(2) PROPOSED REGULATIONS.—Proposed reg25 ulations to implement this Act shall be published in 


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1 the Federal Register by the Secretary no later than 

2 1 year after the date of enactment of the Indian 

3 Health Care Improvement Act Amendments of 2006 

4 and shall have no less than a 120-day comment pe5 riod. 

6 ‘‘(3) EXPIRATION OF AUTHORITY.—Except as 

7 otherwise provided herein, the authority to promul8 gate regulations under this Act shall expire 24 

9 months from the date of enactment of this Act. 

10 ‘‘(b) COMMITTEE.—A negotiated rulemaking com11 mittee established pursuant to section 565 of title 5, 

12 United States Code, to carry out this section shall have 

13 as its members only representatives of the Federal Gov14 ernment and representatives of Indian Tribes and Tribal 

15 Organizations, a majority of whom shall be nominated by 

16 and be representatives of Indian Tribes, Tribal Organiza17 tions, and Urban Indian Organizations from each Service 

18 Area. The representative of the Urban Indian Organiza19 tion shall be deemed to be an elected officer of a tribal 

20 government for purposes of applying section 204(b) of the 

21 Unfunded Mandates Reform Act of 1995 (2 U.S.C. 

22 1534(b)). 

23 ‘‘(c) ADAPTATION OF PROCEDURES.—The Secretary 

24 shall adapt the negotiated rulemaking procedures to the 

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1 government relationship between the United States and 

2 Indian Tribes. 

3 ‘‘(d) LACK OF REGULATIONS.—The lack of promul4 gated regulations shall not limit the effect of this Act. 

5 ‘‘(e) INCONSISTENT REGULATIONS.—The provisions 

6 of this Act shall supersede any conflicting provisions of 

7 law in effect on the day before the date of enactment of 

8 the Indian Health Care Improvement Act Amendments of 

9 2006, and the Secretary is authorized to repeal any regu10 lation inconsistent with the provisions of this Act. 

11 ‘‘SEC. 803. PLAN OF IMPLEMENTATION. 

12 ‘‘Not later than 9 months after the date of enactment 

13 of the Indian Health Care Improvement Act Amendments 

14 of 2006, the Secretary in consultation with Indian Tribes, 

15 Tribal Organizations, and Urban Indian Organizations, 

16 shall submit to Congress a plan explaining the manner and 

17 schedule (including a schedule of appropriation requests), 

18 by title and section, by which the Secretary will implement 

19 the provisions of this Act. 

20 ‘‘SEC. 804. AVAILABILITY OF FUNDS. 

21 ‘‘The funds appropriated pursuant to this Act shall 

22 remain available until expended. 


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1 ‘‘SEC. 805. LIMITATION ON USE OF FUNDS APPROPRIATED 

2 TO THE INDIAN HEALTH SERVICE. 

3 ‘‘Any limitation on the use of funds contained in an 

4 Act providing appropriations for the Department for a pe5 riod with respect to the performance of abortions shall 

6 apply for that period with respect to the performance of 

7 abortions using funds contained in an Act providing ap8 propriations for the Service. 

9 ‘‘SEC. 806. ELIGIBILITY OF CALIFORNIA INDIANS. 

10 ‘‘(a) IN GENERAL.—The following California Indians 

11 shall be eligible for health services provided by the Service: 

12 ‘‘(1) Any member of a federally recognized In13 dian Tribe. 

14 ‘‘(2) Any descendant of an Indian who was re15 siding in California on June 1, 1852, if such de16 scendant— 

17 ‘‘(A) is a member of the Indian community 

18 served by a local program of the Service; and 

19 ‘‘(B) is regarded as an Indian by the com20 munity in which such descendant lives. 

21 ‘‘(3) Any Indian who holds trust interests in 

22 public domain, national forest, or reservation allot23 ments in California. 

24 ‘‘(4) Any Indian in California who is listed on 

25 the plans for distribution of the assets of rancherias 

26 and reservations located within the State of CaliVerDate Aug 31 2005 03:45 May 16, 2006 Jkt 049200 PO 00000 Frm 00305 Fmt 6652 Sfmt 6201 E:\BILLS\H5312.IH H5312

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1 fornia under the Act of August 18, 1958 (72 Stat. 

2 619), and any descendant of such an Indian. 

3 ‘‘(b) CLARIFICATION.—Nothing in this section may 

4 be construed as expanding the eligibility of California Indi5 ans for health services provided by the Service beyond the 

6 scope of eligibility for such health services that applied on 

7 May 1, 1986. 

8 ‘‘SEC. 807. HEALTH SERVICES FOR INELIGIBLE PERSONS. 

9 ‘‘(a) CHILDREN.—Any individual who— 

10 ‘‘(1) has not attained 19 years of age; 

11 ‘‘(2) is the natural or adopted child, stepchild, 

12 foster child, legal ward, or orphan of an eligible In13 dian; and 

14 ‘‘(3) is not otherwise eligible for health services 

15 provided by the Service, 

16 shall be eligible for all health services provided by the 

17 Service on the same basis and subject to the same rules 

18 that apply to eligible Indians until such individual attains 

19 19 years of age. The existing and potential health needs 

20 of all such individuals shall be taken into consideration 

21 by the Service in determining the need for, or the alloca22 tion of, the health resources of the Service. If such an indi23 vidual has been determined to be legally incompetent prior 

24 to attaining 19 years of age, such individual shall remain 


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1 eligible for such services until 1 year after the date of a 

2 determination of competency. 

3 ‘‘(b) SPOUSES.—Any spouse of an eligible Indian who 

4 is not an Indian, or who is of Indian descent but is not 

5 otherwise eligible for the health services provided by the 

6 Service, shall be eligible for such health services if all such 

7 spouses or spouses who are married to members of each 

8 Indian Tribe being served are made eligible, as a class, 

9 by an appropriate resolution of the governing body of the 

10 Indian Tribe or Tribal Organization providing such serv11 ices. The health needs of persons made eligible under this 

12 paragraph shall not be taken into consideration by the 

13 Service in determining the need for, or allocation of, its 

14 health resources. 

15 ‘‘(c) PROVISION OF SERVICES TO OTHER INDIVID16 UALS.— 

17 ‘‘(1) IN GENERAL.—The Secretary is authorized 

18 to provide health services under this subsection 

19 through health programs operated directly by the 

20 Service to individuals who reside within the Service 

21 Unit and who are not otherwise eligible for such 

22 health services if— 

23 ‘‘(A) the Indian Tribes served by such 

24 Service Unit request such provision of health 

25 services to such individuals; and 


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1 ‘‘(B) the Secretary and the served Indian 

2 Tribes have jointly determined that— 

3 ‘‘(i) the provision of such health serv4 ices will not result in a denial or diminu5 tion of health services to eligible Indians; 

6 and 

7 ‘‘(ii) there is no reasonable alternative 

8 health facilities or services, within or with9 out the Service Unit, available to meet the 

10 health needs of such individuals. 

11 ‘‘(2) ISDEAA PROGRAMS.—In the case of 

12 health programs and facilities operated under a con13 tract or compact entered into under the Indian Self14 Determination and Education Assistance Act (25 

15 U.S.C. 450 et seq.), the governing body of the In16 dian Tribe or Tribal Organization providing health 

17 services under such contract or compact is author18 ized to determine whether health services should be 

19 provided under such contract or compact to individ20 uals who are not otherwise eligible for such services 

21 under any other subsection of this section or under 

22 any other provision of law. In making such deter23 mination, the governing body of the Indian Tribe or 

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1 siderations described in clauses (i) and (ii) of para2 graph (1)(B). 

3 ‘‘(3) PAYMENT FOR SERVICES.— 

4 ‘‘(A) IN GENERAL.—Persons receiving 

5 health services provided by the Service under 

6 this subsection shall be liable for payment of 

7 such health services under a schedule of charges 

8 prescribed by the Secretary which, in the judg9 ment of the Secretary, results in reimbursement 

10 in an amount not less than the actual cost of 

11 providing the health services. Notwithstanding 

12 section 404 of this Act or any other provision 

13 of law, amounts collected under this subsection, 

14 including medicare, medicaid, or SCHIP reim15 bursements under titles XVIII, XIX, and XXI 

16 of the Social Security Act, shall be credited to 

17 the account of the program providing the serv18 ice and shall be used for the purposes listed in 

19 section 401(d)(2) and amounts collected under 

20 this subsection shall be available for expendi21 ture within such program. 

22 ‘‘(B) INDIGENT PEOPLE.—Health services 

23 may be provided by the Secretary through the 

24 Service under this subsection to an indigent in25 dividual who would not be otherwise eligible for 


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1 such health services but for the provisions of 

2 paragraph (1) only if an agreement has been 

3 entered into with a State or local government 

4 under which the State or local government 

5 agrees to reimburse the Service for the expenses 

6 incurred by the Service in providing such health 

7 services to such indigent individual. 

8 ‘‘(4) REVOCATION OF CONSENT FOR SERV9 ICES.— 

10 ‘‘(A) SINGLE TRIBE SERVICE AREA.—In 

11 the case of a Service Area which serves only 1 

12 Indian Tribe, the authority of the Secretary to 

13 provide health services under paragraph (1) 

14 shall terminate at the end of the fiscal year suc15 ceeding the fiscal year in which the governing 

16 body of the Indian Tribe revokes its concur17 rence to the provision of such health services. 

18 ‘‘(B) MULTITRIBAL SERVICE AREA.—In 

19 the case of a multitribal Service Area, the au20 thority of the Secretary to provide health serv21 ices under paragraph (1) shall terminate at the 

22 end of the fiscal year succeeding the fiscal year 

23 in which at least 51 percent of the number of 

24 Indian Tribes in the Service Area revoke their 


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1 concurrence to the provisions of such health 

2 services. 

3 ‘‘(d) OTHER SERVICES.—The Service may provide 

4 health services under this subsection to individuals who 

5 are not eligible for health services provided by the Service 

6 under any other provision of law in order to— 

7 ‘‘(1) achieve stability in a medical emergency; 

8 ‘‘(2) prevent the spread of a communicable dis9 ease or otherwise deal with a public health hazard; 

10 ‘‘(3) provide care to non-Indian women preg11 nant with an eligible Indian’s child for the duration 

12 of the pregnancy through postpartum; or 

13 ‘‘(4) provide care to immediate family members 

14 of an eligible individual if such care is directly re15 lated to the treatment of the eligible individual. 

16 ‘‘(e) HOSPITAL PRIVILEGES FOR PRACTITIONERS.— 

17 Hospital privileges in health facilities operated and main18 tained by the Service or operated under a contract or com19 pact pursuant to the Indian Self-Determination and Edu20 cation Assistance Act (25 U.S.C. 450 et seq.) may be ex21 tended to non-Service health care practitioners who pro22 vide services to individuals described in subsection (a), (b), 

23 (c), or (d). Such non-Service health care practitioners 

24 may, as part of privileging process, be designated as em25 ployees of the Federal Government for purposes of section 


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1 1346(b) and chapter 171 of title 28, United States Code 

2 (relating to Federal tort claims) only with respect to acts 

3 or omissions which occur in the course of providing serv4 ices to eligible individuals as a part of the conditions under 

5 which such hospital privileges are extended. 

6 ‘‘(f) ELIGIBLE INDIAN.—For purposes of this sec7 tion, the term ‘eligible Indian’ means any Indian who is 

8 eligible for health services provided by the Service without 

9 regard to the provisions of this section. 

10 ‘‘SEC. 808. REALLOCATION OF BASE RESOURCES. 

11 ‘‘(a) REPORT REQUIRED.—Notwithstanding any 

12 other provision of law, any allocation of Service funds for 

13 a fiscal year that reduces by 5 percent or more from the 

14 previous fiscal year the funding for any recurring pro15 gram, project, or activity of a Service Unit may be imple16 mented only after the Secretary has submitted to the 

17 President, for inclusion in the report required to be trans18 mitted to Congress under section 801, a report on the pro19 posed change in allocation of funding, including the rea20 sons for the change and its likely effects. 

21 ‘‘(b) EXCEPTION.—Subsection (a) shall not apply if 

22 the total amount appropriated to the Service for a fiscal 

23 year is at least 5 percent less than the amount appro24 priated to the Service for the previous fiscal year. 


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1 ‘‘SEC. 809. RESULTS OF DEMONSTRATION PROJECTS. 

2 ‘‘The Secretary shall provide for the dissemination to 

3 Indian Tribes, Tribal Organizations, and Urban Indian 

4 Organizations of the findings and results of demonstration 

5 projects conducted under this Act. 

6 ‘‘SEC. 810. PROVISION OF SERVICES IN MONTANA. 

7 ‘‘(a) CONSISTENT WITH COURT DECISION.—The 

8 Secretary, acting through the Service, shall provide serv9 ices and benefits for Indians in Montana in a manner con10 sistent with the decision of the United States Court of Ap11 peals for the Ninth Circuit in McNabb for McNabb v. 

12 Bowen, 829 F.2d 787 (9th Cir. 1987). 

13 ‘‘(b) CLARIFICATION.—The provisions of subsection 

14 (a) shall not be construed to be an expression of the sense 

15 of Congress on the application of the decision described 

16 in subsection (a) with respect to the provision of services 

17 or benefits for Indians living in any State other than Mon18 tana. 

19 ‘‘SEC. 811. MORATORIUM. 

20 ‘‘During the period of the moratorium imposed on 

21 implementation of the final rule published in the Federal 

22 Register on September 16, 1987, by the Health Resources 

23 and Services Administration of the Public Health Service, 

24 relating to eligibility for the health care services of the 

25 Indian Health Service, the Indian Health Service shall 

26 provide services pursuant to the criteria for eligibility for 


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1 such services that were in effect on September 15, 1987, 

2 subject to the provisions of sections 806 and 807 until 

3 such time as new criteria governing eligibility for services 

4 are developed in accordance with section 802. 

5 ‘‘SEC. 812. TRIBAL EMPLOYMENT. 

6 ‘‘For purposes of section 2(2) of the Act of July 5, 

7 1935 (49 Stat. 450, chapter 372), an Indian Tribe or 

8 Tribal Organization carrying out a contract or compact 

9 pursuant to the Indian Self-Determination and Education 

10 Assistance Act (25 U.S.C. 450 et seq.) shall not be consid11 ered an ‘employer’. 

12 ‘‘SEC. 813. SEVERABILITY PROVISIONS. 

13 ‘‘If any provision of this Act, any amendment made 

14 by the Act, or the application of such provision or amend15 ment to any person or circumstances is held to be invalid, 

16 the remainder of this Act, the remaining amendments 

17 made by this Act, and the application of such provisions 

18 to persons or circumstances other than those to which it 

19 is held invalid, shall not be affected thereby. 

20 ‘‘SEC. 814. ESTABLISHMENT OF NATIONAL BIPARTISAN 

21 COMMISSION ON INDIAN HEALTH CARE. 

22 ‘‘(a) ESTABLISHMENT.—There is established the Na23 tional Bipartisan Indian Health Care Commission (the 

24 ‘Commission’). 


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1 ‘‘(b) DUTIES OF COMMISSION.—The duties of the 

2 Commission are the following: 

3 ‘‘(1) To establish a study committee composed 

4 of those members of the Commission appointed by 

5 the Director and at least 4 members of Congress 

6 from among the members of the Commission, the 

7 duties of which shall be the following: 

8 ‘‘(A) To the extent necessary to carry out 

9 its duties, collect and compile data necessary to 

10 understand the extent of Indian needs with re11 gard to the provision of health services, regard12 less of the location of Indians, including holding 

13 hearings and soliciting the views of Indians, In14 dian Tribes, Tribal Organizations, and Urban 

15 Indian Organizations, which may include au16 thorizing and making funds available for feasi17 bility studies of various models for providing 

18 and funding health services for all Indian bene19 ficiaries, including those who live outside of a 

20 reservation, temporarily or permanently. 

21 ‘‘(B) To make legislative recommendations 

22 to the Commission regarding the delivery of 

23 Federal health care services to Indians. Such 

24 recommendations shall include those related to 

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1 ice providers, the cost of such services, financ2 ing such services, and the optimal manner in 

3 which to provide such services. 

4 ‘‘(C) To determine the effect of the enact5 ment of such recommendations on (i) the exist6 ing system of delivery of health services for In7 dians, and (ii) the sovereign status of Indian 

8 Tribes. 

9 ‘‘(D) Not later than 12 months after the 

10 appointment of all members of the Commission, 

11 to submit a written report of its findings and 

12 recommendations to the full Commission. The 

13 report shall include a statement of the minority 

14 and majority position of the Committee and 

15 shall be disseminated, at a minimum, to every 

16 Indian Tribe, Tribal Organization, and Urban 

17 Indian Organization for comment to the Com18 mission. 

19 ‘‘(E) To report regularly to the full Com20 mission regarding the findings and rec21 ommendations developed by the study com22 mittee in the course of carrying out its duties 

23 under this section. 

24 ‘‘(2) To review and analyze the recommenda25 tions of the report of the study committee. 


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1 ‘‘(3) To make legislative recommendations to 

2 Congress regarding the delivery of Federal health 

3 care services to Indians. Such recommendations 

4 shall include those related to issues of eligibility, 

5 benefits, the range of service providers, the cost of 

6 such services, financing such services, and the opti7 mal manner in which to provide such services. 

8 ‘‘(4) Not later than 18 months following the 

9 date of appointment of all members of the Commis10 sion, submit a written report to Congress regarding 

11 the delivery of Federal health care services to Indi12 ans. Such recommendations shall include those re13 lated to issues of eligibility, benefits, the range of 

14 service providers, the cost of such services, financing 

15 such services, and the optimal manner in which to 

16 provide such services. 

17 ‘‘(c) MEMBERS.— 

18 ‘‘(1) APPOINTMENT.—The Commission shall be 

19 composed of 25 members, appointed as follows: 

20 ‘‘(A) Ten members of Congress, including 

21 3 from the House of Representatives and 2 

22 from the Senate, appointed by their respective 

23 majority leaders, and 3 from the House of Rep24 resentatives and 2 from the Senate, appointed 

25 by their respective minority leaders, and who 


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1 shall be members of the standing committees of 

2 Congress that consider legislation affecting 

3 health care to Indians. 

4 ‘‘(B) Twelve persons chosen by the con5 gressional members of the Commission, 1 from 

6 each Service Area as currently designated by 

7 the Director to be chosen from among 3 nomi8 nees from each Service Area put forward by the 

9 Indian Tribes within the area, with due regard 

10 being given to the experience and expertise of 

11 the nominees in the provision of health care to 

12 Indians and to a reasonable representation on 

13 the commission of members who are familiar 

14 with various health care delivery modes and 

15 who represent Indian Tribes of various size 

16 populations. 

17 ‘‘(C) Three persons appointed by the Di18 rector who are knowledgeable about the provi19 sion of health care to Indians, at least 1 of 

20 whom shall be appointed from among 3 nomi21 nees put forward by those programs whose 

22 funds are provided in whole or in part by the 

23 Service primarily or exclusively for the benefit 

24 of Urban Indians. 


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1 ‘‘(D) All those persons chosen by the con2 gressional members of the Commission and by 

3 the Director shall be members of federally rec4 ognized Indian Tribes. 

5 ‘‘(2) CHAIR; VICE CHAIR.—The Chair and Vice 

6 Chair of the Commission shall be selected by the 

7 congressional members of the Commission. 

8 ‘‘(3) TERMS.—The terms of members of the 

9 Commission shall be for the life of the Commission. 

10 ‘‘(4) DEADLINE FOR APPOINTMENTS.—Con11 gressional members of the Commission shall be ap12 pointed not later than 180 days after the date of en13 actment of the Indian Health Care Improvement Act 

14 Amendments of 2006, and the remaining members 

15 of the Commission shall be appointed not later than 

16 60 days following the appointment of the congres17 sional members. 

18 ‘‘(5) VACANCY.—A vacancy in the Commission 

19 shall be filled in the manner in which the original 

20 appointment was made. 

21 ‘‘(d) COMPENSATION.— 

22 ‘‘(1) CONGRESSIONAL MEMBERS.—Each con23 gressional member of the Commission shall receive 

24 no additional pay, allowances, or benefits by reason 

25 of their service on the Commission and shall receive 


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1 travel expenses and per diem in lieu of subsistence 

2 in accordance with sections 5702 and 5703 of title 

3 5, United States Code. 

4 ‘‘(2) OTHER MEMBERS.—Remaining members 

5 of the Commission, while serving on the business of 

6 the Commission (including travel time), shall be en7 titled to receive compensation at the per diem equiv8 alent of the rate provided for level IV of the Execu9 tive Schedule under section 5315 of title 5, United 

10 States Code, and while so serving away from home 

11 and the member’s regular place of business, a mem12 ber may be allowed travel expenses, as authorized by 

13 the Chairman of the Commission. For purpose of 

14 pay (other than pay of members of the Commission) 

15 and employment benefits, rights, and privileges, all 

16 personnel of the Commission shall be treated as if 

17 they were employees of the United States Senate. 

18 ‘‘(e) MEETINGS.—The Commission shall meet at the 

19 call of the Chair. 

20 ‘‘(f) QUORUM.—A quorum of the Commission shall 

21 consist of not less than 15 members, provided that no less 

22 than 6 of the members of Congress who are Commission 

23 members are present and no less than 9 of the members 

24 who are Indians are present. 

25 ‘‘(g) EXECUTIVE DIRECTOR; STAFF; FACILITIES.— 


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1 ‘‘(1) APPOINTMENT; PAY.—The Commission 

2 shall appoint an executive director of the Commis3 sion. The executive director shall be paid the rate of 

4 basic pay for level V of the Executive Schedule. 

5 ‘‘(2) STAFF APPOINTMENT.—With the approval 

6 of the Commission, the executive director may ap7 point such personnel as the executive director deems 

8 appropriate. 

9 ‘‘(3) STAFF PAY.—The staff of the Commission 

10 shall be appointed without regard to the provisions 

11 of title 5, United States Code, governing appoint12 ments in the competitive service, and shall be paid 

13 without regard to the provisions of chapter 51 and 

14 subchapter III of chapter 53 of such title (relating 

15 to classification and General Schedule pay rates). 

16 ‘‘(4) TEMPORARY SERVICES.—With the ap17 proval of the Commission, the executive director may 

18 procure temporary and intermittent services under 

19 section 3109(b) of title 5, United States Code. 

20 ‘‘(5) FACILITIES.—The Administrator of Gen21 eral Services shall locate suitable office space for the 

22 operation of the Commission. The facilities shall 

23 serve as the headquarters of the Commission and 

24 shall include all necessary equipment and incidentals 


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1 required for the proper functioning of the Commis2 sion. 

3 ‘‘(h) HEARINGS.—(1) For the purpose of carrying 

4 out its duties, the Commission may hold such hearings 

5 and undertake such other activities as the Commission de6 termines to be necessary to carry out its duties, provided 

7 that at least 6 regional hearings are held in different areas 

8 of the United States in which large numbers of Indians 

9 are present. Such hearings are to be held to solicit the 

10 views of Indians regarding the delivery of health care serv11 ices to them. To constitute a hearing under this sub12 section, at least 5 members of the Commission, including 

13 at least 1 member of Congress, must be present. Hearings 

14 held by the study committee established in this section 

15 may count toward the number of regional hearings re16 quired by this subsection. 

17 ‘‘(2) Upon request of the Commission, the Comp18 troller General shall conduct such studies or investigations 

19 as the Commission determines to be necessary to carry 

20 out its duties. 

21 ‘‘(3)(A) The Director of the Congressional Budget 

22 Office or the Chief Actuary of the Centers for Medicare 

23 & Medicaid Services, or both, shall provide to the Commis24 sion, upon the request of the Commission, such cost estiVerDate Aug 31 2005 03:45 May 16, 2006 Jkt 049200 PO 00000 Frm 00322 Fmt 6652 Sfmt 6201 E:\BILLS\H5312.IH H5312

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1 mates as the Commission determines to be necessary to 

2 carry out its duties. 

3 ‘‘(B) The Commission shall reimburse the Director 

4 of the Congressional Budget Office for expenses relating 

5 to the employment in the office of the Director of such 

6 additional staff as may be necessary for the Director to 

7 comply with requests by the Commission under subpara8 graph (A). 

9 ‘‘(4) Upon the request of the Commission, the head 

10 of any Federal agency is authorized to detail, without re11 imbursement, any of the personnel of such agency to the 

12 Commission to assist the Commission in carrying out its 

13 duties. Any such detail shall not interrupt or otherwise 

14 affect the civil service status or privileges of the Federal 

15 employee. 

16 ‘‘(5) Upon the request of the Commission, the head 

17 of a Federal agency shall provide such technical assistance 

18 to the Commission as the Commission determines to be 

19 necessary to carry out its duties. 

20 ‘‘(6) The Commission may use the United States 

21 mails in the same manner and under the same conditions 

22 as Federal agencies and shall, for purposes of the frank, 

23 be considered a commission of Congress as described in 

24 section 3215 of title 39, United States Code. 


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1 ‘‘(7) The Commission may secure directly from any 

2 Federal agency information necessary to enable it to carry 

3 out its duties, if the information may be disclosed under 

4 section 552 of title 4, United States Code. Upon request 

5 of the Chairman of the Commission, the head of such 

6 agency shall furnish such information to the Commission. 

7 ‘‘(8) Upon the request of the Commission, the Ad8 ministrator of General Services shall provide to the Com9 mission on a reimbursable basis such administrative sup10 port services as the Commission may request. 

11 ‘‘(9) For purposes of costs relating to printing and 

12 binding, including the cost of personnel detailed from the 

13 Government Printing Office, the Commission shall be 

14 deemed to be a committee of Congress. 

15 ‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—There is 

16 authorized to be appropriated $4,000,000 to carry out the 

17 provisions of this section, which sum shall not be deducted 

18 from or affect any other appropriation for health care for 

19 Indian persons. 

20 ‘‘(j) FACA.—The Federal Advisory Committee Act 

21 (5 U.S.C. App.) shall not apply to the Commission. 

22 ‘‘SEC. 815. APPROPRIATIONS; AVAILABILITY. 

23 ‘‘Any new spending authority (described in subsection 

24 (c)(2)(A) or (B) of section 401 of the Congressional Budg25 et Act of 1974) which is provided under this Act shall 


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1 be effective for any fiscal year only to such extent or in 

2 such amounts as are provided in appropriation Acts. 

3 ‘‘SEC. 816. AUTHORIZATION OF APPROPRIATIONS. 

4 ‘‘(a) IN GENERAL.—There are authorized to be ap5 propriated such sums as may be necessary for each fiscal 

6 year through fiscal year 2015 to carry out this title.’’. 

7 (b) RATE OF PAY.— 

8 (1) POSITIONS AT LEVEL IV.—Section 5315 of 

9 title 5, United States Code, is amended by striking 

10 ‘‘Assistant Secretaries of Health and Human Serv11 ices (6).’’ and inserting ‘‘Assistant Secretaries of 

12 Health and Human Services (7)’’. 

13 (2) POSITIONS AT LEVEL V.—Section 5316 of 

14 title 5, United States Code, is amended by striking 

15 ‘‘Director, Indian Health Service, Department of 

16 Health and Human Services’’. 

17 (c) AMENDMENTS TO OTHER PROVISIONS OF LAW.— 

18 (1) Section 3307(b)(1)(C) of the Children’s 

19 Health Act of 2000 (25 U.S.C. 1671 note; Public 

20 Law 106–310) is amended by striking ‘‘Director of 

21 the Indian Health Service’’ and inserting ‘‘Assistant 

22 Secretary for Indian Health’’. 

23 (2) The Indian Lands Open Dump Cleanup Act 

24 of 1994 is amended— 

25 (A) in section 3 (25 U.S.C. 3902)— 


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1 (i) by striking paragraph (2); 

2 (ii) by redesignating paragraphs (1), 

3 (3), (4), (5), and (6) as paragraphs (4), 

4 (5), (2), (6), and (1), respectively, and 

5 moving those paragraphs so as to appear 

6 in numerical order; and 

7 (iii) by inserting before paragraph (4) 

8 (as redesignated by subclause (II)) the fol9 lowing: 

10 ‘‘(3) ASSISTANT SECRETARY.—The term ‘As11 sistant Secretary’ means the Assistant Secretary for 

12 Indian Health.’’; 

13 (B) in section 5 (25 U.S.C. 3904), by 

14 striking the section heading and inserting the 

15 following: 

16 ‘‘AUTHORITY OF ASSISTANT SECRETARY FOR INDIAN

17 HEALTH

18 ‘‘SEC. 5.’’; 

19 (C) in section 6(a) (25 U.S.C. 3905(a)), in 

20 the subsection heading, by striking ‘‘DIREC21 TOR’’ and inserting ‘‘ASSISTANT SECRETARY’’; 

22 (D) in section 9(a) (25 U.S.C. 3908(a)), in 

23 the subsection heading, by striking ‘‘DIREC24 TOR’’ and inserting ‘‘ASSISTANT SECRETARY’’; 

25 and 


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1 (E) by striking ‘‘Director’’ each place it 

2 appears and inserting ‘‘Assistant Secretary’’. 

3 (3) Section 5504(d)(2) of the Augustus F. 

4 Hawkins-Robert T. Stafford Elementary and Sec5 ondary School Improvement Amendments of 1988 

6 (25 U.S.C. 2001 note; Public Law 100–297) is 

7 amended by striking ‘‘Director of the Indian Health 

8 Service’’ and inserting ‘‘Assistant Secretary for In9 dian Health’’. 

10 (4) Section 203(a)(1) of the Rehabilitation Act 

11 of 1973 (29 U.S.C. 763(a)(1)) is amended by strik12 ing ‘‘Director of the Indian Health Service’’ and in13 serting ‘‘Assistant Secretary for Indian Health’’. 

14 (5) Subsections (b) and (e) of section 518 of 

15 the Federal Water Pollution Control Act (33 U.S.C. 

16 1377) are amended by striking ‘‘Director of the In17 dian Health Service’’ each place it appears and in18 serting ‘‘Assistant Secretary for Indian Health’’. 

19 (6) Section 317M(b) of the Public Health Serv20 ice Act (42 U.S.C. 247b–14(b)) is amended— 

21 (A) by striking ‘‘Director of the Indian 

22 Health Service’’ each place it appears and in23 serting ‘‘Assistant Secretary for Indian 

24 Health’’; and 


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1 (B) in paragraph (2)(A), by striking ‘‘the 

2 Directors referred to in such paragraph’’ and 

3 inserting ‘‘the Director of the Centers for Dis4 ease Control and Prevention and the Assistant 

5 Secretary for Indian Health’’. 

6 (7) Section 417C(b) of the Public Health Serv7 ice Act (42 U.S.C. 285–9(b)) is amended by striking 

8 ‘‘Director of the Indian Health Service’’ and insert9 ing ‘‘Assistant Secretary for Indian Health’’. 

10 (8) Section 1452(i) of the Safe Drinking Water 

11 Act (42 U.S.C. 300j–12(i)) is amended by striking 

12 ‘‘Director of the Indian Health Service’’ each place 

13 it appears and inserting ‘‘Assistant Secretary for In14 dian Health’’. 

15 (9) Section 803B(d)(1) of the Native American 

16 Programs Act of 1974 (42 U.S.C. 2991b–2(d)(1)) is 

17 amended in the last sentence by striking ‘‘Director 

18 of the Indian Health Service’’ and inserting ‘‘Assist19 ant Secretary for Indian Health’’. 

20 (10) Section 203(b) of the Michigan Indian 

21 Land Claims Settlement Act (Public Law 105–143; 

22 111 Stat. 2666) is amended by striking ‘‘Director of 

23 the Indian Health Service’’ and inserting ‘‘Assistant 

24 Secretary for Indian Health’’. 


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1 SEC. 3. SOBOBA SANITATION FACILITIES. 

2 The Act of December 17, 1970 (84 Stat. 1465), is 

3 amended by adding at the end the following new section: 

4 ‘‘SEC. 9. Nothing in this Act shall preclude the 

5 Soboba Band of Mission Indians and the Soboba Indian 

6 Reservation from being provided with sanitation facilities 

7 and services under the authority of section 7 of the Act 

8 of August 5, 1954 (68 Stat. 674), as amended by the Act 

9 of July 31, 1959 (73 Stat. 267).’’. 

10 SEC. 4. AMENDMENTS TO THE MEDICAID AND STATE CHIL11 DREN’S HEALTH INSURANCE PROGRAMS. 

12 (a) EXPANSION OF MEDICAID PAYMENT FOR ALL

13 COVERED SERVICES FURNISHED BY INDIAN HEALTH

14 PROGRAMS.— 

15 (1) EXPANSION TO ALL COVERED SERVICES.— 

16 Section 1911 of the Social Security Act (42 U.S.C. 

17 1396j) is amended— 

18 (A) by amending the heading to read as 

19 follows: 

20 ‘‘INDIAN HEALTH PROGRAMS

21 ‘‘SEC. 1911.’’; and 

22 (B) by amending subsection (a) to read as 

23 follows: 

24 ‘‘(a) ELIGIBILITY FOR REIMBURSEMENT FOR MED25 ICAL ASSISTANCE.—The Indian Health Service and an In26 dian Tribe, Tribal Organization, or an Urban Indian OrVerDate Aug 31 2005 01:35 May 21, 2006 Jkt 049200 PO 00000 Frm 00329 Fmt 6652 Sfmt 6201 E:\BILLS\H5312.IH H5312

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1 ganization (as such terms are defined in section 4 of the 

2 Indian Health Care Improvement Act) shall be eligible for 

3 reimbursement for medical assistance provided under a 

4 State plan or under waiver authority with respect to items 

5 and services furnished by the Indian Health Service, In6 dian Tribe, Tribal Organization, or Urban Indian Organi7 zation if the furnishing of such services meets all the con8 ditions and requirements which are applicable generally to 

9 the furnishing of items and services under this title and 

10 under such plan or waiver authority.’’. 

11 (2) ELIMINATION OF TEMPORARY DEEMING

12 PROVISION.—Such section is amended by striking 

13 subsection (b). 

14 (3) REVISION OF AUTHORITY TO ENTER INTO

15 AGREEMENTS.—Subsection (c) of such section is re16 designated as subsection (b) and is amended to read 

17 as follows: 

18 ‘‘(b) AUTHORITY TO ENTER INTO AGREEMENTS.— 

19 The Secretary may enter into an agreement with a State 

20 for the purpose of reimbursing the State for medical as21 sistance provided by the Indian Health Service, an Indian 

22 Tribe, Tribal Organizations, or an Urban Indian Organi23 zation (as so defined), directly, through referral, or under 

24 contracts or other arrangements between the Indian 

25 Health Service, an Indian Tribe, Tribal Organization, or 


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•HR 5312 IH

1 an Urban Indian Organization and another health care 

2 provider to Indians who are eligible for medical assistance 

3 under the State plan or under waiver authority.’’. 

4 (4) REFERENCE CORRECTION.—Subsection (d) 

5 of such section is redesignated as subsection (c) and 

6 is amended— 

7 (A) by striking ‘‘For’’ and inserting ‘‘DI8 RECT BILLING.—For’’; and 

9 (B) by striking ‘‘section 405’’ and insert10 ing ‘‘section 401(d)’’. 

11 (b) SPECIAL RULES FOR INDIANS, INDIAN HEALTH

12 CARE PROVIDERS, AND INDIAN MANAGED CARE ENTI13 TIES.— 

14 (1) IN GENERAL.—Section 1932 of the Social 

15 Security Act (42 U.S.C. 1396u–2) is amended by 

16 adding at the end the following new subsection: 

17 ‘‘(h) SPECIAL RULES FOR INDIANS, INDIAN HEALTH

18 CARE PROVIDERS, AND INDIAN MANAGED CARE ENTI19 TIES.—A State shall comply with the provisions of section 

20 413 of the Indian Health Care Improvement Act (relating 

21 to the treatment of Indians, Indian health care providers, 

22 and Indian managed care entities under a medicaid man23 aged care program).’’. 

24 (2) APPLICATION TO SCHIP.—Section 

25 2107(e)(1) of the Social Security Act (42 U.S.C. 


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•HR 5312 IH

1 1397gg(1)) is amended by adding at the end the fol2 lowing: 

3 ‘‘(E) Subsections (a)(2)(C) and (h) of sec4 tion 1932.’’. 

5 (c) SCHIP TREATMENT OF INDIAN TRIBES, TRIBAL

6 ORGANIZATIONS, AND URBAN INDIAN ORGANIZATIONS.— 

7 Section 2105(c) of the Social Security Act (42 U.S.C. 

8 1397ee(c)) is amended— 

9 (1) in paragraph (2), by adding at the end the 

10 following: 

11 ‘‘(C) INDIAN HEALTH PROGRAM PAY12 MENTS.—For provisions relating to authorizing 

13 use of allotments under this title for payments 

14 to Indian Health Programs and Urban Indian 

15 Organizations, see section 410 of the Indian 

16 Health Care Improvement Act.’’; and 

17 (2) in paragraph (6)(B), by inserting ‘‘or by an 

18 Indian Tribe, Tribal Organization, or Urban Indian 

19 Organization (as such terms are defined in section 

20 4 of the Indian Health Care Improvement Act)’’ 

21 after ‘‘Service’’. 


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•HR 5312 IH

1 SEC. 5. NATIVE AMERICAN HEALTH AND WELLNESS FOUN2 DATION. 

3 (a) IN GENERAL.—The Indian Self-Determination 

4 and Education Assistance Act (25 U.S.C. 450 et seq.) is 

5 amended by adding at the end the following: 

6 ‘‘TITLE VIII—NATIVE AMERICAN 

7 HEALTH AND WELLNESS 

8 FOUNDATION 

9 ‘‘SEC. 801. DEFINITIONS. 

10 ‘‘In this title: 

11 ‘‘(1) BOARD.—The term ‘Board’ means the 

12 Board of Directors of the Foundation. 

13 ‘‘(2) COMMITTEE.—The term ‘Committee’ 

14 means the Committee for the Establishment of Na15 tive American Health and Wellness Foundation es16 tablished under section 802(f). 

17 ‘‘(3) FOUNDATION.—The term ‘Foundation’ 

18 means the Native American Health and Wellness 

19 Foundation established under section 802. 

20 ‘‘(4) SECRETARY.—The term ‘Secretary’ means 

21 the Secretary of Health and Human Services. 

22 ‘‘(5) SERVICE.—The term ‘Service’ means the 

23 Indian Health Service of the Department of Health 

24 and Human Services. 


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•HR 5312 IH

1 ‘‘SEC. 802. NATIVE AMERICAN HEALTH AND WELLNESS 

2 FOUNDATION. 

3 ‘‘(a) ESTABLISHMENT.— 

4 ‘‘(1) IN GENERAL.—As soon as practicable 

5 after the date of enactment of this title, the Sec6 retary shall establish, under the laws of the District 

7 of Columbia and in accordance with this title, the 

8 Native American Health and Wellness Foundation. 

9 ‘‘(2) FUNDING DETERMINATIONS.—No funds, 

10 gift, property, or other item of value (including any 

11 interest accrued on such an item) acquired by the 

12 Foundation shall— 

13 ‘‘(A) be taken into consideration for pur14 poses of determining Federal appropriations re15 lating to the provision of health care and serv16 ices to Indians; or 

17 ‘‘(B) otherwise limit, diminish, or affect 

18 the Federal responsibility for the provision of 

19 health care and services to Indians. 

20 ‘‘(b) PERPETUAL EXISTENCE.—The Foundation 

21 shall have perpetual existence. 

22 ‘‘(c) NATURE OF CORPORATION.—The Foundation— 

23 ‘‘(1) shall be a charitable and nonprofit feder24 ally chartered corporation; and 

25 ‘‘(2) shall not be an agency or instrumentality 

26 of the United States. 


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•HR 5312 IH

1 ‘‘(d) PLACE OF INCORPORATION AND DOMICILE.— 

2 The Foundation shall be incorporated and domiciled in the 

3 District of Columbia. 

4 ‘‘(e) DUTIES.—The Foundation shall— 

5 ‘‘(1) encourage, accept, and administer private 

6 gifts of real and personal property, and any income 

7 from or interest in such gifts, for the benefit of, or 

8 in support of, the mission of the Service; 

9 ‘‘(2) undertake and conduct such other activi10 ties as will further the health and wellness activities 

11 and opportunities of Native Americans; and 

12 ‘‘(3) participate with and assist Federal, State, 

13 and tribal governments, agencies, entities, and indi14 viduals in undertaking and conducting activities that 

15 will further the health and wellness activities and op16 portunities of Native Americans. 

17 ‘‘(f) COMMITTEE FOR THE ESTABLISHMENT OF NA18 TIVE AMERICAN HEALTH AND WELLNESS FOUNDA19 TION.— 

20 ‘‘(1) IN GENERAL.—The Secretary shall estab21 lish the Committee for the Establishment of Native 

22 American Health and Wellness Foundation to assist 

23 the Secretary in establishing the Foundation. 


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•HR 5312 IH

1 ‘‘(2) DUTIES.—Not later than 180 days after 

2 the date of enactment of this section, the Committee 

3 shall— 

4 ‘‘(A) carry out such activities as are nec5 essary to incorporate the Foundation under the 

6 laws of the District of Columbia, including act7 ing as incorporators of the Foundation; 

8 ‘‘(B) ensure that the Foundation qualifies 

9 for and maintains the status required to carry 

10 out this section, until the Board is established; 

11 ‘‘(C) establish the constitution and initial 

12 bylaws of the Foundation; 

13 ‘‘(D) provide for the initial operation of 

14 the Foundation, including providing for tem15 porary or interim quarters, equipment, and 

16 staff; and 

17 ‘‘(E) appoint the initial members of the 

18 Board in accordance with the constitution and 

19 initial bylaws of the Foundation. 

20 ‘‘(g) BOARD OF DIRECTORS.— 

21 ‘‘(1) IN GENERAL.—The Board of Directors 

22 shall be the governing body of the Foundation. 

23 ‘‘(2) POWERS.—The Board may exercise, or 

24 provide for the exercise of, the powers of the Foun25 dation. 


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•HR 5312 IH

1 ‘‘(3) SELECTION.— 

2 ‘‘(A) IN GENERAL.—Subject to subpara3 graph (B), the number of members of the 

4 Board, the manner of selection of the members 

5 (including the filling of vacancies), and the 

6 terms of office of the members shall be as pro7 vided in the constitution and bylaws of the 

8 Foundation. 

9 ‘‘(B) REQUIREMENTS.— 

10 ‘‘(i) NUMBER OF MEMBERS.—The 

11 Board shall have at least 11 members, who 

12 shall have staggered terms. 

13 ‘‘(ii) INITIAL VOTING MEMBERS.—The 

14 initial voting members of the Board— 

15 ‘‘(I) shall be appointed by the 

16 Committee not later than 180 days 

17 after the date on which the Founda18 tion is established; and 

19 ‘‘(II) shall have staggered terms. 

20 ‘‘(iii) QUALIFICATION.—The members 

21 of the Board shall be United States citi22 zens who are knowledgeable or experienced 

23 in Native American health care and related 

24 matters. 


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•HR 5312 IH

1 ‘‘(C) COMPENSATION.—A member of the 

2 Board shall not receive compensation for service 

3 as a member, but shall be reimbursed for actual 

4 and necessary travel and subsistence expenses 

5 incurred in the performance of the duties of the 

6 Foundation. 

7 ‘‘(h) OFFICERS.— 

8 ‘‘(1) IN GENERAL.—The officers of the Founda9 tion shall be— 

10 ‘‘(A) a secretary, elected from among the 

11 members of the Board; and 

12 ‘‘(B) any other officers provided for in the 

13 constitution and bylaws of the Foundation. 

14 ‘‘(2) SECRETARY.—The secretary of the Foun15 dation shall serve, at the direction of the Board, as 

16 the chief operating officer of the Foundation. 

17 ‘‘(3) ELECTION.—The manner of election, term 

18 of office, and duties of the officers of the Founda19 tion shall be as provided in the constitution and by20 laws of the Foundation. 

21 ‘‘(i) POWERS.—The Foundation— 

22 ‘‘(1) shall adopt a constitution and bylaws for 

23 the management of the property of the Foundation 

24 and the regulation of the affairs of the Foundation; 

25 ‘‘(2) may adopt and alter a corporate seal; 


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•HR 5312 IH

1 ‘‘(3) may enter into contracts; 

2 ‘‘(4) may acquire (through a gift or otherwise), 

3 own, lease, encumber, and transfer real or personal 

4 property as necessary or convenient to carry out the 

5 purposes of the Foundation; 

6 ‘‘(5) may sue and be sued; and 

7 ‘‘(6) may perform any other act necessary and 

8 proper to carry out the purposes of the Foundation. 

9 ‘‘(j) PRINCIPAL OFFICE.— 

10 ‘‘(1) IN GENERAL.—The principal office of the 

11 Foundation shall be in the District of Columbia. 

12 ‘‘(2) ACTIVITIES; OFFICES.—The activities of 

13 the Foundation may be conducted, and offices may 

14 be maintained, throughout the United States in ac15 cordance with the constitution and bylaws of the 

16 Foundation. 

17 ‘‘(k) SERVICE OF PROCESS.—The Foundation shall 

18 comply with the law on service of process of each State 

19 in which the Foundation is incorporated and of each State 

20 in which the Foundation carries on activities. 

21 ‘‘(l) LIABILITY OF OFFICERS, EMPLOYEES, AND

22 AGENTS.— 

23 ‘‘(1) IN GENERAL.—The Foundation shall be 

24 liable for the acts of the officers, employees, and 


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•HR 5312 IH

1 agents of the Foundation acting within the scope of 

2 their authority. 

3 ‘‘(2) PERSONAL LIABILITY.—A member of the 

4 Board shall be personally liable only for gross neg5 ligence in the performance of the duties of the mem6 ber. 

7 ‘‘(m) RESTRICTIONS.— 

8 ‘‘(1) LIMITATION ON SPENDING.—Beginning 

9 with the fiscal year following the first full fiscal year 

10 during which the Foundation is in operation, the ad11 ministrative costs of the Foundation shall not exceed 

12 10 percent of the sum of— 

13 ‘‘(A) the amounts transferred to the Foun14 dation under subsection (o) during the pre15 ceding fiscal year; and 

16 ‘‘(B) donations received from private 

17 sources during the preceding fiscal year. 

18 ‘‘(2) APPOINTMENT AND HIRING.—The ap19 pointment of officers and employees of the Founda20 tion shall be subject to the availability of funds. 

21 ‘‘(3) STATUS.—A member of the Board or offi22 cer, employee, or agent of the Foundation shall not 

23 by reason of association with the Foundation be con24 sidered to be an officer, employee, or agent of the 

25 United States. 


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•HR 5312 IH

1 ‘‘(n) AUDITS.—The Foundation shall comply with 

2 section 10101 of title 36, United States Code, as if the 

3 Foundation were a corporation under part B of subtitle 

4 II of that title. 

5 ‘‘(o) FUNDING.— 

6 ‘‘(1) AUTHORIZATION OF APPROPRIATIONS.— 

7 There is authorized to be appropriated to carry out 

8 subsection (e)(1) $500,000 for each fiscal year, as 

9 adjusted to reflect changes in the Consumer Price 

10 Index for all-urban consumers published by the De11 partment of Labor. 

12 ‘‘(2) TRANSFER OF DONATED FUNDS.—The 

13 Secretary shall transfer to the Foundation funds 

14 held by the Department of Health and Human Serv15 ices under the Act of August 5, 1954 (42 U.S.C. 

16 2001 et seq.), if the transfer or use of the funds is 

17 not prohibited by any term under which the funds 

18 were donated. 

19 ‘‘SEC. 803. ADMINISTRATIVE SERVICES AND SUPPORT. 

20 ‘‘(a) PROVISION OF SUPPORT BY SECRETARY.—Sub21 ject to subsection (b), during the 5-year period beginning 

22 on the date on which the Foundation is established, the 

23 Secretary— 

24 ‘‘(1) may provide personnel, facilities, and other 

25 administrative support services to the Foundation; 


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•HR 5312 IH

1 ‘‘(2) may provide funds for initial operating 

2 costs and to reimburse the travel expenses of the 

3 members of the Board; and 

4 ‘‘(3) shall require and accept reimbursements 

5 from the Foundation for— 

6 ‘‘(A) services provided under paragraph 

7 (1); and 

8 ‘‘(B) funds provided under paragraph (2). 

9 ‘‘(b) REIMBURSEMENT.—Reimbursements accepted 

10 under subsection (a)(3)— 

11 ‘‘(1) shall be deposited in the Treasury of the 

12 United States to the credit of the applicable appro13 priations account; and 

14 ‘‘(2) shall be chargeable for the cost of pro15 viding services described in subsection (a)(1) and 

16 travel expenses described in subsection (a)(2). 

17 ‘‘(c) CONTINUATION OF CERTAIN SERVICES.—The 

18 Secretary may continue to provide facilities and necessary 

19 support services to the Foundation after the termination 

20 of the 5-year period specified in subsection (a) if the facili21 ties and services— 

22 ‘‘(1) are available; and 

23 ‘‘(2) are provided on reimbursable cost basis.’’. 

24 (b) TECHNICAL AMENDMENTS.—The Indian Self-De25 termination and Education Assistance Act is amended— 


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•HR 5312 IH

1 (1) by redesignating title V (25 U.S.C. 458bbb 

2 et seq.)) as title VII; 

3 (2) by redesignating sections 501, 502, and 503 

4 (25 U.S.C. 458bbb, 458bbb–1, 458bbb–2) as sec5 tions 701, 702, and 703, respectively; and 

6 (3) in subsection (a)(2) of section 702 and 

7 paragraph (2) of section 703 (as redesignated by 

8 paragraph (2)), by striking ‘‘section 501’’ and in9 serting ‘‘section 701’’. 

Æ 


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