I 

116TH CONGRESS 

1ST SESSION H. R. 4533 

To amend the Public Health Service Act to improve behavioral health 

outcomes for American Indians and Alaskan Natives, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

SEPTEMBER 26, 2019 

Mr. PALLONE (for himself and Mr. RUIZ) introduced the following bill; which 

was referred to the Committee on Energy and Commerce, and in addition 

to the Committees on Ways and Means, and Natural Resources, 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 Public Health Service Act to improve behavioral health outcomes for American Indians and Alaskan 

Natives, and for other purposes. 

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

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Native Health Access 

5 Improvement Act of 2019’’. 


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1 SEC. 2. SPECIAL BEHAVIORAL HEALTH PROGRAM FOR IN2 DIANS. 

3 Part A of title V of the Public Health Service Act 

4 (42 U.S.C. 290aa et seq.) is amended by adding at the 

5 end the following new section: 

6 ‘‘SEC. 506B. SPECIAL BEHAVIORAL HEALTH PROGRAM FOR 

7 INDIANS. 

8 ‘‘(a) IN GENERAL.—The Director of the Indian 

9 Health Service, in coordination with the Assistant Sec10 retary for Mental Health and Substance Use, shall award 

11 grants for providing services in accordance with subsection 

12 (b) for the prevention and treatment of mental health and 

13 substance use disorders. 

14 ‘‘(b) SERVICES THROUGH INDIAN HEALTH FACILI15 TIES.—For purposes of subsection (a), services are pro16 vided in accordance with this subsection if the services are 

17 provided through any of the following entities: 

18 ‘‘(1) The Indian Health Service. 

19 ‘‘(2) An Indian health program operated by an 

20 Indian tribe or tribal organization pursuant to a 

21 contract, grant, cooperative agreement, or compact 

22 with the Indian Health Service pursuant to the In23 dian Self-Determination and Education Assistance 

24 Act (25 U.S.C. 5301 et seq.). 

25 ‘‘(3) An urban Indian health program operated 

26 by an urban Indian organization pursuant to a grant 


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1 or contract with the Indian Health Service pursuant 

2 to title V of the Indian Health Care Improvement 

3 Act (25 U.S.C. 1651 et seq.). 

4 ‘‘(c) REPORTS.—Each grantee under this section 

5 shall submit reports at such time, in such manner, and 

6 containing such information as the Director of the Indian 

7 Health Service may require. 

8 ‘‘(d) TECHNICAL ASSISTANCE CENTER.— 

9 ‘‘(1) ESTABLISHMENT.—The Director of the 

10 Indian Health Service, in coordination with the As11 sistant Secretary for Mental Health and Substance 

12 Use, shall establish a technical assistance center (di13 rectly or by contract or cooperative agreement)— 

14 ‘‘(A) to provide technical assistance to 

15 grantees under this section; and 

16 ‘‘(B) to collect and evaluate information on 

17 the program carried out under this section. 

18 ‘‘(2) CONSULTATION.—The technical assistance 

19 center shall consult with grantees under this section 

20 for purposes of developing evaluation measures and 

21 data submission requirements for purposes of the 

22 collection and evaluation of information under para23 graph (1)(B). 

24 ‘‘(3) DATA SUBMISSION.—As a condition on re25 ceipt of a grant under this section, an applicant 


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1 shall agree to submit data consistent with the data 

2 submission requirements developed pursuant to 

3 paragraph (2). 

4 ‘‘(e) FUNDING.— 

5 ‘‘(1) IN GENERAL.—For the purpose of making 

6 grants under this section, there is authorized to be 

7 appropriated, and there is appropriated, out of any 

8 money in the Treasury not otherwise appropriated, 

9 $150,000,000 for each of fiscal years 2020 through 

10 2024. 

11 ‘‘(2) TECHNICAL ASSISTANCE CENTER.—Of the 

12 amount made available to carry out this section for 

13 each of fiscal years 2020 through 2024, the Director 

14 of the Indian Health Service shall allocate a percent15 age of such amount, to be determined by the Direc16 tor in consultation with Indian tribes, for the tech17 nical assistance center under subsection (d). 

18 ‘‘(f) DEFINITIONS.—In this section, the terms ‘In19 dian health program’, ‘Indian tribe’, ‘tribal organization’, 

20 and ‘urban Indian organization’ have the meanings given 

21 those terms in section 4 of the Indian Health Care Im22 provement Act (25 U.S.C. 1603).’’. 

23 SEC. 3. INDIAN DEFINED IN PPACA. 

24 (a) INDIAN DEFINED IN PPACA.— 


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1 (1) IN GENERAL.—Section 1304 of the Patient 

2 Protection and Affordable Care Act (42 U.S.C. 

3 18024) is amended by adding at the end the fol4 lowing new subsection: 

5 ‘‘(f) INDIAN.— 

6 ‘‘(1) IN GENERAL.—In this title, the term ‘In7 dian’ means any individual— 

8 ‘‘(A) described in paragraph (13) or (28) 

9 of section 4 of the Indian Health Care Improve10 ment Act (25 U.S.C. 1603); 

11 ‘‘(B) who is eligible for health services pro12 vided by the Indian Health Service under sec13 tion 809 of the Indian Health Care Improve14 ment Act (25 U.S.C. 1679); 

15 ‘‘(C) who is of Indian descent and belongs 

16 to the Indian community served by the local fa17 cilities and program of the Indian Health Serv18 ice; or 

19 ‘‘(D) who is described in paragraph (2). 

20 ‘‘(2) INCLUDED INDIVIDUALS.—For purposes of 

21 this title, the following individuals shall be consid22 ered to be an ‘Indian’: 

23 ‘‘(A) A member of a Federally recognized 

24 Indian tribe. 


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1 ‘‘(B) A resident of an urban center who 

2 meets one or more of the following four criteria: 

3 ‘‘(i) Membership in a Tribe, band, or 

4 other organized group of Indians, including 

5 those Tribes, bands, or groups terminated 

6 since 1940 and those recognized by the 

7 State in which they reside, or being a de8 scendant, in the first or second degree, of 

9 any such member. 

10 ‘‘(ii) Is an Eskimo or Aleut or other 

11 Alaska Native. 

12 ‘‘(iii) Is considered by the Secretary of 

13 the Interior to be an Indian for any pur14 pose. 

15 ‘‘(iv) Is determined to be an Indian 

16 under regulations promulgated by the Sec17 retary. 

18 ‘‘(C) An individual who is considered by 

19 the Secretary of the Interior to be an Indian for 

20 any purpose. 

21 ‘‘(D) An individual who is considered by 

22 the Secretary to be an Indian for purposes of 

23 eligibility for Indian health care services, includ24 ing as a California Indian, Eskimo, Aleut, or 

25 other Alaska Native.’’. 


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1 (2) CONFORMING AMENDMENTS.— 

2 (A) AFFORDABLE CHOICES HEALTH BEN3 EFIT PLANS.—Section 1311(c)(6)(D) of the Pa4 tient Protection and Affordable Care Act (42 

5 U.S.C. 18031(c)(6)(D)) is amended by striking 

6 ‘‘section 4 of the Indian Health Care Improve7 ment Act’’ and inserting ‘‘section 1304(f)’’. 

8 (B) REDUCED COST-SHARING FOR INDI9 VIDUALS ENROLLING IN QUALIFIED HEALTH

10 PLANS.—Section 1402(d) of the Patient Protec11 tion and Affordable Care Act (42 U.S.C. 

12 18071(d)) is amended— 

13 (i) in paragraph (1), in the matter 

14 preceding subparagraph (A), by striking 

15 ‘‘section 4(d) of the Indian Self-Deter16 mination and Education Assistance Act 

17 (25 U.S.C. 450b(d))’’ and inserting ‘‘sec18 tion 1304(f)’’; and 

19 (ii) in paragraph (2), in the matter 

20 preceding subparagraph (A), by striking 

21 ‘‘(as so defined)’’ and inserting ‘‘(as de22 fined in section 1304(f))’’. 

23 (C) EXEMPTION FROM PENALTY FOR NOT

24 MAINTAINING MINIMUM ESSENTIAL COV25 ERAGE.—Section 5000A(e) of the Internal RevVerDate Sep 11 2014 21:50 Oct 03, 2019 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H4533.IH H4533

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1 enue Code of 1986 is amended by striking para2 graph (3) and inserting the following new para3 graph: 

4 ‘‘(3) INDIANS.—Any applicable individual who 

5 is an Indian (as defined in section 1304(f) of the 

6 Patient Protection and Affordable Care Act).’’. 

7 (3) EFFECTIVE DATE.—The amendments made 

8 by this subsection shall apply with respect to plan 

9 years beginning on or after January 1, 2021. 

10 (b) TECHNICAL AMENDMENTS.—Section 4 of the In11 dian Health Care Improvement Act (25 U.S.C. 1603) is 

12 amended— 

13 (1) in paragraph (13), by striking ‘‘as defined 

14 in subsection (d) hereof’’ and inserting ‘‘as defined 

15 in paragraph (14)’’; and 

16 (2) in paragraph (28)— 

17 (A) by striking ‘‘as defined in subsection 

18 (g) hereof’’ and inserting ‘‘as defined in para19 graph (27)’’; and 

20 (B) by striking ‘‘subsection (c)(1) through 

21 (4)’’ and inserting ‘‘subparagraphs (A) through 

22 (D) of paragraph (13)’’. 

Æ 


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