II

106TH CONGRESS

2D SESSION S. 2526

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

such Act.

IN THE SENATE OF THE UNITED STATES

MAY 9, 2000

Mr. CAMPBELL (for himself and for Mr. INOUYE) introduced the following bill;

which was read twice and referred to the Committee on Indian Affairs

A BILL

To amend the Indian Health Care Improvement Act to revise

and extend such 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; TABLE OF CONTENTS.

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

5 ‘‘Indian Health Care Improvement Act Reauthorization of

6 2000’’.

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

8 this Act is as follows:

Sec. 1. Short title.

TITLE I—REAUTHORIZATION AND REVISIONS OF THE INDIAN

HEALTH CARE IMPROVEMENT ACT
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Sec. 101. Amendment to the Indian Health Care Improvement Act.

TITLE II—CONFORMING AMENDMENTS TO THE SOCIAL

SECURITY ACT

Subtitle A—Medicare

Sec. 201. Limitations on charges.

Sec. 202. Indian health programs.

Sec. 203. Qualified Indian health program.

Subtitle B—Medicaid

Sec. 211. Payments to Federally-qualified health centers.

Sec. 212. State consultation with Indian health programs.

Sec. 213. Fmap for services provided by Indian health programs.

Sec. 214. Indian Health Service programs.

Subtitle C—State Children’s Health Insurance Program

Sec. 221. Enhanced fmap for State children’s health insurance program.

Sec. 222. Direct funding of State children’s health insurance program.

‘‘Sec. 2111. Direct funding of Indian health programs.

Subtitle D—Authorization of Appropriations

Sec. 231. Authorization of appropriations.

TITLE III—MISCELLANEOUS PROVISIONS

Sec. 301. Repeals.

Sec. 302. Severability provisions.

1 TITLE I—REAUTHORIZATION

2 AND REVISIONS OF THE IN3 DIAN HEALTH CARE IM4 PROVEMENT ACT

5 SEC. 101. AMENDMENT TO THE INDIAN HEALTH CARE IM6 PROVEMENT ACT.

7 The Indian Health Care Improvement Act (25 U.S.C.

8 1601 et seq.) is amended to read as follows:

9 ‘‘SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

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

11 ‘Indian Health Care Improvement Act’.
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1 ‘‘(b) TABLE OF CONTENTS.—The table of contents

2 for this Act is as follows:

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

‘‘Sec. 2. Findings.

‘‘Sec. 3. Declaration of health objectives.

‘‘Sec. 4. Definitions.

‘‘TITLE I—INDIAN HEALTH, HUMAN RESOURCES AND

DEVELOPMENT

‘‘Sec. 101. Purpose.

‘‘Sec. 102. General requirements.

‘‘Sec. 103. Health professions recruitment program for Indians.

‘‘Sec. 104. Health professions preparatory scholarship program for Indians.

‘‘Sec. 105. Indian health professions scholarships.

‘‘Sec. 106. American Indians into psychology program.

‘‘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. Tribal recruitment and retention program.

‘‘Sec. 114. Advanced training and research.

‘‘Sec. 115. Nursing programs; Quentin N. Burdick American Indians into

Nursing Program.

‘‘Sec. 116. Tribal culture and history.

‘‘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 for Alaska.

‘‘Sec. 122. Tribal health program administration.

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

‘‘Sec. 124. Scholarships.

‘‘Sec. 125. National Health Service Corps.

‘‘Sec. 126. Substance abuse counselor education demonstration project.

‘‘Sec. 127. Mental health training and community education.

‘‘Sec. 128. 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.

‘‘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.
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‘‘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. 217. California contract health services demonstration 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. Authorization for emergency contract health services.

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

‘‘Sec. 224. Liability for payment.

‘‘Sec. 225. Authorization of appropriations.

‘‘TITLE III—FACILITIES

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

‘‘Sec. 302. Safe water and sanitary waste disposal facilities.

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

‘‘Sec. 304. Soboba sanitation facilities.

‘‘Sec. 305. Expenditure of nonservice funds for renovation.

‘‘Sec. 306. Funding for the construction, expansion, and modernization of

small ambulatory care facilities.

‘‘Sec. 307. Indian health care delivery demonstration project.

‘‘Sec. 308. Land transfer.

‘‘Sec. 309. Leases.

‘‘Sec. 310. Loans, loan guarantees and loan repayment.

‘‘Sec. 311. Tribal leasing.

‘‘Sec. 312. Indian Health Service/tribal facilities joint venture program.

‘‘Sec. 313. Location of facilities.

‘‘Sec. 314. Maintenance and improvement of health care facilities.

‘‘Sec. 315. Tribal management of Federally-owned quarters.

‘‘Sec. 316. Applicability of buy American requirement.

‘‘Sec. 317. Other funding for facilities.

‘‘Sec. 318. Authorization of appropriations.

‘‘TITLE IV—ACCESS TO HEALTH SERVICES

‘‘Sec. 401. Treatment of payments under medicare program.

‘‘Sec. 402. Treatment of payments under medicaid program.

‘‘Sec. 403. Report.

‘‘Sec. 404. Grants to and funding agreements with the service, Indian

tribes or tribal organizations, and urban Indian organizations.

‘‘Sec. 405. Direct billing and reimbursement of medicare, medicaid, and

other third party payors.

‘‘Sec. 406. Reimbursement from certain third parties of costs of health

services.

‘‘Sec. 407. Crediting of reimbursements.

‘‘Sec. 408. Purchasing health care coverage.

‘‘Sec. 409. Indian Health Service, Department of Veteran’s Affairs, and

other Federal agency health facilities and services sharing.

‘‘Sec. 410. Payor of last resort.

‘‘Sec. 411. Right to recover from Federal health care programs.
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‘‘Sec. 412. Tuba city demonstration project.

‘‘Sec. 413. Access to Federal insurance.

‘‘Sec. 414. Consultation and rulemaking.

‘‘Sec. 415. Limitations on charges.

‘‘Sec. 416. Limitation on Secretary’s waiver authority.

‘‘Sec. 417. Waiver of medicare and medicaid sanctions.

‘‘Sec. 418. Meaning of ‘remuneration’ for purposes of safe harbor provisions; antitrust immunity.

‘‘Sec. 419. Co-insurance, co-payments, deductibles and premiums.

‘‘Sec. 420. Inclusion of income and resources for purposes of medically

needy medicaid eligibility.

‘‘Sec. 421. Estate recovery provisions.

‘‘Sec. 422. Medical child support.

‘‘Sec. 423. Provisions relating to managed care.

‘‘Sec. 424. Navajo Nation medicaid agency.

‘‘Sec. 425. Indian advisory committees.

‘‘Sec. 426. 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. Office 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. Federal Tort Claims Act coverage.

‘‘Sec. 516. Urban youth treatment center demonstration.

‘‘Sec. 517. Use of Federal government facilities and sources of supply.

‘‘Sec. 518. Grants for diabetes prevention, treatment and control.

‘‘Sec. 519. Community health representatives.

‘‘Sec. 520. Regulations.

‘‘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. Memorandum 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. Inpatient and community-based mental health facilities design,

construction and staffing assessment.

‘‘Sec. 709. Training and community education.

‘‘Sec. 710. Behavioral health program.

‘‘Sec. 711. Fetal alcohol disorder funding.

‘‘Sec. 712. Child sexual abuse and prevention treatment programs.

‘‘Sec. 713. Behavioral mental health research.

‘‘Sec. 714. Definitions.

‘‘Sec. 715. 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. Prime vendor.

‘‘Sec. 814. National Bi-Partisan Commission on Indian Health Care Entitlement.

‘‘Sec. 815. Appropriations; availability.

‘‘Sec. 816. Authorization of appropriations.

1 ‘‘SEC. 2. FINDINGS.

2 ‘‘Congress makes the following findings:

3 ‘‘(1) Federal delivery of health services and

4 funding of tribal and urban Indian health programs

5 to maintain and improve the health of the Indians

6 are consonant with and required by the Federal Gov7 ernment’s historical and unique legal relationship

8 with the American Indian people, as reflected in the

9 Constitution, treaties, Federal laws, and the course
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1 of dealings of the United States with Indian Tribes,

2 and the United States’ resulting government to gov3 ernment and trust responsibility and obligations to

4 the American Indian people.

5 ‘‘(2) From the time of European occupation

6 and colonization through the 20th century, the poli7 cies and practices of the United States caused or

8 contributed to the severe health conditions of Indi9 ans.

10 ‘‘(3) Indian Tribes have, through the cession of

11 over 400,000,000 acres of land to the United States

12 in exchange for promises, often reflected in treaties,

13 of health care secured a de facto contract that enti14 tles Indians to health care in perpetuity, based on

15 the moral, legal, and historic obligation of the

16 United States.

17 ‘‘(4) The population growth of the Indian peo18 ple that began in the later part of the 20th century

19 increases the need for Federal health care services.

20 ‘‘(5) A major national goal of the United States

21 is to provide the quantity and quality of health serv22 ices which will permit the health status of Indians,

23 regardless of where they live, to be raised to the

24 highest possible level, a level that is not less than

25 that of the general population, and to provide for the
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1 maximum participation of Indian Tribes, tribal orga2 nizations, and urban Indian organizations in the

3 planning, delivery, and management of those serv4 ices.

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

7 of illnesses among, and unnecessary and premature

8 deaths of, Indians.

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

10 needs of the American Indian people remain alarm11 ingly severe, and even continue to increase, and the

12 health status of the Indians is far below the health

13 status of the general population of the United

14 States.

15 ‘‘(8) The disparity in health status that is to be

16 addresses is formidable. In death rates for example,

17 Indian people suffer a death rate for diabetes

18 mellitus that is 249 percent higher than the death

19 rate for all races in the United States, a pneumonia

20 and influenza death rate that is 71 percent higher,

21 a tuberculosis death rate that is 533 percent higher,

22 and a death rate from alcoholism that is 627 percent

23 higher.
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1 ‘‘SEC. 3. DECLARATION OF HEALTH OBJECTIVES.

2 ‘‘Congress hereby declares that it is the policy of the

3 United States, in fulfillment of its special trust respon4 sibilities and legal obligations to the American Indian

5 people—

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

7 for Indians and to provide all resources necessary to

8 effect that policy;

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

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

11 contained within the Healthy People 2000, or any

12 successor standards thereto;

13 ‘‘(3) in order to raise the health status of In14 dian people to at least the levels set forth in the

15 goals contained within the Healthy People 2000, or

16 any successor standards thereto, to permit Indian

17 Tribes and tribal organizations to set their own

18 health care priorities and establish goals that reflect

19 their unmet needs;

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

21 the health professions and allied and associated

22 health professions awarded to Indians so that the

23 proportion of Indian health professionals in each ge24 ographic service area is raised to at least the level

25 of that of the general population;
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1 ‘‘(5) to require meaningful, active consultation

2 with Indian Tribes, Indian organizations, and urban

3 Indian organizations to implement this Act and the

4 national policy of Indian self-determination; and

5 ‘‘(6) that funds for health care programs and

6 facilities operated by Tribes and tribal organizations

7 be provided in amounts that are not less than the

8 funds that are provided to programs and facilities

9 operated directly by the Service.

10 ‘‘SEC. 4. DEFINITIONS.

11 ‘‘In this Act:

12 ‘‘(1) ACCREDITED AND ACCESSIBLE.—The term

13 ‘accredited and accessible’, with respect to an entity,

14 means a community college or other appropriate en15 tity that is on or near a reservation and accredited

16 by a national or regional organization with accred17 iting authority.

18 ‘‘(2) AREA OFFICE.—The term ‘area office’

19 mean an administrative entity including a program

20 office, within the Indian Health Service through

21 which services and funds are provided to the service

22 units within a defined geographic area.

23 ‘‘(3) ASSISTANT SECRETARY.—The term ‘As24 sistant Secretary’ means the Assistant Secretary of

25 the Indian Health as established under section 601.
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1 ‘‘(4) CONTRACT HEALTH SERVICE.—The term

2 ‘contract health service’ means a health service that

3 is provided at the expense of the Service, Indian

4 Tribe, or tribal organization by a public or private

5 medical provider or hospital, other than a service

6 funded under the Indian Self-Determination and

7 Education Assistance Act or under this Act.

8 ‘‘(5) DEPARTMENT.—The term ‘Department’,

9 unless specifically provided otherwise, means the De10 partment of Health and Human Services.

11 ‘‘(6) FUND.—The terms ‘fund’ or ‘funding’

12 mean the transfer of monies from the Department

13 to any eligible entity or individual under this Act by

14 any legal means, including funding agreements, con15 tracts, memoranda of understanding, Buy Indian

16 Act contracts, or otherwise.

17 ‘‘(7) FUNDING AGREEMENT.—The term ‘fund18 ing agreement’ means any agreement to transfer

19 funds for the planning, conduct, and administration

20 of programs, functions, services and activities to

21 Tribes and tribal organizations from the Secretary

22 under the authority of the Indian Self-Determination

23 and Education Assistance Act.

24 ‘‘(8) HEALTH PROFESSION.—The term ‘health

25 profession’ means allopathic medicine, family medi-
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1 cine, internal medicine, pediatrics, geriatric medi2 cine, obstetrics and gynecology, podiatric medicine,

3 nursing, public health nursing, dentistry, psychiatry,

4 osteopathy, optometry, pharmacy, psychology, public

5 health, social work, marriage and family therapy,

6 chiropractic medicine, environmental health and en7 gineering, and allied health professions, or any other

8 health profession.

9 ‘‘(9) HEALTH PROMOTION; DISEASE PREVEN10 TION.—The terms ‘health promotion’ and ‘disease

11 prevention’ shall have the meanings given such

12 terms in paragraphs (1) and (2) of section 203(c).

13 ‘‘(10) INDIAN.—The term ‘Indian’ and ‘Indi14 ans’ shall have meanings given such terms for pur15 poses of the Indian Self-Determination and Edu16 cation Assistance Act.

17 ‘‘(11) INDIAN HEALTH PROGRAM.—The term

18 ‘Indian health program’ shall have the meaning

19 given such term in section 110(a)(2)(A).

20 ‘‘(12) INDIAN TRIBE.—The term ‘Indian tribe’

21 shall have the meaning given such term in section

22 4(e) of the Indian Self Determination and Education

23 Assistance Act.

24 ‘‘(13) RESERVATION.—The term ‘reservation’

25 means any Federally recognized Indian tribe’s res-
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1 ervation, Pueblo or colony, including former reserva2 tions in Oklahoma, Alaska Native Regions estab3 lished pursuant to the Alaska Native Claims Settle4 ment Act, and Indian allotments.

5 ‘‘(14) SECRETARY.—The term ‘Secretary’, un6 less specifically provided otherwise, means the Sec7 retary of Health and Human Services.

8 ‘‘(15) SERVICE.—The term ‘Service’ means the

9 Indian Health Service.

10 ‘‘(16) SERVICE AREA.—The term ‘service area’

11 means the geographical area served by each area of12 fice.

13 ‘‘(17) SERVICE UNIT.—The term ‘service unit’

14 means—

15 ‘‘(A) an administrative entity within the

16 Indian Health Service; or

17 ‘‘(B) a tribe or tribal organization oper18 ating health care programs or facilities with

19 funds from the Service under the Indian Self20 Determination and Education Assistance Act,

21 through which services are provided, directly or

22 by contract, to the eligible Indian population

23 within a defined geographic area.

24 ‘‘(18) TRADITIONAL HEALTH CARE PRAC25 TICES.—The term ‘traditional health care practices’
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1 means the application by Native healing practi2 tioners of the Native healing sciences (as opposed or

3 in contradistinction to western healing sciences)

4 which embodies the influences or forces of innate

5 tribal discovery, history, description, explanation and

6 knowledge of the states of wellness and illness and

7 which calls upon these influences or forces, including

8 physical, mental, and spiritual forces in the pro9 motion, restoration, preservation and maintenance of

10 health, well-being, and life’s harmony.

11 ‘‘(19) TRIBAL ORGANIZATION.—The term ‘trib12 al organization’ shall have the meaning given such

13 term in section 4(l) of the Indian Self Determination

14 and Education Assistance Act.

15 ‘‘(20) TRIBALLY CONTROLLED COMMUNITY

16 COLLEGE.—The term ‘tribally controlled community

17 college’ shall have the meaning given such term in

18 section 126 (g)(2).

19 ‘‘(21) URBAN CENTER.—The term ‘urban cen20 ter’ means any community that has a sufficient

21 urban Indian population with unmet health needs to

22 warrant assistance under title V, as determined by

23 the Secretary.
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1 ‘‘(22) URBAN INDIAN.—The term ‘urban In2 dian’ means any individual who resides in an urban

3 center and who—

4 ‘‘(A) regardless of whether such individual

5 lives on or near a reservation, is a member of

6 a tribe, band or other organized group of Indi7 ans, including those tribes, bands or groups ter8 minated since 1940;

9 ‘‘(B) is an Eskimo or Aleut or other Alas10 kan Native;

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

12 Interior to be an Indian for any purpose; or

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

14 regulations promulgated by the Secretary.

15 ‘‘(23) URBAN INDIAN ORGANIZATION.—The

16 term ‘urban Indian organization’ means a nonprofit

17 corporate body situated in an urban center, governed

18 by an urban Indian controlled board of directors,

19 and providing for the participation of all interested

20 Indian groups and individuals, and which is capable

21 of legally cooperating with other public and private

22 entities for the purpose of performing the activities

23 described in 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 Service, Indian tribes, tribal organizations, and urban In10 dian organizations involved in the provision of health serv11 ices to Indian people.

12 ‘‘SEC. 102. GENERAL REQUIREMENTS.

13 ‘‘(a) SERVICE AREA PRIORITIES.—Unless specifically

14 provided otherwise, amounts appropriated for each fiscal

15 year to carry out each program authorized under this title

16 shall be allocated by the Secretary to the area office of

17 each service area using a formula—

18 ‘‘(1) to be developed in consultation with Indian

19 Tribes, tribal organizations and urban Indian orga20 nizations; and

21 ‘‘(2) that takes into account the human re22 source and development needs in each such service

23 area.

24 ‘‘(b) CONSULTATION.—Each area office receiving

25 funds under this title shall actively and continuously con-
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1 sult with representatives of Indian tribes, tribal organiza2 tions, and urban Indian organizations to prioritize the uti3 lization of funds provided under this title within the serv4 ice area.

5 ‘‘(c) REALLOCATION.—Unless specifically prohibited,

6 an area office may reallocate funds provided to the office

7 under this title among the programs authorized by this

8 title, except that scholarship and loan repayment funds

9 shall not be used for administrative functions or expenses.

10 ‘‘(d) LIMITATION.—This section shall not apply with

11 respect to individual recipients of scholarships, loans or

12 other funds provided under this title (as this title existed

13 1 day prior to the date of enactment of this Act) until

14 such time as the individual completes the course of study

15 that is supported through the use of such funds.

16 ‘‘SEC. 103. HEALTH PROFESSIONS RECRUITMENT PROGRAM

17 FOR INDIANS.

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

19 the Service, shall make funds available through the area

20 office to public or nonprofit private health entities, or In21 dian tribes or tribal organizations to assist such entities

22 in meeting the costs of—

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

24 education or training in the health professions and

25 encouraging and assisting them—
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1 ‘‘(A) to enroll in courses of study in such

2 health professions; or

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

4 any such courses of study, to undertake such

5 postsecondary education or training as may be

6 required to qualify them for enrollment;

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

8 available to Indians enrolled in any course of study

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

10 training necessary to qualify them to enroll in any

11 such course of study; or

12 ‘‘(3) establishing other programs which the area

13 office determines will enhance and facilitate the en14 rollment of Indians in, and the subsequent pursuit

15 and completion by them of, courses of study referred

16 to in paragraph (1).

17 ‘‘(b) ADMINISTRATIVE PROVISIONS.—

18 ‘‘(1) APPLICATION.—To be eligible to receive

19 funds under this section an entity described in sub20 section (a) shall submit to the Secretary, through

21 the appropriate area office, and have approved, an

22 application in such form, submitted in such manner,

23 and containing such information as the Secretary

24 shall by regulation prescribe.
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1 ‘‘(2) PREFERENCE.—In awarding funds under

2 this section, the area office shall give a preference

3 to applications submitted by Indian tribes, tribal or4 ganizations, or urban Indian organizations.

5 ‘‘(3) AMOUNT.—The amount of funds to be

6 provided to an eligible entity under this section shall

7 be determined by the area office. Payments under

8 this section may be made in advance or by way of

9 reimbursement, and at such intervals and on such

10 conditions as provided for in regulations promul11 gated pursuant to this Act.

12 ‘‘(4) TERMS.—A funding commitment under

13 this section shall, to the extent not otherwise prohib14 ited by law, be for a term of 3 years, as provided

15 for in regulations promulgated pursuant to this Act.

16 ‘‘(c) DEFINITION.—For purposes of this section and

17 sections 104 and 105, the terms ‘Indian’ and ‘Indians’

18 shall, in addition to the definition provided for in section

19 4, mean any individual who—

20 ‘‘(1) irrespective of whether such individual

21 lives on or near a reservation, is a member of a

22 tribe, band, or other organized group of Indians, in23 cluding those Tribes, bands, or groups terminated

24 since 1940;
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1 ‘‘(2) is an Eskimo or Aleut or other Alaska Na2 tive;

3 ‘‘(3) is considered by the Secretary of the Inte4 rior to be an Indian for any purpose; or

5 ‘‘(4) is determined to be an Indian under regu6 lations promulgated by the Secretary.

7 ‘‘SEC. 104. HEALTH PROFESSIONS PREPARATORY SCHOL8 ARSHIP PROGRAM FOR INDIANS.

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

10 the Service, shall provide scholarships through the area

11 offices to Indians who—

12 ‘‘(1) have successfully completed their high

13 school education or high school equivalency; and

14 ‘‘(2) have demonstrated the capability to suc15 cessfully complete courses of study in the health pro16 fessions.

17 ‘‘(b) PURPOSE.—Scholarships provided under this

18 section shall be for the following purposes:

19 ‘‘(1) Compensatory preprofessional education of

20 any recipient. Such scholarship shall not exceed 2

21 years on a full-time basis (or the part-time equiva22 lent thereof, as determined by the area office pursu23 ant to regulations promulgated under this Act).

24 ‘‘(2) Pregraduate education of any recipient

25 leading to a baccalaureate degree in an approved
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1 course of study preparatory to a field of study in

2 a health profession, such scholarship not to exceed

3 4 years (or the part-time equivalent thereof, as de4 termined by the area office pursuant to regulations

5 promulgated under this Act) except that an exten6 sion of up to 2 years may be approved by the Sec7 retary.

8 ‘‘(c) USE OF SCHOLARSHIP.—Scholarships made

9 under this section may be used to cover costs of tuition,

10 books, transportation, board, and other necessary related

11 expenses of a recipient while attending school.

12 ‘‘(d) LIMITATIONS.—Scholarship assistance to an eli13 gible applicant under this section shall not be denied solely

14 on the basis of—

15 ‘‘(1) the applicant’s scholastic achievement if

16 such applicant has been admitted to, or maintained

17 good standing at, an accredited institution; or

18 ‘‘(2) the applicant’s eligibility for assistance or

19 benefits under any other Federal program.

20 ‘‘SEC. 105. INDIAN HEALTH PROFESSIONS SCHOLARSHIPS.

21 ‘‘(a) SCHOLARSHIPS.—

22 ‘‘(1) IN GENERAL.—In order to meet the needs

23 of Indians, Indian tribes, tribal organizations, and

24 urban Indian organizations for health professionals,

25 the Secretary, acting through the Service and in ac-
22

•S 2526 IS

1 cordance with this section, shall provide scholarships

2 through the area offices to Indians who are enrolled

3 full or part time in accredited schools and pursuing

4 courses of study in the health professions. Such

5 scholarships shall be designated Indian Health

6 Scholarships and shall, except as provided in sub7 section (b), be made in accordance with section

8 338A of the Public Health Service Act (42 U.S.C.

9 254l).

10 ‘‘(2) NO DELEGATION.—The Director of the

11 Service shall administer this section and shall not

12 delegate any administrative functions under a fund13 ing agreement pursuant to the Indian Self-Deter14 mination and Education Assistance Act.

15 ‘‘(b) ELIGIBILITY.—

16 ‘‘(1) ENROLLMENT.—An Indian shall be eligible

17 for a scholarship under subsection (a) in any year in

18 which such individual is enrolled full or part time in

19 a course of study referred to in subsection (a)(1).

20 ‘‘(2) SERVICE OBLIGATION.—

21 ‘‘(A) PUBLIC HEALTH SERVICE ACT.—The

22 active duty service obligation under a written

23 contract with the Secretary under section 338A

24 of the Public Health Service Act (42 U.S.C.

25 254l) that an Indian has entered into under
23

•S 2526 IS

1 that section shall, if that individual is a recipi2 ent of an Indian Health Scholarship, be met in

3 full-time practice on an equivalent year for year

4 obligation, by service—

5 ‘‘(i) in the Indian Health Service;

6 ‘‘(ii) in a program conducted under a

7 funding agreement entered into under the

8 Indian Self-Determination and Education

9 Assistance Act;

10 ‘‘(iii) in a program assisted under title

11 V; or

12 ‘‘(iv) in the private practice of the ap13 plicable profession if, as determined by the

14 Secretary, in accordance with guidelines

15 promulgated by the Secretary, such prac16 tice is situated in a physician or other

17 health professional shortage area and ad18 dresses the health care needs of a substan19 tial number of Indians.

20 ‘‘(B) DEFERRING ACTIVE SERVICE.—At

21 the request of any Indian who has entered into

22 a contract referred to in subparagraph (A) and

23 who receives a degree in medicine (including os24 teopathic or allopathic medicine), dentistry, op25 tometry, podiatry, or pharmacy, the Secretary
24

•S 2526 IS

1 shall defer the active duty service obligation of

2 that individual under that contract, in order

3 that such individual may complete any intern4 ship, residency, or other advanced clinical train5 ing that is required for the practice of that

6 health profession, for an appropriate period (in

7 years, as determined by the Secretary), subject

8 to the following conditions:

9 ‘‘(i) No period of internship, resi10 dency, or other advanced clinical training

11 shall be counted as satisfying any period of

12 obligated service that is required under

13 this section.

14 ‘‘(ii) The active duty service obligation

15 of that individual shall commence not later

16 than 90 days after the completion of that

17 advanced clinical training (or by a date

18 specified by the Secretary).

19 ‘‘(iii) The active duty service obliga20 tion will be served in the health profession

21 of that individual, in a manner consistent

22 with clauses (i) through (iv) of subpara23 graph (A).

24 ‘‘(C) NEW SCHOLARSHIP RECIPIENTS.—A

25 recipient of an Indian Health Scholarship that
25

•S 2526 IS

1 is awarded after December 31, 2001, shall meet

2 the active duty service obligation under such

3 scholarship by providing service within the serv4 ice area from which the scholarship was award5 ed. In placing the recipient for active duty the

6 area office shall give priority to the program

7 that funded the recipient, except that in cases

8 of special circumstances, a recipient may be

9 placed in a different service area pursuant to an

10 agreement between the areas or programs in11 volved.

12 ‘‘(D) PRIORITY IN ASSIGNMENT.—Subject

13 to subparagraph (C), the area office, in making

14 assignments of Indian Health Scholarship re15 cipients required to meet the active duty service

16 obligation described in subparagraph (A), shall

17 give priority to assigning individuals to service

18 in those programs specified in subparagraph

19 (A) that have a need for health professionals to

20 provide health care services as a result of indi21 viduals having breached contracts entered into

22 under this section.

23 ‘‘(3) PART-TIME ENROLLMENT.—In the case of

24 an Indian receiving a scholarship under this section
26

•S 2526 IS

1 who is enrolled part time in an approved course of

2 study—

3 ‘‘(A) such scholarship shall be for a period

4 of years not to exceed the part-time equivalent

5 of 4 years, as determined by the appropriate

6 area office;

7 ‘‘(B) the period of obligated service de8 scribed in paragraph (2)(A) shall be equal to

9 the greater of—

10 ‘‘(i) the part-time equivalent of 1 year

11 for each year for which the individual was

12 provided a scholarship (as determined by

13 the area office); or

14 ‘‘(ii) two years; and

15 ‘‘(C) the amount of the monthly stipend

16 specified in section 338A(g)(1)(B) of the Public

17 Health Service Act (42 U.S.C. 254l(g)(1)(B))

18 shall be reduced pro rata (as determined by the

19 Secretary) based on the number of hours such

20 student is enrolled.

21 ‘‘(4) BREACH OF CONTRACT.—

22 ‘‘(A) IN GENERAL.—An Indian who has,

23 on or after the date of the enactment of this

24 paragraph, entered into a written contract with
27

•S 2526 IS

1 the area office pursuant to a scholarship under

2 this section and who—

3 ‘‘(i) fails to maintain an acceptable

4 level of academic standing in the edu5 cational institution in which he or she is

6 enrolled (such level determined by the edu7 cational institution under regulations of

8 the Secretary);

9 ‘‘(ii) is dismissed from such edu10 cational institution for disciplinary reasons;

11 ‘‘(iii) voluntarily terminates the train12 ing in such an educational institution for

13 which he or she is provided a scholarship

14 under such contract before the completion

15 of such training; or

16 ‘‘(iv) fails to accept payment, or in17 structs the educational institution in which

18 he or she is enrolled not to accept pay19 ment, in whole or in part, of a scholarship

20 under such contract;

21 in lieu of any service obligation arising under

22 such contract, shall be liable to the United

23 States for the amount which has been paid to

24 him or her, or on his or her behalf, under the

25 contract.
28

•S 2526 IS

1 ‘‘(B) FAILURE TO PERFORM SERVICE OB2 LIGATION.—If for any reason not specified in

3 subparagraph (A) an individual breaches his or

4 her written contract by failing either to begin

5 such individual’s service obligation under this

6 section or to complete such service obligation,

7 the United States shall be entitled to recover

8 from the individual an amount determined in

9 accordance with the formula specified in sub10 section (l) of section 110 in the manner pro11 vided for in such subsection.

12 ‘‘(C) DEATH.—Upon the death of an indi13 vidual who receives an Indian Health Scholar14 ship, any obligation of that individual for serv15 ice or payment that relates to that scholarship

16 shall be canceled.

17 ‘‘(D) WAIVER.—The Secretary shall pro18 vide for the partial or total waiver or suspen19 sion of any obligation of service or payment of

20 a recipient of an Indian Health Scholarship if

21 the Secretary, in consultation with the appro22 priate area office, Indian tribe, tribal organiza23 tion, and urban Indian organization, determines

24 that—
29

•S 2526 IS

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

2 to meet that obligation or make that pay3 ment;

4 ‘‘(ii) requiring that recipient to meet

5 that obligation or make that payment

6 would result in extreme hardship to the re7 cipient; or

8 ‘‘(iii) the enforcement of the require9 ment to meet the obligation or make the

10 payment would be unconscionable.

11 ‘‘(E) HARDSHIP OR GOOD CAUSE.—Not12 withstanding any other provision of law, in any

13 case of extreme hardship or for other good

14 cause shown, the Secretary may waive, in whole

15 or in part, the right of the United States to re16 cover funds made available under this section.

17 ‘‘(F) BANKRUPTCY.—Notwithstanding any

18 other provision of law, with respect to a recipi19 ent of an Indian Health Scholarship, no obliga20 tion for payment may be released by a dis21 charge in bankruptcy under title 11, United

22 States Code, unless that discharge is granted

23 after the expiration of the 5-year period begin24 ning on the initial date on which that payment

25 is due, and only if the bankruptcy court finds
30

•S 2526 IS

1 that the nondischarge of the obligation would

2 be unconscionable.

3 ‘‘(c) FUNDING FOR TRIBES FOR SCHOLARSHIP PRO4 GRAMS.—

5 ‘‘(1) PROVISION OF FUNDS.—

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

7 make funds available, through area offices, to

8 Indian Tribes and tribal organizations for the

9 purpose of assisting such Tribes and tribal or10 ganizations in educating Indians to serve as

11 health professionals in Indian communities.

12 ‘‘(B) LIMITATION.—The Secretary shall

13 ensure that amounts available for grants under

14 subparagraph (A) for any fiscal year shall not

15 exceed an amount equal to 5 percent of the

16 amount available for each fiscal year for Indian

17 Health Scholarships under this section.

18 ‘‘(C) APPLICATION.—An application for

19 funds under subparagraph (A) shall be in such

20 form and contain such agreements, assurances

21 and information as consistent with this section.

22 ‘‘(2) REQUIREMENTS.—

23 ‘‘(A) IN GENERAL.—An Indian Tribe or

24 tribal organization receiving funds under para25 graph (1) shall agree to provide scholarships to
31

•S 2526 IS

1 Indians in accordance with the requirements of

2 this subsection.

3 ‘‘(B) MATCHING REQUIREMENT.—With re4 spect to the costs of providing any scholarship

5 pursuant to subparagraph (A)—

6 ‘‘(i) 80 percent of the costs of the

7 scholarship shall be paid from the funds

8 provided under paragraph (1) to the In9 dian Tribe or tribal organization; and

10 ‘‘(ii) 20 percent of such costs shall be

11 paid from any other source of funds.

12 ‘‘(3) ELIGIBILITY.—An Indian Tribe or tribal

13 organization shall provide scholarships under this

14 subsection only to Indians who are enrolled or ac15 cepted for enrollment in a course of study (approved

16 by the Secretary) in one of the health professions

17 described in this Act.

18 ‘‘(4) CONTRACTS.—In providing scholarships

19 under paragraph (1), the Secretary and the Indian

20 Tribe or tribal organization shall enter into a writ21 ten contract with each recipient of such scholarship.

22 Such contract shall—

23 ‘‘(A) obligate such recipient to provide

24 service in an Indian health program (as defined

25 in section 110(a)(2)(A)) in the same service
32

•S 2526 IS

1 area where the Indian Tribe or tribal organiza2 tion providing the scholarship is located, for—

3 ‘‘(i) a number of years equal to the

4 number of years for which the scholarship

5 is provided (or the part-time equivalent

6 thereof, as determined by the Secretary),

7 or for a period of 2 years, whichever period

8 is greater; or

9 ‘‘(ii) such greater period of time as

10 the recipient and the Indian Tribe or tribal

11 organization may agree;

12 ‘‘(B) provide that the scholarship—

13 ‘‘(i) may only be expended for—

14 ‘‘(I) tuition expenses, other rea15 sonable educational expenses, and rea16 sonable living expenses incurred in at17 tendance at the educational institu18 tion; and

19 ‘‘(II) payment to the recipient of

20 a monthly stipend of not more than

21 the amount authorized by section

22 338(g)(1)(B) of the Public Health

23 Service Act (42 U.S.C.

24 254m(g)(1)(B), such amount to be re25 duced pro rata (as determined by the
33

•S 2526 IS

1 Secretary) based on the number of

2 hours such student is enrolled, and

3 may not exceed, for any year of at4 tendance which the scholarship is pro5 vided, the total amount required for

6 the year for the purposes authorized

7 in this clause; and

8 ‘‘(ii) may not exceed, for any year of

9 attendance which the scholarship is pro10 vided, the total amount required for the

11 year for the purposes authorized in clause

12 (i);

13 ‘‘(C) require the recipient of such scholar14 ship to maintain an acceptable level of academic

15 standing as determined by the educational insti16 tution in accordance with regulations issued

17 pursuant to this Act; and

18 ‘‘(D) require the recipient of such scholar19 ship to meet the educational and licensure re20 quirements appropriate to the health profession

21 involved.

22 ‘‘(5) BREACH OF CONTRACT.—

23 ‘‘(A) IN GENERAL.—An individual who has

24 entered into a written contract with the Sec-
34

•S 2526 IS

1 retary and an Indian Tribe or tribal organiza2 tion under this subsection and who—

3 ‘‘(i) fails to maintain an acceptable

4 level of academic standing in the education

5 institution in which he or she is enrolled

6 (such level determined by the educational

7 institution under regulations of the Sec8 retary);

9 ‘‘(ii) is dismissed from such education

10 for disciplinary reasons;

11 ‘‘(iii) voluntarily terminates the train12 ing in such an educational institution for

13 which he or she has been provided a schol14 arship under such contract before the com15 pletion of such training; or

16 ‘‘(iv) fails to accept payment, or in17 structs the educational institution in which

18 he or she is enrolled not to accept pay19 ment, in whole or in part, of a scholarship

20 under such contract, in lieu of any service

21 obligation arising under such contract;

22 shall be liable to the United States for the Fed23 eral share of the amount which has been paid

24 to him or her, or on his or her behalf, under

25 the contract.
35

•S 2526 IS

1 ‘‘(B) FAILURE TO PERFORM SERVICE OB2 LIGATION.—If for any reason not specified in

3 subparagraph (A), an individual breaches his or

4 her written contract by failing to either begin

5 such individual’s service obligation required

6 under such contract or to complete such service

7 obligation, the United States shall be entitled to

8 recover from the individual an amount deter9 mined in accordance with the formula specified

10 in subsection (l) of section 110 in the manner

11 provided for in such subsection.

12 ‘‘(C) INFORMATION.—The Secretary may

13 carry out this subsection on the basis of infor14 mation received from Indian Tribes or tribal or15 ganizations involved, or on the basis of informa16 tion collected through such other means as the

17 Secretary deems appropriate.

18 ‘‘(6) REQUIRED AGREEMENTS.—The recipient

19 of a scholarship under paragraph (1) shall agree, in

20 providing health care pursuant to the requirements

21 of this subsection—

22 ‘‘(A) not to discriminate against an indi23 vidual seeking care on the basis of the ability

24 of the individual to pay for such care or on the

25 basis that payment for such care will be made
36

•S 2526 IS

1 pursuant to the program established in title

2 XVIII of the Social Security Act or pursuant to

3 the programs established in title XIX of such

4 Act; and

5 ‘‘(B) to accept assignment under section

6 1842(b)(3)(B)(ii) of the Social Security Act for

7 all services for which payment may be made

8 under part B of title XVIII of such Act, and to

9 enter into an appropriate agreement with the

10 State agency that administers the State plan

11 for medical assistance under title XIX of such

12 Act to provide service to individuals entitled to

13 medical assistance under the plan.

14 ‘‘(7) PAYMENTS.—The Secretary, through the

15 area office, shall make payments under this sub16 section to an Indian Tribe or tribal organization for

17 any fiscal year subsequent to the first fiscal year of

18 such payments unless the Secretary or area office

19 determines that, for the immediately preceding fiscal

20 year, the Indian Tribe or tribal organization has not

21 complied with the requirements of this subsection.

22 ‘‘SEC. 106. AMERICAN INDIANS INTO PSYCHOLOGY PRO23 GRAM.

24 ‘‘(a) IN GENERAL.—Notwithstanding section 102,

25 the Secretary shall provide funds to at least 3 colleges and
37

•S 2526 IS

1 universities for the purpose of developing and maintaining

2 American Indian psychology career recruitment programs

3 as a means of encouraging Indians to enter the mental

4 health field. These programs shall be located at various

5 colleges and universities throughout the country to maxi6 mize their availability to Indian students and new pro7 grams shall be established in different locations from time

8 to time.

9 ‘‘(b) QUENTIN N. BURDICK AMERICAN INDIANS

10 INTO PSYCHOLOGY PROGRAM.—The Secretary shall pro11 vide funds under subsection (a) to develop and maintain

12 a program at the University of North Dakota to be known

13 as the ‘Quentin N. Burdick American Indians Into Psy14 chology Program’. Such program shall, to the maximum

15 extent feasible, coordinate with the Quentin N. Burdick

16 American Indians Into Nursing Program authorized under

17 section 115, the Quentin N. Burdick Indians into Health

18 Program authorized under section 117, and existing uni19 versity research and communications networks.

20 ‘‘(c) REQUIREMENTS.—

21 ‘‘(1) REGULATIONS.—The Secretary shall pro22 mulgate regulations pursuant to this Act for the

23 competitive awarding of funds under this section.
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•S 2526 IS

1 ‘‘(2) PROGRAM.—Applicants for funds under

2 this section shall agree to provide a program which,

3 at a minimum—

4 ‘‘(A) provides outreach and recruitment for

5 health professions to Indian communities in6 cluding elementary, secondary and accredited

7 and accessible community colleges that will be

8 served by the program;

9 ‘‘(B) incorporates a program advisory

10 board comprised of representatives from the

11 Tribes and communities that will be served by

12 the program;

13 ‘‘(C) provides summer enrichment pro14 grams to expose Indian students to the various

15 fields of psychology through research, clinical,

16 and experimental activities;

17 ‘‘(D) provides stipends to undergraduate

18 and graduate students to pursue a career in

19 psychology;

20 ‘‘(E) develops affiliation agreements with

21 tribal community colleges, the Service, univer22 sity affiliated programs, and other appropriate

23 accredited and accessible entities to enhance the

24 education of Indian students;
39

•S 2526 IS

1 ‘‘(F) utilizes, to the maximum extent fea2 sible, existing university tutoring, counseling

3 and student support services; and

4 ‘‘(G) employs, to the maximum extent fea5 sible, qualified Indians in the program.

6 ‘‘(d) ACTIVE DUTY OBLIGATION.—The active duty

7 service obligation prescribed under section 338C of the

8 Public Health Service Act (42 U.S.C. 254m) shall be met

9 by each graduate who receives a stipend described in sub10 section (c)(2)(C) that is funded under this section. Such

11 obligation shall be met by service—

12 ‘‘(1) in the Indian Health Service;

13 ‘‘(2) in a program conducted under a funding

14 agreement contract entered into under the Indian

15 Self-Determination and Education Assistance Act;

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

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

18 determined by the Secretary, in accordance with

19 guidelines promulgated by the Secretary, such prac20 tice is situated in a physician or other health profes21 sional shortage area and addresses the health care

22 needs of a substantial number of Indians.

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

24 ‘‘(a) IN GENERAL.—Any individual who receives a

25 scholarship pursuant to section 105 shall be entitled to
40

•S 2526 IS

1 employment in the Service, or may be employed by a pro2 gram of an Indian tribe, tribal organization, or urban In3 dian organization, or other agency of the Department as

4 may be appropriate and available, during any nonacademic

5 period of the year. Periods of employment pursuant to this

6 subsection shall not be counted in determining the fulfill7 ment of the service obligation incurred as a condition of

8 the scholarship.

9 ‘‘(b) ENROLLEES IN COURSE OF STUDY.—Any indi10 vidual who is enrolled in a course of study in the health

11 professions may be employed by the Service or by an In12 dian tribe, tribal organization, or urban Indian organiza13 tion, during any nonacademic period of the year. Any such

14 employment shall not exceed 120 days during any calendar

15 year.

16 ‘‘(c) HIGH SCHOOL PROGRAMS.—Any individual who

17 is in a high school program authorized under section

18 103(a) may be employed by the Service, or by a Indian

19 Tribe, tribal organization, or urban Indian organization,

20 during any nonacademic period of the year. Any such em21 ployment shall not exceed 120 days during any calendar

22 year.

23 ‘‘(d) ADMINISTRATIVE PROVISIONS.—Any employ24 ment pursuant to this section shall be made without re25 gard to any competitive personnel system or agency per-
41

•S 2526 IS

1 sonnel limitation and to a position which will enable the

2 individual so employed to receive practical experience in

3 the health profession in which he or she is engaged in

4 study. Any individual so employed shall receive payment

5 for his or her services comparable to the salary he or she

6 would receive if he or she were employed in the competitive

7 system. Any individual so employed shall not be counted

8 against any employment ceiling affecting the Service or

9 the Department.

10 ‘‘SEC. 108. CONTINUING EDUCATION ALLOWANCES.

11 ‘‘In order to encourage health professionals, including

12 for purposes of this section, community health representa13 tives and emergency medical technicians, to join or con14 tinue in the Service or in any program of an Indian tribe,

15 tribal organization, or urban Indian organization and to

16 provide their services in the rural and remote areas where

17 a significant portion of the Indian people reside, the Sec18 retary, acting through the area offices, may provide allow19 ances to health professionals employed in the Service or

20 such a program to enable such professionals to take leave

21 of their duty stations for a period of time each year (as

22 prescribed by regulations of the Secretary) for professional

23 consultation and refresher training courses.
42

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1 ‘‘SEC. 109. COMMUNITY HEALTH REPRESENTATIVE PRO2 GRAM.

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

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

5 as the Snyder Act), the Secretary shall maintain a Com6 munity Health Representative Program under which the

7 Service, Indian tribes and tribal organizations—

8 ‘‘(1) provide for the training of Indians as com9 munity health representatives; and

10 ‘‘(2) use such community health representatives

11 in the provision of health care, health promotion,

12 and disease prevention services to Indian commu13 nities.

14 ‘‘(b) ACTIVITIES.—The Secretary, acting through the

15 Community Health Representative Program, shall—

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

17 community health representatives to ensure that the

18 community health representatives provide quality

19 health care, health promotion, and disease preven20 tion services to the Indian communities served by

21 such Program;

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

23 and maintain a curriculum that—

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

25 health care with supervised practical experience

26 in the provision of health care; and
43

•S 2526 IS

1 ‘‘(B) provides instruction and practical ex2 perience in health promotion and disease pre3 vention activities, with appropriate consider4 ation given to lifestyle factors that have an im5 pact on Indian health status, such as alco6 holism, family dysfunction, and poverty;

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

8 needs of community health representatives for con9 tinuing education in health care, health promotion,

10 and disease prevention and maintain programs that

11 meet the needs for such continuing education;

12 ‘‘(4) maintain a system that provides close su13 pervision of community health representatives;

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

15 of community health representatives is reviewed and

16 evaluated; and

17 ‘‘(6) promote traditional health care practices

18 of the Indian tribes served consistent with the Serv19 ice standards for the provision of health care, health

20 promotion, and disease prevention.

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

22 PROGRAM.

23 ‘‘(a) ESTABLISHMENT.—

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

25 through the Service, shall establish a program to be
44

•S 2526 IS

1 known as the Indian Health Service Loan Repay2 ment Program (referred to in this Act as the ‘Loan

3 Repayment Program’) in order to assure an ade4 quate supply of trained health professionals nec5 essary to maintain accreditation of, and provide

6 health care services to Indians through, Indian

7 health programs.

8 ‘‘(2) DEFINITIONS.—In this section:

9 ‘‘(A) INDIAN HEALTH PROGRAM.—The

10 term ‘Indian health program’ means any health

11 program or facility funded, in whole or part, by

12 the Service for the benefit of Indians and

13 administered—

14 ‘‘(i) directly by the Service;

15 ‘‘(ii) by any Indian tribe or tribal or

16 Indian organization pursuant to a funding

17 agreement under—

18 ‘‘(I) the Indian Self-Determina19 tion and Educational Assistance Act;

20 or

21 ‘‘(II) section 23 of the Act of

22 April 30, 1908 (25 U.S.C. 47) (com23 monly known as the ‘Buy-Indian

24 Act’); or
45

•S 2526 IS

1 ‘‘(iii) by an urban Indian organization

2 pursuant to title V.

3 ‘‘(B) STATE.—The term ‘State’ has the

4 same meaning given such term in section

5 331(i)(4) of the Public Health Service Act.

6 ‘‘(b) ELIGIBILITY.—To be eligible to participate in

7 the Loan Repayment Program, an individual must—

8 ‘‘(1)(A) be enrolled—

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

10 accredited institution, as determined by the

11 Secretary, within any State and be scheduled to

12 complete such course of study in the same year

13 such individual applies to participate in such

14 program; or

15 ‘‘(ii) in an approved graduate training pro16 gram in a health profession; or

17 ‘‘(B) have—

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

19 ‘‘(ii) a license to practice a health profes20 sion in a State;

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

22 as a commissioned officer in the Regular or Reserve

23 Corps of the Public Health Service;
46

•S 2526 IS

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

2 in the Regular or Reserve Corps of the Public

3 Health Service;

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

5 service employment in the Indian Health Service; or

6 ‘‘(D) be employed in an Indian health program

7 without a service obligation; and

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

9 a contract described in subsection (f).

10 ‘‘(c) FORMS.—

11 ‘‘(1) IN GENERAL.—In disseminating applica12 tion forms and contract forms to individuals desiring

13 to participate in the Loan Repayment Program, the

14 Secretary shall include with such forms a fair sum15 mary of the rights and liabilities of an individual

16 whose application is approved (and whose contract is

17 accepted) by the Secretary, including in the sum18 mary a clear explanation of the damages to which

19 the United States is entitled under subsection (l) in

20 the case of the individual’s breach of the contract.

21 The Secretary shall provide such individuals with

22 sufficient information regarding the advantages and

23 disadvantages of service as a commissioned officer in

24 the Regular or Reserve Corps of the Public Health

25 Service or a civilian employee of the Indian Health
47

•S 2526 IS

1 Service to enable the individual to make a decision

2 on an informed basis.

3 ‘‘(2) FORMS TO BE UNDERSTANDABLE.—The

4 application form, contract form, and all other infor5 mation furnished by the Secretary under this section

6 shall be written in a manner calculated to be under7 stood by the average individual applying to partici8 pate in the Loan Repayment Program.

9 ‘‘(3) AVAILABILITY.—The Secretary shall make

10 such application forms, contract forms, and other in11 formation available to individuals desiring to partici12 pate in the Loan Repayment Program on a date suf13 ficiently early to ensure that such individuals have

14 adequate time to carefully review and evaluate such

15 forms and information.

16 ‘‘(d) PRIORITY.—

17 ‘‘(1) ANNUAL DETERMINATIONS.—The Sec18 retary, acting through the Service and in accordance

19 with subsection (k), shall annually—

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

21 health program for which there is a need or a

22 vacancy; and

23 ‘‘(B) rank those positions in order of pri24 ority.
48

•S 2526 IS

1 ‘‘(2) PRIORITY IN APPROVAL.—Consistent with

2 the priority determined under paragraph (1), the

3 Secretary, in determining which applications under

4 the Loan Repayment Program to approve (and

5 which contracts to accept), shall give priority to ap6 plications made by—

7 ‘‘(A) Indians; and

8 ‘‘(B) individuals recruited through the ef9 forts an Indian tribe, tribal organization, or

10 urban Indian organization.

11 ‘‘(e) CONTRACTS.—

12 ‘‘(1) IN GENERAL.—An individual becomes a

13 participant in the Loan Repayment Program only

14 upon the Secretary and the individual entering into

15 a written contract described in subsection (f).

16 ‘‘(2) NOTICE.—Not later than 21 days after

17 considering an individual for participation in the

18 Loan Repayment Program under paragraph (1), the

19 Secretary shall provide written notice to the indi20 vidual of—

21 ‘‘(A) the Secretary’s approving of the indi22 vidual’s participation in the Loan Repayment

23 Program, including extensions resulting in an

24 aggregate period of obligated service in excess

25 of 4 years; or
49

•S 2526 IS

1 ‘‘(B) the Secretary’s disapproving an indi2 vidual’s participation in such Program.

3 ‘‘(f) WRITTEN CONTRACT.—The written contract re4 ferred to in this section between the Secretary and an indi5 vidual shall contain—

6 ‘‘(1) an agreement under which—

7 ‘‘(A) subject to paragraph (3), the Sec8 retary agrees—

9 ‘‘(i) to pay loans on behalf of the indi10 vidual in accordance with the provisions of

11 this section; and

12 ‘‘(ii) to accept (subject to the avail13 ability of appropriated funds for carrying

14 out this section) the individual into the

15 Service or place the individual with a tribe,

16 tribal organization, or urban Indian orga17 nization as provided in subparagraph

18 (B)(iii); and

19 ‘‘(B) subject to paragraph (3), the indi20 vidual agrees—

21 ‘‘(i) to accept loan payments on behalf

22 of the individual;

23 ‘‘(ii) in the case of an individual de24 scribed in subsection (b)(1)—
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1 ‘‘(I) to maintain enrollment in a

2 course of study or training described

3 in subsection (b)(1)(A) until the indi4 vidual completes the course of study

5 or training; and

6 ‘‘(II) while enrolled in such

7 course of study or training, to main8 tain an acceptable level of academic

9 standing (as determined under regula10 tions of the Secretary by the edu11 cational institution offering such

12 course of study or training);

13 ‘‘(iii) to serve for a time period (re14 ferred to in this section as the ‘period of

15 obligated service’) equal to 2 years or such

16 longer period as the individual may agree

17 to serve in the full-time clinical practice of

18 such individual’s profession in an Indian

19 health program to which the individual

20 may be assigned by the Secretary;

21 ‘‘(2) a provision permitting the Secretary to ex22 tend for such longer additional periods, as the indi23 vidual may agree to, the period of obligated service

24 agreed to by the individual under paragraph

25 (1)(B)(iii);
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1 ‘‘(3) a provision that any financial obligation of

2 the United States arising out of a contract entered

3 into under this section and any obligation of the in4 dividual which is conditioned thereon is contingent

5 upon funds being appropriated for loan repayments

6 under this section;

7 ‘‘(4) a statement of the damages to which the

8 United States is entitled under subsection (l) for the

9 individual’s breach of the contract; and

10 ‘‘(5) such other statements of the rights and li11 abilities of the Secretary and of the individual, not

12 inconsistent with this section.

13 ‘‘(g) LOAN REPAYMENTS.—

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

15 for an individual under a written contract under the

16 Loan Repayment Program shall consist of payment,

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

18 individual of the principal, interest, and related ex19 penses on government and commercial loans received

20 by the individual regarding the undergraduate or

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

22 loans were made for—

23 ‘‘(A) tuition expenses;
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1 ‘‘(B) all other reasonable educational ex2 penses, including fees, books, and laboratory ex3 penses, incurred by the individual; and

4 ‘‘(C) reasonable living expenses as deter5 mined by the Secretary.

6 ‘‘(2) AMOUNT OF PAYMENT.—

7 ‘‘(A) IN GENERAL.—For each year of obli8 gated service that an individual contracts to

9 serve under subsection (f) the Secretary may

10 pay up to $35,000 (or an amount equal to the

11 amount specified in section 338B(g)(2)(A) of

12 the Public Health Service Act) on behalf of the

13 individual for loans described in paragraph (1).

14 In making a determination of the amount to

15 pay for a year of such service by an individual,

16 the Secretary shall consider the extent to which

17 each such determination—

18 ‘‘(i) affects the ability of the Secretary

19 to maximize the number of contracts that

20 can be provided under the Loan Repay21 ment Program from the amounts appro22 priated for such contracts;

23 ‘‘(ii) provides an incentive to serve in

24 Indian health programs with the greatest

25 shortages of health professionals; and
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1 ‘‘(iii) provides an incentive with re2 spect to the health professional involved re3 maining in an Indian health program with

4 such a health professional shortage, and

5 continuing to provide primary health serv6 ices, after the completion of the period of

7 obligated service under the Loan Repay8 ment Program.

9 ‘‘(B) TIME FOR PAYMENT.—Any arrange10 ment made by the Secretary for the making of

11 loan repayments in accordance with this sub12 section shall provide that any repayments for a

13 year of obligated service shall be made not later

14 than the end of the fiscal year in which the in15 dividual completes such year of service.

16 ‘‘(3) SCHEDULE FOR PAYMENTS.—The Sec17 retary may enter into an agreement with the holder

18 of any loan for which payments are made under the

19 Loan Repayment Program to establish a schedule

20 for the making of such payments.

21 ‘‘(h) COUNTING OF INDIVIDUALS.—Notwithstanding

22 any other provision of law, individuals who have entered

23 into written contracts with the Secretary under this sec24 tion, while undergoing academic training, shall not be
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1 counted against any employment ceiling affecting the De2 partment.

3 ‘‘(i) RECRUITING PROGRAMS.—The Secretary shall

4 conduct recruiting programs for the Loan Repayment Pro5 gram and other health professional programs of the Serv6 ice at educational institutions training health professionals

7 or specialists identified in subsection (a).

8 ‘‘(j) NONAPPLICATION OF CERTAIN PROVISION.—

9 Section 214 of the Public Health Service Act (42 U.S.C.

10 215) shall not apply to individuals during their period of

11 obligated service under the Loan Repayment Program.

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

13 in assigning individuals to serve in Indian health programs

14 pursuant to contracts entered into under this section,

15 shall—

16 ‘‘(1) ensure that the staffing needs of Indian

17 health programs administered by an Indian tribe or

18 tribal or health organization receive consideration on

19 an equal basis with programs that are administered

20 directly by the Service; and

21 ‘‘(2) give priority to assigning individuals to In22 dian health programs that have a need for health

23 professionals to provide health care services as a re24 sult of individuals having breached contracts entered

25 into under this section.
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1 ‘‘(l) BREACH OF CONTRACT.—

2 ‘‘(1) IN GENERAL.—An individual who has en3 tered into a written contract with the Secretary

4 under this section and who—

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

6 course of study and who—

7 ‘‘(i) fails to maintain an acceptable

8 level of academic standing in the edu9 cational institution in which he is enrolled

10 (such level determined by the educational

11 institution under regulations of the Sec12 retary);

13 ‘‘(ii) voluntarily terminates such en14 rollment; or

15 ‘‘(iii) is dismissed from such edu16 cational institution before completion of

17 such course of study; or

18 ‘‘(B) is enrolled in a graduate training pro19 gram, and who fails to complete such training

20 program, and does not receive a waiver from

21 the Secretary under subsection (b)(1)(B)(ii),

22 shall be liable, in lieu of any service obligation aris23 ing under such contract, to the United States for the

24 amount which has been paid on such individual’s be25 half under the contract.
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1 ‘‘(2) AMOUNT OF RECOVERY.—If, for any rea2 son not specified in paragraph (1), an individual

3 breaches his written contract under this section by

4 failing either to begin, or complete, such individual’s

5 period of obligated service in accordance with sub6 section (f), the United States shall be entitled to re7 cover from such individual an amount to be deter8 mined in accordance with the following formula:

9 A=3Z(t-s/t)

10 in which—

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

12 is entitled to recover;

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

14 under this section to, or on behalf of, the indi15 vidual and the interest on such amounts which

16 would be payable if, at the time the amounts

17 were paid, they were loans bearing interest at

18 the maximum legal prevailing rate, as deter19 mined by the Treasurer of the United States;

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

21 the individual’s period of obligated service in

22 accordance with subsection (f); and

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

24 period served by such individual in accordance

25 with this section.
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1 Amounts not paid within such period shall be sub2 ject to collection through deductions in Medicare

3 payments pursuant to section 1892 of the Social Se4 curity Act.

5 ‘‘(3) DAMAGES.—

6 ‘‘(A) TIME FOR PAYMENT.—Any amount

7 of damages which the United States is entitled

8 to recover under this subsection shall be paid to

9 the United States within the 1-year period be10 ginning on the date of the breach of contract or

11 such longer period beginning on such date as

12 shall be specified by the Secretary.

13 ‘‘(B) DELINQUENCIES.—If damages de14 scribed in subparagraph (A) are delinquent for

15 3 months, the Secretary shall, for the purpose

16 of recovering such damages—

17 ‘‘(i) utilize collection agencies con18 tracted with by the Administrator of the

19 General Services Administration; or

20 ‘‘(ii) enter into contracts for the re21 covery of such damages with collection

22 agencies selected by the Secretary.

23 ‘‘(C) CONTRACTS FOR RECOVERY OF DAM24 AGES.—Each contract for recovering damages

25 pursuant to this subsection shall provide that
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1 the contractor will, not less than once each 6

2 months, submit to the Secretary a status report

3 on the success of the contractor in collecting

4 such damages. Section 3718 of title 31, United

5 States Code, shall apply to any such contract to

6 the extent not inconsistent with this subsection.

7 ‘‘(m) CANCELLATION, WAIVER OR RELEASE.—

8 ‘‘(1) CANCELLATION.—Any obligation of an in9 dividual under the Loan Repayment Program for

10 service or payment of damages shall be canceled

11 upon the death of the individual.

12 ‘‘(2) WAIVER OF SERVICE OBLIGATION.—The

13 Secretary shall by regulation provide for the partial

14 or total waiver or suspension of any obligation of

15 service or payment by an individual under the Loan

16 Repayment Program whenever compliance by the in17 dividual is impossible or would involve extreme hard18 ship to the individual and if enforcement of such ob19 ligation with respect to any individual would be un20 conscionable.

21 ‘‘(3) WAIVER OF RIGHTS OF UNITED STATES.—

22 The Secretary may waive, in whole or in part, the

23 rights of the United States to recover amounts

24 under this section in any case of extreme hardship
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1 or other good cause shown, as determined by the

2 Secretary.

3 ‘‘(4) RELEASE.—Any obligation of an individual

4 under the Loan Repayment Program for payment of

5 damages may be released by a discharge in bank6 ruptcy under title 11 of the United States Code only

7 if such discharge is granted after the expiration of

8 the 5-year period beginning on the first date that

9 payment of such damages is required, and only if

10 the bankruptcy court finds that nondischarge of the

11 obligation would be unconscionable.

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

13 President, for inclusion in each report required to be sub14 mitted to the Congress under section 801, a report con15 cerning the previous fiscal year which sets forth—

16 ‘‘(1) the health professional positions main17 tained by the Service or by tribal or Indian organi18 zations for which recruitment or retention is dif19 ficult;

20 ‘‘(2) the number of Loan Repayment Program

21 applications filed with respect to each type of health

22 profession;

23 ‘‘(3) the number of contracts described in sub24 section (f) that are entered into with respect to each

25 health profession;
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1 ‘‘(4) the amount of loan payments made under

2 this section, in total and by health profession;

3 ‘‘(5) the number of scholarship grants that are

4 provided under section 105 with respect to each

5 health profession;

6 ‘‘(6) the amount of scholarship grants provided

7 under section 105, in total and by health profession;

8 ‘‘(7) the number of providers of health care

9 that will be needed by Indian health programs, by

10 location and profession, during the 3 fiscal years be11 ginning after the date the report is filed; and

12 ‘‘(8) the measures the Secretary plans to take

13 to fill the health professional positions maintained

14 by the Service or by tribes, tribal organizations, or

15 urban Indian organizations for which recruitment or

16 retention is difficult.

17 ‘‘SEC. 111. SCHOLARSHIP AND LOAN REPAYMENT RECOV18 ERY FUND.

19 ‘‘(a) ESTABLISHMENT.—Notwithstanding section

20 102, there is established in the Treasury of the United

21 States a fund to be known as the Indian Health Scholar22 ship and Loan Repayment Recovery Fund (referred to in

23 this section as the ‘LRRF’). The LRRF Fund shall con24 sist of—
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1 ‘‘(1) such amounts as may be collected from in2 dividuals under subparagraphs (A) and (B) of sec3 tion 105(b)(4) and section 110(l) for breach of con4 tract;

5 ‘‘(2) such funds as may be appropriated to the

6 LRRF;

7 ‘‘(3) such interest earned on amounts in the

8 LRRF; and

9 ‘‘(4) such additional amounts as may be col10 lected, appropriated, or earned relative to the

11 LRRF.

12 Amounts appropriated to the LRRF shall remain available

13 until expended.

14 ‘‘(b) USE OF LRRF.—

15 ‘‘(1) IN GENERAL.—Amounts in the LRRF

16 may be expended by the Secretary, subject to section

17 102, acting through the Service, to make payments

18 to the Service or to an Indian tribe or tribal organi19 zation administering a health care program pursuant

20 to a funding agreement entered into under the In21 dian Self-Determination and Education Assistance

22 Act—

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

24 section 105 or a loan repayment program par25 ticipant under section 110 has been assigned to
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1 meet the obligated service requirements pursu2 ant to sections; and

3 ‘‘(B) that has a need for a health profes4 sional to provide health care services as a result

5 of such recipient or participant having breached

6 the contract entered into under section 105 or

7 section 110.

8 ‘‘(2) SCHOLARSHIPS AND RECRUITING.—An In9 dian tribe or tribal organization receiving payments

10 pursuant to paragraph (1) may expend the payments

11 to provide scholarships or to recruit and employ, di12 rectly or by contract, health professionals to provide

13 health care services.

14 ‘‘(c) INVESTING OF FUND.—

15 ‘‘(1) IN GENERAL.—The Secretary of the

16 Treasury shall invest such amounts of the LRRF as

17 the Secretary determines are not required to meet

18 current withdrawals from the LRRF. Such invest19 ments may be made only in interest-bearing obliga20 tions of the United States. For such purpose, such

21 obligations may be acquired on original issue at the

22 issue price, or by purchase of outstanding obliga23 tions at the market price.
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1 ‘‘(2) SALE PRICE.—Any obligation acquired by

2 the LRRF may be sold by the Secretary of the

3 Treasury at the market price.

4 ‘‘SEC. 112. RECRUITMENT ACTIVITIES.

5 ‘‘(a) REIMBURSEMENT OF EXPENSES.—The Sec6 retary may reimburse health professionals seeking posi7 tions in the Service, Indian tribes, tribal organizations, or

8 urban Indian organizations, including unpaid student vol9 unteers and individuals considering entering into a con10 tract under section 110, and their spouses, for actual and

11 reasonable expenses incurred in traveling to and from

12 their places of residence to an area in which they may

13 be assigned for the purpose of evaluating such area with

14 respect to such assignment.

15 ‘‘(b) ASSIGNMENT OF PERSONNEL.—The Secretary,

16 acting through the Service, shall assign one individual in

17 each area office to be responsible on a full-time basis for

18 recruitment activities.

19 ‘‘SEC. 113. TRIBAL RECRUITMENT AND RETENTION PRO20 GRAM.

21 ‘‘(a) FUNDING OF PROJECTS.—The Secretary, acting

22 through the Service, shall fund innovative projects for a

23 period not to exceed 3 years to enable Indian tribes, tribal

24 organizations, and urban Indian organizations to recruit,

25 place, and retain health professionals to meet the staffing
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1 needs of Indian health programs (as defined in section

2 110(a)(2)(A)).

3 ‘‘(b) ELIGIBILITY.—Any Indian tribe, tribal organi4 zation, or urban Indian organization may submit an appli5 cation for funding of a project pursuant to this section.

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

7 ‘‘(a) DEMONSTRATION PROJECT.—The Secretary,

8 acting through the Service, shall establish a demonstration

9 project to enable health professionals who have worked in

10 an Indian health program (as defined in section 110) for

11 a substantial period of time to pursue advanced training

12 or research in areas of study for which the Secretary de13 termines a need exists.

14 ‘‘(b) SERVICE OBLIGATION.—

15 ‘‘(1) IN GENERAL.—An individual who partici16 pates in the project under subsection (a), where the

17 educational costs are borne by the Service, shall

18 incur an obligation to serve in an Indian health pro19 gram for a period of obligated service equal to at

20 least the period of time during which the individual

21 participates in such project.

22 ‘‘(2) FAILURE TO COMPLETE SERVICE.—In the

23 event that an individual fails to complete a period of

24 obligated service under paragraph (1), the individual

25 shall be liable to the United States for the period of
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1 service remaining. In such event, with respect to in2 dividuals entering the project after the date of the

3 enactment of this Act, the United States shall be en4 titled to recover from such individual an amount to

5 be determined in accordance with the formula speci6 fied in subsection (l) of section 110 in the manner

7 provided for in such subsection.

8 ‘‘(c) OPPORTUNITY TO PARTICIPATE.—Health pro9 fessionals from Indian tribes, tribal organizations, and

10 urban Indian organizations under the authority of the In11 dian Self-Determination and Education Assistance Act

12 shall be given an equal opportunity to participate in the

13 program under subsection (a).

14 ‘‘SEC. 115. NURSING PROGRAMS; QUENTIN N. BURDICK

15 AMERICAN INDIANS INTO NURSING PRO16 GRAM.

17 ‘‘(a) GRANTS.—Notwithstanding section 102, the

18 Secretary, acting through the Service, shall provide funds

19 to—

20 ‘‘(1) public or private schools of nursing;

21 ‘‘(2) tribally controlled community colleges and

22 tribally controlled postsecondary vocational institu23 tions (as defined in section 390(2) of the Tribally

24 Controlled Vocational Institutions Support Act of

25 1990 (20 U.S.C. 2397h(2)); and
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1 ‘‘(3) nurse midwife programs, and advance

2 practice nurse programs, that are provided by any

3 tribal college accredited nursing program, or in the

4 absence of such, any other public or private institu5 tion,

6 for the purpose of increasing the number of nurses, nurse

7 midwives, and nurse practitioners who deliver health care

8 services to Indians.

9 ‘‘(b) USE OF GRANTS.—Funds provided under sub10 section (a) may be used to—

11 ‘‘(1) recruit individuals for programs which

12 train individuals to be nurses, nurse midwives, or

13 advanced practice nurses;

14 ‘‘(2) provide scholarships to Indian individuals

15 enrolled in such programs that may be used to pay

16 the tuition charged for such program and for other

17 expenses incurred in connection with such program,

18 including books, fees, room and board, and stipends

19 for living expenses;

20 ‘‘(3) provide a program that encourages nurses,

21 nurse midwives, and advanced practice nurses to

22 provide, or continue to provide, health care services

23 to Indians;
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1 ‘‘(4) provide a program that increases the skills

2 of, and provides continuing education to, nurses,

3 nurse midwives, and advanced practice nurses; or

4 ‘‘(5) provide any program that is designed to

5 achieve the purpose described in subsection (a).

6 ‘‘(c) APPLICATIONS.—Each application for funds

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

8 Secretary may require to establish the connection between

9 the program of the applicant and a health care facility

10 that primarily serves Indians.

11 ‘‘(d) PREFERENCES.—In providing funds under sub12 section (a), the Secretary shall extend a preference to—

13 ‘‘(1) programs that provide a preference to In14 dians;

15 ‘‘(2) programs that train nurse midwives or ad16 vanced practice nurses;

17 ‘‘(3) programs that are interdisciplinary; and

18 ‘‘(4) programs that are conducted in coopera19 tion with a center for gifted and talented Indian stu20 dents established under section 5324(a) of the In21 dian Education Act of 1988.

22 ‘‘(e) QUENTIN N. BURDICK AMERICAN INDIANS INTO

23 NURSING PROGRAM.—The Secretary shall ensure that a

24 portion of the funds authorized under subsection (a) is

25 made available to establish and maintain a program at the
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1 University of North Dakota to be known as the ‘Quentin

2 N. Burdick American Indians Into Nursing Program’.

3 Such program shall, to the maximum extent feasible, co4 ordinate with the Quentin N. Burdick American Indians

5 Into Psychology Program established under section 106(b)

6 and the Quentin N. Burdick Indian Health Programs es7 tablished under section 117(b).

8 ‘‘(f) SERVICE OBLIGATION.—The active duty service

9 obligation prescribed under section 338C of the Public

10 Health Service Act (42 U.S.C. 254m) shall be met by each

11 individual who receives training or assistance described in

12 paragraph (1) or (2) of subsection (b) that is funded

13 under subsection (a). Such obligation shall be met by

14 service—

15 ‘‘(1) in the Indian Health Service;

16 ‘‘(2) in a program conducted under a contract

17 entered into under the Indian Self-Determination

18 and Education assistance Act;

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

20 ‘‘(4) in the private practice of nursing if, as de21 termined by the Secretary, in accordance with guide22 lines promulgated by the Secretary, such practice is

23 situated in a physician or other health professional

24 shortage area and addresses the health care needs of

25 a substantial number of Indians.
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1 ‘‘SEC. 116. TRIBAL CULTURE AND HISTORY.

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

3 the Service, shall require that appropriate employees of

4 the Service who serve Indian tribes in each service area

5 receive educational instruction in the history and culture

6 of such tribes and their relationship to the Service.

7 ‘‘(b) REQUIREMENTS.—To the extent feasible, the

8 educational instruction to be provided under subsection

9 (a) shall—

10 ‘‘(1) be provided in consultation with the af11 fected tribal governments, tribal organizations, and

12 urban Indian organizations;

13 ‘‘(2) be provided through tribally-controlled

14 community colleges (within the meaning of section

15 2(4) of the Tribally Controlled Community College

16 Assistance Act of 1978) and tribally controlled post17 secondary vocational institutions (as defined in sec18 tion 390(2) of the Tribally Controlled Vocational In19 stitutions Support Act of 1990 (20 U.S.C.

20 2397h(2)); and

21 ‘‘(3) include instruction in Native American

22 studies.

23 ‘‘SEC. 117. INMED PROGRAM.

24 ‘‘(a) GRANTS.—The Secretary may provide grants to

25 3 colleges and universities for the purpose of maintaining

26 and expanding the Native American health careers recruit-
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1 ment program known as the ‘Indians into Medicine Pro2 gram’ (referred to in this section as ‘INMED’) as a means

3 of encouraging Indians to enter the health professions.

4 ‘‘(b) QUENTIN N. BURDICK INDIAN HEALTH PRO5 GRAM.—The Secretary shall provide 1 of the grants under

6 subsection (a) to maintain the INMED program at the

7 University of North Dakota, to be known as the ‘Quentin

8 N. Burdick Indian Health Program’, unless the Secretary

9 makes a determination, based upon program reviews, that

10 the program is not meeting the purposes of this section.

11 Such program shall, to the maximum extent feasible, co12 ordinate with the Quentin N. Burdick American Indians

13 Into Psychology Program established under section 106(b)

14 and the Quentin N. Burdick American Indians Into Nurs15 ing Program established under section 115.

16 ‘‘(c) REQUIREMENTS.—

17 ‘‘(1) IN GENERAL.—The Secretary shall develop

18 regulations to govern grants under to this section.

19 ‘‘(2) PROGRAM REQUIREMENTS.—Applicants

20 for grants provided under this section shall agree to

21 provide a program that—

22 ‘‘(A) provides outreach and recruitment for

23 health professions to Indian communities in24 cluding elementary, secondary and community
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1 colleges located on Indian reservations which

2 will be served by the program;

3 ‘‘(B) incorporates a program advisory

4 board comprised of representatives from the

5 tribes and communities which will be served by

6 the program;

7 ‘‘(C) provides summer preparatory pro8 grams for Indian students who need enrichment

9 in the subjects of math and science in order to

10 pursue training in the health professions;

11 ‘‘(D) provides tutoring, counseling and

12 support to students who are enrolled in a health

13 career program of study at the respective col14 lege or university; and

15 ‘‘(E) to the maximum extent feasible, em16 ploys qualified Indians in the program.

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

18 COLLEGES.

19 ‘‘(a) ESTABLISHMENT GRANTS.—

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

21 through the Service, shall award grants to accredited

22 and accessible community colleges for the purpose of

23 assisting such colleges in the establishment of pro24 grams which provide education in a health profes25 sion leading to a degree or diploma in a health pro-
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1 fession for individuals who desire to practice such

2 profession on an Indian reservation, in the Service,

3 or in a tribal health program.

4 ‘‘(2) AMOUNT.—The amount of any grant

5 awarded to a community college under paragraph

6 (1) for the first year in which such a grant is pro7 vided to the community college shall not exceed

8 $100,000.

9 ‘‘(b) CONTINUATION GRANTS.—

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

11 through the Service, shall award grants to accredited

12 and accessible community colleges that have estab13 lished a program described in subsection (a)(1) for

14 the purpose of maintaining the program and recruit15 ing students for the program.

16 ‘‘(2) ELIGIBILITY.—Grants may only be made

17 under this subsection to a community college that—

18 ‘‘(A) is accredited;

19 ‘‘(B) has a relationship with a hospital fa20 cility, Service facility, or hospital that could

21 provide training of nurses or health profes22 sionals;

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

24 an accredited college or university medical

25 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 which train health professionals;

5 and

6 ‘‘(ii) stipulate certifications necessary

7 to approve internship and field placement

8 opportunities at health programs of the

9 Service or at tribal health programs;

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

11 appropriate certifications;

12 ‘‘(E) is capable of obtaining State or re13 gional accreditation of the program described in

14 subsection (a)(1); and

15 ‘‘(F) agrees to provide for Indian pref16 erence for applicants for programs under this

17 section.

18 ‘‘(c) SERVICE PERSONNEL AND TECHNICAL ASSIST19 ANCE.—The Secretary shall encourage community colleges

20 described in subsection (b)(2) to establish and maintain

21 programs described in subsection (a)(1) by—

22 ‘‘(1) entering into agreements with such col23 leges for the provision of qualified personnel of the

24 Service to teach courses of study in such programs,

25 and
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1 ‘‘(2) providing technical assistance and support

2 to such colleges.

3 ‘‘(d) SPECIFIED COURSES OF STUDY.—Any program

4 receiving assistance under this section that is conducted

5 with respect to a health profession shall also offer courses

6 of study which provide advanced training for any health

7 professional who—

8 ‘‘(1) has already received a degree or diploma

9 in such health profession; and

10 ‘‘(2) provides clinical services on an Indian res11 ervation, at a Service facility, or at a tribal clinic.

12 Such courses of study may be offered in conjunction with

13 the college or university with which the community college

14 has entered into the agreement required under subsection

15 (b)(2)(C).

16 ‘‘(e) PRIORITY.—Priority shall be provided under this

17 section to tribally controlled colleges in service areas that

18 meet the requirements of subsection (b).

19 ‘‘(f) DEFINITIONS.—In this section:

20 ‘‘(1) COMMUNITY COLLEGE.—The term ‘com21 munity college’ means—

22 ‘‘(A) a tribally controlled community col23 lege; or

24 ‘‘(B) a junior or community college.
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1 ‘‘(2) JUNIOR OR COMMUNITY COLLEGE.—The

2 term ‘junior or community college’’ has the meaning

3 given such term by section 312(e) of the Higher

4 Education Act of 1965 (20 U.S.C. 1058(e)).

5 ‘‘(3) TRIBALLY CONTROLLED COLLEGE.—The

6 term ‘tribally controlled college’ has the meaning

7 given the term ‘tribally controlled community college’

8 by section 2(4) of the Tribally Controlled Commu9 nity College Assistance Act of 1978.

10 ‘‘SEC. 119. RETENTION BONUS.

11 ‘‘(a) IN GENERAL.—The Secretary may pay a reten12 tion bonus to any health professional employed by, or as13 signed to, and serving in, the Service, an Indian tribe, a

14 tribal organization, or an urban Indian organization either

15 as a civilian employee or as a commissioned officer in the

16 Regular or Reserve Corps of the Public Health Service

17 who—

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

19 for which recruitment or retention of personnel is

20 difficult;

21 ‘‘(2) the Secretary determines is needed by the

22 Service, tribe, tribal organization, or urban organiza23 tion;

24 ‘‘(3) has—
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1 ‘‘(A) completed 3 years of employment

2 with the Service; tribe, tribal organization, or

3 urban organization; or

4 ‘‘(B) completed any service obligations in5 curred as a requirement of—

6 ‘‘(i) any Federal scholarship program;

7 or

8 ‘‘(ii) any Federal education loan re9 payment program; and

10 ‘‘(4) enters into an agreement with the Service,

11 Indian tribe, tribal organization, or urban Indian or12 ganization for continued employment for a period of

13 not less than 1 year.

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

15 the retention bonus which shall provide for a higher an16 nual rate for multiyear agreements than for single year

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

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

19 annum.

20 ‘‘(c) FAILURE TO COMPLETE TERM OF SERVICE.—

21 Any health professional failing to complete the agreed

22 upon term of service, except where such failure is through

23 no fault of the individual, shall be obligated to refund to

24 the Government the full amount of the retention bonus

25 for the period covered by the agreement, plus interest as
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1 determined by the Secretary in accordance with section

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

3 ‘‘(d) FUNDING AGREEMENT.—The Secretary may

4 pay a retention bonus to any health professional employed

5 by an organization providing health care services to Indi6 ans pursuant to a funding agreement under the Indian

7 Self-Determination and Education Assistance Act if such

8 health professional is serving in a position which the Sec9 retary determines is—

10 ‘‘(1) a position for which recruitment or reten11 tion is difficult; and

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

13 to Indians.

14 ‘‘SEC. 120. NURSING RESIDENCY PROGRAM.

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

16 through the Service, shall establish a program to enable

17 Indians who are licensed practical nurses, licensed voca18 tional nurses, and registered nurses who are working in

19 an Indian health program (as defined in section

20 110(a)(2)(A)), and have done so for a period of not less

21 than 1 year, to pursue advanced training.

22 ‘‘(b) REQUIREMENT.—The program established

23 under subsection (a) shall include a combination of edu24 cation and work study in an Indian health program (as

25 defined in section 110(a)(2)(A)) leading to an associate
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1 or bachelor’s degree (in the case of a licensed practical

2 nurse or licensed vocational nurse) or a bachelor’s degree

3 (in the case of a registered nurse) or an advanced degrees

4 in nursing and public health.

5 ‘‘(c) SERVICE OBLIGATION.—An individual who par6 ticipates in a program under subsection (a), where the

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

8 obligation to serve in an Indian health program for a pe9 riod of obligated service equal to the amount of time dur10 ing which the individual participates in such program. In

11 the event that the individual fails to complete such obli12 gated service, the United States shall be entitled to recover

13 from such individual an amount determined in accordance

14 with the formula specified in subsection (l) of section 110

15 in the manner provided for in such subsection.

16 ‘‘SEC. 121. COMMUNITY HEALTH AIDE PROGRAM FOR

17 ALASKA.

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

19 of November 2, 1921 (25 U.S.C. 13; commonly known as

20 the Snyder Act), the Secretary shall maintain a Commu21 nity Health Aide Program in Alaska under which the

22 Service—

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

24 as health aides or community health practitioners;
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1 ‘‘(2) uses such aides or practitioners in the pro2 vision of health care, health promotion, and disease

3 prevention services to Alaska Natives living in vil4 lages in rural Alaska; and

5 ‘‘(3) provides for the establishment of tele6 conferencing capacity in health clinics located in or

7 near such villages for use by community health aides

8 or community health practitioners.

9 ‘‘(b) ACTIVITIES.—The Secretary, acting through the

10 Community Health Aide Program under subsection (a),

11 shall—

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

13 provide a high standard of training to community

14 health aides and community health practitioners to

15 ensure that such aides and practitioners provide

16 quality health care, health promotion, and disease

17 prevention services to the villages served by the Pro18 gram;

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

20 a curriculum that—

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

22 health care with supervised practical experience

23 in the provision of health care;

24 ‘‘(B) provides instruction and practical ex25 perience in the provision of acute care, emer-
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1 gency care, health promotion, disease preven2 tion, and the efficient and effective manage3 ment of clinic pharmacies, supplies, equipment,

4 and facilities; and

5 ‘‘(C) promotes the achievement of the

6 health status objective specified in section 3(b);

7 ‘‘(3) establish and maintain a Community

8 Health Aide Certification Board to certify as com9 munity health aides or community health practi10 tioners individuals who have successfully completed

11 the training described in paragraph (1) or who can

12 demonstrate equivalent experience;

13 ‘‘(4) develop and maintain a system which iden14 tifies the needs of community health aides and com15 munity health practitioners for continuing education

16 in the provision of health care, including the areas

17 described in paragraph (2)(B), and develop pro18 grams that meet the needs for such continuing edu19 cation;

20 ‘‘(5) develop and maintain a system that pro21 vides close supervision of community health aides

22 and community health practitioners; and

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

24 community health aides and community health prac25 titioners is reviewed and evaluated to assure the pro-
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1 vision of quality health care, health promotion, and

2 disease prevention services.

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

4 ‘‘Subject to Section 102, the Secretary, acting

5 through the Service, shall, through a funding agreement

6 or otherwise, provide training for Indians in the adminis7 tration and planning of tribal health programs.

8 ‘‘SEC. 123. HEALTH PROFESSIONAL CHRONIC SHORTAGE

9 DEMONSTRATION PROJECT.

10 ‘‘(a) PILOT PROGRAMS.—The Secretary may,

11 through area offices, fund pilot programs for tribes and

12 tribal organizations to address chronic shortages of health

13 professionals.

14 ‘‘(b) PURPOSE.—It is the purpose of the health pro15 fessions demonstration project under this section to—

16 ‘‘(1) provide direct clinical and practical experi17 ence in a service area to health professions students

18 and residents from medical schools;

19 ‘‘(2) improve the quality of health care for Indi20 ans by assuring access to qualified health care pro21 fessionals; and

22 ‘‘(3) provide academic and scholarly opportuni23 ties for health professionals serving Indian people by

24 identifying and utilizing all academic and scholarly

25 resources of the region.
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1 ‘‘(c) ADVISORY BOARD.—A pilot program established

2 under subsection (a) shall incorporate a program advisory

3 board that shall be composed of representatives from the

4 tribes and communities in the service area that will be

5 served by the program.

6 ‘‘SEC. 124. SCHOLARSHIPS.

7 ‘‘Scholarships and loan reimbursements provided to

8 individuals pursuant to this title shall be treated as ‘quali9 fied scholarships’ for purposes of section 117 of the Inter10 nal Revenue Code of 1986.

11 ‘‘SEC. 125. NATIONAL HEALTH SERVICE CORPS.

12 ‘‘(a) LIMITATIONS.—The Secretary shall not—

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

14 Services Corps from a health program operated by

15 Indian Health Service or by a tribe or tribal organi16 zation under a funding agreement with the Service

17 under the Indian Self-Determination and Education

18 Assistance Act, or by urban Indian organizations; or

19 ‘‘(2) withdraw the funding used to support such

20 a member;

21 unless the Secretary, acting through the Service, tribes or

22 tribal organization, has ensured that the Indians receiving

23 services from such member will experience no reduction

24 in services.
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1 ‘‘(b) DESIGNATION OF SERVICE AREAS AS HEALTH

2 PROFESSIONAL SHORTAGE AREAS.—All service areas

3 served by programs operated by the Service or by a tribe

4 or tribal organization sunder the Indian Self-Determina5 tion and Education Assistance Act, or by an urban Indian

6 organization, shall be designated under section 332 of the

7 Public Health Service Act (42 U.S.C. 254e) as Health

8 Professional Shortage Areas.

9 ‘‘(c) FULL TIME EQUIVALENT.—National Health

10 Service Corps scholars that qualify for the commissioned

11 corps in the Public Health Service shall be exempt from

12 the full time equivalent limitations of the National Health

13 Service Corps and the Service when such scholars serve

14 as commissioned corps officers in a health program oper15 ated by an Indian tribe or tribal organization under the

16 Indian Self-Determination and Education Assistance Act

17 or by an urban Indian organization.

18 ‘‘SEC. 126. SUBSTANCE ABUSE COUNSELOR EDUCATION

19 DEMONSTRATION PROJECT.

20 ‘‘(a) DEMONSTRATION PROJECTS.—The Secretary,

21 acting through the Service, may enter into contracts with,

22 or make grants to, accredited tribally controlled commu23 nity colleges, tribally controlled postsecondary vocational

24 institutions, and eligible accredited and accessible commu-
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1 nity colleges to establish demonstration projects to develop

2 educational curricula for substance abuse counseling.

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

4 section shall be used only for developing and providing

5 educational curricula for substance abuse counseling (in6 cluding paying salaries for instructors). Such curricula

7 may be provided through satellite campus programs.

8 ‘‘(c) TERM OF GRANT.—A contract entered into or

9 a grant provided under this section shall be for a period

10 of 1 year. Such contract or grant may be renewed for an

11 additional 1 year period upon the approval of the Sec12 retary.

13 ‘‘(d) REVIEW OF APPLICATIONS.—Not later than 180

14 days after the date of the enactment of this Act, the Sec15 retary, after consultation with Indian tribes and adminis16 trators of accredited tribally controlled community col17 leges, tribally controlled postsecondary vocational institu18 tions, and eligible accredited and accessible community

19 colleges, shall develop and issue criteria for the review and

20 approval of applications for funding (including applica21 tions for renewals of funding) under this section. Such cri22 teria shall ensure that demonstration projects established

23 under this section promote the development of the capacity

24 of such entities to educate substance abuse counselors.
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1 ‘‘(e) TECHNICAL ASSISTANCE.—The Secretary shall

2 provide such technical and other assistance as may be nec3 essary to enable grant recipients to comply with the provi4 sions of this section.

5 ‘‘(f) REPORT.—The Secretary shall submit to the

6 President, for inclusion in the report required to be sub7 mitted under section 801 for fiscal year 1999, a report

8 on the findings and conclusions derived from the dem9 onstration projects conducted under this section.

10 ‘‘(g) DEFINITIONS.—In this section:

11 ‘‘(1) EDUCATIONAL CURRICULUM.—The term

12 ‘educational curriculum’ means 1 or more of the fol13 lowing:

14 ‘‘(A) Classroom education.

15 ‘‘(B) Clinical work experience.

16 ‘‘(C) Continuing education workshops.

17 ‘‘(2) TRIBALLY CONTROLLED COMMUNITY COL18 LEGE.—The term ‘tribally controlled community col19 lege’ has the meaning given such term in section

20 2(a)(4) of the Tribally Controlled Community Col21 lege Assistance Act of 1978 (25 U.S.C. 1801(a)(4)).

22 ‘‘(3) TRIBALLY CONTROLLED POSTSECONDARY

23 VOCATIONAL INSTITUTION.—The term ‘tribally con24 trolled postsecondary vocational institution’ has the

25 meaning given such term in section 390(2) of the
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1 Tribally Controlled Vocational Institutions Support

2 Act of 1990 (20 U.S.C. 2397h(2)).

3 ‘‘SEC. 127. MENTAL HEALTH TRAINING AND COMMUNITY

4 EDUCATION.

5 ‘‘(a) STUDY AND LIST.—

6 ‘‘(1) IN GENERAL.—The Secretary and the Sec7 retary of the Interior in consultation with Indian

8 tribes and tribal organizations shall conduct a study

9 and compile a list of the types of staff positions

10 specified in subsection (b) whose qualifications in11 clude or should include, training in the identifica12 tion, prevention, education, referral or treatment of

13 mental illness, dysfunctional or self-destructive be14 havior.

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

16 paragraph (1) are—

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

18 Indian Affairs, including existing positions, in

19 the fields of—

20 ‘‘(i) elementary and secondary edu21 cation;

22 ‘‘(ii) social services, family and child

23 welfare;

24 ‘‘(iii) law enforcement and judicial

25 services; and
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1 ‘‘(iv) alcohol and substance abuse;

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

3 ‘‘(C) staff positions similar to those speci4 fied in subsection (b) and established and main5 tained by Indian tribes, tribal organizations,

6 and urban Indian organizations, including posi7 tions established pursuant to funding agree8 ments under the Indian Self-determination and

9 Education Assistance Act, and this Act.

10 ‘‘(3) TRAINING CRITERIA.—

11 ‘‘(A) IN GENERAL.—The appropriate Sec12 retary shall provide training criteria appropriate

13 to each type of position specified in subsection

14 (b)(1) and ensure that appropriate training has

15 been or will be provided to any individual in any

16 such position.

17 ‘‘(B) TRAINING.—With respect to any such

18 individual in a position specified pursuant to

19 subsection (b)(3), the respective Secretaries

20 shall provide appropriate training or provide

21 funds to an Indian tribe, tribal organization, or

22 urban Indian organization for the training of

23 appropriate individuals. In the case of a fund24 ing agreement, the appropriate Secretary shall
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1 ensure that such training costs are included in

2 the funding agreement, if necessary.

3 ‘‘(4) CULTURAL RELEVANCY.—Position specific

4 training criteria shall be culturally relevant to Indi5 ans and Indian tribes and shall ensure that appro6 priate information regarding traditional health care

7 practices is provided.

8 ‘‘(5) COMMUNITY EDUCATION.—

9 ‘‘(A) DEVELOPMENT.—The Service shall

10 develop and implement, or on request of an In11 dian tribe or tribal organization, assist an In12 dian tribe or tribal organization, in developing

13 and implementing a program of community

14 education on mental illness.

15 ‘‘(B) TECHNICAL ASSISTANCE.—In car16 rying out this paragraph, the Service shall,

17 upon the request of an Indian tribe or tribal or18 ganization, provide technical assistance to the

19 Indian tribe or tribal organization to obtain and

20 develop community educational materials on the

21 identification, prevention, referral and treat22 ment of mental illness, dysfunctional and self23 destructive behavior.

24 ‘‘(b) STAFFING.—
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1 ‘‘(1) IN GENERAL.—Not later than 90 days

2 after the date of enactment of the Act, the Director

3 of the Service shall develop a plan under which the

4 Service will increase the number of health care staff

5 that are providing mental health services by at least

6 500 positions within 5 years after such date of en7 actment, with at least 200 of such positions devoted

8 to child, adolescent, and family services. The alloca9 tion of such positions shall be subject to the provi10 sions of section 102(a).

11 ‘‘(2) IMPLEMENTATION.—The plan developed

12 under paragraph (1) shall be implemented under the

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

14 know as the ‘Snyder Act’).

15 ‘‘SEC. 128. AUTHORIZATION OF APPROPRIATIONS.

16 ‘‘There are authorized to be appropriated such sums

17 as may be necessary for each fiscal year through fiscal

18 year 2012 to carry out this title.

19 ‘‘TITLE II—HEALTH SERVICES

20 ‘‘SEC. 201. INDIAN HEALTH CARE IMPROVEMENT FUND.

21 ‘‘(a) IN GENERAL.—The Secretary may expend

22 funds, directly or under the authority of the Indian Self23 Determination and Education Assistance Act, that are ap24 propriated under the authority of this section, for the pur25 poses of—
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1 ‘‘(1) eliminating the deficiencies in the health

2 status and resources of all Indian tribes;

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

4 health care services to Indians;

5 ‘‘(3) meeting the health needs of Indians in an

6 efficient and equitable manner;

7 ‘‘(4) eliminating inequities in funding for both

8 direct care and contract health service programs;

9 and

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

11 meet the following health service responsibilities with

12 respect to those Indian tribes with the highest levels

13 of health status and resource deficiencies:

14 ‘‘(A) clinical care, including inpatient care,

15 outpatient care (including audiology, clinical eye

16 and vision care), primary care, secondary and

17 tertiary care, and long term care;

18 ‘‘(B) preventive health, including mam19 mography and other cancer screening in accord20 ance with section 207;

21 ‘‘(C) dental care;

22 ‘‘(D) mental health, including community

23 mental health services, inpatient mental health

24 services, dormitory mental health services,

25 therapeutic and residential treatment centers,
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1 and training of traditional health care practi2 tioners;

3 ‘‘(E) emergency medical services;

4 ‘‘(F) treatment and control of, and reha5 bilitative care related to, alcoholism and drug

6 abuse (including fetal alcohol syndrome) among

7 Indians;

8 ‘‘(G) accident prevention programs;

9 ‘‘(H) home health care;

10 ‘‘(I) community health representatives;

11 ‘‘(J) maintenance and repair; and

12 ‘‘(K) traditional health care practices.

13 ‘‘(b) USE OF FUNDS.—

14 ‘‘(1) LIMITATION.—Any funds appropriated

15 under the authority of this section shall not be used

16 to offset or limit any other appropriations made to

17 the Service under this Act, the Act of November 2,

18 1921 (25 U.S.C. 13) (commonly known as the ‘Sny19 der Act’), or any other provision of law.

20 ‘‘(2) ALLOCATION.—

21 ‘‘(A) IN GENERAL.—Funds appropriated

22 under the authority of this section shall be allo23 cated to service units or Indian tribes or tribal

24 organizations. The funds allocated to each tribe,

25 tribal organization, or service unit under this
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1 subparagraph shall be used to improve the

2 health status and reduce the resource deficiency

3 of each tribe served by such service unit, tribe

4 or tribal organization.

5 ‘‘(B) APPORTIONMENT.—The apportion6 ment of funds allocated to a service unit, tribe

7 or tribal organization under subparagraph (A)

8 among the health service responsibilities de9 scribed in subsection (a)(4) shall be determined

10 by the Service in consultation with, and with

11 the active participation of, the affected Indian

12 tribes in accordance with this section and such

13 rules as may be established under title VIII.

14 ‘‘(c) HEALTH STATUS AND RESOURCE DEFI15 CIENCY.—In this section:

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

17 and resource deficiency’ means the extent to

18 which—

19 ‘‘(A) the health status objective set forth

20 in section 3(2) is not being achieved; and

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

22 does not have available to it the health re23 sources it needs, taking into account the actual

24 cost of providing health care services given local
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1 geographic, climatic, rural, or other cir2 cumstances.

3 ‘‘(2) RESOURCES.—The health resources avail4 able to an Indian tribe or tribal organization shall

5 include health resources provided by the Service as

6 well as health resources used by the Indian Tribe or

7 tribal organization, including services and financing

8 systems provided by any Federal programs, private

9 insurance, and programs of State or local govern10 ments.

11 ‘‘(3) REVIEW OF DETERMINATION.—The Sec12 retary shall establish procedures which allow any In13 dian tribe or tribal organization to petition the Sec14 retary for a review of any determination of the ex15 tent of the health status and resource deficiency of

16 such tribe or tribal organization.

17 ‘‘(d) ELIGIBILITY.—Programs administered by any

18 Indian tribe or tribal organization under the authority of

19 the Indian Self-Determination and Education Assistance

20 Act shall be eligible for funds appropriated under the au21 thority of this section on an equal basis with programs

22 that are administered directly by the Service.

23 ‘‘(e) REPORT.—Not later than the date that is 3

24 years after the date of enactment of this Act, the Sec25 retary shall submit to the Congress the current health sta-
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1 tus and resource deficiency report of the Service for each

2 Indian tribe or service unit, including newly recognized or

3 acknowledged tribes. Such report shall set out—

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

5 for determining tribal health status and resource de6 ficiencies, as well as the most recent application of

7 that methodology;

8 ‘‘(2) the extent of the health status and re9 source deficiency of each Indian tribe served by the

10 Service;

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

12 the health status and resource deficiencies of all In13 dian tribes served by the Service; and

14 ‘‘(4) an estimate of—

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

16 appropriated under the authority of this Act, or

17 any other Act, including the amount of any

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

20 service unit, Indian tribe, or comparable entity;

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

22 health services in each service unit or Indian

23 tribe or tribal organization; and

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

25 Service resources made available to each service
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1 unit or Indian tribe or tribal organization, and,

2 to the extent available, information on the wait3 ing lists and number of Indians turned away for

4 services due to lack of resources.

5 ‘‘(f) BUDGETARY RULE.—Funds appropriated under

6 the authority of this section for any fiscal year shall be

7 included in the base budget of the Service for the purpose

8 of determining appropriations under this section in subse9 quent fiscal years.

10 ‘‘(g) RULE OF CONSTRUCTION.—Nothing in this sec11 tion shall be construed to diminish the primary responsi12 bility of the Service to eliminate existing backlogs in

13 unmet health care needs or to discourage the Service from

14 undertaking additional efforts to achieve equity among In15 dian tribes and tribal organizations.

16 ‘‘(h) DESIGNATION.—Any funds appropriated under

17 the authority of this section shall be designated as the ‘In18 dian Health Care Improvement Fund’.

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

20 ‘‘(a) ESTABLISHMENT.—

21 ‘‘(1) IN GENERAL.—There is hereby established

22 an Indian Catastrophic Health Emergency Fund (re23 ferred to in this section as the ‘CHEF’) consisting

24 of—
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1 ‘‘(A) the amounts deposited under sub2 section (d); and

3 ‘‘(B) any amounts appropriated to the

4 CHEF under this Act.

5 ‘‘(2) ADMINISTRATION.—The CHEF shall be

6 administered by the Secretary solely for the purpose

7 of meeting the extraordinary medical costs associ8 ated with the treatment of victims of disasters or

9 catastrophic illnesses who are within the responsi10 bility of the Service.

11 ‘‘(3) EQUITABLE ALLOCATION.—The CHEF

12 shall be equitably allocated, apportioned or delegated

13 on a service unit or area office basis, based upon a

14 formula to be developed by the Secretary in con15 sultation with the Indian tribes and tribal organiza16 tions through negotiated rulemaking under title

17 VIII. Such formula shall take into account the

18 added needs of service areas which are contract

19 health service dependent.

20 ‘‘(4) NOT SUBJECT TO CONTRACT OR

21 GRANT.—No part of the CHEF or its adminis22 tration shall be subject to contract or grant

23 under any law, including the Indian Self-Deter24 mination and Education Assistance Act.
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1 ‘‘(5) ADMINISTRATION.—Amounts pro2 vided from the CHEF shall be administered by

3 the area offices based upon priorities deter4 mined by the Indian tribes and tribal organiza5 tions within each service area, including a con6 sideration of the needs of Indian tribes and

7 tribal organizations which are contract health

8 service-dependent.

9 ‘‘(b) REQUIREMENTS.—The Secretary shall, through

10 the negotiated rulemaking process under title VIII, pro11 mulgate regulations consistent with the provisions of this

12 section—

13 ‘‘(1) establish a definition of disasters and cata14 strophic illnesses for which the cost of treatment

15 provided under contract would qualify for payment

16 from the CHEF;

17 ‘‘(2) provide that a service unit, Indian tribe, or

18 tribal organization shall not be eligible for reim19 bursement for the cost of treatment from the CHEF

20 until its cost of treatment for any victim of such a

21 catastrophic illness or disaster has reached a certain

22 threshold cost which the Secretary shall establish

23 at—

24 ‘‘(A) for 1999, not less than $19,000; and
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1 ‘‘(B) for any subsequent year, not less

2 than the threshold cost of the previous year in3 creased by the percentage increase in the med4 ical care expenditure category of the consumer

5 price index for all urban consumers (United

6 States city average) for the 12-month period

7 ending with December of the previous year;

8 ‘‘(3) establish a procedure for the reimburse9 ment of the portion of the costs incurred by—

10 ‘‘(A) service units, Indian tribes, or tribal

11 organizations, or facilities of the Service; or

12 ‘‘(B) non-Service facilities or providers

13 whenever otherwise authorized by the Service;

14 in rendering treatment that exceeds threshold cost

15 described in paragraph (2);

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

17 the CHEF in cases in which the exigencies of the

18 medical circumstances warrant treatment prior to

19 the authorization of such treatment by the Service;

20 and

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

22 no payment shall be made from the CHEF to any

23 provider of treatment to the extent that such pro24 vider is eligible to receive payment for the treatment

25 from any other Federal, State, local, or private
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1 source of reimbursement for which the patient is eli2 gible.

3 ‘‘(c) LIMITATION.—Amounts appropriated to the

4 CHEF under this section shall not be used to offset or

5 limit appropriations made to the Service under the author6 ity of the Act of November 2, 1921 (25 U.S.C. 13) (com7 monly known as the Snyder Act) or any other law.

8 ‘‘(d) DEPOSITS.—There shall be deposited into the

9 CHEF all reimbursements to which the Service is entitled

10 from any Federal, State, local, or private source (including

11 third party insurance) by reason of treatment rendered to

12 any victim of a disaster or catastrophic illness the cost

13 of which was paid from the CHEF.

14 ‘‘SEC. 203. HEALTH PROMOTION AND DISEASE PREVENTION

15 SERVICES.

16 ‘‘(a) FINDINGS.—Congress finds that health pro17 motion and disease prevention activities will—

18 ‘‘(1) improve the health and well-being of Indi19 ans; and

20 ‘‘(2) reduce the expenses for health care of In21 dians.

22 ‘‘(b) PROVISION OF SERVICES.—The Secretary, act23 ing through the Service and through Indian tribes and

24 tribal organizations, shall provide health promotion and
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1 disease prevention services to Indians so as to achieve the

2 health status objective set forth in section 3(b).

3 ‘‘(c) DISEASE PREVENTION AND HEALTH PRO4 MOTION.—In this section:

5 ‘‘(1) DISEASE PREVENTION.—The term ‘disease

6 prevention’ means the reduction, limitation, and pre7 vention of disease and its complications, and the re8 duction in the consequences of such diseases,

9 including—

10 ‘‘(A) controlling—

11 ‘‘(i) diabetes;

12 ‘‘(ii) high blood pressure;

13 ‘‘(iii) infectious agents;

14 ‘‘(iv) injuries;

15 ‘‘(v) occupational hazards and disabil16 ities;

17 ‘‘(vi) sexually transmittable diseases;

18 and

19 ‘‘(vii) toxic agents; and

20 ‘‘(B) providing—

21 ‘‘(i) for the fluoridation of water; and

22 ‘‘(ii) immunizations.

23 ‘‘(2) HEALTH PROMOTION.—The term ‘health

24 promotion’ means fostering social, economic, envi-
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1 ronmental, and personal factors conducive to health,

2 including—

3 ‘‘(A) raising people’s awareness about

4 health matters and enabling them to cope with

5 health problems by increasing their knowledge

6 and providing them with valid information;

7 ‘‘(B) encouraging adequate and appro8 priate diet, exercise, and sleep;

9 ‘‘(C) promoting education and work in con10 formity with physical and mental capacity;

11 ‘‘(E) making available suitable housing,

12 safe water, and sanitary facilities;

13 ‘‘(F) improving the physical economic, cul14 tural, psychological, and social environment;

15 ‘‘(G) promoting adequate opportunity for

16 spiritual, religious, and traditional practices;

17 and

18 ‘‘(H) adequate and appropriate programs

19 including—

20 ‘‘(i) abuse prevention (mental and

21 physical);

22 ‘‘(iii) community health;

23 ‘‘(iv) community safety;

24 ‘‘(v) consumer health education;

25 ‘‘(vi) diet and nutrition;
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1 ‘‘(vii) disease prevention (commu2 nicable, immunizations, HIV/AIDS);

3 ‘‘(viii) environmental health;

4 ‘‘(ix) exercise and physical fitness;

5 ‘‘(x) fetal alcohol disorders;

6 ‘‘(xi) first aid and CPR education;

7 ‘‘(xii) human growth and develop8 ment;

9 ‘‘(xiii) injury prevention and personal

10 safety;

11 ‘‘(xiv) mental health (emotional, self12 worth);

13 ‘‘(xv) personal health and wellness

14 practices;

15 ‘‘(xvi) personal capacity building;

16 ‘‘(xvii) prenatal, pregnancy, and in17 fant care;

18 ‘‘(xviii) psychological well being;

19 ‘‘(xix) reproductive health (family

20 planning);

21 ‘‘(xx) safe and adequate water;

22 ‘‘(xxi) safe housing;

23 ‘‘(xxii) safe work environments;

24 ‘‘(xxiii) stress control;

25 ‘‘(xxiv) substance abuse;
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1 ‘‘(xxv) sanitary facilities;

2 ‘‘(xxvi) tobacco use cessation and re3 duction;

4 ‘‘(xxvii) violence prevention; and

5 ‘‘(xxviii) such other activities identi6 fied by the Service, an Indian tribe or trib7 al organization, to promote the achieve8 ment of the objective described in section

9 3(b).

10 ‘‘(d) EVALUATION.—The Secretary, after obtaining

11 input from affected Indian tribes and tribal organizations,

12 shall submit to the President for inclusion in each state13 ment which is required to be submitted to Congress under

14 section 801 an evaluation of—

15 ‘‘(1) the health promotion and disease preven16 tion needs of Indians;

17 ‘‘(2) the health promotion and disease preven18 tion activities which would best meet such needs;

19 ‘‘(3) the internal capacity of the Service to meet

20 such needs; and

21 ‘‘(4) the resources which would be required to

22 enable the Service to undertake the health promotion

23 and disease prevention activities necessary to meet

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

3 ‘‘(a) DETERMINATION.—The Secretary, in consulta4 tion with Indian tribes and tribal organizations, shall

5 determine—

6 ‘‘(1) by tribe, tribal organization, and service

7 unit of the Service, the prevalence of, and the types

8 of complications resulting from, diabetes among In9 dians; and

10 ‘‘(2) based on paragraph (1), the measures (in11 cluding patient education) each service unit should

12 take to reduce the prevalence of, and prevent, treat,

13 and control the complications resulting from, diabe14 tes among Indian tribes within that service unit.

15 ‘‘(b) SCREENING.—The Secretary shall screen each

16 Indian who receives services from the Service for diabetes

17 and for conditions which indicate a high risk that the indi18 vidual will become diabetic. Such screening may be done

19 by an Indian tribe or tribal organization operating health

20 care programs or facilities with funds from the Service

21 under the Indian Self-Determination and Education As22 sistance Act.

23 ‘‘(c) CONTINUED FUNDING.—The Secretary shall

24 continue to fund, through fiscal year 2012, each effective

25 model diabetes project in existence on the date of the en26 actment of this Act and such other diabetes programs op-
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1 erated by the Secretary or by Indian tribes and tribal or2 ganizations and any additional programs added to meet

3 existing diabetes needs. Indian tribes and tribal organiza4 tions shall receive recurring funding for the diabetes pro5 grams which they operate pursuant to this section. Model

6 diabetes projects shall consult, on a regular basis, with

7 tribes and tribal organizations in their regions regarding

8 diabetes needs and provide technical expertise as needed.

9 ‘‘(d) DIALYSIS PROGRAMS.—The Secretary shall pro10 vide funding through the Service, Indian tribes and tribal

11 organizations to establish dialysis programs, including

12 funds to purchase dialysis equipment and provide nec13 essary staffing.

14 ‘‘(e) OTHER ACTIVITIES.—The Secretary shall, to the

15 extent funding is available—

16 ‘‘(1) in each area office of the Service, consult

17 with Indian tribes and tribal organizations regarding

18 programs for the prevention, treatment, and control

19 of diabetes;

20 ‘‘(2) establish in each area office of the Service

21 a registry of patients with diabetes to track the

22 prevalence of diabetes and the complications from

23 diabetes in that area; and

24 ‘‘(3) ensure that data collected in each area of25 fice regarding diabetes and related complications
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1 among Indians is disseminated to tribes, tribal orga2 nizations, and all other area offices.

3 ‘‘SEC. 205. SHARED SERVICES.

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

5 the Service and notwithstanding any other provision of

6 law, is authorized to enter into funding agreements or

7 other arrangements with Indian tribes or tribal organiza8 tions for the delivery of long-term care and similar services

9 to Indians. Such projects shall provide for the sharing of

10 staff or other services between a Service or tribal facility

11 and a long-term care or other similar facility owned and

12 operated (directly or through a funding agreement) by

13 such Indian tribe or tribal organization.

14 ‘‘(b) REQUIREMENTS.—A funding agreement or

15 other arrangement entered into pursuant to subsection

16 (a)—

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

18 tribal organization, delegate to such tribe or tribal

19 organization such powers of supervision and control

20 over Service employees as the Secretary deems nec21 essary to carry out the purposes of this section;

22 ‘‘(2) shall provide that expenses (including sala23 ries) relating to services that are shared between the

24 Service and the tribal facility be allocated propor-
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1 tionately between the Service and the tribe or tribal

2 organization; and

3 ‘‘(3) may authorize such tribe or tribal organi4 zation to construct, renovate, or expand a long-term

5 care or other similar facility (including the construc6 tion of a facility attached to a Service facility).

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

8 provide such technical and other assistance as may be nec9 essary to enable applicants to comply with the provisions

10 of this section.

11 ‘‘(d) USE OF EXISTING FACILITIES.—The Secretary

12 shall encourage the use for long-term or similar care of

13 existing facilities that are under-utilized or allow the use

14 of swing beds for such purposes.

15 ‘‘SEC. 206. HEALTH SERVICES RESEARCH.

16 ‘‘(a) FUNDING.—The Secretary shall make funding

17 available for research to further the performance of the

18 health service responsibilities of the Service, Indian tribes,

19 and tribal organizations and shall coordinate the activities

20 of other Agencies within the Department to address these

21 research needs.

22 ‘‘(b) ALLOCATION.—Funding under subsection (a)

23 shall be allocated equitably among the area offices. Each

24 area office shall award such funds competitively within

25 that area.
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1 ‘‘(c) ELIGIBILITY FOR FUNDS.—Indian tribes and

2 tribal organizations receiving funding from the Service

3 under the authority of the Indian Self-Determination and

4 Education Assistance Act shall be given an equal oppor5 tunity to compete for, and receive, research funds under

6 this section.

7 ‘‘(d) USE.—Funds received under this section may

8 be used for both clinical and non-clinical research by In9 dian tribes and tribal organizations and shall be distrib10 uted to the area offices. Such area offices may make

11 grants using such funds within each area.

12 ‘‘SEC. 207. MAMMOGRAPHY AND OTHER CANCER SCREEN13 ING.

14 ‘‘The Secretary, through the Service or through In15 dian tribes or tribal organizations, shall provide for the

16 following screening:

17 ‘‘(1) Mammography (as defined in section

18 1861(jj) of the Social Security Act) for Indian

19 women at a frequency appropriate to such women

20 under national standards, and under such terms and

21 conditions as are consistent with standards estab22 lished by the Secretary to assure the safety and ac23 curacy of screening mammography under part B of

24 title XVIII of the Social Security Act.
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1 ‘‘(2) Other cancer screening meeting national

2 standards.

3 ‘‘SEC. 208. PATIENT TRAVEL COSTS.

4 ‘‘The Secretary, acting through the Service, Indian

5 tribes and tribal organizations shall provide funds for the

6 following patient travel costs, including appropriate and

7 necessary qualified escorts, associated with receiving

8 health care services provided (either through direct or con9 tract care or through funding agreements entered into

10 pursuant to the Indian Self-Determination and Education

11 Assistance Act) under this Act:

12 ‘‘(1) Emergency air transportation and non13 emergency air transportation where ground trans14 portation is infeasible.

15 ‘‘(2) Transportation by private vehicle, specially

16 equipped vehicle and ambulance.

17 ‘‘(3) Transportation by such other means as

18 may be available and required when air or motor ve19 hicle transportation is not available.

20 ‘‘SEC. 209. EPIDEMIOLOGY CENTERS.

21 ‘‘(a) ESTABLISHMENT.—

22 ‘‘(1) IN GENERAL.—In addition to those centers

23 operating 1 day prior to the date of enactment of

24 this Act, (including those centers for which funding

25 is currently being provided through funding agree-
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1 ments under the Indian Self-Determination and

2 Education Assistance Act), the Secretary shall, not

3 later than 180 days after such date of enactment,

4 establish and fund an epidemiology center in each

5 service area which does not have such a center to

6 carry out the functions described in paragraph (2).

7 Any centers established under the preceding sen8 tence may be operated by Indian tribes or tribal or9 ganizations pursuant to funding agreements under

10 the Indian Self-Determination and Education Assist11 ance Act, but funding under such agreements may

12 not be divisible.

13 ‘‘(2) FUNCTIONS.—In consultation with and

14 upon the request of Indian tribes, tribal organiza15 tions and urban Indian organizations, each area epi16 demiology center established under this subsection

17 shall, with respect to such area shall—

18 ‘‘(A) collect data related to the health sta19 tus objective described in section 3(b), and

20 monitor the progress that the Service, Indian

21 tribes, tribal organizations, and urban Indian

22 organizations have made in meeting such health

23 status objective;
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1 ‘‘(B) evaluate existing delivery systems,

2 data systems, and other systems that impact

3 the improvement of Indian health;

4 ‘‘(C) assist Indian tribes, tribal organiza5 tions, and urban Indian organizations in identi6 fying their highest priority health status objec7 tives and the services needed to achieve such

8 objectives, based on epidemiological data;

9 ‘‘(D) make recommendations for the tar10 geting of services needed by tribal, urban, and

11 other Indian communities;

12 ‘‘(E) make recommendations to improve

13 health care delivery systems for Indians and

14 urban Indians;

15 ‘‘(F) provide requested technical assistance

16 to Indian Tribes and urban Indian organiza17 tions in the development of local health service

18 priorities and incidence and prevalence rates of

19 disease and other illness in the community; and

20 ‘‘(G) provide disease surveillance and assist

21 Indian tribes, tribal organizations, and urban

22 Indian organizations to promote public health.

23 ‘‘(3) TECHNICAL ASSISTANCE.—The director of

24 the Centers for Disease Control and Prevention shall
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1 provide technical assistance to the centers in car2 rying out the requirements of this subsection.

3 ‘‘(b) FUNDING.—The Secretary may make funding

4 available to Indian tribes, tribal organizations, and eligible

5 intertribal consortia or urban Indian organizations to con6 duct epidemiological studies of Indian communities.

7 ‘‘SEC. 210. COMPREHENSIVE SCHOOL HEALTH EDUCATION

8 PROGRAMS.

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

10 the Service, shall provide funding to Indian tribes, tribal

11 organizations, and urban Indian organizations to develop

12 comprehensive school health education programs for chil13 dren from preschool through grade 12 in schools for the

14 benefit of Indian and urban Indian children.

15 ‘‘(b) USE OF FUNDS.—Funds awarded under this

16 section may be used to—

17 ‘‘(1) develop and implement health education

18 curricula both for regular school programs and after

19 school programs;

20 ‘‘(2) train teachers in comprehensive school

21 health education curricula;

22 ‘‘(3) integrate school-based, community-based,

23 and other public and private health promotion ef24 forts;
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1 ‘‘(4) encourage healthy, tobacco-free school en2 vironments;

3 ‘‘(5) coordinate school-based health programs

4 with existing services and programs available in the

5 community;

6 ‘‘(6) develop school programs on nutrition edu7 cation, personal health, oral health, and fitness;

8 ‘‘(7) develop mental health wellness programs;

9 ‘‘(8) develop chronic disease prevention pro10 grams;

11 ‘‘(9) develop substance abuse prevention pro12 grams;

13 ‘‘(10) develop injury prevention and safety edu14 cation programs;

15 ‘‘(11) develop activities for the prevention and

16 control of communicable diseases;

17 ‘‘(12) develop community and environmental

18 health education programs that include traditional

19 health care practitioners;

20 ‘‘(13) carry out violence prevention activities;

21 and

22 ‘‘(14) carry out activities relating to such other

23 health issues as are appropriate.

24 ‘‘(c) TECHNICAL ASSISTANCE.—The Secretary shall,

25 upon request, provide technical assistance to Indian tribes,
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1 tribal organization and urban Indian organizations in the

2 development of comprehensive health education plans, and

3 the dissemination of comprehensive health education ma4 terials and information on existing health programs and

5 resources.

6 ‘‘(d) CRITERIA.—The Secretary, in consultation with

7 Indian tribes tribal organizations, and urban Indian orga8 nizations shall establish criteria for the review and ap9 proval of applications for funding under this section.

10 ‘‘(e) COMPREHENSIVE SCHOOL HEALTH EDUCATION

11 PROGRAM.—

12 ‘‘(1) DEVELOPMENT.—The Secretary of the In13 terior, acting through the Bureau of Indian Affairs

14 and in cooperation with the Secretary and affected

15 Indian tribes and tribal organizations, shall develop

16 a comprehensive school health education program for

17 children from preschool through grade 12 for use in

18 schools operated by the Bureau of Indian Affairs.

19 ‘‘(2) REQUIREMENTS.—The program developed

20 under paragraph (1) shall include—

21 ‘‘(A) school programs on nutrition edu22 cation, personal health, oral health, and fitness;

23 ‘‘(B) mental health wellness programs;

24 ‘‘(C) chronic disease prevention programs;
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1 ‘‘(D) substance abuse prevention pro2 grams;

3 ‘‘(E) injury prevention and safety edu4 cation programs; and

5 ‘‘(F) activities for the prevention and con6 trol of communicable diseases.

7 ‘‘(3) TRAINING AND COORDINATION.—The Sec8 retary of the Interior shall—

9 ‘‘(A) provide training to teachers in com10 prehensive school health education curricula;

11 ‘‘(B) ensure the integration and coordina12 tion of school-based programs with existing

13 services and health programs available in the

14 community; and

15 ‘‘(C) encourage healthy, tobacco-free school

16 environments.

17 ‘‘SEC. 211. INDIAN YOUTH PROGRAM.

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

19 the Service, is authorized to provide funding to Indian

20 tribes, tribal organizations, and urban Indian organiza21 tions for innovative mental and physical disease prevention

22 and health promotion and treatment programs for Indian

23 and urban Indian preadolescent and adolescent youths.

24 ‘‘(b) USE OF FUNDS.—
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1 ‘‘(1) IN GENERAL.—Funds made available

2 under this section may be used to—

3 ‘‘(A) develop prevention and treatment

4 programs for Indian youth which promote men5 tal and physical health and incorporate cultural

6 values, community and family involvement, and

7 traditional health care practitioners; and

8 ‘‘(B) develop and provide community train9 ing and education.

10 ‘‘(2) LIMITATION.—Funds made available

11 under this section may not be used to provide serv12 ices described in section 707(c).

13 ‘‘(c) REQUIREMENTS.—The Secretary shall—

14 ‘‘(1) disseminate to Indian tribes, tribal organi15 zations, and urban Indian organizations information

16 regarding models for the delivery of comprehensive

17 health care services to Indian and urban Indian ado18 lescents;

19 ‘‘(2) encourage the implementation of such

20 models; and

21 ‘‘(3) at the request of an Indian tribe, tribal or22 ganization, or urban Indian organization, provide

23 technical assistance in the implementation of such

24 models.
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1 ‘‘(d) CRITERIA.—The Secretary, in consultation with

2 Indian tribes, tribal organization, and urban Indian orga3 nizations, shall establish criteria for the review and ap4 proval of applications under this section.

5 ‘‘SEC. 212. PREVENTION, CONTROL, AND ELIMINATION OF

6 COMMUNICABLE AND INFECTIOUS DISEASES.

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

8 the Service after consultation with Indian tribes, tribal or9 ganizations, urban Indian organizations, and the Centers

10 for Disease Control and Prevention, may make funding

11 available to Indian tribes and tribal organizations for—

12 ‘‘(1) projects for the prevention, control, and

13 elimination of communicable and infectious diseases,

14 including tuberculosis, hepatitis, HIV, respiratory

15 syncitial virus, hanta virus, sexually transmitted dis16 eases, and H. Pylori;

17 ‘‘(2) public information and education programs

18 for the prevention, control, and elimination of com19 municable and infectious diseases; and

20 ‘‘(3) education, training, and clinical skills im21 provement activities in the prevention, control, and

22 elimination of communicable and infectious diseases

23 for health professionals, including allied health pro24 fessionals.
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1 ‘‘(b) REQUIREMENT OF APPLICATION.—The Sec2 retary may provide funds under subsection (a) only if an

3 application or proposal for such funds is submitted.

4 ‘‘(c) TECHNICAL ASSISTANCE AND REPORT.—In car5 rying out this section, the Secretary—

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

7 tribal organization, provide technical assistance; and

8 ‘‘(2) shall prepare and submit, biennially, a re9 port to Congress on the use of funds under this sec10 tion and on the progress made toward the preven11 tion, control, and elimination of communicable and

12 infectious diseases among Indians and urban Indi13 ans.

14 ‘‘SEC. 213. AUTHORITY FOR PROVISION OF OTHER SERV15 ICES.

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

17 the Service, Indian tribes, and tribal organizations, may

18 provide funding under this Act to meet the objective set

19 forth in section 3 through health care related services and

20 programs not otherwise described in this Act. Such serv21 ices and programs shall include services and programs re22 lated to—

23 ‘‘(1) hospice care and assisted living;

24 ‘‘(2) long-term health care;

25 ‘‘(3) home- and community-based services;
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1 ‘‘(4) public health functions; and

2 ‘‘(5) traditional health care practices.

3 ‘‘(b) AVAILABILITY OF SERVICES FOR CERTAIN INDI4 VIDUALS.—At the discretion of the Service, Indian tribe,

5 or tribal organization, services hospice care, home health

6 care (under section 201), home- and community-based

7 care, assisted living, and long term care may be provided

8 (on a cost basis) to individuals otherwise ineligible for the

9 health care benefits of the Service. Any funds received

10 under this subsection shall not be used to offset or limit

11 the funding allocated to a tribe or tribal organization.

12 ‘‘(c) DEFINITIONS.—In this section:

13 ‘‘(1) HOME- AND COMMUNITY-BASED SERV14 ICES.—The term ‘home- and community-based serv15 ices’ means 1 or more of the following:

16 ‘‘(A) Homemaker/home health aide serv17 ices.

18 ‘‘(B) Chore services.

19 ‘‘(C) Personal care services.

20 ‘‘(D) Nursing care services provided out21 side of a nursing facility by, or under the super22 vision of, a registered nurse.

23 ‘‘(E) Training for family members.

24 ‘‘(F) Adult day care.
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1 ‘‘(G) Such other home- and community2 based services as the Secretary or a tribe or

3 tribal organization may approve.

4 ‘‘(2) HOSPICE CARE.—The term ‘hospice care’

5 means the items and services specified in subpara6 graphs (A) through (H) of section 1861(dd)(1) of

7 the Social Security Act (42 U.S.C. 1395x(dd)(1)),

8 and such other services which an Indian tribe or

9 tribal organization determines are necessary and ap10 propriate to provide in furtherance of such care.

11 ‘‘(3) PUBLIC HEALTH FUNCTIONS.—The term

12 ‘public health functions’ means public health related

13 programs, functions, and services including assess14 ments, assurances, and policy development that In15 dian tribes and tribal organizations are authorized

16 and encouraged, in those circumstances where it

17 meets their needs, to carry out by forming collabo18 rative relationships with all levels of local, State, and

19 Federal governments.

20 ‘‘SEC. 214. INDIAN WOMEN’S HEALTH CARE.

21 ‘‘The Secretary acting through the Service, Indian

22 tribes, tribal organizations, and urban Indian organiza23 tions shall provide funding to monitor and improve the

24 quality of health care for Indian women of all ages

25 through the planning and delivery of programs adminis-
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1 tered by the Service, in order to improve and enhance the

2 treatment models of care for Indian women.

3 ‘‘SEC. 215. ENVIRONMENTAL AND NUCLEAR HEALTH HAZ4 ARDS.

5 ‘‘(a) STUDY AND MONITORING PROGRAMS.—The

6 Secretary and the Service shall, in conjunction with other

7 appropriate Federal agencies and in consultation with con8 cerned Indian tribes and tribal organizations, conduct a

9 study and carry out ongoing monitoring programs to de10 termine the trends that exist in the health hazards posed

11 to Indian miners and to Indians on or near Indian reserva12 tions and in Indian communities as a result of environ13 mental hazards that may result in chronic or life-threat14 ening health problems. Such hazards include nuclear re15 source development, petroleum contamination, and con16 tamination of the water source or of the food chain. Such

17 study (and any reports with respect to such study) shall

18 include—

19 ‘‘(1) an evaluation of the nature and extent of

20 health problems caused by environmental hazards

21 currently exhibited among Indians and the causes of

22 such health problems;

23 ‘‘(2) an analysis of the potential effect of ongo24 ing and future environmental resource development

25 on or near Indian reservations and communities in-
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1 cluding the cumulative effect of such development

2 over time on health;

3 ‘‘(3) an evaluation of the types and nature of

4 activities, practices, and conditions causing or affect5 ing such health problems including uranium mining

6 and milling, uranium mine tailing deposits, nuclear

7 power plant operation and construction, and nuclear

8 waste disposal, oil and gas production or transpor9 tation on or near Indian reservations or commu10 nities, and other development that could affect the

11 health of Indians and their water supply and food

12 chain;

13 ‘‘(4) a summary of any findings or rec14 ommendations provided in Federal and State stud15 ies, reports, investigations, and inspections during

16 the 5 years prior to the date of the enactment of

17 this Act that directly or indirectly relate to the ac18 tivities, practices, and conditions affecting the health

19 or safety of such Indians; and

20 ‘‘(5) a description of the efforts that have been

21 made by Federal and State agencies and resource

22 and economic development companies to effectively

23 carry out an education program for such Indians re24 garding the health and safety hazards of such devel25 opment.
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1 ‘‘(b) DEVELOPMENT OF HEALTH CARE PLANS.—

2 Upon the completion of the study under subsection (a),

3 the Secretary and the Service shall take into account the

4 results of such study and, in consultation with Indian

5 tribes and tribal organizations, develop a health care plan

6 to address the health problems that were the subject of

7 such study. The plans shall include—

8 ‘‘(1) methods for diagnosing and treating Indi9 ans currently exhibiting such health problems;

10 ‘‘(2) preventive care and testing for Indians

11 who may be exposed to such health hazards, includ12 ing the monitoring of the health of individuals who

13 have or may have been exposed to excessive amounts

14 of radiation, or affected by other activities that have

15 had or could have a serious impact upon the health

16 of such individuals; and

17 ‘‘(3) a program of education for Indians who,

18 by reason of their work or geographic proximity to

19 such nuclear or other development activities, may ex20 perience health problems.

21 ‘‘(c) SUBMISSION TO CONGRESS.—

22 ‘‘(1) GENERAL REPORT.—Not later than 18

23 months after the date of enactment of this Act, the

24 Secretary and the Service shall submit to Congress
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1 a report concerning the study conducted under sub2 section (a).

3 ‘‘(2) HEALTH CARE PLAN REPORT.—Not later

4 than 1 year after the date on which the report under

5 paragraph (1) is submitted to Congress, the Sec6 retary and the Service shall submit to Congress the

7 health care plan prepared under subsection (b).

8 Such plan shall include recommended activities for

9 the implementation of the plan, as well as an evalua10 tion of any activities previously undertaken by the

11 Service to address the health problems involved.

12 ‘‘(d) TASK FORCE.—

13 ‘‘(1) ESTABLISHED.—There is hereby estab14 lished an Intergovernmental Task Force (referred to

15 in this section as the ‘task force’) that shall be com16 posed of the following individuals (or their des17 ignees):

18 ‘‘(A) The Secretary of Energy.

19 ‘‘(B) The Administrator of the Environ20 mental Protection Agency.

21 ‘‘(C) The Director of the Bureau of Mines.

22 ‘‘(D) The Assistant Secretary for Occupa23 tional Safety and Health.

24 ‘‘(E) The Secretary of the Interior.
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1 ‘‘(2) DUTIES.—The Task Force shall identify

2 existing and potential operations related to nuclear

3 resource development or other environmental haz4 ards that affect or may affect the health of Indians

5 on or near an Indian reservation or in an Indian

6 community, and enter into activities to correct exist7 ing health hazards and ensure that current and fu8 ture health problems resulting from nuclear resource

9 or other development activities are minimized or re10 duced.

11 ‘‘(3) ADMINISTRATIVE PROVISIONS.—The Sec12 retary shall serve as the chairperson of the Task

13 Force. The Task Force shall meet at least twice

14 each year. Each member of the Task Force shall

15 furnish necessary assistance to the Task Force.

16 ‘‘(e) PROVISION OF APPROPRIATE MEDICAL CARE.—

17 In the case of any Indian who—

18 ‘‘(1) as a result of employment in or near a

19 uranium mine or mill or near any other environ20 mental hazard, suffers from a work related illness or

21 condition;

22 ‘‘(2) is eligible to receive diagnosis and treat23 ment services from a Service facility; and

24 ‘‘(3) by reason of such Indian’s employment, is

25 entitled to medical care at the expense of such mine
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1 or mill operator or entity responsible for the environ2 mental hazard;

3 the Service shall, at the request of such Indian, render

4 appropriate medical care to such Indian for such illness

5 or condition and may recover the costs of any medical care

6 so rendered to which such Indian is entitled at the expense

7 of such operator or entity from such operator or entity.

8 Nothing in this subsection shall affect the rights of such

9 Indian to recover damages other than such costs paid to

10 the Service from the employer for such illness or condition.

11 ‘‘SEC. 216. ARIZONA AS A CONTRACT HEALTH SERVICE DE12 LIVERY AREA.

13 ‘‘(a) IN GENERAL.—For fiscal years beginning with

14 the fiscal year ending September 30, 1983, and ending

15 with the fiscal year ending September 30, 2012, the State

16 of Arizona shall be designated as a contract health service

17 delivery area by the Service for the purpose of providing

18 contract health care services to members of federally rec19 ognized Indian Tribes of Arizona.

20 ‘‘(b) LIMITATION.—The Service shall not curtail any

21 health care services provided to Indians residing on Fed22 eral reservations in the State of Arizona if such curtail23 ment is due to the provision of contract services in such

24 State pursuant to the designation of such State as a con-
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1 tract health service delivery area pursuant to subsection

2 (a).

3 ‘‘SEC. 217. CALIFORNIA CONTRACT HEALTH SERVICES DEM4 ONSTRATION PROGRAM.

5 ‘‘(a) IN GENERAL.—The Secretary may fund a pro6 gram that utilizes the California Rural Indian Health

7 Board as a contract care intermediary to improve the ac8 cessibility of health services to California Indians.

9 ‘‘(b) REIMBURSEMENT OF BOARD.—

10 ‘‘(1) AGREEMENT.—The Secretary shall enter

11 into an agreement with the California Rural Indian

12 Health Board to reimburse the Board for costs (in13 cluding reasonable administrative costs) incurred

14 pursuant to this section in providing medical treat15 ment under contract to California Indians described

16 in section 809(b) throughout the California contract

17 health services delivery area described in section 218

18 with respect to high-cost contract care cases.

19 ‘‘(2) ADMINISTRATION.—Not more than 5 per20 cent of the amounts provided to the Board under

21 this section for any fiscal year may be used for reim22 bursement for administrative expenses incurred by

23 the Board during such fiscal year.

24 ‘‘(3) LIMITATION.—No payment may be made

25 for treatment provided under this section to the ex-
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1 tent that payment may be made for such treatment

2 under the Catastrophic Health Emergency Fund de3 scribed in section 202 or from amounts appropriated

4 or otherwise made available to the California con5 tract health service delivery area for a fiscal year.

6 ‘‘(c) ADVISORY BOARD.—There is hereby established

7 an advisory board that shall advise the California Rural

8 Indian Health Board in carrying out this section. The ad9 visory board shall be composed of representatives, selected

10 by the California Rural Indian Health Board, from not

11 less than 8 tribal health programs serving California Indi12 ans covered under this section, at least 50 percent of

13 whom are not affiliated with the California Rural Indian

14 Health Board.

15 ‘‘SEC. 218. CALIFORNIA AS A CONTRACT HEALTH SERVICE

16 DELIVERY AREA.

17 ‘‘The State of California, excluding the counties of

18 Alameda, Contra Costa, Los Angeles, Marin, Orange, Sac19 ramento, San Francisco, San Mateo, Santa Clara, Kern,

20 Merced, Monterey, Napa, San Benito, San Joaquin, San

21 Luis Obispo, Santa Cruz, Solano, Stanislaus, and Ventura

22 shall be designated as a contract health service delivery

23 area by the Service for the purpose of providing contract

24 health services to Indians in such State, except that any

25 of the counties described in this section may be included
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1 in the contract health services delivery area if funding is

2 specifically provided by the Service for such services in

3 those counties.

4 ‘‘SEC. 219. CONTRACT HEALTH SERVICES FOR THE TREN5 TON SERVICE AREA.

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

7 the Service, shall provide contract health services to mem8 bers of the Turtle Mountain Band of Chippewa Indians

9 that reside in the Trenton Service Area of Divide,

10 McKenzie, and Williams counties in the State of North

11 Dakota and the adjoining counties of Richland, Roosevelt,

12 and Sheridan in the State of Montana.

13 ‘‘(b) RULE OF CONSTRUCTION.—Nothing in this sec14 tion shall be construed as expanding the eligibility of mem15 bers of the Turtle Mountain Band of Chippewa Indians

16 for health services provided by the Service beyond the

17 scope of eligibility for such health services that applied on

18 May 1, 1986.

19 ‘‘SEC. 220. PROGRAMS OPERATED BY INDIAN TRIBES AND

20 TRIBAL ORGANIZATIONS.

21 ‘‘The Service shall provide funds for health care pro22 grams and facilities operated by Indian tribes and tribal

23 organizations under funding agreements with the Service

24 entered into under the Indian Self-Determination and

25 Education Assistance Act on the same basis as such funds
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1 are provided to programs and facilities operated directly

2 by the Service.

3 ‘‘SEC. 221. LICENSING.

4 ‘‘Health care professionals employed by Indian Tribes

5 and tribal organizations to carry out agreements under the

6 Indian Self-Determination and Education Assistance Act,

7 shall, if licensed in any State, be exempt from the licensing

8 requirements of the State in which the agreement is per9 formed.

10 ‘‘SEC. 222. AUTHORIZATION FOR EMERGENCY CONTRACT

11 HEALTH SERVICES.

12 ‘‘With respect to an elderly Indian or an Indian with

13 a disability receiving emergency medical care or services

14 from a non-Service provider or in a non-Service facility

15 under the authority of this Act, the time limitation (as

16 a condition of payment) for notifying the Service of such

17 treatment or admission shall be 30 days.

18 ‘‘SEC. 223. PROMPT ACTION ON PAYMENT OF CLAIMS.

19 ‘‘(a) REQUIREMENT.—The Service shall respond to

20 a notification of a claim by a provider of a contract care

21 service with either an individual purchase order or a denial

22 of the claim within 5 working days after the receipt of

23 such notification.

24 ‘‘(b) FAILURE TO RESPOND.—If the Service fails to

25 respond to a notification of a claim in accordance with
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1 subsection (a), the Service shall accept as valid the claim

2 submitted by the provider of a contract care service.

3 ‘‘(c) PAYMENT.—The Service shall pay a valid con4 tract care service claim within 30 days after the comple5 tion of the claim.

6 ‘‘SEC. 224. LIABILITY FOR PAYMENT.

7 ‘‘(a) NO LIABILITY.—A patient who receives contract

8 health care services that are authorized by the Service

9 shall not be liable for the payment of any charges or costs

10 associated with the provision of such services.

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

12 contract care provider and any patient who receives con13 tract health care services authorized by the Service that

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

15 or costs associated with the provision of such services.

16 ‘‘(c) LIMITATION.—Following receipt of the notice

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

18 deemed accepted under section 223(b), the provider shall

19 have no further recourse against the patient who received

20 the services involved.

21 ‘‘SEC. 225. AUTHORIZATION OF APPROPRIATIONS.

22 ‘‘There are authorized to be appropriated such sums

23 as may be necessary for each fiscal year through fiscal

24 year 2012 to carry out this title.
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1 ‘‘TITLE III—FACILITIES

2 ‘‘SEC. 301. CONSULTATION, CONSTRUCTION AND RENOVA3 TION OF FACILITIES; REPORTS.

4 ‘‘(a) CONSULTATION.—Prior to the expenditure of, or

5 the making of any firm commitment to expend, any funds

6 appropriated for the planning, design, construction, or

7 renovation of facilities pursuant to the Act of November

8 2, 1921 (25 U.S.C. 13) (commonly known as the Snyder

9 Act), the Secretary, acting through the Service, shall—

10 ‘‘(1) consult with any Indian tribe that would

11 be significantly affected by such expenditure for the

12 purpose of determining and, whenever practicable,

13 honoring tribal preferences concerning size, location,

14 type, and other characteristics of any facility on

15 which such expenditure is to be made; and

16 ‘‘(2) ensure, whenever practicable, that such fa17 cility meets the construction standards of any na18 tionally recognized accrediting body by not later

19 than 1 year after the date on which the construction

20 or renovation of such facility is completed.

21 ‘‘(b) CLOSURE OF FACILITIES.—

22 ‘‘(1) IN GENERAL.—Notwithstanding any provi23 sion of law other than this subsection, no Service

24 hospital or outpatient health care facility or any in25 patient service or special care facility operated by
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1 the Service, may be closed if the Secretary has not

2 submitted to the Congress at least 1 year prior to

3 the date such proposed closure an evaluation of the

4 impact of such proposed closure which specifies, in

5 addition to other considerations—

6 ‘‘(A) the accessibility of alternative health

7 care resources for the population served by such

8 hospital or facility;

9 ‘‘(B) the cost effectiveness of such closure;

10 ‘‘(C) the quality of health care to be pro11 vided to the population served by such hospital

12 or facility after such closure;

13 ‘‘(D) the availability of contract health

14 care funds to maintain existing levels of service;

15 ‘‘(E) the views of the Indian tribes served

16 by such hospital or facility concerning such clo17 sure;

18 ‘‘(F) the level of utilization of such hos19 pital or facility by all eligible Indians; and

20 ‘‘(G) the distance between such hospital or

21 facility and the nearest operating Service hos22 pital.

23 ‘‘(2) TEMPORARY CLOSURE.—Paragraph (1)

24 shall not apply to any temporary closure of a facility
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1 or of any portion of a facility if such closure is nec2 essary for medical, environmental, or safety reasons.

3 ‘‘(c) PRIORITY SYSTEM.—

4 ‘‘(1) ESTABLISHMENT.—The Secretary shall es5 tablish a health care facility priority system, that

6 shall—

7 ‘‘(A) be developed with Indian tribes and

8 tribal organizations through negotiated rule9 making under section 802;

10 ‘‘(B) give the needs of Indian tribes’ the

11 highest priority; and

12 ‘‘(C) at a minimum, include the lists re13 quired in paragraph (2)(B) and the method14 ology required in paragraph (2)(E);

15 except that the priority of any project established

16 under the construction priority system in effect on

17 the date of this Act shall not be affected by any

18 change in the construction priority system taking

19 place thereafter if the project was identified as one

20 of the top 10 priority inpatient projects or one of the

21 top 10 outpatient projects in the Indian Health

22 Service budget justification for fiscal year 2000, or

23 if the project had completed both Phase I and Phase

24 II of the construction priority system in effect on

25 the date of this Act.
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1 ‘‘(2) REPORT.—The Secretary shall submit to

2 the President, for inclusion in each report required

3 to be transmitted to the Congress under section 801,

4 a report that includes—

5 ‘‘(A) a description of the health care facil6 ity priority system of the Service, as established

7 under paragraph (1);

8 ‘‘(B) health care facility lists, including—

9 ‘‘(i) the total health care facility plan10 ning, design, construction and renovation

11 needs for Indians;

12 ‘‘(ii) the 10 top-priority inpatient care

13 facilities;

14 ‘‘(iii) the 10 top-priority outpatient

15 care facilities;

16 ‘‘(iv) the 10 top-priority specialized

17 care facilities (such as long-term care and

18 alcohol and drug abuse treatment); and

19 ‘‘(v) any staff quarters associated

20 with such prioritized facilities;

21 ‘‘(C) the justification for the order of pri22 ority among facilities;

23 ‘‘(D) the projected cost of the projects in24 volved; and
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1 ‘‘(E) the methodology adopted by the Serv2 ice in establishing priorities under its health

3 care facility priority system.

4 ‘‘(3) CONSULTATION.—In preparing each report

5 required under paragraph (2) (other than the initial

6 report) the Secretary shall annually—

7 ‘‘(A) consult with, and obtain information

8 on all health care facilities needs from, Indian

9 tribes and tribal organizations including those

10 tribes or tribal organizations operating health

11 programs or facilities under any funding agree12 ment entered into with the Service under the

13 Indian Self-Determination and Education As14 sistance Act; and

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

16 tribes and tribal organizations for health care

17 facilities (including staff quarters), including

18 needs for renovation and expansion of existing

19 facilities.

20 ‘‘(4) CRITERIA.—For purposes of this sub21 section, the Secretary shall, in evaluating the needs

22 of facilities operated under any funding agreement

23 entered into with the Service under the Indian Self24 Determination and Education Assistance Act, use

25 the same criteria that the Secretary uses in evalu-
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1 ating the needs of facilities operated directly by the

2 Service.

3 ‘‘(5) EQUITABLE INTEGRATION.—The Secretary

4 shall ensure that the planning, design, construction,

5 and renovation needs of Service and non-Service fa6 cilities, operated under funding agreements in ac7 cordance with the Indian Self-Determination and

8 Education Assistance Act are fully and equitably in9 tegrated into the health care facility priority system.

10 ‘‘(d) REVIEW OF NEED FOR FACILITIES.—

11 ‘‘(1) REPORT.—Beginning in 2001, the Sec12 retary shall annually submit to the President, for in13 clusion in the report required to be transmitted to

14 Congress under section 801 of this Act, a report

15 which sets forth the needs of the Service and all In16 dian tribes and tribal organizations, including urban

17 Indian organizations, for inpatient, outpatient and

18 specialized care facilities, including the needs for

19 renovation and expansion of existing facilities .

20 ‘‘(2) CONSULTATION.—In preparing each report

21 required under paragraph (1) (other than the initial

22 report), the Secretary shall consult with Indian

23 tribes and tribal organizations including those tribes

24 or tribal organizations operating health programs or

25 facilities under any funding agreement entered into
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1 with the Service under the Indian Self-Determina2 tion and Education Assistance Act, and with urban

3 Indian organizations.

4 ‘‘(3) CRITERIA.—For purposes of this sub5 section, the Secretary shall, in evaluating the needs

6 of facilities operated under any funding agreement

7 entered into with the Service under the Indian Self8 Determination and Education Assistance Act, use

9 the same criteria that the Secretary uses in evalu10 ating the needs of facilities operated directly by the

11 Service.

12 ‘‘(4) EQUITABLE INTEGRATION.—The Secretary

13 shall ensure that the planning, design, construction,

14 and renovation needs of facilities operated under

15 funding agreements, in accordance with the Indian

16 Self-Determination and Education Assistance Act,

17 are fully and equitably integrated into the develop18 ment of the health facility priority system.

19 ‘‘(5) ANNUAL NOMINATIONS.—Each year the

20 Secretary shall provide an opportunity for the nomi21 nation of planning, design, and construction projects

22 by the Service and all Indian tribes and tribal orga23 nizations for consideration under the health care fa24 cility priority system.
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1 ‘‘(e) INCLUSION OF CERTAIN PROGRAMS.—All funds

2 appropriated under the Act of November 2, 1921 (25

3 U.S.C. 13), for the planning, design, construction, or ren4 ovation of health facilities for the benefit of an Indian

5 tribe or tribes shall be subject to the provisions of section

6 102 of the Indian Self-Determination and Education As7 sistance Act.

8 ‘‘(f) INNOVATIVE APPROACHES.—The Secretary shall

9 consult and cooperate with Indian tribes, tribal organiza10 tions and urban Indian organizations in developing inno11 vative approaches to address all or part of the total unmet

12 need for construction of health facilities, including those

13 provided for in other sections of this title and other ap14 proaches.

15 ‘‘SEC. 302. SAFE WATER AND SANITARY WASTE DISPOSAL

16 FACILITIES.

17 ‘‘(a) FINDINGS.—Congress finds and declares that—

18 ‘‘(1) the provision of safe water supply facilities

19 and sanitary sewage and solid waste disposal facili20 ties is primarily a health consideration and function;

21 ‘‘(2) Indian people suffer an inordinately high

22 incidence of disease, injury, and illness directly at23 tributable to the absence or inadequacy of such fa24 cilities;
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1 ‘‘(3) the long-term cost to the United States of

2 treating and curing such disease, injury, and illness

3 is substantially greater than the short-term cost of

4 providing such facilities and other preventive health

5 measures;

6 ‘‘(4) many Indian homes and communities still

7 lack safe water supply facilities and sanitary sewage

8 and solid waste disposal facilities; and

9 ‘‘(5) it is in the interest of the United States,

10 and it is the policy of the United States, that all In11 dian communities and Indian homes, new and exist12 ing, be provided with safe and adequate water sup13 ply facilities and sanitary sewage waste disposal fa14 cilities as soon as possible.

15 ‘‘(b) PROVISION OF FACILITIES AND SERVICES.—

16 ‘‘(1) IN GENERAL.—In furtherance of the find17 ings and declarations made in subsection (a), Con18 gress reaffirms the primary responsibility and au19 thority of the Service to provide the necessary sani20 tation facilities and services as provided in section 7

21 of the Act of August 5, 1954 (42 U.S.C. 2004a).

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

23 through the Service, is authorized to provide under

24 section 7 of the Act of August 5, 1954 (42 U.S.C.

25 2004a)—
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1 ‘‘(A) financial and technical assistance to

2 Indian tribes, tribal organizations and Indian

3 communities in the establishment, training, and

4 equipping of utility organizations to operate

5 and maintain Indian sanitation facilities, in6 cluding the provision of existing plans, standard

7 details, and specifications available in the De8 partment, to be used at the option of the tribe

9 or tribal organization;

10 ‘‘(B) ongoing technical assistance and

11 training in the management of utility organiza12 tions which operate and maintain sanitation fa13 cilities; and

14 ‘‘(C) priority funding for the operation,

15 and maintenance assistance for, and emergency

16 repairs to, tribal sanitation facilities when nec17 essary to avoid an imminent health threat or to

18 protect the investment in sanitation facilities

19 and the investment in the health benefits

20 gained through the provision of sanitation fa21 cilities.

22 ‘‘(3) PROVISIONS RELATING TO FUNDING.—

23 Notwithstanding any other provision of law—

24 ‘‘(A) the Secretary of Housing and Urban

25 Development is authorized to transfer funds ap-
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1 propriated under the Native American Housing

2 Assistance and Self-Determination Act of 1996

3 to the Secretary of Health and Human Serv4 ices;

5 ‘‘(B) the Secretary of Health and Human

6 Services is authorized to accept and use such

7 funds for the purpose of providing sanitation

8 facilities and services for Indians under section

9 7 of the Act of August 5, 1954 (42 U.S.C.

10 2004a);

11 ‘‘(C) unless specifically authorized when

12 funds are appropriated, the Secretary of Health

13 and Human Services shall not use funds appro14 priated under section 7 of the Act of August 5,

15 1954 (42 U.S.C. 2004a) to provide sanitation

16 facilities to new homes constructed using funds

17 provided by the Department of Housing and

18 Urban Development;

19 ‘‘(D) the Secretary of Health and Human

20 Services is authorized to accept all Federal

21 funds that are available for the purpose of pro22 viding sanitation facilities and related services

23 and place those funds into funding agreements,

24 authorized under the Indian Self-Determination

25 and Education Assistance Act, between the Sec-
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1 retary and Indian tribes and tribal organiza2 tions;

3 ‘‘(E) the Secretary may permit funds ap4 propriated under the authority of section 4 of

5 the Act of August 5, 1954 (42 U.S.C. 2004) to

6 be used to fund up to 100 percent of the

7 amount of a tribe’s loan obtained under any

8 Federal program for new projects to construct

9 eligible sanitation facilities to serve Indian

10 homes;

11 ‘‘(F) the Secretary may permit funds ap12 propriated under the authority of section 4 of

13 the Act of August 5, 1954 (42 U.S.C. 2004) to

14 be used to meet matching or cost participation

15 requirements under other Federal and non-Fed16 eral programs for new projects to construct eli17 gible sanitation facilities;

18 ‘‘(G) all Federal agencies are authorized to

19 transfer to the Secretary funds identified,

20 granted, loaned or appropriated and thereafter

21 the Department’s applicable policies, rules, reg22 ulations shall apply in the implementation of

23 such projects;

24 ‘‘(H) the Secretary of Health and Human

25 Services shall enter into inter-agency agree-
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1 ments with the Bureau of Indian Affairs, the

2 Department of Housing and Urban Develop3 ment, the Department of Agriculture, the Envi4 ronmental Protection Agency and other appro5 priate Federal agencies, for the purpose of pro6 viding financial assistance for safe water supply

7 and sanitary sewage disposal facilities under

8 this Act; and

9 ‘‘(I) the Secretary of Health and Human

10 Services shall, by regulation developed through

11 rulemaking under section 802, establish stand12 ards applicable to the planning, design and con13 struction of water supply and sanitary sewage

14 and solid waste disposal facilities funded under

15 this Act.

16 ‘‘(c) 10-YEAR FUNDING PLAN.—The Secretary, act17 ing through the Service and in consultation with Indian

18 tribes and tribal organizations, shall develop and imple19 ment a 10-year funding plan to provide safe water supply

20 and sanitary sewage and solid waste disposal facilities

21 serving existing Indian homes and communities, and to

22 new and renovated Indian homes.

23 ‘‘(d) CAPABILITY OF TRIBE OR COMMUNITY.—The

24 financial and technical capability of an Indian tribe or

25 community to safely operate and maintain a sanitation fa-
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1 cility shall not be a prerequisite to the provision or con2 struction of sanitation facilities by the Secretary.

3 ‘‘(e) FINANCIAL ASSISTANCE.—The Secretary may

4 provide financial assistance to Indian tribes, tribal organi5 zations and communities for the operation, management,

6 and maintenance of their sanitation facilities.

7 ‘‘(f) RESPONSIBILITY FOR FEES FOR OPERATION

8 AND MAINTENANCE.—The Indian family, community or

9 tribe involved shall have the primary responsibility to es10 tablish, collect, and use reasonable user fees, or otherwise

11 set aside funding, for the purpose of operating and main12 taining sanitation facilities. If a community facility is

13 threatened with imminent failure and there is a lack of

14 tribal capacity to maintain the integrity or the health ben15 efit of the facility, the Secretary may assist the Tribe in

16 the resolution of the problem on a short term basis

17 through cooperation with the emergency coordinator or by

18 providing operation and maintenance service.

19 ‘‘(g) ELIGIBILITY OF CERTAIN TRIBES OR ORGANI20 ZATIONS.—Programs administered by Indian tribes or

21 tribal organizations under the authority of the Indian Self22 Determination and Education Assistance Act shall be eli23 gible for—

24 ‘‘(1) any funds appropriated pursuant to this

25 section; and
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1 ‘‘(2) any funds appropriated for the purpose of

2 providing water supply, sewage disposal, or solid

3 waste facilities;

4 on an equal basis with programs that are administered

5 directly by the Service.

6 ‘‘(h) REPORT.—

7 ‘‘(1) IN GENERAL.—The Secretary shall submit

8 to the President, for inclusion in each report re9 quired to be transmitted to the Congress under sec10 tion 801, a report which sets forth—

11 ‘‘(A) the current Indian sanitation facility

12 priority system of the Service;

13 ‘‘(B) the methodology for determining

14 sanitation deficiencies;

15 ‘‘(C) the level of initial and final sanitation

16 deficiency for each type sanitation facility for

17 each project of each Indian tribe or community;

18 and

19 ‘‘(D) the amount of funds necessary to re20 duce the identified sanitation deficiency levels of

21 all Indian tribes and communities to a level I

22 sanitation deficiency as described in paragraph

23 (4)(A).

24 ‘‘(2) CONSULTATION.—In preparing each report

25 required under paragraph (1), the Secretary shall
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1 consult with Indian tribes and tribal organizations

2 (including those tribes or tribal organizations oper3 ating health care programs or facilities under any

4 funding agreements entered into with the Service

5 under the Indian Self-Determination and Education

6 Assistance Act) to determine the sanitation needs of

7 each tribe and in developing the criteria on which

8 the needs will be evaluated through a process of ne9 gotiated rulemaking.

10 ‘‘(3) METHODOLOGY.—The methodology used

11 by the Secretary in determining, preparing cost esti12 mates for and reporting sanitation deficiencies for

13 purposes of paragraph (1) shall be applied uniformly

14 to all Indian tribes and communities.

15 ‘‘(4) SANITATION DEFICIENCY LEVELS.—For

16 purposes of this subsection, the sanitation deficiency

17 levels for an individual or community sanitation fa18 cility serving Indian homes are as follows:

19 ‘‘(A) A level I deficiency is a sanitation fa20 cility serving and individual or community—

21 ‘‘(i) which complies with all applicable

22 water supply, pollution control and solid

23 waste disposal laws; and
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1 ‘‘(ii) in which the deficiencies relate to

2 routine replacement, repair, or mainte3 nance needs.

4 ‘‘(B) A level II deficiency is a sanitation

5 facility serving and individual or community—

6 ‘‘(i) which substantially or recently

7 complied with all applicable water supply,

8 pollution control and solid waste laws, in

9 which the deficiencies relate to small or

10 minor capital improvements needed to

11 bring the facility back into compliance;

12 ‘‘(ii) in which the deficiencies relate to

13 capital improvements that are necessary to

14 enlarge or improve the facilities in order to

15 meet the current needs for domestic sani16 tation facilities; or

17 ‘‘(iii) in which the deficiencies relate

18 to the lack of equipment or training by an

19 Indian Tribe or community to properly op20 erate and maintain the sanitation facilities.

21 ‘‘(C) A level III deficiency is an individual

22 or community facility with water or sewer serv23 ice in the home, piped services or a haul system

24 with holding tanks and interior plumbing, or

25 where major significant interruptions to water
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1 supply or sewage disposal occur frequently, re2 quiring major capital improvements to correct

3 the deficiencies. There is no access to or no ap4 proved or permitted solid waste facility avail5 able.

6 ‘‘(D) A level IV deficiency is an individual

7 or community facility where there are no piped

8 water or sewer facilities in the home or the fa9 cility has become inoperable due to major com10 ponent failure or where only a washeteria or

11 central facility exists.

12 ‘‘(E) A level V deficiency is the absence of

13 a sanitation facility, where individual homes do

14 not have access to safe drinking water or ade15 quate wastewater disposal.

16 ‘‘(i) DEFINITIONS.—In this section:

17 ‘‘(1) FACILITY.—The terms ‘facility’ or ‘facili18 ties’ shall have the same meaning as the terms ‘sys19 tem’ or ‘systems’ unless the context requires other20 wise.

21 ‘‘(2) INDIAN COMMUNITY.—The term ‘Indian

22 community’ means a geographic area, a significant

23 proportion of whose inhabitants are Indians and

24 which is served by or capable of being served by a

25 facility described in this section.
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1 ‘‘SEC. 303. PREFERENCE TO INDIANS AND INDIAN FIRMS.

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

3 the Service, may utilize the negotiating authority of the

4 Act of June 25, 1910 (25 U.S.C. 47), to give preference

5 to any Indian or any enterprise, partnership, corporation,

6 or other type of business organization owned and con7 trolled by an Indian or Indians including former or cur8 rently federally recognized Indian tribes in the State of

9 New York (hereinafter referred to as an ‘Indian firm’) in

10 the construction and renovation of Service facilities pursu11 ant to section 301 and in the construction of safe water

12 and sanitary waste disposal facilities pursuant to section

13 302. Such preference may be accorded by the Secretary

14 unless the Secretary finds, pursuant to rules and regula15 tions promulgated by the Secretary, that the project or

16 function to be contracted for will not be satisfactory or

17 such project or function cannot be properly completed or

18 maintained under the proposed contract. The Secretary,

19 in arriving at such finding, shall consider whether the In20 dian or Indian firm will be deficient with respect to—

21 ‘‘(1) ownership and control by Indians;

22 ‘‘(2) equipment;

23 ‘‘(3) bookkeeping and accounting procedures;

24 ‘‘(4) substantive knowledge of the project or

25 function to be contracted for;

26 ‘‘(5) adequately trained personnel; or
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1 ‘‘(6) other necessary components of contract

2 performance.

3 ‘‘(b) EXEMPTION FROM DAVIS-BACON.—For the

4 purpose of implementing the provisions of this title, con5 struction or renovation of facilities constructed or ren6 ovated in whole or in part by funds made available pursu7 ant to this title are exempt from the Act of March 3, 1931

8 (40 U.S.C. 276a—276a–5, known as the Davis-Bacon

9 Act). For all health facilities, staff quarters and sanitation

10 facilities, construction and renovation subcontractors shall

11 be paid wages at rates that are not less than the prevailing

12 wage rates for similar construction in the locality involved,

13 as determined by the Indian tribe, Tribes, or tribal organi14 zations served by such facilities.

15 ‘‘SEC. 304. SOBOBA SANITATION FACILITIES.

16 ‘‘Nothing in the Act of December 17, 1970 (84 Stat.

17 1465) shall be construed to preclude the Soboba Band of

18 Mission Indians and the Soboba Indian Reservation from

19 being provided with sanitation facilities and services under

20 the authority of section 7 of the Act of August 5, 1954

21 (68 Stat 674), as amended by the Act of July 31, 1959

22 (73 Stat. 267).

23 ‘‘SEC. 305. EXPENDITURE OF NONSERVICE FUNDS FOR REN24 OVATION.

25 ‘‘(a) PERMISSIBILITY.—
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1 ‘‘(1) IN GENERAL.—Notwithstanding any other

2 provision of law, the Secretary is authorized to ac3 cept any major expansion, renovation or moderniza4 tion by any Indian tribe of any Service facility, or

5 of any other Indian health facility operated pursuant

6 to a funding agreement entered into under the In7 dian Self-Determination and Education Assistance

8 Act, including—

9 ‘‘(A) any plans or designs for such expan10 sion, renovation or modernization; and

11 ‘‘(B) any expansion, renovation or mod12 ernization for which funds appropriated under

13 any Federal law were lawfully expended;

14 but only if the requirements of subsection (b) are

15 met.

16 ‘‘(2) PRIORITY LIST.—The Secretary shall

17 maintain a separate priority list to address the need

18 for increased operating expenses, personnel or equip19 ment for such facilities described in paragraph (1).

20 The methodology for establishing priorities shall be

21 developed by negotiated rulemaking under section

22 802. The list of priority facilities will be revised an23 nually in consultation with Indian tribes and tribal

24 organizations.
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1 ‘‘(3) REPORT.—The Secretary shall submit to

2 the President, for inclusion in each report required

3 to be transmitted to the Congress under section 801,

4 the priority list maintained pursuant to paragraph

5 (2).

6 ‘‘(b) REQUIREMENTS.—The requirements of this sub7 section are met with respect to any expansion, renovation

8 or modernization if—

9 ‘‘(1) the tribe or tribal organization—

10 ‘‘(A) provides notice to the Secretary of its

11 intent to expand, renovate or modernize; and

12 ‘‘(B) applies to the Secretary to be placed

13 on a separate priority list to address the needs

14 of such new facilities for increased operating ex15 penses, personnel or equipment; and

16 ‘‘(2) the expansion renovation or

17 modernization—

18 ‘‘(A) is approved by the appropriate area

19 director of the Service for Federal facilities; and

20 ‘‘(B) is administered by the Indian tribe or

21 tribal organization in accordance with any ap22 plicable regulations prescribed by the Secretary

23 with respect to construction or renovation of

24 Service facilities.
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1 ‘‘(c) RIGHT OF TRIBE IN CASE OF FAILURE OF FA2 CILITY TO BE USED AS A SERVICE FACILITY.—If any

3 Service facility which has been expanded, renovated or

4 modernized by an Indian tribe under this section ceases

5 to be used as a Service facility during the 20-year period

6 beginning on the date such expansion, renovation or mod7 ernization is completed, such Indian tribe shall be entitled

8 to recover from the United States an amount which bears

9 the same ratio to the value of such facility at the time

10 of such cessation as the value of such expansion, renova11 tion or modernization (less the total amount of any funds

12 provided specifically for such facility under any Federal

13 program that were expended for such expansion, renova14 tion or modernization) bore to the value of such facility

15 at the time of the completion of such expansion, renova16 tion or modernization.

17 ‘‘SEC. 306. FUNDING FOR THE CONSTRUCTION, EXPANSION,

18 AND MODERNIZATION OF SMALL AMBULA19 TORY CARE FACILITIES.

20 ‘‘(a) AVAILABILITY OF FUNDING.—

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

22 through the Service and in consultation with Indian

23 tribes and tribal organization, shall make funding

24 available to tribes and tribal organizations for the

25 construction, expansion, or modernization of facili-
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1 ties for the provision of ambulatory care services to

2 eligible Indians (and noneligible persons as provided

3 for in subsections (b)(2) and (c)(1)(C)). Funding

4 under this section may cover up to 100 percent of

5 the costs of such construction, expansion, or mod6 ernization. For the purposes of this section, the term

7 ‘construction’ includes the replacement of an exist8 ing facility.

9 ‘‘(2) REQUIREMENT.—Funding under para10 graph (1) may only be made available to an Indian

11 tribe or tribal organization operating an Indian

12 health facility (other than a facility owned or con13 structed by the Service, including a facility originally

14 owned or constructed by the Service and transferred

15 to an Indian tribe or tribal organization) pursuant

16 to a funding agreement entered into under the In17 dian Self-Determination and Education Assistance

18 Act.

19 ‘‘(b) USE OF FUNDS.—

20 ‘‘(1) IN GENERAL.—Funds provided under this

21 section may be used only for the construction, ex22 pansion, or modernization (including the planning

23 and design of such construction, expansion, or mod24 ernization) of an ambulatory care facility—

25 ‘‘(A) located apart from a hospital;
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1 ‘‘(B) not funded under section 301 or sec2 tion 307; and

3 ‘‘(C) which, upon completion of such con4 struction, expansion, or modernization will—

5 ‘‘(i) have a total capacity appropriate

6 to its projected service population;

7 ‘‘(ii) provide annually not less than

8 500 patient visits by eligible Indians and

9 other users who are eligible for services in

10 such facility in accordance with section

11 807(b)(1)(B); and

12 ‘‘(iii) provide ambulatory care in a

13 service area (specified in the funding

14 agreement entered into under the Indian

15 Self-Determination and Education Assist16 ance Act) with a population of not less

17 than 1,500 eligible Indians and other users

18 who are eligible for services in such facility

19 in accordance with section 807(b)(1)(B).

20 ‘‘(2) LIMITATION.—Funding provided under

21 this section may be used only for the cost of that

22 portion of a construction, expansion or moderniza23 tion project that benefits the service population de24 scribed in clauses (ii) and (iii) of paragraph (1)(C).

25 The requirements of such clauses (ii) and (iii) shall
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1 not apply to a tribe or tribal organization applying

2 for funding under this section whose principal office

3 for health care administration is located on an island

4 or where such office is not located on a road system

5 providing direct access to an inpatient hospital

6 where care is available to the service population.

7 ‘‘(c) APPLICATION AND PRIORITY.—

8 ‘‘(1) APPLICATION.—No funding may be made

9 available under this section unless an application for

10 such funding has been submitted to and approved by

11 the Secretary. An application or proposal for fund12 ing under this section shall be submitted in accord13 ance with applicable regulations and shall set forth

14 reasonable assurance by the applicant that, at all

15 times after the construction, expansion, or mod16 ernization of a facility carried out pursuant to fund17 ing received under this section—

18 ‘‘(A) adequate financial support will be

19 available for the provision of services at such

20 facility;

21 ‘‘(B) such facility will be available to eligi22 ble Indians without regard to ability to pay or

23 source of payment; and

24 ‘‘(C) such facility will, as feasible without

25 diminishing the quality or quantity of services
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1 provided to eligible Indians, serve noneligible

2 persons on a cost basis.

3 ‘‘(2) PRIORITY.—In awarding funds under this

4 section, the Secretary shall give priority to tribes

5 and tribal organizations that demonstrate—

6 ‘‘A) a need for increased ambulatory care

7 services; and

8 ‘‘(B) insufficient capacity to deliver such

9 services.

10 ‘‘(d) FAILURE TO USE FACILITY AS HEALTH FACIL11 ITY.—If any facility (or portion thereof) with respect to

12 which funds have been paid under this section, ceases,

13 within 5 years after completion of the construction, expan14 sion, or modernization carried out with such funds, to be

15 utilized for the purposes of providing health care services

16 to eligible Indians, all of the right, title, and interest in

17 and to such facility (or portion thereof) shall transfer to

18 the United States unless otherwise negotiated by the Serv19 ice and the Indian tribe or tribal organization.

20 ‘‘(e) NO INCLUSION IN TRIBAL SHARE.—Funding

21 provided to Indian tribes and tribal organizations under

22 this section shall be non-recurring and shall not be avail23 able for inclusion in any individual tribe’s tribal share for

24 an award under the Indian Self-Determination and Edu-
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1 cation Assistance Act or for reallocation or redesign there2 under.

3 ‘‘SEC. 307. INDIAN HEALTH CARE DELIVERY DEMONSTRA4 TION PROJECT.

5 ‘‘(a) HEALTH CARE DELIVERY DEMONSTRATION

6 PROJECTS.—The Secretary, acting through the Service

7 and in consultation with Indian tribes and tribal organiza8 tions, may enter into funding agreements with, or make

9 grants or loan guarantees to, Indian tribes or tribal orga10 nizations for the purpose of carrying out a health care de11 livery demonstration project to test alternative means of

12 delivering health care and services through health facili13 ties, including hospice, traditional Indian health and child

14 care facilities, to Indians.

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

16 projects pursuant to this section, may authorize funding

17 for the construction and renovation of hospitals, health

18 centers, health stations, and other facilities to deliver

19 health care services and is authorized to—

20 ‘‘(1) waive any leasing prohibition;

21 ‘‘(2) permit carryover of funds appropriated for

22 the provision of health care services;

23 ‘‘(3) permit the use of other available funds;

24 ‘‘(4) permit the use of funds or property do25 nated from any source for project purposes;
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1 ‘‘(5) provide for the reversion of donated real or

2 personal property to the donor; and

3 ‘‘(6) permit the use of Service funds to match

4 other funds, including Federal funds.

5 ‘‘(c) CRITERIA.—

6 ‘‘(1) IN GENERAL.—The Secretary shall develop

7 and publish regulations through rulemaking under

8 section 802 for the review and approval of applica9 tions submitted under this section. The Secretary

10 may enter into a contract, funding agreement or

11 award a grant under this section for projects which

12 meet the following criteria:

13 ‘‘(A) There is a need for a new facility or

14 program or the reorientation of an existing fa15 cility or program.

16 ‘‘(B) A significant number of Indians, in17 cluding those with low health status, will be

18 served by the project.

19 ‘‘(C) The project has the potential to ad20 dress the health needs of Indians in an innova21 tive manner.

22 ‘‘(D) The project has the potential to de23 liver services in an efficient and effective man24 ner.

25 ‘‘(E) The project is economically viable.
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1 ‘‘(F) The Indian tribe or tribal organization has

2 the administrative and financial capability to admin3 ister the project.

4 ‘‘(G) The project is integrated with pro5 viders of related health and social services and

6 is coordinated with, and avoids duplication of,

7 existing services.

8 ‘‘(2) PEER REVIEW PANELS.—The Secretary

9 may provide for the establishment of peer review

10 panels, as necessary, to review and evaluate applica11 tions and to advise the Secretary regarding such ap12 plications using the criteria developed pursuant to

13 paragraph (1).

14 ‘‘(3) PRIORITY.—The Secretary shall give pri15 ority to applications for demonstration projects

16 under this section in each of the following service

17 units to the extent that such applications are filed

18 in a timely manner and otherwise meet the criteria

19 specified in paragraph (1):

20 ‘‘(A) Cass Lake, Minnesota.

21 ‘‘(B) Clinton, Oklahoma.

22 ‘‘(C) Harlem, Montana.

23 ‘‘(D) Mescalero, New Mexico.

24 ‘‘(E) Owyhee, Nevada.

25 ‘‘(F) Parker, Arizona.
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1 ‘‘(G) Schurz, Nevada.

2 ‘‘(H) Winnebago, Nebraska.

3 ‘‘(I) Ft. Yuma, California

4 ‘‘(d) TECHNICAL ASSISTANCE.—The Secretary shall

5 provide such technical and other assistance as may be nec6 essary to enable applicants to comply with the provisions

7 of this section.

8 ‘‘(e) SERVICE TO INELIGIBLE PERSONS.—The au9 thority to provide services to persons otherwise ineligible

10 for the health care benefits of the Service and the author11 ity to extend hospital privileges in Service facilities to non12 Service health care practitioners as provided in section

13 807 may be included, subject to the terms of such section,

14 in any demonstration project approved pursuant to this

15 section.

16 ‘‘(f) EQUITABLE TREATMENT.—For purposes of sub17 section (c)(1)(A), the Secretary shall, in evaluating facili18 ties operated under any funding agreement entered into

19 with the Service under the Indian Self-Determination and

20 Education Assistance Act, use the same criteria that the

21 Secretary uses in evaluating facilities operated directly by

22 the Service.

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

24 The Secretary shall ensure that the planning, design, con25 struction, renovation and expansion needs of Service and
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1 non-Service facilities which are the subject of a funding

2 agreement for health services entered into with the Service

3 under the Indian Self-Determination and Education As4 sistance Act, are fully and equitably integrated into the

5 implementation of the health care delivery demonstration

6 projects under this section.

7 ‘‘SEC. 308. LAND TRANSFER.

8 ‘‘(a) GENERAL AUTHORITY FOR TRANSFERS.—Not9 withstanding any other provision of law, the Bureau of

10 Indian Affairs and all other agencies and departments of

11 the United States are authorized to transfer, at no cost,

12 land and improvements to the Service for the provision

13 of health care services. The Secretary is authorized to ac14 cept such land and improvements for such purposes.

15 ‘‘(b) CHEMAWA INDIAN SCHOOL.—The Bureau of In16 dian Affairs is authorized to transfer, at no cost, up to

17 5 acres of land at the Chemawa Indian School, Salem,

18 Oregon, to the Service for the provision of health care

19 services. The land authorized to be transferred by this sec20 tion is that land adjacent to land under the jurisdiction

21 of the Service and occupied by the Chemawa Indian

22 Health Center.

23 ‘‘SEC. 309. LEASES.

24 ‘‘(a) IN GENERAL.—Notwithstanding any other pro25 vision of law, the Secretary is authorized, in carrying out
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1 the purposes of this Act, to enter into leases with Indian

2 tribes and tribal organizations for periods not in excess

3 of 20 years. Property leased by the Secretary from an In4 dian tribe or tribal organization may be reconstructed or

5 renovated by the Secretary pursuant to an agreement with

6 such Indian tribe or tribal organization.

7 ‘‘(b) FACILITIES FOR THE ADMINISTRATION AND DE8 LIVERY OF HEALTH SERVICES.—The Secretary may enter

9 into leases, contracts, and other legal agreements with In10 dian tribes or tribal organizations which hold—

11 ‘‘(1) title to;

12 ‘‘(2) a leasehold interest in; or

13 ‘‘(3) a beneficial interest in (where title is held

14 by the United States in trust for the benefit of a

15 tribe);

16 facilities used for the administration and delivery of health

17 services by the Service or by programs operated by Indian

18 tribes or tribal organizations to compensate such Indian

19 tribes or tribal organizations for costs associated with the

20 use of such facilities for such purposes, and such leases

21 shall be considered as operating leases for the purposes

22 of scoring under the Budget Enforcement Act, notwith23 standing any other provision of law. Such costs include

24 rent, depreciation based on the useful life of the building,

25 principal and interest paid or accrued, operation and
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1 maintenance expenses, and other expenses determined by

2 regulation to be allowable pursuant to regulations under

3 section 105(l) of the Indian Self-Determination and Edu4 cation Assistance Act.

5 ‘‘SEC. 310. LOANS, LOAN GUARANTEES AND LOAN REPAY6 MENT.

7 ‘‘(a) HEALTH CARE FACILITIES LOAN FUND.—

8 There is established in the Treasury of the United States

9 a fund to be known as the ‘Health Care Facilities Loan

10 Fund’ (referred to in this Act as the ‘HCFLF’) to provide

11 to Indian Tribes and tribal organizations direct loans, or

12 guarantees for loans, for the construction of health care

13 facilities (including inpatient facilities, outpatient facili14 ties, associated staff quarters and specialized care facili15 ties such as behavioral health and elder care facilities).

16 ‘‘(b) STANDARDS AND PROCEDURES.—The Secretary

17 may promulgate regulations, developed through rule18 making as provided for in section 802, to establish stand19 ards and procedures for governing loans and loan guaran20 tees under this section, subject to the following conditions:

21 ‘‘(1) The principal amount of a loan or loan

22 guarantee may cover up to 100 percent of eligible

23 costs, including costs for the planning, design, fi24 nancing, site land development, construction, reha25 bilitation, renovation, conversion, improvements,
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1 medical equipment and furnishings, other facility re2 lated costs and capital purchase (but excluding staff3 ing).

4 ‘‘(2) The cumulative total of the principal of di5 rect loans and loan guarantees, respectively, out6 standing at any one time shall not exceed such limi7 tations as may be specified in appropriation Acts.

8 ‘‘(3) In the discretion of the Secretary, the pro9 gram under this section may be administered by the

10 Service or the Health Resources and Services Ad11 ministration (which shall be specified by regulation).

12 ‘‘(4) The Secretary may make or guarantee a

13 loan with a term of the useful estimated life of the

14 facility, or 25 years, whichever is less.

15 ‘‘(5) The Secretary may allocate up to 100 per16 cent of the funds available for loans or loan guaran17 tees in any year for the purpose of planning and ap18 plying for a loan or loan guarantee.

19 ‘‘(6) The Secretary may accept an assignment

20 of the revenue of an Indian tribe or tribal organiza21 tion as security for any direct loan or loan guarantee

22 under this section.

23 ‘‘(7) In the planning and design of health facili24 ties under this section, users eligible under section
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1 807(b) may be included in any projection of patient

2 population.

3 ‘‘(8) The Secretary shall not collect loan appli4 cation, processing or other similar fees from Indian

5 tribes or tribal organizations applying for direct

6 loans or loan guarantees under this section.

7 ‘‘(9) Service funds authorized under loans or

8 loan guarantees under this section may be used in

9 matching other Federal funds.

10 ‘‘(c) FUNDING.—

11 ‘‘(1) IN GENERAL.—The HCFLF shall consist

12 of—

13 ‘‘(A) such sums as may be initially appro14 priated to the HCFLF and as may be subse15 quently appropriated under paragraph (2);

16 ‘‘(B) such amounts as may be collected

17 from borrowers; and

18 ‘‘(C) all interest earned on amounts in the

19 HCFLF.

20 ‘‘(2) AUTHORIZATION OF APPROPRIATIONS.—

21 There is authorized to be appropriated such sums as

22 may be necessary to initiate the HCFLF. For each

23 fiscal year after the initial year in which funds are

24 appropriated to the HCFLF, there is authorized to

25 be appropriated an amount equal to the sum of the
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1 amount collected by the HCFLF during the pre2 ceding fiscal year, and all accrued interest on such

3 amounts.

4 ‘‘(3) AVAILABILITY OF FUNDS.—Amounts ap5 propriated, collected or earned relative to the

6 HCFLF shall remain available until expended.

7 ‘‘(d) FUNDING AGREEMENTS.—Amounts in the

8 HCFLF and available pursuant to appropriation Acts may

9 be expended by the Secretary, acting through the Service,

10 to make loans under this section to an Indian tribe or trib11 al organization pursuant to a funding agreement entered

12 into under the Indian Self-Determination and Education

13 Assistance Act.

14 ‘‘(e) INVESTMENTS.—The Secretary of the Treasury

15 shall invest such amounts of the HCFLF as such Sec16 retary determines are not required to meet current with17 drawals from the HCFLF. Such investments may be made

18 only in interest-bearing obligations of the United States.

19 For such purpose, such obligations may be acquired on

20 original issue at the issue price, or by purchase of out21 standing obligations at the market price. Any obligation

22 acquired by the fund may be sold by the Secretary of the

23 Treasury at the market price.

24 ‘‘(f) GRANTS.—The Secretary is authorized to estab25 lish a program to provide grants to Indian tribes and trib-
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1 al organizations for the purpose of repaying all or part

2 of any loan obtained by an Indian tribe or tribal organiza3 tion for construction and renovation of health care facili4 ties (including inpatient facilities, outpatient facilities, as5 sociated staff quarters and specialized care facilities).

6 Loans eligible for such repayment grants shall include

7 loans that have been obtained under this section or other8 wise.

9 ‘‘SEC. 311. TRIBAL LEASING.

10 ‘‘Indian Tribes and tribal organizations providing

11 health care services pursuant to a funding agreement con12 tract entered into under the Indian Self-Determination

13 and Education Assistance Act may lease permanent struc14 tures for the purpose of providing such health care serv15 ices without obtaining advance approval in appropriation

16 Acts.

17 ‘‘SEC. 312. INDIAN HEALTH SERVICE/TRIBAL FACILITIES

18 JOINT VENTURE PROGRAM.

19 ‘‘(a) AUTHORITY.—

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

21 through the Service, shall make arrangements with

22 Indian tribes and tribal organizations to establish

23 joint venture demonstration projects under which an

24 Indian tribe or tribal organization shall expend trib25 al, private, or other available funds, for the acquisi-
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1 tion or construction of a health facility for a min2 imum of 10 years, under a no-cost lease, in ex3 change for agreement by the Service to provide the

4 equipment, supplies, and staffing for the operation

5 and maintenance of such a health facility.

6 ‘‘(2) USE OF RESOURCES.—A tribe or tribal or7 ganization may utilize tribal funds, private sector, or

8 other available resources, including loan guarantees,

9 to fulfill its commitment under this subsection.

10 ‘‘(3) ELIGIBILITY OF CERTAIN ENTITIES.—A

11 tribe that has begun and substantially completed the

12 process of acquisition or construction of a health fa13 cility shall be eligible to establish a joint venture

14 project with the Service using such health facility.

15 ‘‘(b) REQUIREMENTS.—

16 ‘‘(1) IN GENERAL.—The Secretary shall enter

17 into an arrangement under subsection (a)(1) with an

18 Indian tribe or tribal organization only if—

19 ‘‘(A) the Secretary first determines that

20 the Indian tribe or tribal organization has the

21 administrative and financial capabilities nec22 essary to complete the timely acquisition or con23 struction of the health facility described in sub24 section (a)(1); and
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1 ‘‘(B) the Indian tribe or tribal organization

2 meets the needs criteria that shall be developed

3 through the negotiated rulemaking process pro4 vided for under section 802.

5 ‘‘(2) CONTINUED OPERATION OF FACILITY.—

6 The Secretary shall negotiate an agreement with the

7 Indian tribe or tribal organization regarding the con8 tinued operation of a facility under this section at

9 the end of the initial 10 year no-cost lease period.

10 ‘‘(3) BREACH OR TERMINATION OF AGREE11 MENT.—An Indian tribe or tribal organization that

12 has entered into a written agreement with the Sec13 retary under this section, and that breaches or ter14 minates without cause such agreement, shall be lia15 ble to the United States for the amount that has

16 been paid to the tribe or tribal organization, or paid

17 to a third party on the tribe’s or tribal organiza18 tion’s behalf, under the agreement. The Secretary

19 has the right to recover tangible property (including

20 supplies), and equipment, less depreciation, and any

21 funds expended for operations and maintenance

22 under this section. The preceding sentence shall not

23 apply to any funds expended for the delivery of

24 health care services, or for personnel or staffing.
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1 ‘‘(d) RECOVERY FOR NON-USE.—An Indian tribe or

2 tribal organization that has entered into a written agree3 ment with the Secretary under this section shall be enti4 tled to recover from the United States an amount that

5 is proportional to the value of such facility should at any

6 time within 10 years the Service ceases to use the facility

7 or otherwise breaches the agreement.

8 ‘‘(e) DEFINITION.—In this section, the terms ‘health

9 facility’ or ‘health facilities’ include staff quarters needed

10 to provide housing for the staff of the tribal health pro11 gram.

12 ‘‘SEC. 313. LOCATION OF FACILITIES.

13 ‘‘(a) PRIORITY.—The Bureau of Indian Affairs and

14 the Service shall, in all matters involving the reorganiza15 tion or development of Service facilities, or in the estab16 lishment of related employment projects to address unem17 ployment conditions in economically depressed areas, give

18 priority to locating such facilities and projects on Indian

19 lands if requested by the Indian owner and the Indian

20 tribe with jurisdiction over such lands or other lands

21 owned or leased by the Indian tribe or tribal organization

22 so long as priority is given to Indian land owned by an

23 Indian tribe or tribes.

24 ‘‘(b) DEFINITION.—In this section, the term ‘Indian

25 lands’ means—
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1 ‘‘(1) all lands within the exterior boundaries of

2 any Indian reservation;

3 ‘‘(2) any lands title to which is held in trust by

4 the United States for the benefit of any Indian tribe

5 or individual Indian, or held by any Indian tribe or

6 individual Indian subject to restriction by the United

7 States against alienation and over which an Indian

8 tribe exercises governmental power; and

9 ‘‘(3) all lands in Alaska owned by any Alaska

10 Native village, or any village or regional corporation

11 under the Alaska Native Claims Settlement Act, or

12 any land allotted to any Alaska Native.

13 ‘‘SEC. 314. MAINTENANCE AND IMPROVEMENT OF HEALTH

14 CARE FACILITIES.

15 ‘‘(a) REPORT.—The Secretary shall submit to the

16 President, for inclusion in the report required to be trans17 mitted to Congress under section 801, a report that identi18 fies the backlog of maintenance and repair work required

19 at both Service and tribal facilities, including new facilities

20 expected to be in operation in the fiscal year after the year

21 for which the report is being prepared. The report shall

22 identify the need for renovation and expansion of existing

23 facilities to support the growth of health care programs.

24 ‘‘(b) MAINTENANCE OF NEWLY CONSTRUCTED

25 SPACE.—
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1 ‘‘(1) IN GENERAL.—The Secretary may expend

2 maintenance and improvement funds to support the

3 maintenance of newly constructed space only if such

4 space falls within the approved supportable space al5 location for the Indian tribe or tribal organization.

6 ‘‘(2) DEFINITION.—For purposes of paragraph

7 (1), the term ‘supportable space allocation’ shall be

8 defined through the negotiated rulemaking process

9 provided for under section 802.

10 ‘‘(c) CONSTRUCTION OF REPLACEMENT FACILI11 TIES.—

12 ‘‘(1) IN GENERAL.—In addition to using main13 tenance and improvement funds for the maintenance

14 of facilities under subsection (b)(1), an Indian tribe

15 or tribal organization may use such funds for the

16 construction of a replacement facility if the costs of

17 the renovation of such facility would exceed a max18 imum renovation cost threshold.

19 ‘‘(2) DEFINITION.—For purposes of paragraph

20 (1), the term ‘maximum renovation cost threshold’

21 shall be defined through the negotiated rulemaking

22 process provided for under section 802.

23 ‘‘SEC. 315. TRIBAL MANAGEMENT OF FEDERALLY-OWNED

24 QUARTERS.

25 ‘‘(a) ESTABLISHMENT OF RENTAL RATES.—
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1 ‘‘(1) IN GENERAL.—Notwithstanding any other

2 provision of law, an Indian tribe or tribal organiza3 tion which operates a hospital or other health facility

4 and the Federally-owned quarters associated there5 with, pursuant to a funding agreement under the In6 dian Self-Determination and Education Assistance

7 Act, may establish the rental rates charged to the

8 occupants of such quarters by providing notice to

9 the Secretary of its election to exercise such author10 ity.

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

12 under paragraph (1), an Indian tribe or tribal orga13 nization shall attempt to achieve the following objec14 tives:

15 ‘‘(A) The rental rates should be based on

16 the reasonable value of the quarters to the oc17 cupants thereof.

18 ‘‘(B) The rental rates should generate suf19 ficient funds to prudently provide for the oper20 ation and maintenance of the quarters, and,

21 subject to the discretion of the Indian tribe or

22 tribal organization, to supply reserve funds for

23 capital repairs and replacement of the quarters.

24 ‘‘(3) ELIGIBILITY FOR QUARTERS IMPROVE25 MENT AND REPAIR.—Any quarters whose rental
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1 rates are established by an Indian tribe or tribal or2 ganization under this subsection shall continue to be

3 eligible for quarters improvement and repair funds

4 to the same extent as other Federally-owned quar5 ters that are used to house personnel in Service-sup6 ported programs.

7 ‘‘(4) NOTICE OF CHANGE IN RATES.—An In8 dian tribe or tribal organization that exercises the

9 authority provided under this subsection shall pro10 vide occupants with not less than 60 days notice of

11 any change in rental rates.

12 ‘‘(b) COLLECTION OF RENTS.—

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

14 provision of law, and subject to paragraph (2), an

15 Indian tribe or a tribal organization that operates

16 Federally-owned quarters pursuant to a funding

17 agreement under the Indian Self-Determination and

18 Education Assistance Act shall have the authority to

19 collect rents directly from Federal employees who oc20 cupy such quarters in accordance with the following:

21 ‘‘(A) The Indian tribe or tribal organiza22 tion shall notify the Secretary and the Federal

23 employees involved of its election to exercise its

24 authority to collect rents directly from such

25 Federal employees.
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1 ‘‘(B) Upon the receipt of a notice described

2 in subparagraph (A), the Federal employees in3 volved shall pay rents for the occupancy of such

4 quarters directly to the Indian tribe or tribal

5 organization and the Secretary shall have no

6 further authority to collect rents from such em7 ployees through payroll deduction or otherwise.

8 ‘‘(C) Such rent payments shall be retained

9 by the Indian tribe or tribal organization and

10 shall not be made payable to or otherwise be

11 deposited with the United States.

12 ‘‘(D) Such rent payments shall be depos13 ited into a separate account which shall be used

14 by the Indian tribe or tribal organization for

15 the maintenance (including capital repairs and

16 replacement expenses) and operation of the

17 quarters and facilities as the Indian tribe or

18 tribal organization shall determine appropriate.

19 ‘‘(2) RETROCESSION.—If an Indian tribe or

20 tribal organization which has made an election under

21 paragraph (1) requests retrocession of its authority

22 to directly collect rents from Federal employees oc23 cupying Federally-owned quarters, such retrocession

24 shall become effective on the earlier of—
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1 ‘‘(A) the first day of the month that begins

2 not less than 180 days after the Indian tribe or

3 tribal organization notifies the Secretary of its

4 desire to retrocede; or

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

6 agreed upon by the Secretary and the Indian

7 tribe or tribal organization.

8 ‘‘(c) RATES.—To the extent that an Indian tribe or

9 tribal organization, pursuant to authority granted in sub10 section (a), establishes rental rates for Federally-owned

11 quarters provided to a Federal employee in Alaska, such

12 rents may be based on the cost of comparable private rent13 al housing in the nearest established community with a

14 year-round population of 1,500 or more individuals.

15 ‘‘SEC. 316. APPLICABILITY OF BUY AMERICAN REQUIRE16 MENT.

17 ‘‘(a) IN GENERAL.—The Secretary shall ensure that

18 the requirements of the Buy American Act apply to all

19 procurements made with funds provided pursuant to the

20 authorization contained in section 318, except that Indian

21 tribes and tribal organizations shall be exempt from such

22 requirements.

23 ‘‘(b) FALSE OR MISLEADING LABELING.—If it has

24 been finally determined by a court or Federal agency that

25 any person intentionally affixed a label bearing a ‘Made
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1 in America’ inscription, or any inscription with the same

2 meaning, to any product sold in or shipped to the United

3 States that is not made in the United States, such person

4 shall be ineligible to receive any contract or subcontract

5 made with funds provided pursuant to the authorization

6 contained in section 318, pursuant to the debarment, sus7 pension, and ineligibility procedures described in sections

8 9.400 through 9.409 of title 48, Code of Federal Regula9 tions.

10 (c) DEFINITION.—In this section, the term ‘Buy

11 American Act’ means title III of the Act entitled ‘An Act

12 making appropriations for the Treasury and Post Office

13 Departments for the fiscal year ending June 30, 1934,

14 and for other purposes’, approved March 3, 1933 (41

15 U.S.C. 10a et seq.).

16 ‘‘SEC. 317. OTHER FUNDING FOR FACILITIES.

17 ‘‘Notwithstanding any other provision of law—

18 ‘‘(1) the Secretary may accept from any source,

19 including Federal and State agencies, funds that are

20 available for the construction of health care facilities

21 and use such funds to plan, design and construct

22 health care facilities for Indians and to place such

23 funds into funding agreements authorized under the

24 Indian Self-Determination and Education Assistance

25 Act (25 U.S.C. 450f et seq.) between the Secretary
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1 and an Indian tribe or tribal organization, except

2 that the receipt of such funds shall not have an ef3 fect on the priorities established pursuant to section

4 301;

5 ‘‘(2) the Secretary may enter into interagency

6 agreements with other Federal or State agencies and

7 other entities and to accept funds from such Federal

8 or State agencies or other entities to provide for the

9 planning, design and construction of health care fa10 cilities to be administered by the Service or by In11 dian tribes or tribal organizations under the Indian

12 Self-Determination and Education Assistance Act in

13 order to carry out the purposes of this Act, together

14 with the purposes for which such funds are appro15 priated to such other Federal or State agency or for

16 which the funds were otherwise provided;

17 ‘‘(3) any Federal agency to which funds for the

18 construction of health care facilities are appropriated

19 is authorized to transfer such funds to the Secretary

20 for the construction of health care facilities to carry

21 out the purposes of this Act as well as the purposes

22 for which such funds are appropriated to such other

23 Federal agency; and

24 ‘‘(4) the Secretary, acting through the Service,

25 shall establish standards under regulations developed
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1 through rulemaking under section 802, for the plan2 ning, design and construction of health care facilities

3 serving Indians under this Act.

4 ‘‘SEC. 318. AUTHORIZATION OF APPROPRIATIONS.

5 ‘‘There is authorized to be appropriated such sums

6 as may be necessary for each fiscal year through fiscal

7 year 2012 to carry out this title.

8 ‘‘TITLE IV—ACCESS TO HEALTH

9 SERVICES

10 ‘‘SEC. 401. TREATMENT OF PAYMENTS UNDER MEDICARE

11 PROGRAM.

12 ‘‘(a) IN GENERAL.—Any payments received by the

13 Service, by an Indian tribe or tribal organization pursuant

14 to a funding agreement under the Indian Self-Determina15 tion and Education Assistance Act, or by an urban Indian

16 organization pursuant to title V of this Act for services

17 provided to Indians eligible for benefits under title XVIII

18 of the Social Security Act shall not be considered in deter19 mining appropriations for health care and services to Indi20 ans.

21 ‘‘(b) EQUAL TREATMENT.—Nothing in this Act au22 thorizes the Secretary to provide services to an Indian ben23 eficiary with coverage under title XVIII of the Social Secu24 rity Act in preference to an Indian beneficiary without

25 such coverage.
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1 ‘‘(c) SPECIAL FUND.—

2 ‘‘(1) USE OF FUNDS.—Notwithstanding any

3 other provision of this title or of title XVIII of the

4 Social Security Act, payments to which any facility

5 of the Service is entitled by reason of this section

6 shall be placed in a special fund to be held by the

7 Secretary and first used (to such extent or in such

8 amounts as are provided in appropriation Acts) for

9 the purpose of making any improvements in the pro10 grams of the Service which may be necessary to

11 achieve or maintain compliance with the applicable

12 conditions and requirements of this title and of title

13 XVIII of the Social Security Act. Any funds to be

14 reimbursed which are in excess of the amount nec15 essary to achieve or maintain such conditions and

16 requirements shall, subject to the consultation with

17 tribes being served by the service unit, be used for

18 reducing the health resource deficiencies of the In19 dian tribes.

20 ‘‘(2) NONAPPLICATION IN CASE OF ELECTION

21 FOR DIRECT BILLING.—Paragraph (1) shall not

22 apply upon the election of an Indian tribe or tribal

23 organization under section 405 to receive direct pay24 ments for services provided to Indians eligible for

25 benefits under title XVIII of the Social Security Act.
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1 ‘‘SEC. 402. TREATMENT OF PAYMENTS UNDER MEDICAID

2 PROGRAM.

3 ‘‘(a) SPECIAL FUND.—

4 ‘‘(1) USE OF FUNDS.—Notwithstanding any

5 other provision of law, payments to which any facil6 ity of the Service (including a hospital, nursing facil7 ity, intermediate care facility for the mentally re8 tarded, or any other type of facility which provides

9 services for which payment is available under title

10 XIX of the Social Security Act) is entitled under a

11 State plan by reason of section 1911 of such Act

12 shall be placed in a special fund to be held by the

13 Secretary and first used (to such extent or in such

14 amounts as are provided in appropriation Acts) for

15 the purpose of making any improvements in the fa16 cilities of such Service which may be necessary to

17 achieve or maintain compliance with the applicable

18 conditions and requirements of such title. Any pay19 ments which are in excess of the amount necessary

20 to achieve or maintain such conditions and require21 ments shall, subject to the consultation with tribes

22 being served by the service unit, be used for reduc23 ing the health resource deficiencies of the Indian

24 tribes. In making payments from such fund, the Sec25 retary shall ensure that each service unit of the

26 Service receives 100 percent of the amounts to which
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1 the facilities of the Service, for which such service

2 unit makes collections, are entitled by reason of sec3 tion 1911 of the Social Security Act.

4 ‘‘(2) NONAPPLICATION IN CASE OF ELECTION

5 FOR DIRECT BILLING.—Paragraph (1) shall not

6 apply upon the election of an Indian tribe or tribal

7 organization under section 405 to receive direct pay8 ments for services provided to Indians eligible for

9 medical assistance under title XIX of the Social Se10 curity Act.

11 ‘‘(b) PAYMENTS DISREGARDED FOR APPROPRIA12 TIONS.—Any payments received under section 1911 of the

13 Social Security Act for services provided to Indians eligible

14 for benefits under title XIX of the Social Security Act

15 shall not be considered in determining appropriations for

16 the provision of health care and services to Indians.

17 ‘‘(c) DIRECT BILLING.—For provisions relating to

18 the authority of certain Indian tribes and tribal organiza19 tions to elect to directly bill for, and receive payment for,

20 health care services provided by a hospital or clinic of such

21 tribes or tribal organizations and for which payment may

22 be made under this title, see section 405.

23 ‘‘SEC. 403. REPORT.

24 ‘‘(a) INCLUSION IN ANNUAL REPORT.—The Sec25 retary shall submit to the President, for inclusion in the
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1 report required to be transmitted to the Congress under

2 section 801, an accounting on the amount and use of

3 funds made available to the Service pursuant to this title

4 as a result of reimbursements under titles XVIII and XIX

5 of the Social Security Act.

6 ‘‘(b) IDENTIFICATION OF SOURCE OF PAYMENTS.—

7 If an Indian tribe or tribal organization receives funding

8 from the Service under the Indian Self-Determination and

9 Education Assistance Act or an urban Indian organization

10 receives funding from the Service under Title V of this

11 Act and receives reimbursements or payments under title

12 XVIII, XIX, or XXI of the Social Security Act, such In13 dian tribe or tribal organization, or urban Indian organi14 zation, shall provide to the Service a list of each provider

15 enrollment number (or other identifier) under which it re16 ceives such reimbursements or payments.

17 ‘‘SEC. 404. GRANTS TO AND FUNDING AGREEMENTS WITH

18 THE SERVICE, INDIAN TRIBES OR TRIBAL OR19 GANIZATIONS, AND URBAN INDIAN ORGANI20 ZATIONS.

21 ‘‘(a) IN GENERAL.—The Secretary shall make grants

22 to or enter into funding agreements with Indian tribes and

23 tribal organizations to assist such organizations in estab24 lishing and administering programs on or near Federal In-
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1 dian reservations and trust areas and in or near Alaska

2 Native villages to assist individual Indians to—

3 ‘‘(1) enroll under sections 1818, 1836, and

4 1837 of the Social Security Act;

5 ‘‘(2) pay premiums for health insurance cov6 erage; and

7 ‘‘(3) apply for medical assistance provided pur8 suant to titles XIX and XXI of the Social Security

9 Act.

10 ‘‘(b) CONDITIONS.—The Secretary shall place condi11 tions as deemed necessary to effect the purpose of this

12 section in any funding agreement or grant which the Sec13 retary makes with any Indian tribe or tribal organization

14 pursuant to this section. Such conditions shall include, but

15 are not limited to, requirements that the organization suc16 cessfully undertake to—

17 ‘‘(1) determine the population of Indians to be

18 served that are or could be recipients of benefits or

19 assistance under titles XVIII, XIX, and XXI of the

20 Social Security Act;

21 ‘‘(2) assist individual Indians in becoming fa22 miliar with and utilizing such benefits and assist23 ance;
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1 ‘‘(3) provide transportation to such individual

2 Indians to the appropriate offices for enrollment or

3 applications for such benefits and assistance;

4 ‘‘(4) develop and implement—

5 ‘‘(A) a schedule of income levels to deter6 mine the extent of payments of premiums by

7 such organizations for health insurance cov8 erage of needy individuals; and

9 ‘‘(B) methods of improving the participa10 tion of Indians in receiving the benefits and as11 sistance provided under titles XVIII, XIX, and

12 XXI of the Social Security Act.

13 ‘‘(c) AGREEMENTS FOR RECEIPT AND PROCESSING

14 OF APPLICATIONS.—The Secretary may enter into an

15 agreement with an Indian tribe or tribal organization, or

16 an urban Indian organization, which provides for the re17 ceipt and processing of applications for medical assistance

18 under title XIX of the Social Security Act, child health

19 assistance under title XXI of such Act and benefits under

20 title XVIII of such Act by a Service facility or a health

21 care program administered by such Indian tribe or tribal

22 organization, or urban Indian organization, pursuant to

23 a funding agreement under the Indian Self-Determination

24 and Education Assistance Act or a grant or contract en25 tered into with an urban Indian organization under title
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1 V of this Act. Notwithstanding any other provision of law,

2 such agreements shall provide for reimbursement of the

3 cost of outreach, education regarding eligibility and bene4 fits, and translation when such services are provided. The

5 reimbursement may be included in an encounter rate or

6 be made on a fee-for-service basis as appropriate for the

7 provider. When necessary to carry out the terms of this

8 section, the Secretary, acting through the Health Care Fi9 nancing Administration or the Service, may enter into

10 agreements with a State (or political subdivision thereof)

11 to facilitate cooperation between the State and the Service,

12 an Indian tribe or tribal organization, and an urban In13 dian organization.

14 ‘‘(d) GRANTS.—

15 ‘‘(1) IN GENERAL.—The Secretary shall make

16 grants or enter into contracts with urban Indian or17 ganizations to assist such organizations in estab18 lishing and administering programs to assist indi19 vidual urban Indians to—

20 ‘‘(A) enroll under sections 1818, 1836, and

21 1837 of the Social Security Act;

22 ‘‘(B) pay premiums on behalf of such indi23 viduals for coverage under title XVIII of such

24 Act; and
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1 ‘‘(C) apply for medical assistance provided

2 under title XIX of such Act and for child health

3 assistance under title XXI of such Act.

4 ‘‘(2) REQUIREMENTS.—The Secretary shall in5 clude in the grants or contracts made or entered

6 into under paragraph (1) requirements that are—

7 ‘‘(A) consistent with the conditions im8 posed by the Secretary under subsection (b);

9 ‘‘(B) appropriate to urban Indian organi10 zations and urban Indians; and

11 ‘‘(C) necessary to carry out the purposes of

12 this section.

13 ‘‘SEC. 405. DIRECT BILLING AND REIMBURSEMENT OF

14 MEDICARE, MEDICAID, AND OTHER THIRD

15 PARTY PAYORS.

16 ‘‘(a) DIRECT BILLING.—

17 ‘‘(1) IN GENERAL.—An Indian tribe or tribal

18 organization may directly bill for, and receive pay19 ment for, health care services provided by such tribe

20 or organization for which payment is made under

21 title XVIII of the Social Security Act, under a State

22 plan for medical assistance approved under title XIX

23 of such Act, under a State child health plan ap24 proved under title XXI of such Act, or from any

25 other third party payor.
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1 ‘‘(2) APPLICATION OF 100 PERCENT FMAP.—

2 The third sentence of section 1905(b) of the Social

3 Security Act and section 2101(c) of such Act shall

4 apply for purposes of reimbursement under the med5 icaid or State children’s health insurance program

6 for health care services directly billed under the pro7 gram established under this section.

8 ‘‘(b) DIRECT REIMBURSEMENT.—

9 ‘‘(1) USE OF FUNDS.—Each Indian tribe or

10 tribal organization exercising the option described in

11 subsection (a) of this section shall be reimbursed di12 rectly under the medicare, medicaid, and State chil13 dren’s health insurance programs for services fur14 nished, without regard to the provisions of sections

15 1880(c) of the Social Security Act and section

16 402(a) of this Act, but all funds so reimbursed shall

17 first be used by the health program for the purpose

18 of making any improvements in the facility or health

19 programs that may be necessary to achieve or main20 tain compliance with the conditions and require21 ments applicable generally to such health services

22 under the medicare, medicaid, or State children’s

23 health insurance program. Any funds so reimbursed

24 which are in excess of the amount necessary to

25 achieve or maintain such conditions or requirements
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1 shall be used to provide additional health services,

2 improvements in its health care facilities, or other3 wise to achieve the health objectives provided for

4 under section 3 of this Act.

5 ‘‘(2) AUDITS.—The amounts paid to the health

6 programs exercising the option described in sub7 section (a) shall be subject to all auditing require8 ments applicable to programs administered directly

9 by the Service and to facilities participating in the

10 medicare, medicaid, and State children’s health in11 surance programs.

12 ‘‘(3) NO PAYMENTS FROM SPECIAL FUNDS.—

13 Notwithstanding section 401(c) or section 402(a), no

14 payment may be made out of the special fund de15 scribed in section 401(c) or 402(a), for the benefit

16 of any health program exercising the option de17 scribed in subsection (a) of this section during the

18 period of such participation.

19 ‘‘(c) EXAMINATION AND IMPLEMENTATION OF

20 CHANGES.—The Secretary, acting through the Service,

21 and with the assistance of the Administrator of the Health

22 Care Financing Administration, shall examine on an ongo23 ing basis and implement any administrative changes that

24 may be necessary to facilitate direct billing and reimburse25 ment under the program established under this section,
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1 including any agreements with States that may be nec2 essary to provide for direct billing under the medicaid or

3 State children’s health insurance program.

4 ‘‘(d) WITHDRAWAL FROM PROGRAM.—A participant

5 in the program established under this section may with6 draw from participation in the same manner and under

7 the same conditions that an Indian tribe or tribal organi8 zation may retrocede a contracted program to the Sec9 retary under authority of the Indian Self-Determination

10 and Education Assistance Act. All cost accounting and

11 billing authority under the program established under this

12 section shall be returned to the Secretary upon the Sec13 retary’s acceptance of the withdrawal of participation in

14 this program.

15 ‘‘(e) LIMITATION.—Notwithstanding this section, ab16 sent specific written authorization by the governing body

17 of an Indian tribe for the period of such authorization

18 (which may not be for a period of more than 1 year and

19 which may be revoked at any time upon written notice by

20 the governing body to the Service), neither the United

21 States through the Service, nor an Indian tribe or tribal

22 organization under a funding agreement pursuant to the

23 Indian Self-Determination and Education Assistance Act,

24 nor an urban Indian organization funded under title V,

25 shall have a right of recovery under this section if the in-
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1 jury, illness, or disability for which health services were

2 provided is covered under a self-insurance plan funded by

3 an Indian tribe or tribal organization, or urban Indian or4 ganization. Where such tribal authorization is provided,

5 the Service may receive and expend such funds for the

6 provision of additional health services.

7 ‘‘SEC. 406. REIMBURSEMENT FROM CERTAIN THIRD PAR8 TIES OF COSTS OF HEALTH SERVICES.

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

10 subsection (g), the United States, an Indian tribe or tribal

11 organization shall have the right to recover the reasonable

12 charges billed or expenses incurred by the Secretary or

13 an Indian tribe or tribal organization in providing health

14 services, through the Service or an Indian tribe or tribal

15 organization to any individual to the same extent that

16 such individual, or any nongovernmental provider of such

17 services, would be eligible to receive reimbursement or in18 demnification 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 expenses.

23 ‘‘(b) URBAN INDIAN ORGANIZATIONS.—Except as

24 provided in subsection (g), an urban Indian organization

25 shall have the right to recover the reasonable charges
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1 billed or expenses incurred by the organization in pro2 viding health services to any individual to the same extent

3 that such individual, or any other nongovernmental pro4 vider of such services, would be eligible to receive reim5 bursement or indemnification for such charges or expenses

6 if such individual had been required to pay such charges

7 or expenses and did pay such charges or expenses.

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

9 Subsections (a) and (b) shall provide a right of recovery

10 against any State, only if the injury, illness, or disability

11 for which health services were provided is covered under—

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

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

14 plan or program.

15 ‘‘(d) NONAPPLICATION OF OTHER LAWS.—No law of

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

17 no provision of any contract entered into or renewed after

18 the date of enactment of the Indian Health Care Amend19 ments of 1988, shall prevent or hinder the right of recov20 ery of the United States or an Indian tribe or tribal orga21 nization under subsection (a), or an urban Indian organi22 zation under subsection (b).

23 ‘‘(e) NO EFFECT ON PRIVATE RIGHTS OF ACTION.—

24 No action taken by the United States or an Indian tribe

25 or tribal organization to enforce the right of recovery pro-
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1 vided under subsection (a), or by an urban Indian organi2 zation to enforce the right of recovery provided under sub3 section (b), shall affect the right of any person to any

4 damages (other than damages for the cost of health serv5 ices provided by the Secretary through the Service).

6 ‘‘(f) METHODS OF ENFORCEMENT.—

7 ‘‘(1) IN GENERAL.—The United States or an

8 Indian tribe or tribal organization may enforce the

9 right of recovery provided under subsection (a), and

10 an urban Indian organization may enforce the right

11 of recovery provided under subsection (b), by—

12 ‘‘(A) intervening or joining in any civil ac13 tion or proceeding brought—

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

15 services were provided by the Secretary, an

16 Indian tribe or tribal organization, or

17 urban Indian organization; or

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

19 such individual; or

20 ‘‘(B) instituting a civil action.

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

22 made to provide notice of an action instituted in ac23 cordance with paragraph (1)(B) to the individual to

24 whom health services were provided, either before or

25 during the pendency of such action.
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1 ‘‘(g) LIMITATION.—Notwithstanding this section, ab2 sent specific written authorization by the governing body

3 of an Indian tribe for the period of such authorization

4 (which may not be for a period of more than 1 year and

5 which may be revoked at any time upon written notice by

6 the governing body to the Service), neither the United

7 States through the Service, nor an Indian tribe or tribal

8 organization under a funding agreement pursuant to the

9 Indian Self-Determination and Education Assistance Act,

10 nor an urban Indian organization funded under title V,

11 shall have a right of recovery under this section if the in12 jury, illness, or disability for which health services were

13 provided is covered under a self-insurance plan funded by

14 an Indian tribe or tribal organization, or urban Indian or15 ganization. Where such tribal authorization is provided,

16 the Service may receive and expend such funds for the

17 provision of additional health services.

18 ‘‘(h) COSTS AND ATTORNEYS’ FEES.—In any action

19 brought to enforce the provisions of this section, a pre20 vailing plaintiff shall be awarded reasonable attorneys’

21 fees and costs of litigation.

22 ‘‘(i) RIGHT OF ACTION AGAINST INSURERS AND EM23 PLOYEE BENEFIT PLANS.—

24 ‘‘(1) IN GENERAL.—Where an insurance com25 pany or employee benefit plan fails or refuses to pay
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1 the amount due under subsection (a) for services

2 provided to an individual who is a beneficiary, par3 ticipant, or insured of such company or plan, the

4 United States or an Indian tribe or tribal organiza5 tion shall have a right to assert and pursue all the

6 claims and remedies against such company or plan,

7 and against the fiduciaries of such company or plan,

8 that the individual could assert or pursue under ap9 plicable Federal, State or tribal law.

10 ‘‘(2) URBAN INDIAN ORGANIZATIONS.—Where

11 an insurance company or employee benefit plan fails

12 or refuses to pay the amounts due under subsection

13 (b) for health services provided to an individual who

14 is a beneficiary, participant, or insured of such com15 pany or plan, the urban Indian organization shall

16 have a right to assert and pursue all the claims and

17 remedies against such company or plan, and against

18 the fiduciaries of such company or plan, that the in19 dividual could assert or pursue under applicable

20 Federal or State law.

21 ‘‘(j) NONAPPLICATION OF CLAIMS FILING REQUIRE22 MENTS.—Notwithstanding any other provision in law, the

23 Service, an Indian tribe or tribal organization, or an urban

24 Indian organization shall have a right of recovery for any

25 otherwise reimbursable claim filed on a current HCFA-
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1 1500 or UB–92 form, or the current NSF electronic for2 mat, or their successors. No health plan shall deny pay3 ment because a claim has not been submitted in a unique

4 format that differs from such forms.

5 ‘‘SEC. 407. CREDITING OF REIMBURSEMENTS.

6 ‘‘(a) RETENTION OF FUNDS.—Except as provided in

7 section 202(d), this title, and section 807, all reimburse8 ments received or recovered under the authority of this

9 Act, Public Law 87–693, or any other provision of law,

10 by reason of the provision of health services by the Service

11 or by an Indian tribe or tribal organization under a fund12 ing agreement pursuant to the Indian Self-Determination

13 and Education Assistance Act, or by an urban Indian or14 ganization funded under title V, shall be retained by the

15 Service or that tribe or tribal organization and shall be

16 available for the facilities, and to carry out the programs,

17 of the Service or that tribe or tribal organization to pro18 vide health care services to Indians.

19 ‘‘(b) NO OFFSET OF FUNDS.—The Service may not

20 offset or limit the amount of funds 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. 408. PURCHASING HEALTH CARE COVERAGE.

24 ‘‘An Indian tribe or tribal organization, and an urban

25 Indian organization may utilize funding from the Sec-
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1 retary under this Act to purchase managed care coverage

2 for Service beneficiaries (including insurance to limit the

3 financial risks of managed care entities) from—

4 ‘‘(1) a tribally owned and operated managed

5 care plan;

6 ‘‘(2) a State or locally-authorized or licensed

7 managed care plan; or

8 ‘‘(3) a health insurance provider.

9 ‘‘SEC. 409. INDIAN HEALTH SERVICE, DEPARTMENT OF VET10 ERAN’S AFFAIRS, AND OTHER FEDERAL

11 AGENCY HEALTH FACILITIES AND SERVICES

12 SHARING.

13 ‘‘(a) EXAMINATION OF FEASIBILITY OF ARRANGE14 MENTS.—

15 ‘‘(1) IN GENERAL.—The Secretary shall exam16 ine the feasibility of entering into arrangements or

17 expanding existing arrangements for the sharing of

18 medical facilities and services between the Service

19 and the Veterans’ Administration, and other appro20 priate Federal agencies, including those within the

21 Department, and shall, in accordance with sub22 section (b), prepare a report on the feasibility of

23 such arrangements.
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1 ‘‘(2) SUBMISSION OF REPORT.—Not later than

2 September 30, 2000, the Secretary shall submit the

3 report required under paragraph (1) to Congress.

4 ‘‘(3) CONSULTATION REQUIRED.—The Sec5 retary may not finalize any arrangement described

6 in paragraph (1) without first consulting with the

7 affected Indian tribes.

8 ‘‘(b) LIMITATIONS.—The Secretary shall not take

9 any action under this section or under subchapter IV of

10 chapter 81 of title 38, United States Code, which would

11 impair—

12 ‘‘(1) the priority access of any Indian to health

13 care services provided through the Service;

14 ‘‘(2) the quality of health care services provided

15 to any Indian through the Service;

16 ‘‘(3) the priority access of any veteran to health

17 care services provided by the Veterans’ Administra18 tion;

19 ‘‘(4) the quality of health care services provided

20 to any veteran by the Veteran’s Administration;

21 ‘‘(5) the eligibility of any Indian to receive

22 health services through the Service; or

23 ‘‘(6) the eligibility of any Indian who is a vet24 eran to receive health services through the Veterans’

25 Administration provided, however, the Service or the
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1 Indian tribe or tribal organization shall be reim2 bursed by the Veterans’ Administration where serv3 ices are provided through the Service or Indian

4 tribes or tribal organizations to beneficiaries eligible

5 for services from the Veterans’ Administration, not6 withstanding any other provision of law.

7 ‘‘(c) AGREEMENTS FOR PARITY IN SERVICES.—The

8 Service may enter into agreements with other Federal

9 agencies to assist in achieving parity in services for Indi10 ans. Nothing in this section may be construed as creating

11 any right of a veteran to obtain health services from the

12 Service.

13 ‘‘SEC. 410. PAYOR OF LAST RESORT.

14 ‘‘The Service, and programs operated by Indian

15 tribes or tribal organizations, or urban Indian organiza16 tions shall be the payor of last resort for services provided

17 to individuals eligible for services from the Service and

18 such programs, notwithstanding any Federal, State or

19 local law to the contrary, unless such law explicitly pro20 vides otherwise.

21 ‘‘SEC. 411. RIGHT TO RECOVER FROM FEDERAL HEALTH

22 CARE PROGRAMS.

23 ‘‘Notwithstanding any other provision of law, the

24 Service, Indian tribes or tribal organizations, and urban

25 Indian organizations (notwithstanding limitations on who
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1 is eligible to receive services from such entities) shall be

2 entitled to receive payment or reimbursement for services

3 provided by such entities from any Federally funded

4 health care program, unless there is an explicit prohibition

5 on such payments in the applicable authorizing statute.

6 ‘‘SEC. 412. TUBA CITY DEMONSTRATION PROJECT.

7 ‘‘(a) IN GENERAL.—Notwithstanding any other pro8 vision of law, including the Anti-Deficiency Act, provided

9 the Indian tribes to be served approve, the Service in the

10 Tuba City Service Unit may—

11 ‘‘(1) enter into a demonstration project with the

12 State of Arizona under which the Service would pro13 vide certain specified medicaid services to individuals

14 dually eligible for services from the Service and for

15 medical assistance under title XIX of the Social Se16 curity Act in return for payment on a capitated

17 basis from the State of Arizona; and

18 ‘‘(2) purchase insurance to limit the financial

19 risks under the project.

20 ‘‘(b) EXTENSION OF PROJECT.—The demonstration

21 project authorized under subsection (a) may be extended

22 to other service units in Arizona, subject to the approval

23 of the Indian tribes to be served in such service units, the

24 Service, and the State of Arizona.
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1 ‘‘SEC. 413. ACCESS TO FEDERAL INSURANCE.

2 ‘‘Notwithstanding the provisions of title 5, United

3 States Code, Executive Order, or administrative regula4 tion, an Indian tribe or tribal organization carrying out

5 programs under the Indian Self-Determination and Edu6 cation Assistance Act or an urban Indian organization car7 rying out programs under title V of this Act shall be enti8 tled to purchase coverage, rights and benefits for the em9 ployees of such Indian tribe or tribal organization, or

10 urban Indian organization, under chapter 89 of title 5,

11 United States Code, and chapter 87 of such title if nec12 essary employee deductions and agency contributions in

13 payment for the coverage, rights, and benefits for the pe14 riod of employment with such Indian tribe or tribal organi15 zation, or urban Indian organization, are currently depos16 ited in the applicable Employee’s Fund under such title.

17 ‘‘SEC. 414. CONSULTATION AND RULEMAKING.

18 ‘‘(a) CONSULTATION.—Prior to the adoption of any

19 policy or regulation by the Health Care Financing Admin20 istration, the Secretary shall require the Administrator of

21 that Administration to—

22 ‘‘(1) identify the impact such policy or regula23 tion may have on the Service, Indian tribes or tribal

24 organizations, and urban Indian organizations;
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1 ‘‘(2) provide to the Service, Indian tribes or

2 tribal organizations, and urban Indian organizations

3 the information described in paragraph (1);

4 ‘‘(3) engage in consultation, consistent with the

5 requirements of Executive Order 13084 of May 14,

6 1998, with the Service, Indian tribes or tribal orga7 nizations, and urban Indian organizations prior to

8 enacting any such policy or regulation.

9 ‘‘(b) RULEMAKING.—The Administrator of the

10 Health Care Financing Administration shall participate in

11 the negotiated rulemaking provided for under title VIII

12 with regard to any regulations necessary to implement the

13 provisions of this title that relate to the Social Security

14 Act.

15 ‘‘SEC. 415. LIMITATIONS ON CHARGES.

16 ‘‘No provider of health services that is eligible to re17 ceive payments or reimbursements under titles XVIII,

18 XIX, or XXI of the Social Security Act or from any Feder19 ally funded (whether in whole or part) health care pro20 gram may seek to recover payment for services—

21 ‘‘(1) that are covered under and furnished to an

22 individual eligible for the contract health services

23 program operated by the Service, by an Indian tribe

24 or tribal organization, or furnished to an urban In25 dian eligible for health services purchased by an
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1 urban Indian organization, in an amount in excess

2 of the lowest amount paid by any other payor for

3 comparable services; or

4 ‘‘(2) for examinations or other diagnostic proce5 dures that are not medically necessary if such proce6 dures have already been performed by the referring

7 Indian health program and reported to the provider.

8 ‘‘SEC. 416. LIMITATION ON SECRETARY’S WAIVER AUTHOR9 ITY.

10 ‘‘Notwithstanding any other provision of law, the Sec11 retary may not waive the application of section

12 1902(a)(13)(D) of the Social Security Act to any State

13 plan under title XIX of the Social Security Act.

14 ‘‘SEC. 417. WAIVER OF MEDICARE AND MEDICAID SANC15 TIONS.

16 ‘‘Notwithstanding any other provision of law, the

17 Service or an Indian tribe or tribal organization or an

18 urban Indian organization operating a health program

19 under the Indian Self-Determination and Education As20 sistance Act shall be entitled to seek a waiver of sanctions

21 imposed under title XVIII, XIX, or XXI of the Social Se22 curity Act as if such entity were directly responsible for

23 administering the State health care program.
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1 ‘‘SEC. 418. MEANING OF ‘REMUNERATION’ FOR PURPOSES

2 OF SAFE HARBOR PROVISIONS; ANTITRUST

3 IMMUNITY.

4 ‘‘(a) MEANING OF REMUNERATION.—Notwith5 standing any other provision of law, the term ‘remunera6 tion’ as used in sections 1128A and 1128B of the Social

7 Security Act shall not include any exchange of anything

8 of value between or among—

9 ‘‘(1) any Indian tribe or tribal organization or

10 an urban Indian organization that administers

11 health programs under the authority of the Indian

12 Self-Determination and Education Assistance Act;

13 ‘‘(2) any such Indian tribe or tribal organiza14 tion or urban Indian organization and the Service;

15 ‘‘(3) any such Indian tribe or tribal organiza16 tion or urban Indian organization and any patient

17 served or eligible for service under such programs,

18 including patients served or eligible for service pur19 suant to section 813 of this Act (as in effect on the

20 day before the date of enactment of the Indian

21 Health Care Improvement Act Reauthorization of

22 2000); or

23 ‘‘(4) any such Indian tribe or tribal organiza24 tion or urban Indian organization and any third

25 party required by contract, section 206 or 207 of

26 this Act (as so in effect), or other applicable law, to
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1 pay or reimburse the reasonable health care costs in2 curred by the United States or any such Indian tribe

3 or tribal organization or urban Indian organization;

4 provided the exchange arises from or relates to such health

5 programs.

6 ‘‘(b) ANTITRUST IMMUNITY.—An Indian tribe or

7 tribal organization or an urban Indian organization that

8 administers health programs under the authority of the

9 Indian Self-Determination and Education Assistance Act

10 or title V shall be deemed to be an agency of the United

11 States and immune from liability under the Acts com12 monly known as the Sherman Act, the Clayton Act, the

13 Robinson-Patman Anti-Discrimination Act, the Federal

14 Trade Commission Act, and any other Federal, State, or

15 local antitrust laws, with regard to any transaction, agree16 ment, or conduct that relates to such programs.

17 ‘‘SEC. 419. CO-INSURANCE, CO-PAYMENTS, DEDUCTIBLES

18 AND PREMIUMS.

19 ‘‘(a) EXEMPTION FROM COST-SHARING REQUIRE20 MENTS.—Notwithstanding any other provision of Federal

21 or State law, no Indian who is eligible for services under

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

23 under any other Federally funded health care programs,

24 may be charged a deductible, co-payment, or co-insurance

25 for any service provided by or through the Service, an In-
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1 dian tribe or tribal organization or urban Indian organiza2 tion, nor may the payment or reimbursement due to the

3 Service or an Indian tribe or tribal organization or urban

4 Indian organization be reduced by the amount of the de5 ductible, co-payment, or co-insurance that would be due

6 from the Indian but for the operation of this section. For

7 the purposes of this section, the term ‘through’ shall in8 clude services provided directly, by referral, or under con9 tracts or other arrangements between the Service, an In10 dian tribe or tribal organization or an urban Indian orga11 nization and another health provider.

12 ‘‘(b) EXEMPTION FROM PREMIUMS.—

13 ‘‘(1) MEDICAID AND STATE CHILDREN’S

14 HEALTH INSURANCE PROGRAM.—Notwithstanding

15 any other provision of Federal or State law, no In16 dian who is otherwise eligible for medical assistance

17 under title XIX of the Social Security Act or child

18 health assistance under title XXI of such Act may

19 be charged a premium as a condition of receiving

20 such assistance under title XIX of XXI of such Act.

21 ‘‘(2) MEDICARE ENROLLMENT PREMIUM PEN22 ALTIES.—Notwithstanding section 1839(b) of the

23 Social Security Act or any other provision of Federal

24 or State law, no Indian who is eligible for benefits

25 under part B of title XVIII of the Social Security
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1 Act, but for the payment of premiums, shall be

2 charged a penalty for enrolling in such part at a

3 time later than the Indian might otherwise have

4 been first eligible to do so. The preceding sentence

5 applies whether an Indian pays for premiums under

6 such part directly or such premiums are paid by an7 other person or entity, including a State, the Serv8 ice, an Indian Tribe or tribal organization, or an

9 urban Indian organization.

10 ‘‘SEC. 420. INCLUSION OF INCOME AND RESOURCES FOR

11 PURPOSES OF MEDICALLY NEEDY MEDICAID

12 ELIGIBILITY.

13 ‘‘For the purpose of determining the eligibility under

14 section 1902(a)(10)(A)(ii)(IV) of the Social Security Act

15 of an Indian for medical assistance under a State plan

16 under title XIX of such Act, the cost of providing services

17 to an Indian in a health program of the Service, an Indian

18 Tribe or tribal organization, or an urban Indian organiza19 tion shall be deemed to have been an expenditure for

20 health care by the Indian.

21 ‘‘SEC. 421. ESTATE RECOVERY PROVISIONS.

22 ‘‘Notwithstanding any other provision of Federal or

23 State law, the following property may not be included

24 when determining eligibility for services or implementing

25 estate recovery rights under title XVIII, XIX, or XXI of
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1 the Social Security Act, or any other health care programs

2 funded in whole or part with Federal funds:

3 ‘‘(1) Income derived from rents, leases, or roy4 alties of property held in trust for individuals by the

5 Federal Government.

6 ‘‘(2) Income derived from rents, leases, royal7 ties, or natural resources (including timber and fish8 ing activities) resulting from the exercise of Feder9 ally protected rights, whether collected by an indi10 vidual or a tribal group and distributed to individ11 uals.

12 ‘‘(3) Property, including interests in real prop13 erty currently or formerly held in trust by the Fed14 eral Government which is protected under applicable

15 Federal, State or tribal law or custom from re16 course, including public domain allotments.

17 ‘‘(4) Property that has unique religious or cul18 tural significance or that supports subsistence or

19 traditional life style according to applicable tribal

20 law or custom.

21 ‘‘SEC. 422. MEDICAL CHILD SUPPORT.

22 ‘‘Notwithstanding any other provision of law, a par23 ent shall not be responsible for reimbursing the Federal

24 Government or a State for the cost of medical services pro25 vided to a child by or through the Service, an Indian tribe
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1 or tribal organization or an urban Indian organization.

2 For the purposes of this subsection, the term ‘through’

3 includes services provided directly, by referral, or under

4 contracts or other arrangements between the Service, an

5 Indian Tribe or tribal organization or an urban Indian or6 ganization and another health provider.

7 ‘‘SEC. 423. PROVISIONS RELATING TO MANAGED CARE.

8 ‘‘(a) RECOVERY FROM MANAGED CARE PLANS.—

9 Notwithstanding any other provision in law, the Service,

10 an Indian Tribe or tribal organization or an urban Indian

11 organization shall have a right of recovery under section

12 408 from all private and public health plans or programs,

13 including the medicare, medicaid, and State children’s

14 health insurance programs under titles XVIII, XIX, and

15 XXI of the Social Security Act, for the reasonable costs

16 of delivering health services to Indians entitled to receive

17 services from the Service, an Indian Tribe or tribal organi18 zation or an urban Indian organization.

19 ‘‘(b) LIMITATION.—No provision of law or regulation,

20 or of any contract, may be relied upon or interpreted to

21 deny or reduce payments otherwise due under subsection

22 (a), except to the extent the Service, an Indian tribe or

23 tribal organization, or an urban Indian organization has

24 entered into an agreement with a managed care entity re25 garding services to be provided to Indians or rates to be
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1 paid for such services, provided that such an agreement

2 may not be made a prerequisite for such payments to be

3 made.

4 ‘‘(c) PARITY.—Payments due under subsection (a)

5 from a managed care entity may not be paid at a rate

6 that is less than the rate paid to a ‘preferred provider’

7 by the entity or, in the event there is no such rate, the

8 usual and customary fee for equivalent services.

9 ‘‘(d) NO CLAIM REQUIREMENT.—A managed care

10 entity may not deny payment under subsection (a) because

11 an enrollee with the entity has not submitted a claim.

12 ‘‘(e) DIRECT BILLING.—Notwithstanding the pre13 ceding subsections of this section, the Service, an Indian

14 tribe or tribal organization, or an urban Indian organiza15 tion that provides a health service to an Indian entitled

16 to medical assistance under the State plan under title XIX

17 of the Social Security Act or enrolled in a child health

18 plan under title XXI of such Act shall have the right to

19 be paid directly by the State agency administering such

20 plans notwithstanding any agreements the State may have

21 entered into with managed care organizations or pro22 viders.

23 ‘‘(f) REQUIREMENT FOR MEDICAID MANAGED CARE

24 ENTITIES.—A managed care entity (as defined in section

25 1932(a)(1)(B) of the Social Security Act shall, as a condi-
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1 tion of participation in the State plan under title XIX of

2 such Act, offer a contract to health programs administered

3 by the Service, an Indian tribe or tribal organization or

4 an urban Indian organization that provides health services

5 in the geographic area served by the managed care entity

6 and such contract (or other provider participation agree7 ment) shall contain terms and conditions of participation

8 and payment no more restrictive or onerous than those

9 provided for in this section.

10 ‘‘(g) PROHIBITION.—Notwithstanding any other pro11 vision of law or any waiver granted by the Secretary no

12 Indian may be assigned automatically or by default under

13 any managed care entity participating in a State plan

14 under title XIX or XXI of the Social Security Act unless

15 the Indian had the option of enrolling in a managed care

16 plan or health program administered by the Service, an

17 Indian tribe or tribal organization, or an urban Indian or18 ganization.

19 ‘‘(h) INDIAN MANAGED CARE PLANS.—Notwith20 standing any other provision of law, any State entering

21 into agreements with one or more managed care organiza22 tions to provide services under title XIX or XXI of the

23 Social Security Act shall enter into such an agreement

24 with the Service, an Indian tribe or tribal organization or

25 an urban Indian organization under which such an entity
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1 may provide services to Indians who may be eligible or

2 required to enroll with a managed care organization

3 through enrollment in an Indian managed care organiza4 tion that provides services similar to those offered by other

5 managed care organizations in the State. The Secretary

6 and the State are hereby authorized to waive requirements

7 regarding discrimination, capitalization, and other matters

8 that might otherwise prevent an Indian managed care or9 ganization or health program from meeting Federal or

10 State standards applicable to such organizations, provided

11 such Indian managed care organization or health program

12 offers Indian enrollees services of an equivalent quality to

13 that required of other managed care organizations.

14 ‘‘(i) ADVERTISING.—A managed care organization

15 entering into a contract to provide services to Indians on

16 or near an Indian reservation shall provide a certificate

17 of coverage or similar type of document that is written

18 in the Indian language of the majority of the Indian popu19 lation residing on such reservation.

20 ‘‘SEC. 424. NAVAJO NATION MEDICAID AGENCY.

21 ‘‘(a) IN GENERAL.—Notwithstanding any other pro22 vision of law, the Secretary may treat the Navajo Nation

23 as a State under title XIX of the Social Security Act for

24 purposes of providing medical assistance to Indians living

25 within the boundaries of the Navajo Nation.
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1 ‘‘(b) ASSIGNMENT AND PAYMENT.—Notwithstanding

2 any other provision of law, the Secretary may assign and

3 pay all expenditures related to the provision of services

4 to Indians living within the boundaries of the Navajo Na5 tion under title XIX of the Social Security Act (including

6 administrative expenditures) that are currently paid to or

7 would otherwise be paid to the States of Arizona, New

8 Mexico, and Utah, to an entity established by the Navajo

9 Nation and approved by the Secretary, which shall be de10 nominated the Navajo Nation Medicaid Agency.

11 ‘‘(c) AUTHORITY.—The Navajo Nation Medicaid

12 Agency shall serve Indians living within the boundaries of

13 the Navajo Nation and shall have the same authority and

14 perform the same functions as other State agency respon15 sible for the administration of the State plan under title

16 XIX of the Social Security Act.

17 ‘‘(d) TECHNICAL ASSISTANCE.—The Secretary may

18 directly assist the Navajo Nation in the development and

19 implementation of a Navajo Nation Medicaid Agency for

20 the administration, eligibility, payment, and delivery of

21 medical assistance under title XIX of the Social Security

22 Act (which shall, for purposes of reimbursement to such

23 Nation, include Western and traditional Navajo healing

24 services) within the Navajo Nation. Such assistance may
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1 include providing funds for demonstration projects con2 ducted with such Nation.

3 ‘‘(e) FMAP.—Notwithstanding section 1905(b) of

4 the Social Security Act, the Federal medical assistance

5 percentage shall be 100 per cent with respect to amounts

6 the Navajo Nation Medicaid agency expends for medical

7 assistance and related administrative costs.

8 ‘‘(f) WAIVER AUTHORITY.—The Secretary shall have

9 the authority to waive applicable provisions of Title XIX

10 of the Social Security Act to establish, develop and imple11 ment the Navajo Nation Medicaid Agency.

12 ‘‘(g) SCHIP.—At the option of the Navajo Nation,

13 the Secretary may treat the Navajo Nation as a State for

14 purposes of title XXI of the Social Security Act under

15 terms equivalent to those described in the preceding sub16 sections of this section.

17 ‘‘SEC. 425. INDIAN ADVISORY COMMITTEES.

18 ‘‘(a) NATIONAL INDIAN TECHNICAL ADVISORY

19 GROUP.—The Administrator of the Health Care Financ20 ing Administration shall establish and fund the expenses

21 of a National Indian Technical Advisory Group which shall

22 have no fewer than 14 members, including at least 1 mem23 ber designated by the Indian tribes and tribal organiza24 tions in each service area, 1 urban Indian organization

25 representative, and 1 member representing the Service.
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1 The scope of the activities of such group shall be estab2 lished under section 802 provided that such scope shall

3 include providing comment on and advice regarding the

4 programs funded under titles XVIII, XIX, and XXI of the

5 Social Security Act or regarding any other health care pro6 gram funded (in whole or part) by the Health Care Fi7 nancing Administration.

8 ‘‘(b) INDIAN MEDICAID ADVISORY COMMITTEES.—

9 The Administrator of the Health Care Financing Adminis10 tration shall establish and provide funding for a Indian

11 Medicaid Advisory Committee made up of designees of the

12 Service, Indian tribes and tribal organizations and urban

13 Indian organizations in each State in which the Service

14 directly operates a health program or in which there is

15 one or more Indian tribe or tribal organization or urban

16 Indian organization.

17 ‘‘SEC. 426. AUTHORIZATION OF APPROPRIATIONS.

18 There is authorized to be appropriated such sums as

19 may be necessary for each of fiscal years 2000 through

20 2012 to carry out this title.’’.
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1 ‘‘TITLE V—HEALTH SERVICES

2 FOR URBAN INDIANS

3 ‘‘SEC. 501. PURPOSE.

4 ‘‘The purpose of this title is to establish programs

5 in urban centers to make health services more accessible

6 and available to urban Indians.

7 ‘‘SEC. 502. CONTRACTS WITH, AND GRANTS TO, URBAN IN8 DIAN ORGANIZATIONS.

9 ‘‘Under the authority of the Act of November 2, 1921

10 (25 U.S.C. 13)(commonly known as the Snyder Act), the

11 Secretary, through the Service, shall enter into contracts

12 with, or make grants to, urban Indian organizations to

13 assist such organizations in the establishment and admin14 istration, within urban centers, of programs which meet

15 the requirements set forth in this title. The Secretary,

16 through the Service, subject to section 506, shall include

17 such conditions as the Secretary considers necessary to ef18 fect the purpose of this title in any contract which the

19 Secretary enters into with, or in any grant the Secretary

20 makes to, any urban Indian organization pursuant to this

21 title.

22 ‘‘SEC. 503. CONTRACTS AND GRANTS FOR THE PROVISION

23 OF HEALTH CARE AND REFERRAL SERVICES.

24 ‘‘(a) AUTHORITY.—Under the authority of the Act of

25 November 2, 1921 (25 U.S.C. 13) (commonly known as
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1 the Snyder Act), the Secretary, acting through the Serv2 ice, shall enter into contracts with, and make grants to,

3 urban Indian organizations for the provision of health care

4 and referral services for urban Indians. Any such contract

5 or grant shall include requirements that the urban Indian

6 organization successfully undertake to—

7 ‘‘(1) estimate the population of urban Indians

8 residing in the urban center or centers that the or9 ganization proposes to serve who are or could be re10 cipients of health care or referral services;

11 ‘‘(2) estimate the current health status of

12 urban Indians residing in such urban center or cen13 ters;

14 ‘‘(3) estimate the current health care needs of

15 urban Indians residing in such urban center or cen16 ters;

17 ‘‘(4) provide basic health education, including

18 health promotion and disease prevention education,

19 to urban Indians;

20 ‘‘(5) make recommendations to the Secretary

21 and Federal, State, local, and other resource agen22 cies on methods of improving health service pro23 grams to meet the needs of urban Indians; and
220

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1 ‘‘(6) where necessary, provide, or enter into

2 contracts for the provision of, health care services

3 for urban Indians.

4 ‘‘(b) CRITERIA.—The Secretary, acting through the

5 Service, shall by regulation adopted pursuant to section

6 520 prescribe the criteria for selecting urban Indian orga7 nizations to enter into contracts or receive grants under

8 this section. Such criteria shall, among other factors,

9 include—

10 ‘‘(1) the extent of unmet health care needs of

11 urban Indians in the urban center or centers in12 volved;

13 ‘‘(2) the size of the urban Indian population in

14 the urban center or centers involved;

15 ‘‘(3) the extent, if any, to which the activities

16 set forth in subsection (a) would duplicate any

17 project funded under this title;

18 ‘‘(4) the capability of an urban Indian organiza19 tion to perform the activities set forth in subsection

20 (a) and to enter into a contract with the Secretary

21 or to meet the requirements for receiving a grant

22 under this section;

23 ‘‘(5) the satisfactory performance and success24 ful completion by an urban Indian organization of

25 other contracts with the Secretary under this title;
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1 ‘‘(6) the appropriateness and likely effectiveness

2 of conducting the activities set forth in subsection

3 (a) in an urban center or centers; and

4 ‘‘(7) the extent of existing or likely future par5 ticipation in the activities set forth in subsection (a)

6 by appropriate health and health-related Federal,

7 State, local, and other agencies.

8 ‘‘(c) HEALTH PROMOTION AND DISEASE PREVEN9 TION.—The Secretary, acting through the Service, shall

10 facilitate access to, or provide, health promotion and dis11 ease prevention services for urban Indians through grants

12 made to urban Indian organizations administering con13 tracts entered into pursuant to this section or receiving

14 grants under subsection (a).

15 ‘‘(d) IMMUNIZATION SERVICES.—

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

17 through the Service, shall facilitate access to, or pro18 vide, immunization services for urban Indians

19 through grants made to urban Indian organizations

20 administering contracts entered into, or receiving

21 grants, under this section.

22 ‘‘(3) DEFINITION.—In this section, the term

23 ‘immunization services’ means services to provide

24 without charge immunizations against vaccine-pre25 ventable diseases.
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1 ‘‘(e) MENTAL HEALTH SERVICES.—

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

3 through the Service, shall facilitate access to, or pro4 vide, mental health services for urban Indians

5 through grants made to urban Indian organizations

6 administering contracts entered into, or receiving

7 grants, under this section.

8 ‘‘(2) ASSESSMENT.—A grant may not be made

9 under this subsection to an urban Indian organiza10 tion until that organization has prepared, and the

11 Service has approved, an assessment of the mental

12 health needs of the urban Indian population con13 cerned, the mental health services and other related

14 resources available to that population, the barriers

15 to obtaining those services and resources, and the

16 needs that are unmet by such services and resources.

17 ‘‘(3) USE OF FUNDS.—Grants may be made

18 under this subsection—

19 ‘‘(A) to prepare assessments required

20 under paragraph (2);

21 ‘‘(B) to provide outreach, educational, and

22 referral services to urban Indians regarding the

23 availability of direct behavioral health services,

24 to educate urban Indians about behavioral

25 health issues and services, and effect coordina-
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1 tion with existing behavioral health providers in

2 order to improve services to urban Indians;

3 ‘‘(C) to provide outpatient behavioral

4 health services to urban Indians, including the

5 identification and assessment of illness, thera6 peutic treatments, case management, support

7 groups, family treatment, and other treatment;

8 and

9 ‘‘(D) to develop innovative behavioral

10 health service delivery models which incorporate

11 Indian cultural support systems and resources.

12 ‘‘(f) CHILD ABUSE.—

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

14 through the Service, shall facilitate access to, or pro15 vide, services for urban Indians through grants to

16 urban Indian organizations administering contracts

17 entered into pursuant to this section or receiving

18 grants under subsection (a) to prevent and treat

19 child abuse (including sexual abuse) among urban

20 Indians.

21 ‘‘(2) ASSESSMENT.—A grant may not be made

22 under this subsection to an urban Indian organiza23 tion until that organization has prepared, and the

24 Service has approved, an assessment that documents

25 the prevalence of child abuse in the urban Indian
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1 population concerned and specifies the services and

2 programs (which may not duplicate existing services

3 and programs) for which the grant is requested.

4 ‘‘(3) USE OF FUNDS.—Grants may be made

5 under this subsection—

6 ‘‘(A) to prepare assessments required

7 under paragraph (2);

8 ‘‘(B) for the development of prevention,

9 training, and education programs for urban In10 dian populations, including child education, par11 ent education, provider training on identifica12 tion and intervention, education on reporting

13 requirements, prevention campaigns, and estab14 lishing service networks of all those involved in

15 Indian child protection; and

16 ‘‘(C) to provide direct outpatient treatment

17 services (including individual treatment, family

18 treatment, group therapy, and support groups)

19 to urban Indians who are child victims of abuse

20 (including sexual abuse) or adult survivors of

21 child sexual abuse, to the families of such child

22 victims, and to urban Indian perpetrators of

23 child abuse (including sexual abuse).
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1 ‘‘(4) CONSIDERATIONS.—In making grants to

2 carry out this subsection, the Secretary shall take

3 into consideration—

4 ‘‘(A) the support for the urban Indian or5 ganization demonstrated by the child protection

6 authorities in the area, including committees or

7 other services funded under the Indian Child

8 Welfare Act of 1978 (25 U.S.C. 1901 et seq.),

9 if any;

10 ‘‘(B) the capability and expertise dem11 onstrated by the urban Indian organization to

12 address the complex problem of child sexual

13 abuse in the community; and

14 ‘‘(C) the assessment required under para15 graph (2).

16 ‘‘(g) MULTIPLE URBAN CENTERS.—The Secretary,

17 acting through the Service, may enter into a contract with,

18 or make grants to, an urban Indian organization that pro19 vides or arranges for the provision of health care services

20 (through satellite facilities, provider networks, or other21 wise) to urban Indians in more than one urban center.

22 ‘‘SEC. 504. CONTRACTS AND GRANTS FOR THE DETERMINA23 TION OF UNMET HEALTH CARE NEEDS.

24 ‘‘(a) AUTHORITY.—
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1 ‘‘(1) IN GENERAL.—Under authority of the Act

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

3 known as the Snyder Act), the Secretary, acting

4 through the Service, may enter into contracts with,

5 or make grants to, urban Indian organizations situ6 ated in urban centers for which contracts have not

7 been entered into, or grants have not been made,

8 under section 503.

9 ‘‘(2) PURPOSE.—The purpose of a contract or

10 grant made under this section shall be the deter11 mination of the matters described in subsection

12 (b)(1) in order to assist the Secretary in assessing

13 the health status and health care needs of urban In14 dians in the urban center involved and determining

15 whether the Secretary should enter into a contract

16 or make a grant under section 503 with respect to

17 the urban Indian organization which the Secretary

18 has entered into a contract with, or made a grant

19 to, under this section.

20 ‘‘(b) REQUIREMENTS.—Any contract entered into, or

21 grant made, by the Secretary under this section shall in22 clude requirements that—

23 ‘‘(1) the urban Indian organization successfully

24 undertake to—
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1 ‘‘(A) document the health care status and

2 unmet health care needs of urban Indians in

3 the urban center involved; and

4 ‘‘(B) with respect to urban Indians in the

5 urban center involved, determine the matters

6 described in paragraphs (2), (3), (4), and (7) of

7 section 503(b); and

8 ‘‘(2) the urban Indian organization complete

9 performance of the contract, or carry out the re10 quirements of the grant, within 1 year after the date

11 on which the Secretary and such organization enter

12 into such contract, or within 1 year after such orga13 nization receives such grant, whichever is applicable.

14 ‘‘(c) LIMITATION ON RENEWAL.—The Secretary may

15 not renew any contract entered into, or grant made, under

16 this section.

17 ‘‘SEC. 505. EVALUATIONS; RENEWALS.

18 ‘‘(a) PROCEDURES.—The Secretary, acting through

19 the Service, shall develop procedures to evaluate compli20 ance with grant requirements under this title and compli21 ance with, and performance of contracts entered into by

22 urban Indian organizations under this title. Such proce23 dures shall include provisions for carrying out the require24 ments of this section.
228

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1 ‘‘(b) COMPLIANCE WITH TERMS.—The Secretary,

2 acting through the Service, shall evaluate the compliance

3 of each urban Indian organization which has entered into

4 a contract or received a grant under section 503 with the

5 terms of such contract of grant. For purposes of an eval6 uation under this subsection, the Secretary, in deter7 mining the capacity of an urban Indian organization to

8 deliver quality patient care shall, at the option of the

9 organization—

10 ‘‘(1) conduct, through the Service, an annual

11 onsite evaluation of the organization; or

12 ‘‘(2) accept, in lieu of an onsite evaluation, evi13 dence of the organization’s provisional or full accred14 itation by a private independent entity recognized by

15 the Secretary for purposes of conducting quality re16 views of providers participating in the medicare pro17 gram under Title XVIII of the Social Security Act.

18 ‘‘(c) NONCOMPLIANCE.—

19 ‘‘(1) IN GENERAL.—If, as a result of the eval20 uations conducted under this section, the Secretary

21 determines that an urban Indian organization has

22 not complied with the requirements of a grant or

23 complied with or satisfactorily performed a contract

24 under section 503, the Secretary shall, prior to re25 newing such contract or grant, attempt to resolve
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1 with such organization the areas of noncompliance

2 or unsatisfactory performance and modify such con3 tract or grant to prevent future occurrences of such

4 noncompliance or unsatisfactory performance.

5 ‘‘(2) NONRENEWAL.—If the Secretary deter6 mines, under an evaluation under this section, that

7 noncompliance or unsatisfactory performance cannot

8 be resolved and prevented in the future, the Sec9 retary shall not renew such contract or grant with

10 such organization and is authorized to enter into a

11 contract or make a grant under section 503 with an12 other urban Indian organization which is situated in

13 the same urban center as the urban Indian organiza14 tion whose contract or grant is not renewed under

15 this section.

16 ‘‘(d) DETERMINATION OF RENEWAL.—In deter17 mining whether to renew a contract or grant with an

18 urban Indian organization under section 503 which has

19 completed performance of a contract or grant under sec20 tion 504, the Secretary shall review the records of the

21 urban Indian organization, the reports submitted under

22 section 507, and, in the case of a renewal of a contract

23 or grant under section 503, shall consider the results of

24 the onsite evaluations or accreditation under subsection

25 (b).
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1 ‘‘SEC. 506. OTHER CONTRACT AND GRANT REQUIREMENTS.

2 ‘‘(a) APPLICATION OF FEDERAL LAW.—Contracts

3 with urban Indian organizations entered into pursuant to

4 this title shall be in accordance with all Federal con5 tracting laws and regulations relating to procurement ex6 cept that, in the discretion of the Secretary, such contracts

7 may be negotiated without advertising and need not con8 form to the provisions of the Act of August 24, 1935 (40

9 U.S.C. 270a, et seq.).

10 ‘‘(b) PAYMENTS.—Payments under any contracts or

11 grants pursuant to this title shall, notwithstanding any

12 term or condition of such contract or grant—

13 ‘‘(1) be made in their entirety by the Secretary

14 to the urban Indian organization by not later than

15 the end of the first 30 days of the funding period

16 with respect to which the payments apply, unless the

17 Secretary determines through an evaluation under

18 section 505 that the organization is not capable of

19 administering such payments in their entirety; and

20 ‘‘(2) if unexpended by the urban Indian organi21 zation during the funding period with respect to

22 which the payments initially apply, be carried for23 ward for expenditure with respect to allowable or re24 imbursable costs incurred by the organization during

25 1 or more subsequent funding periods without addi26 tional justification or documentation by the organi-
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1 zation as a condition of carrying forward the ex2 penditure of such funds.

3 ‘‘(c) REVISING OR AMENDING CONTRACT.—Notwith4 standing any provision of law to the contrary, the Sec5 retary may, at the request or consent of an urban Indian

6 organization, revise or amend any contract entered into

7 by the Secretary with such organization under this title

8 as necessary to carry out the purposes of this title.

9 ‘‘(d) FAIR AND UNIFORM PROVISION OF SERV10 ICES.—Contracts with, or grants to, urban Indian organi11 zations and regulations adopted pursuant to this title shall

12 include provisions to assure the fair and uniform provision

13 to urban Indians of services and assistance under such

14 contracts or grants by such organizations.

15 ‘‘(e) ELIGIBILITY OF URBAN INDIANS.—Urban Indi16 ans, as defined in section 4(f), shall be eligible for health

17 care or referral services provided pursuant to this title.

18 ‘‘SEC. 507. REPORTS AND RECORDS.

19 ‘‘(a) REPORT.—For each fiscal year during which an

20 urban Indian organization receives or expends funds pur21 suant to a contract entered into, or a grant received, pur22 suant to this title, such organization shall submit to the

23 Secretary, on a basis no more frequent than every 6

24 months, a report including—
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1 ‘‘(1) in the case of a contract or grant under

2 section 503, information gathered pursuant to para3 graph (5) of subsection (a) of such section;

4 ‘‘(2) information on activities conducted by the

5 organization pursuant to the contract or grant;

6 ‘‘(3) an accounting of the amounts and pur7 poses for which Federal funds were expended; and

8 ‘‘(4) a minimum set of data, using uniformly

9 defined elements, that is specified by the Secretary,

10 after consultations consistent with section 514, with

11 urban Indian organizations.

12 ‘‘(b) AUDITS.—The reports and records of the urban

13 Indian organization with respect to a contract or grant

14 under this title shall be subject to audit by the Secretary

15 and the Comptroller General of the United States.

16 ‘‘(c) COST OF AUDIT.—The Secretary shall allow as

17 a cost of any contract or grant entered into or awarded

18 under section 502 or 503 the cost of an annual inde19 pendent financial audit conducted by—

20 ‘‘(1) a certified public accountant; or

21 ‘‘(2) a certified public accounting firm qualified

22 to conduct Federal compliance audits.

23 ‘‘SEC. 508. LIMITATION ON CONTRACT AUTHORITY.

24 ‘‘The authority of the Secretary to enter into con25 tracts or to award grants under this title shall be to the
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1 extent, and in an amount, provided for in appropriation

2 Acts.

3 ‘‘SEC. 509. FACILITIES.

4 ‘‘(a) GRANTS.—The Secretary may make grants to

5 contractors or grant recipients under this title for the

6 lease, purchase, renovation, construction, or expansion of

7 facilities, including leased facilities, in order to assist such

8 contractors or grant recipients in complying with applica9 ble licensure or certification requirements.

10 ‘‘(b) LOANS OR LOAN GUARANTEES.—The Secretary,

11 acting through the Service or through the Health Re12 sources and Services Administration, may provide loans

13 to contractors or grant recipients under this title from the

14 Urban Indian Health Care Facilities Revolving Loan

15 Fund (referred to in this section as the ‘URLF’) described

16 in subsection (c), or guarantees for loans, for the construc17 tion, renovation, expansion, or purchase of health care fa18 cilities, subject to the following requirements:

19 ‘‘(1) The principal amount of a loan or loan

20 guarantee may cover 100 percent of the costs (other

21 than staffing) relating to the facility, including plan22 ning, design, financing, site land development, con23 struction, rehabilitation, renovation, conversion,

24 medical equipment, furnishings, and capital pur25 chase.
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1 ‘‘(2) The total amount of the principal of loans

2 and loan guarantees, respectively, outstanding at

3 any one time shall not exceed such limitations as

4 may be specified in appropriations Acts.

5 ‘‘(3) The loan or loan guarantee may have a

6 term of the shorter of the estimated useful life of the

7 facility, or 25 years.

8 ‘‘(4) An urban Indian organization may assign,

9 and the Secretary may accept assignment of, the

10 revenue of the organization as security for a loan or

11 loan guarantee under this subsection.

12 ‘‘(5) The Secretary shall not collect application,

13 processing, or similar fees from urban Indian organi14 zations applying for loans or loan guarantees under

15 this subsection.

16 ‘‘(c) URBAN INDIAN HEALTH CARE FACILITIES RE17 VOLVING LOAN FUND.—

18 ‘‘(1) ESTABLISHMENT.—There is established in

19 the Treasury of the United States a fund to be

20 known as the Urban Indian Health Care Facilities

21 Revolving Loan Fund. The URLF shall consist of—

22 ‘‘(A) such amounts as may be appropriated

23 to the URLF;
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•S 2526 IS

1 ‘‘(B) amounts received from urban Indian

2 organizations in repayment of loans made to

3 such organizations under paragraph (2); and

4 ‘‘(C) interest earned on amounts in the

5 URLF under paragraph (3).

6 ‘‘(2) USE OF URLF.—Amounts in the URLF

7 may be expended by the Secretary, acting through

8 the Service or the Health Resources and Services

9 Administration, to make loans available to urban In10 dian organizations receiving grants or contracts

11 under this title for the purposes, and subject to the

12 requirements, described in subsection (b). Amounts

13 appropriated to the URLF, amounts received from

14 urban Indian organizations in repayment of loans,

15 and interest on amounts in the URLF shall remain

16 available until expended.

17 ‘‘(3) INVESTMENTS.—The Secretary of the

18 Treasury shall invest such amounts of the URLF as

19 such Secretary determines are not required to meet

20 current withdrawals from the URLF. Such invest21 ments may be made only in interest-bearing obliga22 tions of the United States. For such purpose, such

23 obligations may be acquired on original issue at the

24 issue price, or by purchase of outstanding obliga25 tions at the market price. Any obligation acquired by
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1 the URLF may be sold by the Secretary of the

2 Treasury at the market price.

3 ‘‘SEC. 510. OFFICE OF URBAN INDIAN HEALTH.

4 ‘‘There is hereby established within the Service an

5 Office of Urban Indian Health which shall be responsible

6 for—

7 ‘‘(1) carrying out the provisions of this title;

8 ‘‘(2) providing central oversight of the pro9 grams and services authorized under this title; and

10 ‘‘(3) providing technical assistance to urban In11 dian organizations.

12 ‘‘SEC. 511. GRANTS FOR ALCOHOL AND SUBSTANCE ABUSE

13 RELATED SERVICES.

14 ‘‘(a) GRANTS.—The Secretary may make grants for

15 the provision of health-related services in prevention of,

16 treatment of, rehabilitation of, or school and community17 based education in, alcohol and substance abuse in urban

18 centers to those urban Indian organizations with whom

19 the Secretary has entered into a contract under this title

20 or under section 201.

21 ‘‘(b) GOALS OF GRANT.—Each grant made pursuant

22 to subsection (a) shall set forth the goals to be accom23 plished pursuant to the grant. The goals shall be specific

24 to each grant as agreed to between the Secretary and the

25 grantee.
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1 ‘‘(c) CRITERIA.—The Secretary shall establish cri2 teria for the grants made under subsection (a), including

3 criteria relating to the—

4 ‘‘(1) size of the urban Indian population;

5 ‘‘(2) capability of the organization to adequately

6 perform the activities required under the grant;

7 ‘‘(3) satisfactory performance standards for the

8 organization in meeting the goals set forth in such

9 grant, which standards shall be negotiated and

10 agreed to between the Secretary and the grantee on

11 a grant-by-grant basis; and

12 ‘‘(4) identification of need for services.

13 The Secretary shall develop a methodology for allocating

14 grants made pursuant to this section based on such cri15 teria.

16 ‘‘(d) TREATMENT OF FUNDS RECEIVED BY URBAN

17 INDIAN ORGANIZATIONS.—Any funds received by an

18 urban Indian organization under this Act for substance

19 abuse prevention, treatment, and rehabilitation shall be

20 subject to the criteria set forth in subsection (c).

21 ‘‘SEC. 512. TREATMENT OF CERTAIN DEMONSTRATION

22 PROJECTS.

23 ‘‘(a) OKLAHOMA CITY CLINIC.—

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

25 provision of law, the Oklahoma City Clinic dem-
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1 onstration project shall be treated as a service unit

2 in the allocation of resources and coordination of

3 care and shall not be subject to the provisions of the

4 Indian Self-Determination and Education Assistance

5 Act for the term of such projects. The Secretary

6 shall provide assistance to such projects in the devel7 opment of resources and equipment and facility

8 needs.

9 ‘‘(2) REPORT.—The Secretary shall submit to

10 the President, for inclusion in the report required to

11 be submitted to the Congress under section 801 for

12 fiscal year 1999, a report on the findings and con13 clusions derived from the demonstration project

14 specified in paragraph (1).

15 ‘‘(b) TULSA CLINIC.—Notwithstanding any other

16 provision of law, the Tulsa Clinic demonstration project

17 shall become a permanent program within the Service’s

18 direct care program and continue to be treated as a service

19 unit in the allocation of resources and coordination of

20 care, and shall continue to meet the requirements and

21 definitions of an urban Indian organization in this title,

22 and as such will not be subject to the provisions of the

23 Indian Self-Determination and Education Assistance Act.
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1 ‘‘SEC. 513. URBAN NIAAA TRANSFERRED PROGRAMS.

2 ‘‘(a) GRANTS AND CONTRACTS.—The Secretary, act3 ing through the Office of Urban Indian Health of the

4 Service, shall make grants or enter into contracts, effective

5 not later than September 30, 2001, with urban Indian or6 ganizations for the administration of urban Indian alcohol

7 programs that were originally established under the Na8 tional Institute on Alcoholism and Alcohol Abuse (referred

9 to in this section to as ‘NIAAA’) and transferred to the

10 Service.

11 ‘‘(b) USE OF FUNDS.—Grants provided or contracts

12 entered into under this section shall be used to provide

13 support for the continuation of alcohol prevention and

14 treatment services for urban Indian populations and such

15 other objectives as are agreed upon between the Service

16 and a recipient of a grant or contract under this section.

17 ‘‘(c) ELIGIBILITY.—Urban Indian organizations that

18 operate Indian alcohol programs originally funded under

19 NIAAA and subsequently transferred to the Service are

20 eligible for grants or contracts under this section.

21 ‘‘(d) EVALUATION AND REPORT.—The Secretary

22 shall evaluate and report to the Congress on the activities

23 of programs funded under this section at least every 5

24 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, the Health Care Financing Administration,

5 and other operating divisions and staff divisions of the De6 partment consult, to the maximum extent practicable, with

7 urban Indian organizations (as defined in section 4) prior

8 to taking any action, or approving Federal financial assist9 ance for any action of a State, that may affect urban Indi10 ans or urban Indian organizations.

11 ‘‘(b) REQUIREMENT.—In subsection (a), the term

12 ‘consultation’ means the open and free exchange of infor13 mation and opinion among urban Indian organizations

14 and the operating and staff divisions of the Department

15 which leads to mutual understanding and comprehension

16 and which emphasizes trust, respect, and shared responsi17 bility.

18 ‘‘SEC. 515. FEDERAL TORT CLAIMS ACT COVERAGE.

19 ‘‘For purposes of section 224 of the Public Health

20 Service Act (42 U.S.C. 233), with respect to claims by

21 any person, initially filed on or after October 1, 1999,

22 whether or not such person is an Indian or Alaska Native

23 or is served on a fee basis or under other circumstances

24 as permitted by Federal law or regulations, for personal

25 injury (including death) resulting from the performance

26 prior to, including, or after October 1, 1999, of medical,
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1 surgical, dental, or related functions, including the con2 duct of clinical studies or investigations, or for purposes

3 of section 2679 of title 28, United States Code, with re4 spect to claims by any such person, on or after October

5 1, 1999, for personal injury (including death) resulting

6 from the operation of an emergency motor vehicle, an

7 urban Indian organization that has entered into a contract

8 or received a grant pursuant to this title is deemed to be

9 part of the Public Health Service while carrying out any

10 such contract or grant and its employees (including those

11 acting on behalf of the organization as provided for in sec12 tion 2671 of title 28, United States Code, and including

13 an individual who provides health care services pursuant

14 to a personal services contract with an urban Indian orga15 nization for the provision of services in any facility owned,

16 operated, or constructed under the jurisdiction of the In17 dian Health Service) are deemed employees of the Service

18 while acting within the scope of their employment in car19 rying out the contract or grant, except that such employ20 ees shall be deemed to be acting within the scope of their

21 employment in carrying out the contract or grant when

22 they are required, by reason of their employment, to per23 form medical, surgical, dental or related functions at a fa24 cility other than a facility operated by the urban Indian

25 organization pursuant to such contract or grant, but only
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1 if such employees are not compensated for the perform2 ance of such functions by a person or entity other than

3 the urban Indian organization.

4 ‘‘SEC. 516. URBAN YOUTH TREATMENT CENTER DEM5 ONSTRATION.

6 ‘‘(a) CONSTRUCTION AND OPERATION.—The Sec7 retary, acting through the Service, shall, through grants

8 or contracts, make payment for the construction and oper9 ation of at least 2 residential treatment centers in each

10 State described in subsection (b) to demonstrate the provi11 sion of alcohol and substance abuse treatment services to

12 urban Indian youth in a culturally competent residential

13 setting.

14 ‘‘(b) STATES.—A State described in this subsection

15 is a State in which—

16 ‘‘(1) there reside urban Indian youth with a

17 need for alcohol and substance abuse treatment serv18 ices in a residential setting; and

19 ‘‘(2) there is a significant shortage of culturally

20 competent residential treatment services for urban

21 Indian youth.

22 ‘‘SEC. 517. USE OF FEDERAL GOVERNMENT FACILITIES AND

23 SOURCES OF SUPPLY.

24 ‘‘(a) IN GENERAL.—The Secretary shall permit an

25 urban Indian organization that has entered into a contract
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1 or received a grant pursuant to this title, in carrying out

2 such contract or grant, to use existing facilities and all

3 equipment therein or pertaining thereto and other per4 sonal property owned by the Federal Government within

5 the Secretary’s jurisdiction under such terms and condi6 tions as may be agreed upon for their use and mainte7 nance.

8 ‘‘(b) DONATION OF PROPERTY.—Subject to sub9 section (d), the Secretary may donate to an urban Indian

10 organization that has entered into a contract or received

11 a grant pursuant to this title any personal or real property

12 determined to be excess to the needs of the Service or the

13 General Services Administration for purposes of carrying

14 out the contract or grant.

15 ‘‘(c) ACQUISITION OF PROPERTY.—The Secretary

16 may acquire excess or surplus government personal or real

17 property for donation, subject to subsection (d), to an

18 urban Indian organization that has entered into a contract

19 or received a grant pursuant to this title if the Secretary

20 determines that the property is appropriate for use by the

21 urban Indian organization for a purpose for which a con22 tract or grant is authorized under this title.

23 ‘‘(d) PRIORITY.—In the event that the Secretary re24 ceives a request for a specific item of personal or real

25 property described in subsections (b) or (c) from an urban
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1 Indian organization and from an Indian tribe or tribal or2 ganization, the Secretary shall give priority to the request

3 for donation to the Indian tribe or tribal organization if

4 the Secretary receives the request from the Indian tribe

5 or tribal organization before the date on which the Sec6 retary transfers title to the property or, if earlier, the date

7 on which the Secretary transfers the property physically,

8 to the urban Indian organization.

9 ‘‘(e) RELATION TO FEDERAL SOURCES OF SUP10 PLY.—For purposes of section 201(a) of the Federal

11 Property and Administrative Services Act of 1949 (40

12 U.S.C. 481(a)) (relating to Federal sources of supply, in13 cluding lodging providers, airlines, and other transpor14 tation providers), an urban Indian organization that has

15 entered into a contract or received a grant pursuant to

16 this title shall be deemed an executive agency when car17 rying out such contract or grant, and the employees of

18 the urban Indian organization shall be eligible to have ac19 cess to such sources of supply on the same basis as em20 ployees of an executive agency have such access.

21 ‘‘SEC. 518. GRANTS FOR DIABETES PREVENTION, TREAT22 MENT AND CONTROL.

23 ‘‘(a) AUTHORITY.—The Secretary may make grants

24 to those urban Indian organizations that have entered into

25 a contract or have received a grant under this title for
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1 the provision of services for the prevention, treatment, and

2 control of the complications resulting from, diabetes

3 among urban Indians.

4 ‘‘(b) GOALS.—Each grant made pursuant to sub5 section (a) shall set forth the goals to be accomplished

6 under the grant. The goals shall be specific to each grant

7 as agreed upon between the Secretary and the grantee.

8 ‘‘(c) CRITERIA.—The Secretary shall establish cri9 teria for the awarding of grants made under subsection

10 (a) relating to—

11 ‘‘(1) the size and location of the urban Indian

12 population to be served;

13 ‘‘(2) the need for the prevention of, treatment

14 of, and control of the complications resulting from

15 diabetes among the urban Indian population to be

16 served;

17 ‘‘(3) performance standards for the urban In18 dian organization in meeting the goals set forth in

19 such grant that are negotiated and agreed to by the

20 Secretary and the grantee;

21 ‘‘(4) the capability of the urban Indian organi22 zation to adequately perform the activities required

23 under the grant; and

24 ‘‘(5) the willingness of the urban Indian organi25 zation to collaborate with the registry, if any, estab-
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1 lished by the Secretary under section 204(e) in the

2 area office of the Service in which the organization

3 is located.

4 ‘‘(d) APPLICATION OF CRITERIA.—Any funds re5 ceived by an urban Indian organization under this Act for

6 the prevention, treatment, and control of diabetes among

7 urban Indians shall be subject to the criteria developed

8 by the Secretary under subsection (c).

9 ‘‘SEC. 519. COMMUNITY HEALTH REPRESENTATIVES.

10 ‘‘The Secretary, acting through the Service, may

11 enter into contracts with, and make grants to, urban In12 dian organizations for the use of Indians trained as health

13 service providers through the Community Health Rep14 resentatives Program under section 107(b) in the provi15 sion of health care, health promotion, and disease preven16 tion services to urban Indians.

17 ‘‘SEC. 520. REGULATIONS.

18 ‘‘(a) EFFECT OF TITLE.—This title shall be effective

19 on the date of enactment of this Act regardless of whether

20 the Secretary has promulgated regulations implementing

21 this title.

22 ‘‘(b) PROMULGATION.—

23 ‘‘(1) IN GENERAL.—The Secretary may promul24 gate regulations to implement the provisions of this

25 title.
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1 ‘‘(2) PUBLICATION.—Proposed regulations to

2 implement this title shall be published by the Sec3 retary in the Federal Register not later than 270

4 days after the date of enactment of this Act and

5 shall have a comment period of not less than 120

6 days.

7 ‘‘(3) EXPIRATION OF AUTHORITY.—The author8 ity to promulgate regulations under this title shall

9 expire on the date that is 18 months after the date

10 of enactment of this Act.

11 ‘‘(c) NEGOTIATED RULEMAKING COMMITTEE.—A ne12 gotiated rulemaking committee shall be established pursu13 ant to section 565 of title 5, United States Code, to carry

14 out this section and shall, in addition to Federal represent15 atives, have as the majority of its members representatives

16 of urban Indian organizations from each service area.

17 ‘‘(d) ADAPTION OF PROCEDURES.—The Secretary

18 shall adapt the negotiated rulemaking procedures to the

19 unique context of this Act.

20 ‘‘SEC. 521. AUTHORIZATION OF APPROPRIATIONS.

21 ‘‘There is authorized to be appropriated such sums

22 as may be necessary for each fiscal year through fiscal

23 year 2012 to carry out this title.
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1 ‘‘TITLE VI—ORGANIZATIONAL

2 IMPROVEMENTS

3 ‘‘SEC. 601. ESTABLISHMENT OF THE INDIAN HEALTH SERV4 ICE AS AN AGENCY OF THE PUBLIC HEALTH

5 SERVICE.

6 ‘‘(a) ESTABLISHMENT.—

7 ‘‘(1) IN GENERAL.—In order to more effectively

8 and efficiently carry out the responsibilities, authori9 ties, and functions of the United States to provide

10 health care services to Indians and Indian tribes, as

11 are or may be hereafter provided by Federal statute

12 or treaties, there is established within the Public

13 Health Service of the Department the Indian Health

14 Service.

15 ‘‘(2) ASSISTANT SECRETARY OF INDIAN

16 HEALTH.—The Service shall be administered by an

17 Assistance Secretary of Indian Health, who shall be

18 appointed by the President, by and with the advice

19 and consent of the Senate. The Assistant Secretary

20 shall report to the Secretary. Effective with respect

21 to an individual appointed by the President, by and

22 with the advice and consent of the Senate, after

23 January 1, 1993, the term of service of the Assist24 ant Secretary shall be 4 years. An Assistant Sec25 retary may serve more than 1 term.
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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) FUNCTIONS AND DUTIES.—The Secretary shall

6 carry out through the Assistant Secretary of the Service—

7 ‘‘(1) all functions which were, on the day before

8 the date of enactment of the Indian Health Care

9 Amendments of 1988, carried out by or under the

10 direction of the individual serving as Director of the

11 Service on such day;

12 ‘‘(2) all functions of the Secretary relating to

13 the maintenance and operation of hospital and

14 health facilities for Indians and the planning for,

15 and provision and utilization of, health services for

16 Indians;

17 ‘‘(3) all health programs under which health

18 care is provided to Indians based upon their status

19 as Indians which are administered by the Secretary,

20 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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•S 2526 IS

1 ‘‘(D) the Act of August 16, 1957 (42

2 U.S.C. 2005 et seq.); and

3 ‘‘(E) the Indian Self-Determination Act

4 (25 U.S.C. 450f, et seq.); and

5 ‘‘(4) all scholarship and loan functions carried

6 out under title I.

7 ‘‘(d) AUTHORITY.—

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

9 through the Assistant Secretary, shall have the

10 authority—

11 ‘‘(A) except to the extent provided for in

12 paragraph (2), to appoint and compensate em13 ployees for the Service in accordance with title

14 5, United States Code;

15 ‘‘(B) to enter into contracts for the pro16 curement of goods and services to carry out the

17 functions of the Service; and

18 ‘‘(C) to manage, expend, and obligate all

19 funds appropriated for the Service.

20 ‘‘(2) PERSONNEL ACTIONS.—Notwithstanding

21 any other provision of law, the provisions of section

22 12 of the Act of June 18, 1934 (48 Stat. 986; 25

23 U.S.C. 472), shall apply to all personnel actions

24 taken with respect to new positions created within
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1 the Service as a result of its establishment under

2 subsection (a).

3 ‘‘SEC. 602. AUTOMATED MANAGEMENT INFORMATION SYS4 TEM.

5 ‘‘(a) ESTABLISHMENT.—

6 ‘‘(1) IN GENERAL.—The Secretary, in consulta7 tion with tribes, tribal organizations, and urban In8 dian organizations, shall establish an automated

9 management information system 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;

15 ‘‘(C) a privacy component that protects the

16 privacy of patient information;

17 ‘‘(D) a services-based cost accounting com18 ponent that provides estimates of the costs as19 sociated with the provision of specific medical

20 treatments or services in each area office of the

21 Service;

22 ‘‘(E) an interface mechanism for patient

23 billing and accounts receivable system; and

24 ‘‘(F) a training component.
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1 ‘‘(b) PROVISION OF SYSTEMS TO TRIBES AND ORGA2 NIZATIONS.—The Secretary shall provide each Indian

3 tribe and tribal organization that provides health services

4 under a contract entered into with the Service under the

5 Indian Self-Determination Act automated management in6 formation systems which—

7 ‘‘(1) meet the management information needs

8 of such Indian tribe or tribal organization with re9 spect to the treatment by the Indian tribe or tribal

10 organization of patients of the Service; and

11 ‘‘(2) meet the management information needs

12 of the Service.

13 ‘‘(c) ACCESS TO RECORDS.—Notwithstanding any

14 other provision of law, each patient shall have reasonable

15 access to the medical or health records of such patient

16 which are held by, or on behalf of, the Service.

17 ‘‘(d) AUTHORITY TO ENHANCE INFORMATION TECH18 NOLOGY.—The Secretary, acting through the Assistant

19 Secretary, shall have the authority to enter into contracts,

20 agreements or joint ventures with other Federal agencies,

21 States, private and nonprofit organizations, for the pur22 pose of enhancing information technology in Indian health

23 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 2012 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.—It is the purpose of this section

10 to—

11 ‘‘(1) authorize and direct the Secretary, acting

12 through the Service, Indian tribes, tribal organiza13 tions, and urban Indian organizations to develop a

14 comprehensive behavioral health prevention and

15 treatment program which emphasizes collaboration

16 among alcohol and substance abuse, social services,

17 and mental health programs;

18 ‘‘(2) provide information, direction and guid19 ance relating to mental illness and dysfunction and

20 self-destructive behavior, including child abuse and

21 family violence, to those Federal, tribal, State and

22 local agencies responsible for programs in Indian

23 communities in areas of health care, education, so24 cial services, child and family welfare, alcohol and

25 substance abuse, law enforcement and judicial serv26 ices;
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1 ‘‘(3) assist Indian tribes to identify services and

2 resources available to address mental illness and

3 dysfunctional and self-destructive behavior;

4 ‘‘(4) provide authority and opportunities for In5 dian tribes to develop and implement, and coordinate

6 with, community-based programs which include iden7 tification, prevention, education, referral, and treat8 ment services, including through multi-disciplinary

9 resource teams;

10 ‘‘(5) 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; and

14 ‘‘(6) modify or supplement existing programs

15 and authorities in the areas identified in paragraph

16 (2).

17 ‘‘(b) BEHAVIORAL HEALTH PLANNING.—

18 ‘‘(1) AREA-WIDE PLANS.—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 develop

22 tribal plans, encourage urban Indian organizations

23 to develop local plans, and encourage all such groups

24 to participate in developing area-wide plans for In-
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1 dian Behavioral Health Services. The plans shall, to

2 the extent feasible, include—

3 ‘‘(A) an assessment of the scope of the

4 problem of alcohol or other substance abuse,

5 mental illness, dysfunctional and self-destruc6 tive behavior, including suicide, child abuse and

7 family violence, among Indians, including—

8 ‘‘(i) the number of Indians served who

9 are directly or indirectly affected by such

10 illness or behavior; and

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 ad15 ditional resources necessary for the prevention

16 and treatment of such illness and behavior, in17 cluding an assessment of the progress toward

18 achieving the availability of the full continuum

19 of care described in subsection (c); and

20 ‘‘(C) an estimate of the additional funding

21 needed by the Service, Indian tribes, tribal or22 ganizations and urban Indian organizations to

23 meet their responsibilities under the plans.

24 ‘‘(2) NATIONAL CLEARINGHOUSE.—The Sec25 retary shall establish a national clearinghouse of
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1 plans and reports on the outcomes of such plans de2 veloped under this section by Indian tribes, tribal or3 ganizations and by areas relating to behavioral

4 health. The Secretary shall ensure access to such

5 plans and outcomes by any Indian tribe, tribal orga6 nization, urban Indian organization or the Service.

7 ‘‘(3) TECHNICAL ASSISTANCE.—The Secretary

8 shall provide technical assistance to Indian tribes,

9 tribal organizations, and urban Indian organizations

10 in preparation of plans under this section and in de11 veloping standards of care that may be utilized and

12 adopted locally.

13 ‘‘(c) CONTINUUM OF CARE.—The Secretary, acting

14 through the Service, Indian tribes and tribal organiza15 tions, shall provide, to the extent feasible and to the extent

16 that funding is available, for the implementation of pro17 grams including—

18 ‘‘(1) a comprehensive continuum of behavioral

19 health care that provides for—

20 ‘‘(A) community based prevention, inter21 vention, outpatient and behavioral health

22 aftercare;

23 ‘‘(B) detoxification (social and medical);

24 ‘‘(C) acute hospitalization;
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1 ‘‘(D) intensive outpatient or day treat2 ment;

3 ‘‘(E) residential treatment;

4 ‘‘(F) transitional living for those needing a

5 temporary stable living environment that is sup6 portive of treatment or recovery goals;

7 ‘‘(G) emergency shelter;

8 ‘‘(H) intensive case management; and

9 ‘‘(I) traditional health care practices; and

10 ‘‘(2) behavioral health services for particular

11 populations, including—

12 ‘‘(A) for persons from birth through age

13 17, child behavioral health services, that

14 include—

15 ‘‘(i) pre-school and school age fetal al16 cohol disorder services, including assess17 ment and behavioral intervention);

18 ‘‘(ii) mental health or substance abuse

19 services (emotional, organic, alcohol, drug,

20 inhalant and tobacco);

21 ‘‘(iii) services for co-occurring dis22 orders (multiple diagnosis);

23 ‘‘(iv) prevention services that are fo24 cused on individuals ages 5 years through
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1 10 years (alcohol, drug, inhalant and to2 bacco);

3 ‘‘(v) early intervention, treatment and

4 aftercare services that are focused on indi5 viduals ages 11 years through 17 years;

6 ‘‘(vi) healthy choices or life style serv7 ices (related to STD’s, domestic violence,

8 sexual abuse, suicide, teen pregnancy, obe9 sity, and other risk or safety issues);

10 ‘‘(vii) co-morbidity services;

11 ‘‘(B) for persons ages 18 years through 55

12 years, adult behavioral health services that

13 include—

14 ‘‘(i) early intervention, treatment and

15 aftercare services;

16 ‘‘(ii) mental health and substance

17 abuse services (emotional, alcohol, drug,

18 inhalant and tobacco);

19 ‘‘(iii) services for co-occurring dis20 orders (dual diagnosis) and co-morbidity;

21 ‘‘(iv) healthy choices and life style

22 services (related to parenting, partners, do23 mestic violence, sexual abuse, suicide, obe24 sity, and other risk related behavior);
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1 ‘‘(v) female specific treatment services

2 for—

3 ‘‘(I) women at risk of giving

4 birth to a child with a fetal alcohol

5 disorder;

6 ‘‘(II) substance abuse requiring

7 gender specific services;

8 ‘‘(III) sexual assault and domes9 tic violence; and

10 ‘‘(IV) healthy choices and life

11 style (parenting, partners, obesity,

12 suicide and other related behavioral

13 risk); and

14 ‘‘(vi) male specific treatment services

15 for—

16 ‘‘(I) substance abuse requiring

17 gender specific services;

18 ‘‘(II) sexual assault and domestic

19 violence; and

20 ‘‘(III) healthy choices and life

21 style (parenting, partners, obesity,

22 suicide and other risk related behav23 ior);

24 ‘‘(C) family behavioral health services,

25 including—
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1 ‘‘(i) early intervention, treatment and

2 aftercare for affected families;

3 ‘‘(ii) treatment for sexual assault and

4 domestic violence; and

5 ‘‘(iii) healthy choices and life style (re6 lated to parenting, partners, domestic vio7 lence and other abuse issues);

8 ‘‘(D) for persons age 56 years and older,

9 elder behavioral health services including—

10 ‘‘(i) early intervention, treatment and

11 aftercare services that include—

12 ‘‘(I) mental health and substance

13 abuse services (emotional, alcohol,

14 drug, inhalant and tobacco);

15 ‘‘(II) services for co-occurring

16 disorders (dual diagnosis) and co-mor17 bidity; and

18 ‘‘(III) healthy choices and life

19 style services (managing conditions re20 lated to aging);

21 ‘‘(ii) elder women specific services

22 that include—

23 ‘‘(I) treatment for substance

24 abuse requiring gender specific serv25 ices and
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1 ‘‘(II) treatment for sexual as2 sault, domestic violence and neglect;

3 ‘‘(iii) elder men specific services that

4 include—

5 ‘‘(I) treatment for substance

6 abuse requiring gender specific serv7 ices; and

8 ‘‘(II) treatment for sexual as9 sault, domestic violence and neglect;

10 and

11 ‘‘(iv) services for dementia regardless

12 of cause.

13 ‘‘(d) COMMUNITY BEHAVIORAL HEALTH PLAN.—

14 ‘‘(1) IN GENERAL.—The governing body of any

15 Indian tribe or tribal organization or urban Indian

16 organization may, at its discretion, adopt a resolu17 tion for the establishment of a community behavioral

18 health plan providing for the identification and co19 ordination of available resources and programs to

20 identify, prevent, or treat alcohol and other sub21 stance abuse, mental illness or dysfunctional and

22 self-destructive behavior, including child abuse and

23 family violence, among its members or its service

24 population. Such plan should include behavioral
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1 health services, social services, intensive outpatient

2 services, and continuing after care.

3 ‘‘(2) TECHNICAL ASSISTANCE.—In furtherance

4 of a plan established pursuant to paragraph (1) and

5 at the request of a tribe, the appropriate agency,

6 service unit, or other officials of the Bureau of In7 dian Affairs and the Service shall cooperate with,

8 and provide technical assistance to, the Indian tribe

9 or tribal organization in the development of a plan

10 under paragraph (1). Upon the establishment of

11 such a plan and at the request of the Indian tribe

12 or tribal organization, such officials shall cooperate

13 with the Indian tribe or tribal organization in the

14 implementation of such plan.

15 ‘‘(3) FUNDING.—The Secretary, acting through

16 the Service, may make funding available to Indian

17 tribes and tribal organizations adopting a resolution

18 pursuant to paragraph (1) to obtain technical assist19 ance for the development of a community behavioral

20 health plan and to provide administrative support in

21 the implementation of such plan.

22 ‘‘(e) COORDINATED PLANNING.—The Secretary, act23 ing through the Service, Indian tribes, tribal organiza24 tions, and urban Indian organizations shall coordinate be25 havioral health planning, to the extent feasible, with other
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1 Federal and State agencies, to ensure that comprehensive

2 behavioral health services are available to Indians without

3 regard to their place of residence.

4 ‘‘(f) FACILITIES ASSESSMENT.—Not later than 1

5 year after the date of enactment of this Act, the Secretary,

6 acting through the Service, shall make an assessment of

7 the need for inpatient mental health care among Indians

8 and the availability and cost of inpatient mental health

9 facilities which can meet such need. In making such as10 sessment, the Secretary shall consider the possible conver11 sion of existing, under-utilized service hospital beds into

12 psychiatric units to meet such need.

13 ‘‘SEC. 702. MEMORANDUM OF AGREEMENT WITH THE DE14 PARTMENT OF THE INTERIOR.

15 ‘‘(a) IN GENERAL.—Not later than 1 year after the

16 date of enactment of this Act, the Secretary and the Sec17 retary of the Interior shall develop and enter into a memo18 randum of agreement, or review and update any existing

19 memoranda of agreement as required under section 4205

20 of the Indian Alcohol and Substance Abuse Prevention

21 and Treatment Act of 1986 (25 U.S.C. 2411), and under

22 which the Secretaries address—

23 ‘‘(1) the scope and nature of mental illness and

24 dysfunctional and self-destructive behavior, including

25 child abuse and family violence, among Indians;
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1 ‘‘(2) the existing Federal, tribal, State, local,

2 and private services, resources, and programs avail3 able to provide mental health services for Indians;

4 ‘‘(3) the unmet need for additional services, re5 sources, and programs necessary to meet the needs

6 identified pursuant to paragraph (1);

7 ‘‘(4)(A) the right of Indians, as citizens of the

8 United States and of the States in which they re9 side, to have access to mental health services to

10 which all citizens have access;

11 ‘‘(B) the right of Indians to participate in, and

12 receive the benefit of, such services; and

13 ‘‘(C) the actions necessary to protect the exer14 cise of such right;

15 ‘‘(5) the responsibilities of the Bureau of Indian

16 Affairs and the Service, including mental health

17 identification, prevention, education, referral, and

18 treatment services (including services through multi19 disciplinary resource teams), at the central, area,

20 and agency and service unit levels to address the

21 problems identified in paragraph (1);

22 ‘‘(6) a strategy for the comprehensive coordina23 tion of the mental health services provided by the

24 Bureau of Indian Affairs and the Service to meet
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1 the needs identified pursuant to paragraph (1),

2 including—

3 ‘‘(A) the coordination of alcohol and sub4 stance abuse programs of the Service, the Bu5 reau of Indian Affairs, and the various Indian

6 tribes (developed under the Indian Alcohol and

7 Substance Abuse Prevention and Treatment

8 Act of 1986) with the mental health initiatives

9 pursuant to this Act, particularly with respect

10 to the referral and treatment of dually-diag11 nosed individuals requiring mental health and

12 substance abuse treatment; and

13 ‘‘(B) ensuring that Bureau of Indian Af14 fairs and Service programs and services (includ15 ing multidisciplinary resource teams) address16 ing child abuse and family violence are coordi17 nated with such non-Federal programs and

18 services;

19 ‘‘(7) direct appropriate officials of the Bureau

20 of Indian Affairs and the Service, particularly at the

21 agency and service unit levels, to cooperate fully

22 with tribal requests made pursuant to community

23 behavioral health plans adopted under section 701(c)

24 and section 4206 of the Indian Alcohol and Sub-
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1 stance Abuse Prevention and Treatment Act of 1986

2 (25 U.S.C. 2412); and

3 ‘‘(8) provide for an annual review of such

4 agreement by the 2 Secretaries and a report which

5 shall be submitted to Congress and made available

6 to the Indian tribes.

7 ‘‘(b) SPECIFIC PROVISIONS.—The memorandum of

8 agreement updated or entered into pursuant to subsection

9 (a) shall include specific provisions pursuant to which the

10 Service shall assume responsibility for—

11 ‘‘(1) the determination of the scope of the prob12 lem of alcohol and substance abuse among Indian

13 people, including the number of Indians within the

14 jurisdiction of the Service who are directly or indi15 rectly affected by alcohol and substance abuse and

16 the financial and human cost;

17 ‘‘(2) an assessment of the existing and needed

18 resources necessary for the prevention of alcohol and

19 substance abuse and the treatment of Indians af20 fected by alcohol and substance abuse; and

21 ‘‘(3) an estimate of the funding necessary to

22 adequately support a program of prevention of alco23 hol and substance abuse and treatment of Indians

24 affected by alcohol and substance abuse.
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1 ‘‘(c) CONSULTATION.—The Secretary and the Sec2 retary of the Interior shall, in developing the memo3 randum of agreement under subsection (a), consult with

4 and solicit the comments of—

5 ‘‘(1) Indian tribes and tribal organizations;

6 ‘‘(2) Indian individuals;

7 ‘‘(3) urban Indian organizations and other In8 dian organizations;

9 ‘‘(4) behavioral health service providers.

10 ‘‘(d) PUBLICATION.—The memorandum of agree11 ment under subsection (a) shall be published in the Fed12 eral Register. At the same time as the publication of such

13 agreement in the Federal Register, the Secretary shall

14 provide a copy of such memorandum to each Indian tribe,

15 tribal organization, and urban Indian organization.

16 ‘‘SEC. 703. COMPREHENSIVE BEHAVIORAL HEALTH PRE17 VENTION AND TREATMENT PROGRAM.

18 ‘‘(a) ESTABLISHMENT.—

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

20 through the Service, Indian tribes and tribal organi21 zations consistent with section 701, shall provide a

22 program of comprehensive behavioral health preven23 tion and treatment and aftercare, including tradi24 tional health care practices, which shall include—
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1 ‘‘(A) prevention, through educational inter2 vention, in Indian communities;

3 ‘‘(B) acute detoxification or psychiatric

4 hospitalization and treatment (residential and

5 intensive outpatient);

6 ‘‘(C) community-based rehabilitation and

7 aftercare;

8 ‘‘(D) community education and involve9 ment, including extensive training of health

10 care, educational, and community-based per11 sonnel; and

12 ‘‘(E) specialized residential treatment pro13 grams for high risk populations including preg14 nant and post partum women and their chil15 dren.

16 ‘‘(2) TARGET POPULATIONS.—The target popu17 lation of the program under paragraph (1) shall be

18 members of Indian tribes. Efforts to train and edu19 cate key members of the Indian community shall

20 target employees of health, education, judicial, law

21 enforcement, legal, and social service programs.

22 ‘‘(b) CONTRACT HEALTH SERVICES.—

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

24 through the Service (with the consent of the Indian

25 tribe to be served), Indian tribes and tribal organiza-
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1 tions, may enter into contracts with public or private

2 providers of behavioral health treatment services for

3 the purpose of carrying out the program required

4 under subsection (a).

5 ‘‘(2) PROVISION OF ASSISTANCE.—In carrying

6 out this subsection, the Secretary shall provide as7 sistance to Indian tribes and tribal organizations to

8 develop criteria for the certification of behavioral

9 health service providers and accreditation of service

10 facilities which meet minimum standards for such

11 services and facilities.

12 ‘‘SEC. 704. MENTAL HEALTH TECHNICIAN PROGRAM.

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

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

15 as the Snyder Act), the Secretary shall establish and

16 maintain a Mental Health Technician program within the

17 Service which—

18 ‘‘(1) provides for the training of Indians as

19 mental health technicians; and

20 ‘‘(2) employs such technicians in the provision

21 of community-based mental health care that includes

22 identification, prevention, education, referral, and

23 treatment services.

24 ‘‘(b) TRAINING.—In carrying out subsection (a)(1),

25 the Secretary shall provide high standard paraprofessional
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•S 2526 IS

1 training in mental health care necessary to provide quality

2 care to the Indian communities to be served. Such training

3 shall be based upon a curriculum developed or approved

4 by the Secretary which combines education in the theory

5 of mental health care with supervised practical experience

6 in the provision of such care.

7 ‘‘(c) SUPERVISION AND EVALUATION.—The Sec8 retary shall supervise and evaluate the mental health tech9 nicians in the training program under this section.

10 ‘‘(d) TRADITIONAL CARE.—The Secretary shall en11 sure that the program established pursuant to this section

12 involves the utilization and promotion of the traditional

13 Indian health care and treatment practices of the Indian

14 tribes to be served.

15 ‘‘SEC. 705. LICENSING REQUIREMENT FOR MENTAL

16 HEALTH CARE WORKERS.

17 ‘‘Subject to section 220, any person employed as a

18 psychologist, social worker, or marriage and family thera19 pist for the purpose of providing mental health care serv20 ices to Indians in a clinical setting under the authority

21 of this Act or through a funding agreement pursuant to

22 the Indian Self-Determination and Education Assistance

23 Act shall—

24 ‘‘(1) in the case of a person employed as a psy25 chologist to provide health care services, be licensed
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•S 2526 IS

1 as a clinical or counseling psychologist, or working

2 under the direct supervision of a clinical or coun3 seling psychologist;

4 ‘‘(2) in the case of a person employed as a so5 cial worker, be licensed as a social worker or work6 ing under the direct supervision of a licensed social

7 worker; or

8 ‘‘(3) in the case of a person employed as a mar9 riage and family therapist, be licensed as a marriage

10 and family therapist or working under the direct su11 pervision of a licensed marriage and family thera12 pist.

13 ‘‘SEC. 706. INDIAN WOMEN TREATMENT PROGRAMS.

14 ‘‘(a) FUNDING.—The Secretary, consistent with sec15 tion 701, shall make funding available to Indian tribes,

16 tribal organizations and urban Indian organization to de17 velop and implement a comprehensive behavioral health

18 program of prevention, intervention, treatment, and re19 lapse prevention services that specifically addresses the

20 spiritual, cultural, historical, social, and child care needs

21 of Indian women, regardless of age.

22 ‘‘(b) USE OF FUNDS.—Funding provided pursuant to

23 this section may be used to—

24 ‘‘(1) develop and provide community training,

25 education, and prevention programs for Indian
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1 women relating to behavioral health issues, including

2 fetal alcohol disorders;

3 ‘‘(2) identify and provide psychological services,

4 counseling, advocacy, support, and relapse preven5 tion to Indian women and their families; and

6 ‘‘(3) develop prevention and intervention models

7 for Indian women which incorporate traditional

8 health care practices, cultural values, and commu9 nity and family involvement.

10 ‘‘(c) CRITERIA.—The Secretary, in consultation with

11 Indian tribes and tribal organizations, shall establish cri12 teria for the review and approval of applications and pro13 posals for funding under this section.

14 ‘‘(d) EARMARK OF CERTAIN FUNDS.—Twenty per15 cent of the amounts appropriated to carry out this section

16 shall be used to make grants to urban Indian organiza17 tions funded under title V.

18 ‘‘SEC. 707. INDIAN YOUTH PROGRAM.

19 ‘‘(a) DETOXIFICATION AND REHABILITATION.—The

20 Secretary shall, consistent with section 701, develop and

21 implement a program for acute detoxification and treat22 ment for Indian youth that includes behavioral health

23 services. The program shall include regional treatment

24 centers designed to include detoxification and rehabilita25 tion for both sexes on a referral basis and programs devel-
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1 oped and implemented by Indian tribes or tribal organiza2 tions at the local level under the Indian Self-Determina3 tion and Education Assistance Act. Regional centers shall

4 be integrated with the intake and rehabilitation programs

5 based in the referring Indian community.

6 ‘‘(b) ALCOHOL AND SUBSTANCE ABUSE TREATMENT

7 CENTERS OR FACILITIES.—

8 ‘‘(1) ESTABLISHMENT.—

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

10 through the Service, Indian tribes, or tribal or11 ganizations, shall construct, renovate, or, as

12 necessary, purchase, and appropriately staff

13 and operate, at least 1 youth regional treatment

14 center or treatment network in each area under

15 the jurisdiction of an area office.

16 ‘‘(B) AREA OFFICE IN CALIFORNIA.—For

17 purposes of this subsection, the area office in

18 California shall be considered to be 2 area of19 fices, 1 office whose jurisdiction shall be consid20 ered to encompass the northern area of the

21 State of California, and 1 office whose jurisdic22 tion shall be considered to encompass the re23 mainder of the State of California for the pur24 pose of implementing California treatment net25 works.
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1 ‘‘(2) FUNDING.—For the purpose of staffing

2 and operating centers or facilities under this sub3 section, funding shall be made available pursuant to

4 the Act of November 2, 1921 (25 U.S.C. 13) (com5 monly known as the Snyder Act).

6 ‘‘(3) LOCATION.—A youth treatment center

7 constructed or purchased under this subsection shall

8 be constructed or purchased at a location within the

9 area described in paragraph (1) that is agreed upon

10 (by appropriate tribal resolution) by a majority of

11 the tribes to be served by such center.

12 ‘‘(4) SPECIFIC PROVISION OF FUNDS.—

13 ‘‘(A) IN GENERAL.—Notwithstanding any

14 other provision of this title, the Secretary may,

15 from amounts authorized to be appropriated for

16 the purposes of carrying out this section, make

17 funds available to—

18 ‘‘(i) the Tanana Chiefs Conference,

19 Incorporated, for the purpose of leasing,

20 constructing, renovating, operating and

21 maintaining a residential youth treatment

22 facility in Fairbanks, Alaska;

23 ‘‘(ii) the Southeast Alaska Regional

24 Health Corporation to staff and operate a

25 residential youth treatment facility without
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•S 2526 IS

1 regard to the proviso set forth in section

2 4(l) of the Indian Self-Determination and

3 Education Assistance Act (25 U.S.C.

4 450b(l));

5 ‘‘(iii) the Southern Indian Health

6 Council, for the purpose of staffing, oper7 ating, and maintaining a residential youth

8 treatment facility in San Diego County,

9 California; and

10 ‘‘(iv) the Navajo Nation, for the staff11 ing, operation, and maintenance of the

12 Four Corners Regional Adolescent Treat13 ment Center, a residential youth treatment

14 facility in New Mexico.

15 ‘‘(B) PROVISION OF SERVICES TO ELIGI16 BLE YOUTH.—Until additional residential youth

17 treatment facilities are established in Alaska

18 pursuant to this section, the facilities specified

19 in subparagraph (A) shall make every effort to

20 provide services to all eligible Indian youth re21 siding in such State.

22 ‘‘(c) INTERMEDIATE ADOLESCENT BEHAVIORAL

23 HEALTH SERVICES.—

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

25 through the Service, Indian Tribes and tribal organi-
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1 zations, may provide intermediate behavioral health

2 services, which may incorporate traditional health

3 care practices, to Indian children and adolescents,

4 including—

5 ‘‘(A) pre-treatment assistance;

6 ‘‘(B) inpatient, outpatient, and after-care

7 services;

8 ‘‘(C) emergency care;

9 ‘‘(D) suicide prevention and crisis interven10 tion; and

11 ‘‘(E) prevention and treatment of mental

12 illness, and dysfunctional and self-destructive

13 behavior, including child abuse and family vio14 lence.

15 ‘‘(2) USE OF FUNDS.—Funds provided under

16 this subsection may be used—

17 ‘‘(A) to construct or renovate an existing

18 health facility to provide intermediate behav19 ioral health services;

20 ‘‘(B) to hire behavioral health profes21 sionals;

22 ‘‘(C) to staff, operate, and maintain an in23 termediate mental health facility, group home,

24 sober housing, transitional housing or similar

25 facilities, or youth shelter where intermediate
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•S 2526 IS

1 behavioral health services are being provided;

2 and

3 ‘‘(D) to make renovations and hire appro4 priate staff to convert existing hospital beds

5 into adolescent psychiatric units; and

6 ‘‘(E) intensive home and community based

7 services.

8 ‘‘(3) CRITERIA.—The Secretary shall, in con9 sultation with Indian tribes and tribal organizations,

10 establish criteria for the review and approval of ap11 plications or proposals for funding made available

12 pursuant to this subsection.

13 ‘‘(d) FEDERALLY OWNED STRUCTURES.—

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

15 through the Service, shall, in consultation with In16 dian tribes and tribal organizations—

17 ‘‘(A) identify and use, where appropriate,

18 federally owned structures suitable for local res19 idential or regional behavioral health treatment

20 for Indian youth; and

21 ‘‘(B) establish guidelines, in consultation

22 with Indian tribes and tribal organizations, for

23 determining the suitability of any such Feder24 ally owned structure to be used for local resi-
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1 dential or regional behavioral health treatment

2 for Indian youth.

3 ‘‘(2) TERMS AND CONDITIONS FOR USE OF

4 STRUCTURE.—Any structure described in paragraph

5 (1) may be used under such terms and conditions as

6 may be agreed upon by the Secretary and the agency

7 having responsibility for the structure and any In8 dian tribe or tribal organization operating the pro9 gram.

10 ‘‘(e) REHABILITATION AND AFTERCARE SERVICES.—

11 ‘‘(1) IN GENERAL.—The Secretary, an Indian

12 tribe or tribal organization, in cooperation with the

13 Secretary of the Interior, shall develop and imple14 ment within each service unit, community-based re15 habilitation and follow-up services for Indian youth

16 who have significant behavioral health problems, and

17 require long-term treatment, community reintegra18 tion, and monitoring to support the Indian youth

19 after their return to their home community.

20 ‘‘(2) ADMINISTRATION.—Services under para21 graph (1) shall be administered within each service

22 unit or tribal program by trained staff within the

23 community who can assist the Indian youth in con24 tinuing development of self-image, positive problem25 solving skills, and nonalcohol or substance abusing
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1 behaviors. Such staff may include alcohol and sub2 stance abuse counselors, mental health professionals,

3 and other health professionals and paraprofessionals,

4 including community health representatives.

5 ‘‘(f) INCLUSION OF FAMILY IN YOUTH TREATMENT

6 PROGRAM.—In providing the treatment and other services

7 to Indian youth authorized by this section, the Secretary,

8 an Indian tribe or tribal organization shall provide for the

9 inclusion of family members of such youth in the treat10 ment programs or other services as may be appropriate.

11 Not less than 10 percent of the funds appropriated for

12 the purposes of carrying out subsection (e) shall be used

13 for outpatient care of adult family members related to the

14 treatment of an Indian youth under that subsection.

15 ‘‘(g) MULTIDRUG ABUSE PROGRAM.—The Secretary,

16 acting through the Service, Indian tribes, tribal organiza17 tions and urban Indian organizations, shall provide, con18 sistent with section 701, programs and services to prevent

19 and treat the abuse of multiple forms of substances, in20 cluding alcohol, drugs, inhalants, and tobacco, among In21 dian youth residing in Indian communities, on Indian res22 ervations, and in urban areas and provide appropriate

23 mental health services to address the incidence of mental

24 illness among such youth.
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1 ‘‘SEC. 708. INPATIENT AND COMMUNITY-BASED MENTAL

2 HEALTH FACILITIES DESIGN, CONSTRUCTION

3 AND STAFFING ASSESSMENT.

4 ‘‘(a) IN GENERAL.—Not later than 1 year after the

5 date of enactment of this section, the Secretary, acting

6 through the Service, Indian tribes and tribal organiza7 tions, shall provide, in each area of the Service, not less

8 than 1 inpatient mental health care facility, or the equiva9 lent, for Indians with behavioral health problems.

10 ‘‘(b) TREATMENT OF CALIFORNIA.—For purposes of

11 this section, California shall be considered to be 2 areas

12 of the Service, 1 area whose location shall be considered

13 to encompass the northern area of the State of California

14 and 1 area whose jurisdiction shall be considered to en15 compass the remainder of the State of California.

16 ‘‘(c) CONVERSION OF CERTAIN HOSPITAL BEDS.—

17 The Secretary shall consider the possible conversion of ex18 isting, under-utilized Service hospital beds into psychiatric

19 units to meet needs under this section.

20 ‘‘SEC. 709. TRAINING AND COMMUNITY EDUCATION.

21 ‘‘(a) COMMUNITY EDUCATION.—

22 ‘‘(1) IN GENERAL.—The Secretary, in coopera23 tion with the Secretary of the Interior, shall develop

24 and implement, or provide funding to enable Indian

25 tribes and tribal organization to develop and imple26 ment, within each service unit or tribal program a
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1 program of community education and involvement

2 which shall be designed to provide concise and timely

3 information to the community leadership of each

4 tribal community.

5 ‘‘(2) EDUCATION.—A program under paragraph

6 (1) shall include education concerning behavioral

7 health for political leaders, tribal judges, law en8 forcement personnel, members of tribal health and

9 education boards, and other critical members of each

10 tribal community.

11 ‘‘(3) TRAINING.—Community-based training

12 (oriented toward local capacity development) under a

13 program under paragraph (1) shall include tribal

14 community provider training (designed for adult

15 learners from the communities receiving services for

16 prevention, intervention, treatment and aftercare).

17 ‘‘(b) TRAINING.—The Secretary shall, either directly

18 or through Indian tribes or tribal organization, provide in19 struction in the area of behavioral health issues, including

20 instruction in crisis intervention and family relations in

21 the context of alcohol and substance abuse, child sexual

22 abuse, youth alcohol and substance abuse, and the causes

23 and effects of fetal alcohol disorders, to appropriate em24 ployees of the Bureau of Indian Affairs and the Service,

25 and to personnel in schools or programs operated under
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1 any contract with the Bureau of Indian Affairs or the

2 Service, including supervisors of emergency shelters and

3 halfway houses described in section 4213 of the Indian

4 Alcohol and Substance Abuse Prevention and Treatment

5 Act of 1986 (25 U.S.C. 2433).

6 ‘‘(c) COMMUNITY-BASED TRAINING MODELS.—In

7 carrying out the education and training programs required

8 by this section, the Secretary, acting through the Service

9 and in consultation with Indian tribes, tribal organiza10 tions, Indian behavioral health experts, and Indian alcohol

11 and substance abuse prevention experts, shall develop and

12 provide community-based training models. Such models

13 shall address—

14 ‘‘(1) the elevated risk of alcohol and behavioral

15 health problems faced by children of alcoholics;

16 ‘‘(2) the cultural, spiritual, and

17 multigenerational aspects of behavioral health prob18 lem prevention and recovery; and

19 ‘‘(3) community-based and multidisciplinary

20 strategies for preventing and treating behavioral

21 health problems.

22 ‘‘SEC. 710. BEHAVIORAL HEALTH PROGRAM.

23 ‘‘(a) PROGRAMS FOR INNOVATIVE SERVICES.—The

24 Secretary, acting through the Service, Indian Tribes or

25 tribal organizations, consistent with Section 701, may de-
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1 velop, implement, and carry out programs to deliver inno2 vative community-based behavioral health services to Indi3 ans.

4 ‘‘(b) CRITERIA.—The Secretary may award funding

5 for a project under subsection (a) to an Indian tribe or

6 tribal organization and may consider the following criteria:

7 ‘‘(1) Whether the project will address signifi8 cant unmet behavioral health needs among Indians.

9 ‘‘(2) Whether the project will serve a significant

10 number of Indians.

11 ‘‘(3) Whether the project has the potential to

12 deliver services in an efficient and effective manner.

13 ‘‘(4) Whether the tribe or tribal organization

14 has the administrative and financial capability to ad15 minister the project.

16 ‘‘(5) Whether the project will deliver services in

17 a manner consistent with traditional health care.

18 ‘‘(6) Whether the project is coordinated with,

19 and avoids duplication of, existing services.

20 ‘‘(c) FUNDING AGREEMENTS.—For purposes of this

21 subsection, the Secretary shall, in evaluating applications

22 or proposals for funding for projects to be operated under

23 any funding agreement entered into with the Service

24 under the Indian Self-Determination Act and Education

25 Assistance Act, use the same criteria that the Secretary
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1 uses in evaluating any other application or proposal for

2 such funding.

3 ‘‘SEC. 711. FETAL ALCOHOL DISORDER FUNDING.

4 ‘‘(a) ESTABLISHMENT OF PROGRAM.—

5 ‘‘(1) IN GENERAL.—The Secretary, consistent

6 with Section 701, acting through Indian tribes, trib7 al organizations, and urban Indian organizations,

8 shall establish and operate fetal alcohol disorders

9 programs as provided for in this section for the pur10 poses of meeting the health status objective specified

11 in section 3(b).

12 ‘‘(2) USE OF FUNDS.—Funding provided pursu13 ant to this section shall be used to—

14 ‘‘(A) develop and provide community and

15 in-school training, education, and prevention

16 programs relating to fetal alcohol disorders;

17 ‘‘(B) identify and provide behavioral health

18 treatment to high-risk women;

19 ‘‘(C) identify and provide appropriate edu20 cational and vocational support, counseling, ad21 vocacy, and information to fetal alcohol disorder

22 affected persons and their families or care23 takers;
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1 ‘‘(D) develop and implement counseling

2 and support programs in schools for fetal alco3 hol disorder affected children;

4 ‘‘(E) develop prevention and intervention

5 models which incorporate traditional practi6 tioners, cultural and spiritual values and com7 munity involvement;

8 ‘‘(F) develop, print, and disseminate edu9 cation and prevention materials on fetal alcohol

10 disorders;

11 ‘‘(G) develop and implement, through the

12 tribal consultation process, culturally sensitive

13 assessment and diagnostic tools including

14 dysmorphology clinics and multidisciplinary

15 fetal alcohol disorder clinics for use in tribal

16 and urban Indian communities;

17 ‘‘(H) develop early childhood intervention

18 projects from birth on to mitigate the effects of

19 fetal alcohol disorders; and

20 ‘‘(I) develop and fund community-based

21 adult fetal alcohol disorder housing and support

22 services.

23 ‘‘(3) CRITERIA.—The Secretary shall establish

24 criteria for the review and approval of applications

25 for funding under this section.
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1 ‘‘(b) PROVISION OF SERVICES.—The Secretary, act2 ing through the Service, Indian tribes, tribal organizations

3 and urban Indian organizations, shall—

4 ‘‘(1) develop and provide services for the pre5 vention, intervention, treatment, and aftercare for

6 those affected by fetal alcohol disorders in Indian

7 communities; and

8 ‘‘(2) provide supportive services, directly or

9 through an Indian tribe, tribal organization or urban

10 Indian organization, including services to meet the

11 special educational, vocational, school-to-work transi12 tion, and independent living needs of adolescent and

13 adult Indians with fetal alcohol disorders.

14 ‘‘(c) TASK FORCE.—

15 ‘‘(1) IN GENERAL.—The Secretary shall estab16 lish a task force to be known as the Fetal Alcohol

17 Disorders Task Force to advise the Secretary in car18 rying out subsection (b).

19 ‘‘(2) COMPOSITION.—The task force under

20 paragraph (1) shall be composed of representatives

21 from the National Institute on Drug Abuse, the Na22 tional Institute on Alcohol and Alcoholism, the Of23 fice of Substance Abuse Prevention, the National In24 stitute of Mental Health, the Service, the Office of

25 Minority Health of the Department of Health and
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1 Human Services, the Administration for Native

2 Americans, the National Institute of Child Health

3 & Human Development, the Centers for Disease

4 Control and Prevention, the Bureau of Indian Af5 fairs, Indian tribes, tribal organizations, urban In6 dian communities, and Indian fetal alcohol disorders

7 experts.

8 ‘‘(d) APPLIED RESEARCH.—The Secretary, acting

9 through the Substance Abuse and Mental Health Services

10 Administration, shall make funding available to Indian

11 Tribes, tribal organizations and urban Indian organiza12 tions for applied research projects which propose to elevate

13 the understanding of methods to prevent, intervene, treat,

14 or provide rehabilitation and behavioral health aftercare

15 for Indians and urban Indians affected by fetal alcohol

16 disorders.

17 ‘‘(e) URBAN INDIAN ORGANIZATIONS.—The Sec18 retary shall ensure that 10 percent of the amounts appro19 priated to carry out this section shall be used to make

20 grants to urban Indian organizations funded under title

21 V.

22 ‘‘SEC. 712. CHILD SEXUAL ABUSE AND PREVENTION TREAT23 MENT PROGRAMS.

24 ‘‘(a) ESTABLISHMENT.—The Secretary and the Sec25 retary of the Interior, acting through the Service, Indian
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1 tribes and tribal organizations, shall establish, consistent

2 with section 701, in each service area, programs involving

3 treatment for—

4 ‘‘(1) victims of child sexual abuse; and

5 ‘‘(2) perpetrators of child sexual abuse.

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

7 section shall be used to—

8 ‘‘(1) develop and provide community education

9 and prevention programs related to child sexual

10 abuse;

11 ‘‘(2) identify and provide behavioral health

12 treatment to children who are victims of sexual

13 abuse and to their families who are affected by sex14 ual abuse;

15 ‘‘(3) develop prevention and intervention models

16 which incorporate traditional health care practi17 tioners, cultural and spiritual values, and community

18 involvement;

19 ‘‘(4) develop and implement, though the tribal

20 consultation process, culturally sensitive assessment

21 and diagnostic tools for use in tribal and urban In22 dian communities.

23 ‘‘(5) identify and provide behavioral health

24 treatment to perpetrators of child sexual abuse with

25 efforts being made to begin offender and behavioral
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1 health treatment while the perpetrator is incarcer2 ated or at the earliest possible date if the perpe3 trator is not incarcerated, and to provide treatment

4 after release to the community until it is determined

5 that the perpetrator is not a threat to children.

6 ‘‘SEC. 713. BEHAVIORAL MENTAL HEALTH RESEARCH.

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

8 the Service and in consultation with appropriate Federal

9 agencies, shall provide funding to Indian Tribes, tribal or10 ganizations and urban Indian organizations or, enter into

11 contracts with, or make grants to appropriate institutions,

12 for the conduct of research on the incidence and preva13 lence of behavioral health problems among Indians served

14 by the Service, Indian Tribes or tribal organizations and

15 among Indians in urban areas. Research priorities under

16 this section shall include—

17 ‘‘(1) the inter-relationship and inter-dependance

18 of behavioral health problems with alcoholism and

19 other substance abuse, suicide, homicides, other in20 juries, and the incidence of family violence; and

21 ‘‘(2) the development of models of prevention

22 techniques.

23 ‘‘(b) SPECIAL EMPHASIS.—The effect of the inter-re24 lationships and interdependencies referred to in subsection

25 (a)(1) on children, and the development of prevention
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1 techniques under subsection (a)(2) applicable to children,

2 shall be emphasized.

3 ‘‘SEC. 714. DEFINITIONS.

4 ‘‘In this title:

5 ‘‘(1) ASSESSMENT.—The term ‘assessment’

6 means the systematic collection, analysis and dis7 semination of information on health status, health

8 needs and health problems.

9 ‘‘(2) ALCOHOL RELATED NEURODEVELOP-MEN10 TAL DISORDERS.—The term ‘alcohol related

11 neurodevelop-mental disorders’ or ‘ARND’ with re12 spect to an individual means the individual has a

13 history of maternal alcohol consumption during

14 pregnancy, central nervous system involvement such

15 as developmental delay, intellectual deficit, or

16 neurologic abnormalities, that behaviorally, there

17 may be problems with irritability, and failure to

18 thrive as infants, and that as children become older

19 there will likely be hyperactivity, attention deficit,

20 language dysfunction and perceptual and judgment

21 problems.

22 ‘‘(3) BEHAVIORAL HEALTH.—The term ‘behav23 ioral health’ means the blending of substances (alco24 hol, drugs, inhalants and tobacco) abuse and mental

25 health prevention and treatment, for the purpose of
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1 providing comprehensive services. Such term in2 cludes the joint development of substance abuse and

3 mental health treatment planning and coordinated

4 case management using a multidisciplinary ap5 proach.

6 ‘‘(4) BEHAVIORAL HEALTH AFTERCARE.—

7 ‘‘(A) IN GENERAL.—The term ‘behavioral

8 health aftercare’ includes those activities and

9 resources used to support recovery following in10 patient, residential, intensive substance abuse

11 or mental health outpatient or outpatient treat12 ment, to help prevent or treat relapse, including

13 the development of an aftercare plan.

14 ‘‘(B) AFTERCARE PLAN.—Prior to the

15 time at which an individual is discharged from

16 a level of care, such as outpatient treatment, an

17 aftercare plan shall have been developed for the

18 individual. Such plan may use such resources as

19 community base therapeutic group care, transi20 tional living, a 12-step sponsor, a local 12-step

21 or other related support group, or other com22 munity based providers (such as mental health

23 professionals, traditional health care practi24 tioners, community health aides, community
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1 health representatives, mental health techni2 cians, or ministers).

3 ‘‘(5) DUAL DIAGNOSIS.—The term ‘dual diag4 nosis’ means coexisting substance abuse and mental

5 illness conditions or diagnosis. In individual with a

6 dual diagnosis may be referred to as a mentally ill

7 chemical abuser.

8 ‘‘(6) FETAL ALCOHOL DISORDERS.—The term

9 ‘fetal alcohol disorders’ means fetal alcohol syn10 drome, partial fetal alcohol syndrome, or alcohol re11 lated neural developmental disorder.

12 ‘‘(7) FETAL ALCOHOL SYNDROME.—The term

13 ‘fetal alcohol syndrome’ or ‘FAS’ with respect to an

14 individual means a syndrome in which the individual

15 has a history of maternal alcohol consumption dur16 ing pregnancy, and with respect to which the fol17 lowing criteria should be met:

18 ‘‘(A) Central nervous system involvement

19 such as developmental delay, intellectual deficit,

20 microencephaly, or neurologic abnormalities.

21 ‘‘(B) Craniofacial abnormalities with at

22 least 2 of the following: microphthalmia, short

23 palpebral fissures, poorly developed philtrum,

24 thin upper lip, flat nasal bridge, and short

25 upturned nose.
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1 ‘‘(C) Prenatal or postnatal growth delay.

2 ‘‘(8) PARTIAL FAS.—The term ‘partial FAS’

3 with respect to an individual means a history of ma4 ternal alcohol consumption during pregnancy having

5 most of the criteria of FAS, though not meeting a

6 minimum of at least 2 of the following: micro-oph7 thalmia, short palpebral fissures, poorly developed

8 philtrum, thin upper lip, flat nasal bridge, short

9 upturned nose.

10 ‘‘(9) REHABILITATION.—The term ‘rehabilita11 tion’ means to restore the ability or capacity to en12 gage in usual and customary life activities through

13 education and therapy.

14 ‘‘(10) SUBSTANCE ABUSE.—The term ‘sub15 stance abuse’ includes inhalant abuse.

16 ‘‘SEC. 715. AUTHORIZATION OF APPROPRIATIONS.

17 ‘‘There is authorized to be appropriated such sums

18 as may be necessary for each fiscal year through fiscal

19 year 2012 to carry out this title.

20 ‘‘TITLE VIII—MISCELLANEOUS

21 ‘‘SEC. 801. REPORTS.

22 ‘‘The President shall, at the time the budget is sub23 mitted under section 1105 of title 31, United States Code,

24 for each fiscal year transmit to the Congress a report

25 containing—
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1 ‘‘(1) a report on the progress made in meeting

2 the objectives of this Act, including a review of pro3 grams established or assisted pursuant to this Act

4 and an assessment and recommendations of addi5 tional programs or additional assistance necessary

6 to, at a minimum, provide health services to Indians,

7 and ensure a health status for Indians, which are at

8 a parity with the health services available to and the

9 health status of, the general population, including

10 specific comparisons of appropriations provided and

11 those required for such parity;

12 ‘‘(2) a report on whether, and to what extent,

13 new national health care programs, benefits, initia14 tives, or financing systems have had an impact on

15 the purposes of this Act and any steps that the Sec16 retary may have taken to consult with Indian tribes

17 to address such impact, including a report on pro18 posed changes in the allocation of funding pursuant

19 to section 808;

20 ‘‘(3) a report on the use of health services by

21 Indians—

22 ‘‘(A) on a national and area or other rel23 evant geographical basis;

24 ‘‘(B) by gender and age;
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1 ‘‘(C) by source of payment and type of

2 service;

3 ‘‘(D) comparing such rates of use with

4 rates of use among comparable non-Indian pop5 ulations; and

6 ‘‘(E) on the services provided under fund7 ing agreements pursuant to the Indian Self-De8 termination and Education Assistance Act;

9 ‘‘(4) a report of contractors concerning health

10 care educational loan repayments under section 110;

11 ‘‘(5) a general audit report on the health care

12 educational loan repayment program as required

13 under section 110(n);

14 ‘‘(6) a separate statement that specifies the

15 amount of funds requested to carry out the provi16 sions of section 201;

17 ‘‘(7) a report on infectious diseases as required

18 under section 212;

19 ‘‘(8) a report on environmental and nuclear

20 health hazards as required under section 214;

21 ‘‘(9) a report on the status of all health care fa22 cilities needs as required under sections 301(c)(2)

23 and 301(d);
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1 ‘‘(10) a report on safe water and sanitary waste

2 disposal facilities as required under section

3 302(h)(1);

4 ‘‘(11) a report on the expenditure of non-service

5 funds for renovation as required under sections

6 305(a)(2) and 305(a)(3);

7 ‘‘(12) a report identifying the backlog of main8 tenance and repair required at Service and tribal fa9 cilities as required under section 314(a);

10 ‘‘(13) a report providing an accounting of reim11 bursement funds made available to the Secretary

12 under titles XVIII and XIX of the Social Security

13 Act as required under section 403(a);

14 ‘‘(14) a report on services sharing of the Serv15 ice, the Department of Veteran’s Affairs, and other

16 Federal agency health programs as required under

17 section 412(c)(2);

18 ‘‘(15) a report on the evaluation and renewal of

19 urban Indian programs as required under section

20 505;

21 ‘‘(16) a report on the findings and conclusions

22 derived from the demonstration project as required

23 under section 512(a)(2);

24 ‘‘(17) a report on the evaluation of programs as

25 required under section 513; and
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1 ‘‘(18) a report on alcohol and substance abuse

2 as required under section 701(f).

3 ‘‘SEC. 802. REGULATIONS.

4 ‘‘(a) INITIATION OF RULEMAKING PROCEDURES.—

5 ‘‘(1) IN GENERAL.—Not later than 90 days

6 after the date of enactment of this Act, the Sec7 retary shall initiate procedures under subchapter III

8 of chapter 5 of title 5, United States Code, to nego9 tiate and promulgate such regulations or amend10 ments thereto that are necessary to carry out this

11 Act.

12 ‘‘(2) PUBLICATION.—Proposed regulations to

13 implement this Act shall be published in the Federal

14 Register by the Secretary not later than 270 days

15 after the date of enactment of this Act and shall

16 have not less than a 120 day comment period.

17 ‘‘(3) EXPIRATION OF AUTHORITY.—The author18 ity to promulgate regulations under this Act shall

19 expire 18 months from the date of enactment of this

20 Act.

21 ‘‘(b) RULEMAKING COMMITTEE.—A negotiated rule22 making committee established pursuant to section 565 of

23 Title 5, United States Code, to carry out this section shall

24 have as its members only representatives of the Federal

25 Government and representatives of Indian tribes, and trib-
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1 al organizations, a majority of whom shall be nominated

2 by and be representatives of Indian tribes, tribal organiza3 tions, and urban Indian organizations from each service

4 area.

5 ‘‘(c) ADAPTION OF PROCEDURES.—The Secretary

6 shall adapt the negotiated rulemaking procedures to the

7 unique context of self-governance and the government-to8 government relationship between the United States and

9 Indian Tribes.

10 ‘‘(d) FAILURE TO PROMULGATE REGULATIONS.—

11 The lack of promulgated regulations shall not limit the

12 effect of this Act.

13 ‘‘(e) SUPREMACY OF PROVISIONS.—The provisions of

14 this Act shall supersede any conflicting provisions of law

15 (including any conflicting regulations) in effect on the day

16 before the date of enactment of the Indian Self-Deter17 mination Contract Reform Act of 1994, and the Secretary

18 is authorized to repeal any regulation that is inconsistent

19 with the provisions of this Act.

20 ‘‘SEC. 803. PLAN OF IMPLEMENTATION.

21 ‘‘Not later than 240 days after the date of enactment

22 of this Act, the Secretary, in consultation with Indian

23 tribes, tribal organizations, and urban Indian organiza24 tions, shall prepare and submit to Congress a plan that

25 shall explain the manner and schedule (including a sched-
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1 ule of appropriate requests), by title and section, by which

2 the Secretary will implement the provisions of this Act.

3 ‘‘SEC. 804. AVAILABILITY OF FUNDS.

4 ‘‘Amounts appropriated under this Act shall remain

5 available until expended.

6 ‘‘SEC. 805. LIMITATION ON USE OF FUNDS APPROPRIATED

7 TO THE INDIAN HEALTH SERVICE.

8 ‘‘Any limitation on the use of funds contained in an

9 Act providing appropriations for the Department for a pe10 riod with respect to the performance of abortions shall

11 apply for that period with respect to the performance of

12 abortions using funds contained in an Act providing ap13 propriations for the Service.

14 ‘‘SEC. 806. ELIGIBILITY OF CALIFORNIA INDIANS.

15 ‘‘(a) ELIGIBILITY.—

16 ‘‘(1) IN GENERAL.—Until such time as any

17 subsequent law may otherwise provide, the following

18 California Indians shall be eligible for health services

19 provided by the Service:

20 ‘‘(1) Any member of a Federally recog21 nized Indian tribe.

22 ‘‘(2) Any descendant of an Indian who was

23 residing in California on June 1, 1852, but only

24 if such descendant—
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1 ‘‘(A) is a member of the Indian com2 munity served by a local program of the

3 Service; and

4 ‘‘(B) is regarded as an Indian by the

5 community in which such descendant lives.

6 ‘‘(3) Any Indian who holds trust interests

7 in public domain, national forest, or Indian res8 ervation allotments in California.

9 ‘‘(4) Any Indian in California who is listed

10 on the plans for distribution of the assets of

11 California rancherias and reservations under

12 the Act of August 18, 1958 (72 Stat. 619), and

13 any descendant of such an Indian.

14 ‘‘(b) RULE OF CONSTRUCTION.—Nothing in this sec15 tion may be construed as expanding the eligibility of Cali16 fornia Indians for health services provided by the Service

17 beyond the scope of eligibility for such health services that

18 applied on May 1, 1986.

19 ‘‘SEC. 807. HEALTH SERVICES FOR INELIGIBLE PERSONS.

20 ‘‘(a) INELIGIBLE PERSONS.—

21 ‘‘(1) IN GENERAL.—Any individual who—

22 ‘‘(A) has not attained 19 years of age;

23 ‘‘(B) is the natural or adopted child, step24 child, foster-child, legal ward, or orphan of an

25 eligible Indian; and
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1 ‘‘(C) is not otherwise eligible for the health

2 services provided by the Service,

3 shall be eligible for all health services provided by

4 the Service on the same basis and subject to the

5 same rules that apply to eligible Indians until such

6 individual attains 19 years of age. The existing and

7 potential health needs of all such individuals shall be

8 taken into consideration by the Service in deter9 mining the need for, or the allocation of, the health

10 resources of the Service. If such an individual has

11 been determined to be legally incompetent prior to

12 attaining 19 years of age, such individual shall re13 main eligible for such services until one year after

14 the date such disability has been removed.

15 ‘‘(2) SPOUSES.—Any spouse of an eligible In16 dian who is not an Indian, or who is of Indian de17 scent but not otherwise eligible for the health serv18 ices provided by the Service, shall be eligible for

19 such health services if all of such spouses or spouses

20 who are married to members of the Indian tribe

21 being served are made eligible, as a class, by an ap22 propriate resolution of the governing body of the In23 dian tribe or tribal organization providing such serv24 ices. The health needs of persons made eligible

25 under this paragraph shall not be taken into consid-
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1 eration by the Service in determining the need for,

2 or allocation of, its health resources.

3 ‘‘(b) PROGRAMS AND SERVICES.—

4 ‘‘(1) PROGRAMS.—

5 ‘‘(A) IN GENERAL.—The Secretary may

6 provide health services under this subsection

7 through health programs operated directly by

8 the Service to individuals who reside within the

9 service area of a service unit and who are not

10 eligible for such health services under any other

11 subsection of this section or under any other

12 provision of law if—

13 ‘‘(i) the Indian tribe (or, in the case

14 of a multi-tribal service area, all the Indian

15 tribes) served by such service unit requests

16 such provision of health services to such

17 individuals; and

18 ‘‘(ii) the Secretary and the Indian

19 tribe or tribes have jointly determined

20 that—

21 ‘‘(I) the provision of such health

22 services will not result in a denial or

23 diminution of health services to eligi24 ble Indians; and
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1 ‘‘(II) there is no reasonable alter2 native health program or services,

3 within or without the service area of

4 such service unit, available to meet

5 the health needs of such individuals.

6 ‘‘(B) FUNDING AGREEMENTS.—In the case

7 of health programs operated under a funding

8 agreement entered into under the Indian Self9 Determination and Educational Assistance Act,

10 the governing body of the Indian tribe or tribal

11 organization providing health services under

12 such funding agreement is authorized to deter13 mine whether health services should be provided

14 under such funding agreement to individuals

15 who are not eligible for such health services

16 under any other subsection of this section or

17 under any other provision of law. In making

18 such determinations, the governing body of the

19 Indian tribe or tribal organization shall take

20 into account the considerations described in

21 subparagraph (A)(ii).

22 ‘‘(2) LIABILITY FOR PAYMENT.—

23 ‘‘(A) IN GENERAL.—Persons receiving

24 health services provided by the Service by rea25 son of this subsection shall be liable for pay-
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1 ment of such health services under a schedule

2 of charges prescribed by the Secretary which, in

3 the judgment of the Secretary, results in reim4 bursement in an amount not less than the ac5 tual cost of providing the health services. Not6 withstanding section 1880(c) of the Social Se7 curity Act, section 402(a) of this Act, or any

8 other provision of law, amounts collected under

9 this subsection, including medicare or medicaid

10 reimbursements under titles XVIII and XIX of

11 the Social Security Act, shall be credited to the

12 account of the program providing the service

13 and shall be used solely for the provision of

14 health services within that program. Amounts

15 collected under this subsection shall be available

16 for expenditure within such program for not to

17 exceed 1 fiscal year after the fiscal year in

18 which collected.

19 ‘‘(B) SERVICES FOR INDIGENT PERSONS.—

20 Health services may be provided by the Sec21 retary through the Service under this sub22 section to an indigent person who would not be

23 eligible for such health services but for the pro24 visions of paragraph (1) only if an agreement

25 has been entered into with a State or local gov-
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1 ernment under which the State or local govern2 ment agrees to reimburse the Service for the

3 expenses incurred by the Service in providing

4 such health services to such indigent person.

5 ‘‘(3) SERVICE AREAS.—

6 ‘‘(A) SERVICE TO ONLY ONE TRIBE.—In

7 the case of a service area which serves only one

8 Indian tribe, the authority of the Secretary to

9 provide health services under paragraph (1)(A)

10 shall terminate at the end of the fiscal year suc11 ceeding the fiscal year in which the governing

12 body of the Indian tribe revokes its concurrence

13 to the provision of such health services.

14 ‘‘(B) MULTI-TRIBAL AREAS.—In the case

15 of a multi-tribal service area, the authority of

16 the Secretary to provide health services under

17 paragraph (1)(A) shall terminate at the end of

18 the fiscal year succeeding the fiscal year in

19 which at least 51 percent of the number of In20 dian tribes in the service area revoke their con21 currence to the provision of such health serv22 ices.

23 ‘‘(c) PURPOSE FOR PROVIDING SERVICES.—The

24 Service may provide health services under this subsection

25 to individuals who are not eligible for health services pro-
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1 vided by the Service under any other subsection of this

2 section or under any other provision of law in order to—

3 ‘‘(1) achieve stability in a medical emergency;

4 ‘‘(2) prevent the spread of a communicable dis5 ease or otherwise deal with a public health hazard;

6 ‘‘(3) provide care to non-Indian women preg7 nant with an eligible Indian’s child for the duration

8 of the pregnancy through post partum; or

9 ‘‘(4) provide care to immediate family members

10 of an eligible person if such care is directly related

11 to the treatment of the eligible person.

12 ‘‘(d) HOSPITAL PRIVILEGES.—Hospital privileges in

13 health facilities operated and maintained by the Service

14 or operated under a contract entered into under the Indian

15 Self-Determination Education Assistance Act may be ex16 tended to non-Service health care practitioners who pro17 vide services to persons described in subsection (a) or (b).

18 Such non-Service health care practitioners may be re19 garded as employees of the Federal Government for pur20 poses of section 1346(b) and chapter 171 of title 28,

21 United States Code (relating to Federal tort claims) only

22 with respect to acts or omissions which occur in the course

23 of providing services to eligible persons as a part of the

24 conditions under which such hospital privileges are ex25 tended.
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1 ‘‘(e) DEFINITION.—In this section, the term ‘eligible

2 Indian’ means any Indian who is eligible for health serv3 ices provided by the Service without regard to the provi4 sions of this section.

5 ‘‘SEC. 808. REALLOCATION OF BASE RESOURCES.

6 ‘‘(a) REQUIREMENT OF REPORT.—Notwithstanding

7 any other provision of law, any allocation of Service funds

8 for a fiscal year that reduces by 5 percent or more from

9 the previous fiscal year the funding for any recurring pro10 gram, project, or activity of a service unit may be imple11 mented only after the Secretary has submitted to the

12 President, for inclusion in the report required to be trans13 mitted to the Congress under section 801, a report on the

14 proposed change in allocation of funding, including the

15 reasons for the change and its likely effects.

16 ‘‘(b) NONAPPLICATION OF SECTION.—Subsection (a)

17 shall not apply if the total amount appropriated to the

18 Service for a fiscal year is less than the amount appro19 priated to the Service for previous fiscal year.

20 ‘‘SEC. 809. RESULTS OF DEMONSTRATION PROJECTS.

21 ‘‘The Secretary shall provide for the dissemination to

22 Indian tribes of the findings and results of demonstration

23 projects conducted under this Act.
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1 ‘‘SEC. 810. PROVISION OF SERVICES IN MONTANA.

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

3 the Service, shall provide services and benefits for Indians

4 in Montana in a manner consistent with the decision of

5 the United States Court of Appeals for the Ninth Circuit

6 in McNabb for McNabb v. Bowen, 829 F.2d 787 (9th Cr.

7 1987).

8 ‘‘(b) RULE OF CONSTRUCTION.—The provisions of

9 subsection (a) shall not be construed to be an expression

10 of the sense of the Congress on the application of the deci11 sion described in subsection (a) with respect to the provi12 sion of services or benefits for Indians living in any State

13 other than Montana.

14 ‘‘SEC. 811. MORATORIUM.

15 ‘‘During the period of the moratorium imposed by

16 Public Law 100–446 on implementation of the final rule

17 published in the Federal Register on September 16, 1987,

18 by the Health Resources and Services Administration, re19 lating to eligibility for the health care services of the Serv20 ice, the Service shall provide services pursuant to the cri21 teria for eligibility for such services that were in effect

22 on September 15, 1987, subject to the provisions of sec23 tions 806 and 807 until such time as new criteria gov24 erning eligibility for services are developed in accordance

25 with section 802.
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1 ‘‘SEC. 812. TRIBAL EMPLOYMENT.

2 ‘‘For purposes of section 2(2) of the Act of July 5,

3 1935 (49 Stat. 450, Chapter 372), an Indian tribe or trib4 al organization carrying out a funding agreement under

5 the Self-Determination and Education Assistance Act

6 shall not be considered an employer.

7 ‘‘SEC. 813. PRIME VENDOR.

8 ‘‘For purposes of section 4 of Public Law 102–585

9 (38 U.S.C. 812) Indian tribes and tribal organizations

10 carrying out a grant, cooperative agreement, or funding

11 agreement under the Indian Self-Determination and Edu12 cation Assistance Act (25 U.S.C. 450 et seq.) shall be

13 deemed to be an executive agency and part of the Service

14 in the and, as such, may act as an ordering agent of the

15 Service and the employees of the tribe or tribal organiza16 tion may order supplies on behalf thereof on the same

17 basis as employees of the Service.

18 ‘‘SEC. 814. NATIONAL BI-PARTISAN COMMISSION ON INDIAN

19 HEALTH CARE ENTITLEMENT.

20 ‘‘(a) ESTABLISHMENT.—There is hereby established

21 the National Bi-Partisan Indian Health Care Entitlement

22 Commission (referred to in this Act as the ‘Commission’).

23 ‘‘(b) MEMBERSHIP.—The Commission shall be com24 posed of 25 members, to be appointed as follows:

25 ‘‘(1) Ten members of Congress, of which—
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1 ‘‘(A) three members shall be from the

2 House of Representatives and shall be ap3 pointed by the majority leader;

4 ‘‘(B) three members shall be from the

5 House of Representatives and shall be ap6 pointed by the minority leader;

7 ‘‘(C) two members shall be from the Sen8 ate and shall be appointed by the majority lead9 er; and

10 ‘‘(D) two members shall be from the Sen11 ate and shall be appointed by the minority lead12 er;

13 who shall each be members of the committees of

14 Congress that consider legislation affecting the pro15 vision of health care to Indians and who shall elect

16 the chairperson and vice-chairperson of the Commis17 sion.

18 ‘‘(2) Twelve individuals to be appointed by the

19 members of the Commission appointed under para20 graph (1), of which at least 1 shall be from each

21 service area as currently designated by the Director

22 of the Service, to be chosen from among 3 nominees

23 from each such area as selected by the Indian tribes

24 within the area, with due regard being given to the

25 experience and expertise of the nominees in the pro-
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1 vision of health care to Indians and with due regard

2 being given to a reasonable representation on the

3 Commission of members who are familiar with var4 ious health care delivery modes and who represent

5 tribes of various size populations.

6 ‘‘(3) Three individuals shall be appointed by the

7 Director of the Service from among individual who

8 are knowledgeable about the provision of health care

9 to Indians, at least 1 of whom shall be appointed

10 from among 3 nominees from each program that is

11 funded in whole or in part by the Service primarily

12 or exclusively for the benefit of urban Indians.

13 All those persons appointed under paragraphs (2) and (3)

14 shall be members of Federally recognized Indian Tribes.

15 ‘‘(c) TERMS.—

16 ‘‘(1) IN GENERAL.—Members of the Commis17 sion shall serve for the life of the Commission.

18 ‘‘(2) APPOINTMENT OF MEMBERS.—Members of

19 the Commission shall be appointed under subsection

20 (b)(1) not later than 90 days after the date of enact21 ment of this Act, and the remaining members of the

22 Commission shall be appointed not later than 60

23 days after the date on which the members are ap24 pointed under such subsection.
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1 ‘‘(3) VACANCY.—A vacancy in the membership

2 of the Commission shall be filled in the manner in

3 which the original appointment was made.

4 ‘‘(d) DUTIES OF THE COMMISSION.—The Commis5 sion shall carry out the following duties and functions:

6 ‘‘(1) Review and analyze the recommendations

7 of the report of the study committee established

8 under paragraph (3) to the Commission.

9 ‘‘(2) Make recommendations to Congress for

10 providing health services for Indian persons as an

11 entitlement, giving due regard to the effects of such

12 a programs on existing health care delivery systems

13 for Indian persons and the effect of such programs

14 on the sovereign status of Indian Tribes;

15 ‘‘(3) Establish a study committee to be com16 posed of those members of the Commission ap17 pointed by the Director of the Service and at least

18 4 additional members of Congress from among the

19 members of the Commission which shall—

20 ‘‘(A) to the extent necessary to carry out

21 its duties, collect and compile data necessary to

22 understand the extent of Indian needs with re23 gard to the provision of health services, regard24 less of the location of Indians, including holding

25 hearings and soliciting the views of Indians, In-
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1 dian tribes, tribal organizations and urban In2 dian organizations, and which may include au3 thorizing and funding feasibility studies of var4 ious models for providing and funding health

5 services for all Indian beneficiaries including

6 those who live outside of a reservation, tempo7 rarily or permanently;

8 ‘‘(B) make recommendations to the Com9 mission for legislation that will provide for the

10 delivery of health services for Indians as an en11 titlement, which shall, at a minimum, address

12 issues of eligibility, benefits to be provided, in13 cluding recommendations regarding from whom

14 such health services are to be provide,d and the

15 cost, including mechanisms for funding of the

16 health services to be provided;

17 ‘‘(C) determine the effect of the enactment

18 of such recommendations on the existing system

19 of the delivery of health services for Indians;

20 ‘‘(D) determine the effect of a health serv21 ices entitlement program for Indian persons on

22 the sovereign status of Indian tribes;

23 ‘‘(E) not later than 12 months after the

24 appointment of all members of the Commission,

25 make a written report of its findings and rec-
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1 ommendations to the Commission, which report

2 shall include a statement of the minority and

3 majority position of the committee and which

4 shall be disseminated, at a minimum, to each

5 Federally recognized Indian tribe, tribal organi6 zation and urban Indian organization for com7 ment to the Commission; and

8 ‘‘(F) report regularly to the full Commis9 sion regarding the findings and recommenda10 tions developed by the committee in the course

11 of carrying out its duties under this section.

12 ‘‘(4) Not later than 18 months after the date

13 of appointment of all members of the Commission,

14 submit a written report to Congress containing a

15 recommendation of policies and legislation to imple16 ment a policy that would establish a health care sys17 tem for Indians based on the delivery of health serv18 ices as an entitlement, together with a determination

19 of the implications of such an entitlement system on

20 existing health care delivery systems for Indians and

21 on the sovereign status of Indian tribes.

22 ‘‘(e) ADMINISTRATIVE PROVISIONS.—

23 ‘‘(1) COMPENSATION AND EXPENSES.—

24 ‘‘(A) CONGRESSIONAL MEMBERS.—Each

25 member of the Commission appointed under
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1 subsection (b)(1) shall receive no additional

2 pay, allowances, or benefits by reason of their

3 service on the Commission and shall receive

4 travel expenses and per diem in lieu of subsist5 ence in accordance with sections 5702 and 5703

6 of title 5, United States Code.

7 ‘‘(B) OTHER MEMBERS.—The members of

8 the Commission appointed under paragraphs

9 (2) and (3) of subsection (b), while serving on

10 the business of the Commission (including trav11 el time) shall be entitled to receive compensa12 tion at the per diem equivalent of the rate pro13 vided for level IV of the Executive Schedule

14 under section 5315 of title 5, United States

15 Code, and while so serving away from home and

16 the member’s regular place of business, be al17 lowed travel expenses, as authorized by the

18 chairperson of the Commission. For purposes of

19 pay (other than pay of members of the Commis20 sion) and employment benefits, rights, and

21 privileges, all personnel of the Commission shall

22 be treated as if they were employees of the

23 United States Senate.

24 ‘‘(2) MEETINGS AND QUORUM.—
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1 ‘‘(A) MEETINGS.—The Commission shall

2 meet at the call of the chairperson.

3 ‘‘(B) QUORUM.—A quorum of the Commis4 sion shall consist of not less than 15 members,

5 of which not less than 6 of such members shall

6 be appointees under subsection (b)(1) and not

7 less than 9 of such members shall be Indians.

8 ‘‘(3) DIRECTOR AND STAFF.—

9 ‘‘(A) EXECUTIVE DIRECTOR.—The mem10 bers of the Commission shall appoint an execu11 tive director of the Commission. The executive

12 director shall be paid the rate of basic pay

13 equal to that for level V of the Executive Sched14 ule.

15 ‘‘(B) STAFF.—With the approval of the

16 Commission, the executive director may appoint

17 such personnel as the executive director deems

18 appropriate.

19 ‘‘(C) APPLICABILITY OF CIVIL SERVICE

20 LAWS.—The staff of the Commission shall be

21 appointed without regard to the provisions of

22 title 5, United States Code, governing appoint23 ments in the competitive service, and shall be

24 paid without regard to the provisions of chapter

25 51 and subchapter III of chapter 53 of such
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1 title (relating to classification and General

2 Schedule pay rates).

3 ‘‘(D) EXPERTS AND CONSULTANTS.—With

4 the approval of the Commission, the executive

5 director may procure temporary and intermit6 tent services under section 3109(b) of title 5,

7 United States Code.

8 ‘‘(E) FACILITIES.—The Administrator of

9 the General Services Administration shall locate

10 suitable office space for the operation of the

11 Commission. The facilities shall serve as the

12 headquarters of the Commission and shall in13 clude all necessary equipment and incidentals

14 required for the proper functioning of the Com15 mission.

16 ‘‘(f) POWERS.—

17 ‘‘(1) HEARINGS AND OTHER ACTIVITIES.—For

18 the purpose of carrying out its duties, the Commis19 sion may hold such hearings and undertake such

20 other activities as the Commission determines to be

21 necessary to carry out its duties, except that at least

22 6 regional hearings shall be held in different areas

23 of the United States in which large numbers of Indi24 ans are present. Such hearings shall be held to so25 licit the views of Indians regarding the delivery of
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1 health care services to them. To constitute a hearing

2 under this paragraph, at least 5 members of the

3 Commission, including at least 1 member of Con4 gress, must be present. Hearings held by the study

5 committee established under this section may be

6 counted towards the number of regional hearings re7 quired by this paragraph.

8 ‘‘(2) STUDIES BY GAO.—Upon request of the

9 Commission, the Comptroller General shall conduct

10 such studies or investigations as the Commission de11 termines to be necessary to carry out its duties.

12 ‘‘(3) COST ESTIMATES.—

13 ‘‘(A) IN GENERAL.—The Director of the

14 Congressional Budget Office or the Chief Actu15 ary of the Health Care Financing Administra16 tion, or both, shall provide to the Commission,

17 upon the request of the Commission, such cost

18 estimates as the Commission determines to be

19 necessary to carry out its duties.

20 ‘‘(B) REIMBURSEMENTS.—The Commis21 sion shall reimburse the Director of the Con22 gressional Budget Office for expenses relating

23 to the employment in the office of the Director

24 of such additional staff as may be necessary for
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1 the Director to comply with requests by the

2 Commission under subparagraph (A).

3 ‘‘(4) DETAIL OF FEDERAL EMPLOYEES.—Upon

4 the request of the Commission, the head of any fed5 eral Agency is authorized to detail, without reim6 bursement, any of the personnel of such agency to

7 the Commission to assist the Commission in car8 rying out its duties. Any such detail shall not inter9 rupt or otherwise affect the civil service status or

10 privileges of the federal employee.

11 ‘‘(5) TECHNICAL ASSISTANCE.—Upon the re12 quest of the Commission, the head of a Federal

13 Agency shall provide such technical assistance to the

14 Commission as the Commission determines to be

15 necessary to carry out its duties.

16 ‘‘(6) USE OF MAILS.—The Commission may use

17 the United States mails in the same manner and

18 under the same conditions as Federal Agencies and

19 shall, for purposes of the frank, be considered a

20 commission of Congress as described in section 3215

21 of title 39, United States Code.

22 ‘‘(7) OBTAINING INFORMATION.—The Commis23 sion may secure directly from the any Federal Agen24 cy information necessary to enable it to carry out its

25 duties, if the information may be disclosed under
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1 section 552 of title 4, United States Code. Upon re2 quest of the chairperson of the Commission, the

3 head of such agency shall furnish such information

4 to the Commission.

5 ‘‘(8) SUPPORT SERVICES.—Upon the request of

6 the Commission, the Administrator of General Serv7 ices shall provide to the Commission on a reimburs8 able basis such administrative support services as

9 the Commission may request.

10 ‘‘(9) PRINTING.—For purposes of costs relating

11 to printing and binding, including the cost of per12 sonnel detailed from the Government Printing Of13 fice, the Commission shall be deemed to be a com14 mittee of the Congress.

15 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There

16 is authorized to be appropriated $4,000,000 to carry out

17 this section. The amount appropriated under this sub18 section shall not be deducted from or affect any other ap19 propriation for health care for Indian persons.

20 ‘‘SEC. 815. APPROPRIATIONS; AVAILABILITY.

21 ‘‘Any new spending authority (described in subsection

22 (c)(2)(A) or (B) of section 401 of the Congressional Budg23 et Act of 1974) which is provided under this Act shall

24 be effective for any fiscal year only to such extent or in

25 such amounts as are provided in appropriation Acts.
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1 ‘‘SEC. 816. 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 2012 to carry out this title.’’.

5 TITLE II—CONFORMING AMEND6 MENTS TO THE SOCIAL SECU7 RITY ACT

8 Subtitle A—Medicare

9 SEC. 201. LIMITATIONS ON CHARGES.

10 Section 1866(a)(1) of the Social Security Act (42

11 U.S.C. 1395cc(a)(1)) is amended—

12 (1) in subparagraph (R), by adding a semicolon

13 at the end;

14 (2) in subparagraph (S), by striking the period

15 and inserting ‘‘; and’’; and

16 (3) by adding at the end the following:

17 ‘‘(T) in the case of hospitals and critical access

18 hospitals which provide inpatient hospital services

19 for which payment may be made under this title, to

20 accept as payment in full for services that are cov21 ered under and furnished to an individual eligible for

22 the contract health services program operated by the

23 Indian Health Service, by an Indian tribe or tribal

24 organization, or furnished to an urban Indian eligi25 ble for health services purchased by an urban Indian

26 organization (as those terms are defined in section
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1 4 of the Indian Health Care Improvement Act), in

2 accordance with such admission practices and such

3 payment methodology and amounts as are prescribed

4 under regulations issued by the Secretary.’’.

5 SEC. 202. INDIAN HEALTH PROGRAMS.

6 Section 1880 of the Social Security Act (42 U.S.C.

7 1395qq) is amended to read as follows:

8 ‘‘INDIAN HEALTH PROGRAMS

9 ‘‘SEC. 1880. (a) ELIGIBILITY FOR PAYMENTS.—The

10 Indian Health Service (referred to in this section as the

11 ‘Service’) and an Indian tribe or tribal organization, or

12 an urban Indian organization (as those terms are defined

13 in section 4 of the Indian Health Care Improvement Act),

14 shall be eligible for payments under this title, notwith15 standing sections 1814(c) and 1835(d), if and for so long

16 as the Service, Indian tribe or tribal organization, or

17 urban Indian organization meets the conditions and re18 quirements for such payments which are applicable gen19 erally to the service or provider type for which the Service,

20 Indian tribe or tribal organization, or urban Indian orga21 nization seeks payment under this title and for services

22 and provider types provided by a qualified Indian health

23 program under section 1880A.

24 ‘‘(b) PERIOD FOR BILLING.—Notwithstanding sub25 section (a), if the Service, an Indian tribe or tribal organi26 zation, or urban Indian organization, does not meet all
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1 of the conditions and requirements of this title which are

2 applicable generally to the service or provider type for

3 which payment is sought, but submits to the Secretary

4 within 6 months after the date on which such reimburse5 ment is first sought an acceptable plan for achieving com6 pliance with such conditions and requirements, the Serv7 ice, an Indian tribe or tribal organization, or urban Indian

8 organization shall be deemed to meet such conditions and

9 requirements (and to be eligible for reimbursement under

10 this title), without regard to the extent of actual compli11 ance with such conditions and requirements during the

12 first 12 months after the month in which such plan is sub13 mitted.

14 ‘‘(c) DIRECT BILLING.—For provisions relating to

15 the authority of certain Indian tribes and tribal organiza16 tions to elect to directly bill for, and receive payment for,

17 health care services provided by a hospital or clinic of such

18 tribes or tribal organizations and for which payment may

19 be made under this title, see section 405 of the Indian

20 Health Care Improvement Act.

21 ‘‘(d) COMMUNITY HEALTH AIDES.—The Service or

22 an Indian Tribe or tribal organization providing a service

23 otherwise eligible for payment under this section through

24 the use of a community health aide or practitioner cer25 tified under the provisions of section 121 of the Indian
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1 Health Care Improvement Act shall be paid for such serv2 ices on the same basis that such services are reimbursed

3 under State plans approved under title XIX.

4 ‘‘(e) TREATMENT OF CERTAIN PROGRAMS.—Not5 withstanding any other provision of law, a health program

6 operated by the Service or an Indian tribe or tribal organi7 zation, which collaborates with a hospital operated by the

8 Service or an Indian tribe or tribal organization, shall, at

9 the option of the Indian tribe or tribal organization, be

10 paid for services for which it would otherwise be eligible

11 for under this as if the health program were an outpatient

12 department of the hospital. In situations where the health

13 program is on a separate campus from the hospital, billing

14 as an outpatient department of the hospital shall not sub15 ject such a health program to the requirements of section

16 1867.

17 ‘‘(f) PAYMENT FOR CERTAIN NURSING SERVICES.—

18 The Service or an Indian tribe or tribal organization pro19 viding visiting nurse services in a home health agency

20 shortage area shall be paid for such services on the same

21 basis that such services are reimbursed under this title

22 for other primary care providers.

23 ‘‘(g) ALTERNATIVE METHODS OF REIMBURSE24 MENT.—Notwithstanding any other provision of law, the

25 Secretary may identify and implement alternative methods
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1 of reimbursing Indian health programs for services reim2 bursable under this title that are provided to Indians, so

3 long as such methods—

4 ‘‘(1) allow an Indian tribe or tribal organization

5 or urban Indian organization to opt to receive reim6 bursement under reimbursement methodologies ap7 plicable to other providers of similar services; and

8 ‘‘(2) provide that the amount of reimbursement

9 resulting under any such methodology shall not be

10 less than 100 percent of the reasonable cost of the

11 service to which the methodology applies under sec12 tion 1861(v).’’.

13 SEC. 203. QUALIFIED INDIAN HEALTH PROGRAM.

14 Title XVIII of the Social Security Act (42 U.S.C.

15 1395 et seq.) is amended by inserting after section 1880

16 the following:

17 ‘‘QUALIFIED INDIAN HEALTH PROGRAM

18 ‘‘SEC. 1880A. (a) DEFINITION OF QUALIFIED IN19 DIAN HEALTH PROGRAM.—In this section:

20 ‘‘(1) IN GENERAL.—The term ‘qualified Indian

21 health program’ means a health program operated

22 by—

23 ‘‘(A) the Indian Health Service;

24 ‘‘(B) an Indian tribe or tribal organization

25 or an urban Indian organization (as those

26 terms are defined in section 4 of the Indian
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1 Health Care Improvement Act) and which is

2 funded in whole or part by the Indian Health

3 Service under the Indian Self Determination

4 and Education Assistance Act; and

5 ‘‘(C) an urban Indian organization (as so

6 defined) and which is funded in whole or in

7 part under title V of the Indian Health Care

8 Improvement Act.

9 ‘‘(2) INCLUDED PROGRAMS AND ENTITIES.—

10 Such term may include 1 or more hospital, nursing

11 home, home health program, clinic, ambulance serv12 ice or other health program that provides a service

13 for which payments may be made under this title

14 and which is covered in the cost report submitted

15 under this title or title XIX for the qualified Indian

16 health program.

17 ‘‘(b) ELIGIBILITY FOR PAYMENTS.—A qualified In18 dian health program shall be eligible for payments under

19 this title, notwithstanding sections 1814(c) and 1835(d),

20 if and for so long as the program meets all the conditions

21 and requirements set forth in this section.

22 ‘‘(c) DETERMINATION OF PAYMENTS.—

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

24 provision in the law, a qualified Indian health pro25 gram shall be entitled to receive payment based on
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1 an all-inclusive rate which shall be calculated to pro2 vide full cost recovery for the cost of furnishing serv3 ices provided under this section.

4 ‘‘(2) DEFINITION OF FULL COST RECOVERY.—

5 ‘‘(A) IN GENERAL.—Subject to subpara6 graph (B), in this section, the term ‘full cost re7 covery’ means the sum of—

8 ‘‘(i) the direct costs, which are reason9 able, adequate and related to the cost of

10 furnishing such services, taking into ac11 count the unique nature, location, and

12 service population of the qualified Indian

13 health program, and which shall include di14 rect program, administrative, and overhead

15 costs, without regard to the customary or

16 other charge or any fee schedule that

17 would otherwise be applicable; and

18 ‘‘(ii) indirect costs which, in the case

19 of a qualified Indian health program—

20 ‘‘(I) for which an indirect cost

21 rate (as that term is defined in sec22 tion 4(g) of the Indian Self-Deter23 mination and Education Assistance

24 Act) has been established, shall be not
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1 less than an amount determined on

2 the basis of the indirect cost rate; or

3 ‘‘(II) for which no such rate has

4 been established, shall be not less

5 than the administrative costs specifi6 cally associated with the delivery of

7 the services being provided.

8 ‘‘(B) LIMITATION.—Notwithstanding any

9 other provision of law, the amount determined

10 to be payable as full cost recovery may not be

11 reduced for co-insurance, co-payments, or

12 deductibles when the service was provided to an

13 Indian entitled under Federal law to receive the

14 service from the Indian Health Service, an In15 dian tribe or tribal organization, or an urban

16 Indian organization or because of any limita17 tions on payment provided for in any managed

18 care plan.

19 ‘‘(3) OUTSTATIONING COSTS.—In addition to

20 full cost recovery, a qualified Indian health program

21 shall be entitled to reasonable outstationing costs,

22 which shall include all administrative costs associ23 ated with outreach and acceptance of eligibility ap24 plications for any Federal or State health program
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1 including the programs established under this title,

2 title XIX, and XXI.

3 ‘‘(4) DETERMINATION OF ALL-INCLUSIVE EN4 COUNTER OR PER DIEM AMOUNT.—

5 ‘‘(A) IN GENERAL.—Costs identified for

6 services addressed in a cost report submitted by

7 a qualified Indian health program shall be used

8 to determine an all-inclusive encounter or per

9 diem payment amount for such services.

10 ‘‘(B) NO SINGLE REPORT REQUIRE11 MENT.—Not all health programs provided or

12 administered by the Indian Health Service, an

13 Indian tribe or tribal organization, or an urban

14 Indian organization need be combined into a

15 single cost report.

16 ‘‘(C) PAYMENT FOR ITEMS NOT COVERED

17 BY A COST REPORT.—A full cost recovery pay18 ment for services not covered by a cost report

19 shall be made on a fee-for-service, encounter, or

20 per diem basis.

21 ‘‘(5) OPTIONAL DETERMINATION.—The full

22 cost recovery rate provided for in paragraphs (1)

23 through (3) may be determined, at the election of

24 the qualified Indian health program, by the Health

25 Care Financing Administration or by the State
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1 agency responsible for administering the State plan

2 under title XIX and shall be valid for reimburse3 ments made under this title, title XIX, and title

4 XXI. The costs described in paragraph (2)(A) shall

5 be calculated under whatever methodology yields the

6 greatest aggregate payment for the cost reporting

7 period, provided that such methodology shall be ad8 justed to include adjustments to such payment to

9 take into account for those qualified Indian health

10 programs that include hospitals—

11 ‘‘(A) a significant decrease in discharges;

12 ‘‘(B) costs for graduate medical education

13 programs;

14 ‘‘(C) additional payment as a dispropor15 tionate share hospital with a payment adjust16 ment factor of 10; and

17 ‘‘(D) payment for outlier cases.

18 ‘‘(6) ELECTION OF PAYMENT.—A qualified In19 dian health program may elect to receive payment

20 for services provided under this section—

21 ‘‘(A) on the full cost recovery basis pro22 vided in paragraphs (1) through (5);

23 ‘‘(B) on the basis of the inpatient or out24 patient encounter rates established for Indian
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1 Health Service facilities and published annually

2 in the Federal Register;

3 ‘‘(C) on the same basis as other providers

4 are reimbursed under this title, provided that

5 the amounts determined under paragraph

6 (c)(2)(B) shall be added to any such amount;

7 ‘‘(D) on the basis of any other rate or

8 methodology applicable to the Indian Health

9 Service or an Indian Tribe or tribal organiza10 tion; or

11 ‘‘(E) on the basis of any rate or method12 ology negotiated with the agency responsible for

13 making payment.

14 ‘‘(d) ELECTION OF REIMBURSEMENT FOR OTHER

15 SERVICES.—

16 ‘‘(1) IN GENERAL.—A qualified Indian health

17 program may elect to be reimbursed for any service

18 the Indian Health Service, an Indian tribe or tribal

19 organization or an urban Indian organization may

20 be reimbursed for under section 1880 and section

21 1911.

22 ‘‘(2) OPTION TO INCLUDE ADDITIONAL SERV23 ICES.—An election under paragraph (1) may in24 clude, at the election of the qualified Indian health

25 program—
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1 ‘‘(A) any service when furnished by an em2 ployee of the qualified Indian health program

3 who is licensed or certified to perform such a

4 service to the same extent that such service

5 would be reimbursable if performed by a physi6 cian and any service or supplies furnished as in7 cident to a physician’s service as would other8 wise be covered if furnished by a physician or

9 as an incident to a physician’s service;

10 ‘‘(B) screening, diagnostic, and therapeutic

11 outpatient services including part-time or inter12 mittent screening, diagnostic, and therapeutic

13 skilled nursing care and related medical sup14 plies (other than drugs and biologicals), fur15 nished by an employee of the qualified Indian

16 health program who is licensed or certified to

17 perform such a service for an individual in the

18 individual’s home or in a community health set19 ting under a written plan of treatment estab20 lished and periodically reviewed by a physician,

21 when furnished to an individual as an out22 patient of a qualified Indian health program;

23 ‘‘(C) preventive primary health services as

24 described under sections 329, 330, and 340 of

25 the Public Health Service Act, when provided
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1 by an employee of the qualified Indian health

2 program who is licensed or certified to perform

3 such a service, regardless of the location in

4 which the service is provided;

5 ‘‘(D) with respect to services for children,

6 all services specified as part of the State plan

7 under title XIX, the State child health plan

8 under title XXI, and early and periodic screen9 ing, diagnostic, and treatment services as de10 scribed in section 1905(r);

11 ‘‘(E) influenza and pneumococcal immuni12 zations;

13 ‘‘(F) other immunizations for prevention of

14 communicable diseases when targeted; and

15 ‘‘(G) the cost of transportation for pro16 viders or patients necessary to facilitate access

17 for patients.’’.

18 Subtitle B—Medicaid

19 SEC. 211. PAYMENTS TO FEDERALLY-QUALIFIED HEALTH

20 CENTERS.

21 Section 1902(a)(13) of the Social Security Act (42

22 U.S.C. 1396a(a)(13)) is amended—

23 (1) in subparagraph (B), by striking ‘‘and’’ at

24 the end;
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1 (2) in subparagraph (C), by adding ‘‘and’’ at

2 the end; and

3 (3) by adding at the end the following:

4 ‘‘(D)(i) for payment for services described

5 in section 1905(a)(2)(C) under the plan fur6 nished by an Indian tribe or tribal organization

7 or an urban Indian organization (as defined in

8 section 4 of the Indian Health Care Improve9 ment Act) of 100 percent of costs which are

10 reasonable and related to the cost of furnishing

11 such services or based on other tests of reason12 ableness as the Secretary prescribes in regula13 tions under section 1833(a)(3), or, in the case

14 of services to which those regulations do not

15 apply, the same methodology used under section

16 1833(a)(3), and

17 ‘‘(ii) in the case of such services furnished

18 pursuant to a contract between a Federally19 qualified health center and a medicaid managed

20 care organization under section 1903(m), for

21 payment to the Federally-qualified health center

22 at least quarterly by the State of a supple23 mental payment equal to the amount (if any) by

24 which the amount determined under clause (i)
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1 exceeds the amount of the payments provided

2 under such contract.’’.

3 SEC. 212. STATE CONSULTATION WITH INDIAN HEALTH

4 PROGRAMS.

5 Section 1902(a) of the Social Security Act (42 U.S.C.

6 1396a(a)) is amended—

7 (1) in paragraph (65), by striking the period;

8 and

9 (2) by inserting after (65), the following:

10 ‘‘(66) if the Indian Health Service operates or

11 funds health programs in the State or if there are

12 Indian tribes or tribal organizations or urban Indian

13 organizations (as those terms are defined in Section

14 4 of the Indian Health Care Improvement Act)

15 present in the State, provide for meaningful con16 sultation with such entities prior to the submission

17 of, and as a precondition of approval of, any pro18 posed amendment, waiver, demonstration project, or

19 other request that would have the effect of changing

20 any aspect of the State’s administration of the State

21 plan under this title, so long as—

22 ‘‘(A) the term ‘meaningful consultation’ is

23 defined through the negotiated rulemaking

24 process provided for under section 802 of the

25 Indian Health Care Improvement Act; and
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1 ‘‘(B) such consultation is carried out in

2 collaboration with the Indian Medicaid Advisory

3 Committee established under section 415(a)(3)

4 of that Act.’’.

5 SEC. 213. FMAP FOR SERVICES PROVIDED BY INDIAN

6 HEALTH PROGRAMS.

7 The third sentence of Section 1905(b) of the Social

8 Security Act (42 U.S.C. 1396d(b)) is amended to read as

9 follows:

10 ‘‘Notwithstanding the first sentence of this section, the

11 Federal medical assistance percentage shall be 100 per

12 cent with respect to amounts expended as medical assist13 ance for services which are received through the Indian

14 Health Service, an Indian tribe or tribal organization, or

15 an urban Indian organization (as defined in section 4 of

16 the Indian Health Care Improvement Act) under section

17 1911, whether directly, by referral, or under contracts or

18 other arrangements between the Indian Health Service,

19 Indian tribe or tribal organization, or urban Indian orga20 nization and another health provider.’’.

21 SEC. 214. INDIAN HEALTH SERVICE PROGRAMS.

22 Section 1911 of the Social Security Act (42 U.S.C.

23 1396j) is amended to read as follows:

24 ‘‘INDIAN HEALTH SERVICE PROGRAMS

25 ‘‘SEC. 1911. (a) IN GENERAL.—The Indian Health

26 Service and an Indian tribe or tribal organization or an
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1 urban Indian organization (as those terms are defined in

2 section 4 of the Indian Health Care Improvement Act),

3 shall be eligible for reimbursement for medical assistance

4 provided under a State plan if and for so long as such

5 Service, Indian tribe or tribal organization, or urban In6 dian organization provides services or provider types of a

7 type otherwise covered under the State plan and meets

8 the conditions and requirements which are applicable gen9 erally to the service for which it seeks reimbursement

10 under this title and for services provided by a qualified

11 Indian health program under section 1880A.

12 ‘‘(b) PERIOD FOR BILLING.—Notwithstanding sub13 section (a), if the Indian Health Service, an Indian tribe

14 or tribal organization, or an urban Indian organization

15 which provides services of a type otherwise covered under

16 the State plan does not meet all of the conditions and re17 quirements of this title which are applicable generally to

18 such services submits to the Secretary within 6 months

19 after the date on which such reimbursement is first sought

20 an acceptable plan for achieving compliance with such con21 ditions and requirements, the Service, an Indian tribe or

22 tribal organization, or urban Indian organization shall be

23 deemed to meet such conditions and requirements (and to

24 be eligible for reimbursement under this title), without re25 gard to the extent of actual compliance with such condi-
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1 tions and requirements during the first 12 months after

2 the month in which such plan is submitted.

3 ‘‘(c) AUTHORITY TO ENTER INTO AGREEMENTS.—

4 The Secretary may enter into agreements with the State

5 agency for the purpose of reimbursing such agency for

6 health care and services provided by the Indian Health

7 Service, Indian tribes or tribal organizations and urban

8 Indian organizations, directly, through referral, or under

9 contracts or other arrangements between the Indian

10 Health Service, an Indian tribe or tribal organization, or

11 an urban Indian organization and another health care pro12 vider to Indians who are eligible for medical assistance

13 under the State plan.

14 Subtitle C—State Children’s Health

15 Insurance Program

16 SEC. 221. ENHANCED FMAP FOR STATE CHILDREN’S

17 HEALTH INSURANCE PROGRAM.

18 (a) IN GENERAL.—Section 2105(b) of the Social Se19 curity Act (42 U.S.C. 1397ee(b)) is amended—

20 (1) by striking ‘‘For purposes’’ and inserting

21 the following:

22 ‘‘(1) IN GENERAL.—Subject to paragraph (2),

23 for purposes’’; and

24 (2) by adding at the end the following:
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1 ‘‘(2) SERVICES PROVIDED BY INDIAN PRO2 GRAMS.—Without regard to which option a State

3 chooses under section 2101(a), the ‘enhanced

4 FMAP’ for a State for a fiscal year shall be 100 per

5 cent with respect to expenditures for child health as6 sistance for services provided through a health pro7 gram operated by the Indian Health Service, an In8 dian tribe or tribal organization, or an urban Indian

9 organization (as such terms are defined in section 4

10 of the Indian Health Care Improvement Act).’’.

11 (b) CONFORMING AMENDMENT.—Section

12 2105(c)(6)(B) of such Act (42 U.S.C. 1397ee(c)(6)(B))

13 is amended by inserting ‘‘an Indian tribe or tribal organi14 zation, or an urban Indian organization (as such terms

15 are defined in section 4 of the Indian Health Care Im16 provement Act)’’ after ‘‘Service’’.

17 SEC. 222. DIRECT FUNDING OF STATE CHILDREN’S HEALTH

18 INSURANCE PROGRAM.

19 Title XXI of Social Security Act (42 U.S.C. 1397aa

20 et seq.) is amended by adding at the end the following:

21 ‘‘SEC. 2111. DIRECT FUNDING OF INDIAN HEALTH PRO22 GRAMS.

23 ‘‘(a) IN GENERAL.—The Secretary may enter into

24 agreements directly with the Indian Health Service, an In25 dian tribe or tribal organization, or an urban Indian orga-
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1 nization (as such terms are defined in section 4 of the

2 Indian Health Care Improvement Act) for such entities

3 to provide child health assistance to Indians who reside

4 in a service area on or near an Indian reservation. Such

5 agreements may provide for funding under a block grant

6 or such other mechanism as is agreed upon by the Sec7 retary and the Indian Health Service, Indian tribe or trib8 al organization, or urban Indian organization. Such agree9 ments may not be made contingent on the approval of the

10 State in which the Indians to be served reside.

11 ‘‘(b) TRANSFER OF FUNDS.—Notwithstanding any

12 other provision of law, a State may transfer funds to

13 which it is, or would otherwise be, entitled to under this

14 title to the Indian Health Service, an Indian tribe or tribal

15 organization or an urban Indian organization—

16 ‘‘(1) to be administered by such entity to

17 achieve the purposes and objectives of this title

18 under an agreement between the State and the enti19 ty; or

20 ‘‘(2) under an agreement entered into under

21 subsection (a) between the entity and the Sec22 retary.’’.
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1 Subtitle D—Authorization of

2 Appropriations

3 SEC. 231. AUTHORIZATION OF APPROPRIATIONS.

4 There is authorized to be appropriated such sums as

5 may be necessary for each of fiscal years 2000 through

6 2012 to carry out this title and the amendments by this

7 title.

8 TITLE III—MISCELLANEOUS

9 PROVISIONS

10 SEC. 301. REPEALS.

11 The following are repealed:

12 (1) Section 506 of Public Law 101–630 (25

13 U.S.C. 1653 note) is repealed.

14 (2) Section 712 of the Indian Health Care

15 Amendments of 1988 is repealed.

16 SEC. 302. SEVERABILITY PROVISIONS.

17 If any provision of this Act, any amendment made

18 by the Act, or the application of such provision or amend19 ment to any person or circumstances is held to be invalid,

20 the remainder of this Act, the remaining amendments

21 made by this Act, and the application of such provisions

22 to persons or circumstances other than those to which it

23 is held invalid, shall not be affected thereby.

Æ